Vaccination of the Immunocompromised Host

Publication Date: December 4, 2013

Key Points

Key Points

Some recommendations in this guideline have not been addressed by the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC), or deviate from their recommendations, and are marked by an asterisk (*).
  • Impaired host defenses predispose patients to an increased rate or severity of vaccine-preventable infection.
  • Such patients may also have greater exposure to pathogens due to frequent contact with medical environments.
  • Data on safety, immunogenicity, and efficacy/effectiveness of vaccines for immunocompromised populations are limited.
  • Immune system defects vary among and within categories of patients with immunodeficiency (eg, degree of immunodeficiency, nutritional status, immunosuppressive regimen), which may limit the generalizability of study findings.
  • Inactivated vaccines can be administered to most immunocompromised patients, and live vaccines are contraindicated for most immunocompromised patients, with some important exceptions.

Responsibility for Vaccination

...Responsibility for Vacc...

...pecialists caring for immunocompromised pati...


...s caring for immunocompromised patients...


Timing of Vaccination

...Timing of V...

...Vaccines should be administered prior to p...


...ve vaccines should be administered ≥4 weeks...

...voided within 2 weeks of initiation of immunos...


...vaccines should be administered ≥2 we...


Household Members (See Table 1)

Household...

...Immunocompetent household members of imm...

...for travel. (SR, M)218...


...Household members of immunocompromised...

a. Inactivated influenza vaccine (IIV...

...Live attenuated influenza vaccine (LAIV)...

...ptions include household members of an im...

...r, if administered, contact between the immunocom...


...Healthy immunocompetent household members...

...ccine in infants ages 2-7 months, (SR, L)21...

...lla vaccine (VAR), (SR, M)2188...

...oster vaccine (ZOS). (SR, M...

...n safely receive vaccines for travel: yell...

...hoid vaccine. (SR, L)21881...


...Oral poliovirus vaccine (OPV) should NOT be admin...


...unocompromised patients should avoid...


...compromised patients should avoid...


Table 1. Safety of Administration of Live Vaccines to Contacts of Immunocompromised Persons

...Table 1...

...In...

...ster; (SR, L)21881...

...nated persons to avoid close conta...


...hedding of Agent? (Site) Transmissibility From...


...ovirus, oral Shedding of Agent? (Sit...


...irus, oral Shedding of Age...


...oral Shedding of Agent? (Site)...


...a Shedding of Agent? (Si...


...ever Shedding of Agent?...


Zoster Shedding of Agent? (S...


International Travel

...International Travel...

...ns may administer inactivated vaccines indic...


...llow fever vaccine generally should NOT b...

...Asymptomatic HIV-infected adults with CD4 T-ce...

...ic HIV-infected children age 9 months...


...n exceptions (eg, yellow fever vaccine and...


Specific Vaccinations

...Specific...

...Varic...

...iven to immunocompetent patients without evidence...

...dministered ≥4 weeks before initiating im...

16. A 2-dose schedule of VAR, sepa...

...7. VAR should NOT be administered to highly...

...be considered for patients without evidence of...

...VAR should be administered to eligible immunocomp...

...be given to patients ≥60 years of age if...

.... ZOS should be considered for varicella-...

...ld be administered to patients ≥60 years of...

...hould NOT be administered to highly...


...Influenza...

...uenza vaccination with IIV is recommended for imm...

...pt for patients who are very unlikely to respond (...

...ose who have received anti-B cell antibodies...

...ould NOT be administered to immunocomp...


Special Populations

...Special Populations...

...Primary (Congenital) I...

...Primary Complemen...

.... Patients with primary complement deficiencies...

...years old should receive 1 dose of 13-valen...

...-18 years old with a classical pathway (C1, C2, C...

...19 years old with a classical path...

...hose who have previously received...

...2 years of age with an early class...

...e 6 weeks through 18 months, adminis...

...ary series of quadrivalent meningococcal con...

...years of age, administer MPSV4 if they have...

...nts 9-23 months of age, administer the d...

...ith a primary complement component...

...Phagocytic Cell...

...ll deficiencies include CGD (chronic granul...

...nts with phagocytic cell deficiencies shou...

...ildren 2-5 years of age should receive PCV13 a...

...Patients ≥6 years of age with phagocytic cell de...

...2 years of age with phagocytic cell deficien...

...ve bacterial vaccines, such as bacillus...

...5. Live viral vaccines should be administered...

...ve viral vaccines should NOT be administere...

...ate defects in the immune system result...

...th innate immune system defects result...

...r patients with innate immune system...

...list advice should be sought on individual con...

.... Live bacterial vaccines should NOT b...

...vaccines should NOT be administered to...

...Minor...

...s with immunoglobulin A (IgA) deficiency or s...

...ith SPAD or ataxia-telangiectasia should receiv...

...se ≥2 years of age should receive PPSV23 ≥8 we...

...f vaccine responses can be useful fo...

...ld NOT be administered to IgA-deficient pati...

.... Inactivated vaccines other than IIV are NOT r...

...patients with suspected major antibody def...

...IIV can be administered to patients w...

...OPV should NOT be administered to patients...

...ccines (other than OPV) should NOT be adm...

...Combined Immu...

...patients with suspected combined immunodeficienci...

...with combined immunodeficiencies who are re...

51. For patients with combined immuno...

...with partial DiGeorge syndrome (pDGS) should...

53. Patients with SCID, DiGeorge s...


HIV-I...

...Inactivated Vaccines...

...(SR, H)21881...

PCV13 in patients

...nzae type b conjugate vaccine (Hib),...

...oxoid, tetanus toxoid, acellular pertus...

...toxoid, reduced diphtheria toxoid, and redu...

...toxoid, reduced diphtheria toxoid vaccine (Td),...

hepatitis B vaccine (HepB),...

...is A vaccine (HepA), (SR, M)21881...

...activated poliovirus vaccine (IPV), (...

...valent human papillomavirus vaccine...

...d be administered to HIV-infected patients ...

...V23 should be administered to HIV-infected chil...

...HIV-infected adults with CD4 T-lymphocy...

...d to HIV-infected adults with CD4 T-ly...

...e given ≥8 weeks after the indicat...

.... HIV-infected children who are >5...

...ib is NOT recommended for HIV-infected adult...

...fected children age 11-18 years shoul...

...ster dose (third dose) should be given at a...

...inistered to HIV-infected children 2-10 years of...

...d patients should receive HepB series, (SR, M)2188...

...consideration of high-dose HepB (40 μg/dose) fo...

and adolescents.* (WR, L)...

One to two months after completion, the...

...tion anti-HBs concentration of ≥10 mIU/mL is...

...hould be administered (alternative...

...e HepB (40 μg/dose)* (WR, L)2188...

...children and high-dose HepB for adolesc...

...B containing 20 μg of HBsAg (hepatitis B s...

...tionally adopted HIV-infected children...

...commended over bivalent human papill...

...Live Va...

...ed or -infected infants should receive rotavirus v...

64. HIV-infected patients should NOT rece...

...ld be administered to clinically stable HIV-infe...

...HIV-infected patients ≥14 years wi...

...ed children with a CD4 T-cell perc...

...nts ≥14 years with a CD4 T-cell lymphocyte c...

...ected patients should NOT receive quadrivalen...

...nimmune, clinically stable HIV-infe...

...ith ≥15% CD4 T-lymphocyte percentage, (SR,...

...4 years with CD4 T-lymphocyte counts of...

...ld be separated by ≥3 months. (SR, M)218...


...Table 2. Vaccination...

...H....

U: age...

...: age 5–18 yc (SR, L...

U: ag...

...18 yc (SR, L)21881...

...Hepatiti...

Low-Levela or No ImmunosuppressionU: (SR,...

...munosuppressionbU: age 1 y (SR, M)21881...

...Hepatitis Bd

...evela or No ImmunosuppressionR: (SR, M)21881...

...ImmunosuppressionbR: (SR, M)21881...

...DT...

...a or No ImmunosuppressionU: (SR, M)21881

...gh-Level ImmunosuppressionbU: (SR, M)2188...

...w-Levela or No ImmunosuppressionU: (SR...

...nosuppressionbU: (SR, VL)21881...

...or No ImmunosuppressionU: (SR, L)21881...

...unosuppressionbU: (SR, L)21881...

...HPV4e...

...No ImmunosuppressionU: age 11-26 y (SR, VL)21881...

...el ImmunosuppressionbU: age 11-26 y (SR...

...Influenza, in...

...-Levela or No ImmunosuppressionU: (SR,...

High-Level ImmunosuppressionbU: (SR, H...

...Influenza, li...

...or No ImmunosuppressionX:f (WR, VL)21881...

...h-Level ImmunosuppressionbX: (WR, VL)21881...

...w-Levela or No Immunosuppr...

...ge 12 mo to 13 y (SR, M)21881...

...e ≥14 y (WR, VL)21881...

...el Immunosuppressionb...

...12 mo to 13 y (SR, M)21881...

...≥14 y (SR, M)21881...

...or No ImmunosuppressionX: (SR, VL)21881...

...Level ImmunosuppressionbX: (SR, V...

...Meningococcal c...

Low-Levela or No ImmunosuppressionU: ag...

...ImmunosuppressionbU: age 11-18 y (SR, M)21881...

...Pne...

...or No Immunosuppression...

...age...

...5 yh (SR, M)21881...

R: age 6-18 yh (SR,...

...: age ≥19 yi (SR, L)21...

...l Immunosuppressionb...

...: age

R: age 5 y (SR, M)...

...-18 y (SR, L)21881

...e ≥19 yi (SR, VL)21881...

...Pn...

Low-Levela or No ImmunosuppressionR:...

...gh-Level Immunosuppre...

...e 2-18 y (SR, M)21...

...dult (CD4 T-lymphocytes...

...Poliovirus...

...No ImmunosuppressionU: (SR, M)21881...

...vel ImmunosuppressionbU: (SR, M)21...

...Rotavirus, l...

...No ImmunosuppressionU: (SR, L)21881...

...vel ImmunosuppressionbU: (WR, VL)2...

...Varicella, live...

...or No Immunosuppression...

...1-8 y (SR, H)21881...

U: age ≥9 y (SR, VL)2...

...munosuppressionbX: (SR, M)2188...

...Zoster,...

...evela or No Immunosuppression...

...: age...

...age ≥60 yk, l (WR, L)218...

...el ImmunosuppressionbX: (SR, M)21881...

...recommended—administer if not previously admi...

...pB (40 µg) should be considered for adults...

...scents (WR, L)21881...

...erred over HPV2 because of its activity a...

...≥19 years of age with HIV who have pre...

...uld be administered 8 weeks or lon...

...nation can be considered for patients 50 thr...

...atients not vaccinated with varicella vacci...


...Cancer...

...tients ≥6 months of age with hematological...

...r solid tumor malignancies (SR,...

...ept those receiving anti-B cell anti...

...ensive chemotherapy, such as for induct...

...should be administered to newly diagnosed adults w...

...malignancies (SR, VL)21881...

...en with malignancies (SR, VL)21881...

...in recommendations 27a-c. (, )21881...

...should be administered to adults and children...

...ed vaccines (other than IIV) recomm...

...cines administered during cancer chemother...

...re is documentation of a protective antibody...

.... Live viral vaccines should NOT be ad...

...arting 3 months following cancer chemotherapy...

...live vaccines VAR, (WR, VL)21881...

...(SR, L)21881...

...MMRV (WR, VL)21881

...cording to the CDC annual schedule r...

...regimens included anti-B cell antibodies, vaccin...


...Table 3....

...H. influenzae type b...

...ior to or During ChemotherapyaU: (WR,...

...≥3 Months Postchemotherapy and ≥6 Months...

...Hepatitis A...

...to or During ChemotherapyaU: (WR,...

...3 Months Postchemotherapy and ≥6 Months After...

...Hepatitis B...

...o or During ChemotherapyaU: (WR, L)21881...

...rting ≥3 Months Postchemotherapy and ≥6 M...

...SR, M)21881...

...: adults (SR, VL)21881

...DTaP, Tdap...

...or During ChemotherapyaU: (WR, L)21881...

...≥3 Months Postchemotherapy and ≥6 Months Aft...

U: age 0-18 y (SR, M)21...

...: adults with acute lymphoblastic leukemia or...

...HPV...

...r to or During ChemotherapyaU: age 11-26 y...

...≥3 Months Postchemotherapy and ≥...

...Influenza, inactiva...

...r During ChemotherapyaU (SR, L)U (SR-L t...

...tarting ≥3 Months Postchemotherapy an...

...Influenza, live att...

...r During ChemotherapyaX: (WR, VL)21881...

...Months Postchemotherapy and ≥6 Months Af...

...or During ChemotherapyaX:c (SR, M)2...

...g ≥3 Months Postchemotherapy and ...

...MM...

...During ChemotherapyaX:c (SR, M)21881...

Starting ≥3 Months Postchemotherapy and ≥...

Meningococca...

...r During ChemotherapyaU (WR, L)21881...

...onths Postchemotherapy and ≥6 Mon...

...Pneumococcal co...

...or During Chemotherapya...

...(SR, L)21881...

...≥6 yd (SR, VL)21881...

...g ≥3 Months Postchemotherapy and ≥6 M...

...Pneumococcal po...

...or During ChemotherapyaR: age ≥2...

...g ≥3 Months Postchemotherapy and ≥6...

...Poliovirus...

...o or During ChemotherapyaU: (WR, L)218...

...≥3 Months Postchemotherapy and...

...Rotavirus...

...to or During ChemotherapyaX: (SR...

...3 Months Postchemotherapy and ≥6 Months Afte...

...Varicella, live...

...r During ChemotherapyaXc (SR, M)21881...

Starting ≥3 Months Postchemotherapy and...

...Zoster, live...

...rior to or During ChemotherapyaX:c (SR, VL)...

...ing ≥3 Months Postchemotherapy a...

...—administer if not previously ad...

...Administer inactivated influenza vaccine (...

...olid tumor malignancies (SR, L)2...

...t those receiving anti–B-cell antibodies...

...of inactivated vaccines other than IIV...

...ccines administered while receiving cance...

...be administered ≤3 months after chemotherapy,...

...patients ≥19 years of age with H...

...R has been given safely 3 months after...

...atients ≥19 years of age who have pre...


...Hemato...

...Donors and Patients Before T...

...he HSCT donor should be current with r...

...AR, and ZOS administration should be avoided with...

...nation of the donor for the benefit of...

...rior to HSCT, candidates should receive vaccine...

...hen the interval to the start of t...

...s for inactivated vaccines. (SR, M)218...

...mmune HSCT candidates ≥12 months of a...

...HSCT Patients Post-transpla...

77. Administer 1 dose of IIV annually. (S...

...s ≥6 months of age starting 6 months aft...

...starting at 4 months if there is a...

...children 6 months through 8 years of age...

...doses of PCV13 to adults and children starting 3...

...s after HSCT a dose of PPSV23 should be given p...

...s with chronic GVHD a fourth dose of PCV1...

...inister 3 doses of Hib starting at 6-12 mon...

80. Administer 2 doses of MCV4 starting 6-12 month...

...3 doses of tetanus/diphtheria-containing vacc...

...children...

...7 years and older, administration of...

...ernatively, administer a dose of Tdap followed...

...r 2 doses of Td. (WR, L)21...

...ister 3 doses of HepB starting at 6-12 mont...

...postvaccination anti-HBs concentration of ≥10...

...: 1 dose of HepB after which anti-HBs is te...

...dose (40 μg)* (WR, L)21881

...dren and high dose for adolescents* and...

...dminister 3 doses of IPV starting 6-12 m...

...onsider administration of 3 doses of HPV starti...

...5. Do not administer live vaccines to HSC...

...nister a 2-dose series of MMR to measles-seronegat...

...sles-seronegative children (SR, M)21881...

...ster a 2-dose series of VAR starting 24 mo...


...Ta...

...H. influenzae type b...

...HSCTU: (SR, M)218...

...3 doses (SR, M)at 6 mo post-tx218...

...Hepatit...

...U: (SR, VL)21881...

...: 2 doses (WR, L)at ≥6 mo post-tx21881...

...Hepatitis B...

...TU: (SR, L)21881...

...doses (SR, M)at 6–12 mo post-tx21881...

...DTaP, DT...

...-HSCTU: (SR, L)21881

...st-HSC...

...: age

...≥7 y: DTaP* 3 doses (WR, VL)at ≥6 mo pos...

...1 dose Tdap, followed by either 2 doses DT* or...

...(WR, L)21881...

H...

...SCTU: age 11-26 y (SR, VL)21881...

Post-HSCTU: 3 doses at ≥6 mo post-tx (WR, VL)...

...Influenza, inactivat...

...e-HSCTU: (SR, L)2...

...st-HSCT...

...4 mo post-tx (SR, VL)if community...

...≥6 mo post-tx (SR, M)21881...

...Influenza, liv...

...e-HSCTX: (WR, VL)218...

...CTX: (WR, VL)21881...

...MMR,...

...SCTU:a (SR, VL)21881...

Post-HSCTX:b (SR, L)...

...MMRV, liv...

...HSCTU:a (WR, VL)21881...

...TX: (SR, VL)21881...

...Meningococcal co...

...re-HSCTU: (SR, VL)2...

...e 11-18 y: 2 doses (SR, L)at 6-12 mo...

...Pneumoc...

...R:c (SR, L)21881...

...oses (SR, L)at 3-6 mo posttx21881...

Pneumoco...

...HSCTR:c (SR, VL)21881...

...TR: ≥12 mo post-tx if no GVHD (SR, L)21881...

...Poliovirus, in...

...SCTU: (SR, VL)2188...

...SCTR: 3 doses (SR, M)at ≥3 mo post-tx21881...

Rotavirus,...

Pre-HSCTX: (WR, VL)21...

...TX: (WR, VL)21881...

...Varicella, live...

...HSCTU:a (SR, L)21881

...st-HSCTX:d (SR, L)2188...

...Zoster,...

...e-HSCT...

...age 50–59 y* (WR, VL)21881...

...:a age ≥60 y (SR, L...

Post-HSC...

...e 50–59 y* (SR, L)21881...

...age ≥60 y (SR, L)21881...

...ecommended—administer if not previou...

...otnotes to Table 4

...hese live vaccines should not be administer...

...minister to adolescents and adults...

...to children (SR, M)21881...

...not previously administered....

...nister if varicella-seronegative, the timing is...

...if the patient is not severely immunosuppressed a...


...Soli...

...Donors and Patie...

...donors should be current with vaccines based on...

...MMR, MMRV, VAR, and ZOS administration s...

...accination of donors solely for the rec...

.... Adults and children with chronic or end-stage ki...

...ing persons should receive PCV13 as in re...

...dults and children age ≥2 years old...

...s with end-stage kidney disease should...

...children ≥2 years of age with end-...

...en both PCV13 and PPSV23 are indicated, PCV...

...negative SOT candidates should recei...

...emodialysis and age ≥20 years they should...

...nation anti-HBs concentration of ≥10 mIU/mL i...

(Alternative: 1 dose of HepB after which anti-HBs...

...e* for children (WR, L)21881...

and the high dose for adolescents* and adult...

...unvaccinated, undervaccinated, or seronegat...

...nd those ≥2 years. (SR, M)should receive a...

...ined HepA-HepB vaccine can be used for SO...

...ies should be administered to SOT candidate...

...OT candidates 6-11 months of age can r...

...plantation is delayed (and the child is...

...ould be administered to SOT candidates with...

...R can be administered to varicella-naiv...

...imally, 2 doses should be administ...

...SOT candidates age ≥60 years (S...

...positive (as defined in recommendation 22) can...

...SOT Recipien...

...tion should be withheld from SOT recipien...

...pt that IIV can be administered ≥1 month after...

...e-appropriate inactivated vaccine serie...

...IIV. (SR, M)(Table 5)21881...

...hould be administered starting 2-6 months aft...

...For SOT patients ≥2 years of age, 1 d...

102. HepB should be considered for chro...

...3. MMR and VAR should generally not be...

...or VAR in children without evidence of immunity...

...accination should not be withheld bec...


...Table 5. Vaccin...

...H. influenzae type...

PretransplantU: (SR...

...g 2–6 Months PosttransplantU: (S...

...Hepatitis A...

...ransplant...

...12-23 mo (SR, M)21881...

R: age ≥2 y (SR, M)...

Starting 2–6 Months PosttransplantR: if no...

...Hepatitis B...

...retransplan...

...age 1-18 y (SR, M)...

R: age ≥18 y (SR...

...ng 2–6 Months PosttransplantR: if not com...

...DTaP, Tdap...

...ansplantU: (SR, M)21881...

...tarting 2–6 Months PosttransplantU:...

...HPV...

...retransplantU: females age 11-26 y (SR, M)218...

...–6 Months Posttransplant...

...age 11-26 y (SR, M)21881...

...males age 11-26 y (SR...

...Influenz...

...nsplantU: (SR, M)2188...

...2–6 Months PosttransplantU:b (SR, M)21881...

...Influenza, live...

...ransplantX: (WR, L)21...

...rting 2–6 Months PosttransplantX: (WR, L)2188...

...MMR, live...

...etranspla...

...e 6-11 mo (WR, VL)21881...

U:d age ≥12 mo (SR, M)2...

...g 2–6 Months PosttransplantX: (SR, L)21881...

...MMRV,...

...ransplantU:d (SR, M)2...

...6 Months PosttransplantX: (SR, L)21881...

...Meningococcal conjugate...

...splantU: (SR, M)218...

Starting 2–6 Months PosttransplantU: (S...

...Pneumococcal conju...

...ransplant...

U: ag...

...age ≥6 ye (SR, VL)218...

...rting 2–6 Months Posttr...

...: age 2-5 y (SR,...

...f not administered pretransplante (SR, VL)21881...

...Pneumococcal polysac...

...lantR: age ≥2 y (SR, M)21881...

...2–6 Months PosttransplantR: age...

...Polioviru...

...ransplantU: (SR, M)21881...

...tarting 2–6 Months PosttransplantU: (SR,...

...Rotavirus, live...

PretransplantU:c (SR, M...

...ing 2–6 Months PosttransplantX: (SR, L)21881...

...Varicella, live...

...ransplant

...6-11 mo (WR, VL)21881...

...d (SR, L)21...

...onths PosttransplantX:g (SR, L)2188...

...Zoster...

...transplant

R:h age 50-59 y (WR, L)2...

...age ≥60 y (SR, M)2...

Starting 2–6 Months PosttransplantX:...

R, recommended—administer if not previous...

...atitis B vaccine for hepatitis B-infected liver...

...IV may be administered to SOT recipients despite i...

...only if patient is not immunosuppressed and t...

...s ≥19 years who have previously received PPSV...

...r only if patient is not immunosuppressed and t...


...Chron...

...Inactivated vaccines, including IIV, should...

...r about to be treated with immunosuppressi...

...d be administered to adults and children wi...

...ould be administered to patients ≥2...

...l immunosuppression, (SR, L)21881...

...vel immunosuppression. (SR, VL)21881...

...receive PPSV23 ≥8 weeks after PCV13 a...

...be administered to patients with chronic...

...to initiation of immunosuppression, (SR, L...

...09. VAR should be considered for p...

...be administered to patients with a chron...

...being treated with low-dose immunosuppres...

...d to those who are 50-59 years of age and vari...

...eing treated with low-dose immunosuppression...

...e vaccines should NOT be administered to patie...

...patients receiving low-level (WR,...

...-level immunosuppression, (WR, VL)2188...

...patients receiving low-level (WR,...

...high-level immunosuppression. (SR, VL)21881...

...e recommended vaccines, including IIV a...


...Table 6. V...

...H. inf...

...nned ImmunosuppressionU: (SR, M)21881...

Low-Level ImmunosuppressionaU: (SR, L)2188...

...unosuppressionaU: (SR, L)21881...

...Hepatitis A...

Planned ImmunosuppressionU: (SR, M)2188...

...ow-Level ImmunosuppressionaU: (SR...

...-Level ImmunosuppressionaU: (SR,...

...Hepatitis B...

Planned ImmunosuppressionU: (SR, M)2188...

Low-Level ImmunosuppressionaU: (SR,...

...-Level ImmunosuppressionaU: (SR, L)21881...

...DTaP, Td, Tdap...

...nned ImmunosuppressionU: (SR...

...ImmunosuppressionaU: (SR, L)2188...

...el ImmunosuppressionaU: (SR, L)21...

...HPV...

...ed ImmunosuppressionU: age 11-26 y...

Low-Level ImmunosuppressionaU: age 11...

...gh-Level ImmunosuppressionaU: age 11-26 y (SR,...

...Influenza, inactivated...

...ImmunosuppressionU: (SR, M)21...

...ImmunosuppressionaU: (SR, M)21881...

High-Level ImmunosuppressionaU:...

...Influenza...

...mmunosuppressionX: (WR, VL)21881...

...munosuppressionaX: (WR, VL)21881...

...ImmunosuppressionaX: (WR, VL)218...

...MMR, live...

...munosuppressionU:b (SR, M)21881...

...nosuppressionaX: (WR, VL)21881...

...ImmunosuppressionaX: (WR, VL)21881...

...MMRV, live...

...nosuppressionU:b (SR, L)21881

...ImmunosuppressionaX: (WR, VL)21881...

...-Level ImmunosuppressionaX: (SR...

...Meningococca...

...ned ImmunosuppressionU: (SR...

...unosuppressionaU: (SR, M)21881...

...evel ImmunosuppressionaU: (SR, L)2...

...P...

...ImmunosuppressionR:c (SR, M)21881...

...Level Immunosuppres...

...age

...age ≥6 yc (SR, VL)21881...

High-Level Immunosuppressio...

U: age

...6 yc (SR, VL)21881...

...ImmunosuppressionR: age ≥2 y (SR, L)21881...

...-Level ImmunosuppressionaR: age ≥2...

...munosuppressionaR: age ≥2 y (SR, VL...

...Poliovirus, inactivat...

...anned ImmunosuppressionU: (SR, M)21881...

...mmunosuppressionaU: (SR, M)21881...

High-Level ImmunosuppressionaU: (SR,...

...Rotavirus, li...

...ImmunosuppressionU: (SR, M)21881...

...w-Level ImmunosuppressionaX: (WR, VL)21881

...nosuppressionaX: (WR, VL)21881...

...Varicell...

...ed ImmunosuppressionU:d (SR, M)21881...

...osuppressionaX:d (WR, VL)21881...

...evel ImmunosuppressionaX: (SR, M)2188...

...Zoster, live

...d Immunosuppression...

...50-59 y* (WR, L)21881...

...age ≥60 y (SR, L)...

...-Level Immunosuppres...

...ge 50-59 y* (WR, VL)...

...60 y (SR, VL)21881...

...h-Level ImmunosuppressionaX: (WR, VL)21881

..., recommended—administer if not previousl...

...For patients ≥19 years who have...

...Administration of VAR can be consid...

...ecommendations deviate from CDC ACIP re...


...Asplenia or Sickle C...

...plenic patients or those with sickle cell...

...in patients with sickle cell disease. (WR, VL...

...should be administered to asplenic patie...

...15. PPSV23 should be administered to aspl...

...terval of ≥8 weeks after PCV13, and a seco...

...ve patients ≥2 years of age for who...

...eks following surgery.* (WR, L)2188...

...e of Hib should be administered to unvacci...

...Meningococcal vaccine should be administ...

...tion 29 except that MCV4--D should not be a...

...with MCV4 (or MPSV4 for those >55 years of age wh...


...Anatomic Barrier D...

...s and children with profound deafness sche...

...atients with a cochlear implant, with pro...

...atients ≥24 months of age with a c...

...d PPSV23 should be administered ≥...


...Table 7. Vaccination o...

...H. influenzae t...

...a or a Sickle Cell Disea...

U: age...

...≥5 y (WR, L)21881...

...lear Implantsa or CSF LeakU: (...

...Hep...

...plenia or a Sickle Cell DiseaseU: (SR,...

...ear Implantsa or CSF LeakU: (SR, M)218...

...Hepat...

...r a Sickle Cell DiseaseU: (SR, M)21881...

...ear Implantsa or CSF LeakU: (SR, M)2188...

...DTaP, Td...

...or a Sickle Cell DiseaseU: (SR, M)2188...

Cochlear Implantsa or CSF LeakU: (...

...HPV...

...a or a Sickle Cell DiseaseU: (SR,...

...ar Implantsa or CSF LeakU: (SR, M)21881...

...Influenza...

...ia or a Sickle Cell DiseaseU: (SR, M)21881...

...ear Implantsa or CSF LeakU: (SR, M)21881...

...Inf...

...lenia or a Sickle Cell DiseaseX: (WR, VL)21881...

...ntsa or CSF LeakU: (SR, M)21881...

...MMR,...

...r a Sickle Cell DiseaseU: (SR, M)21881...

...chlear Implantsa or CSF LeakU: (SR, M)2...

...MMR...

...a Sickle Cell DiseaseU: (SR, M)21881

...ntsa or CSF LeakU: (SR, M)21881...

Meningococ...

...ickle Cell DiseaseR: age 2-55 yb (SR, L)21881...

...plantsa or CSF LeakU: (SR, M)21881...

...Meni...

...Sickle Cell DiseaseR: age >55 yb (SR, L...

...hlear Implantsa or CSF LeakU: (SR, M)21881...

...Pneumococcal conjugate...

...a or a Sickle Cell Disease...

U: age...

...age ≥6 yd (SR, VL)218...

...ochlear Implantsa or CSF Lea...

...age

...age ≥6 yd (SR, L)21...

...Pneumococcal po...

...or a Sickle Cell DiseaseR: age ≥2 ye (SR,...

...tsa or CSF LeakR: age ≥2 ye (SR, M)218...

...Poliovirus, ina...

...ckle Cell DiseaseU: (SR, M)21881...

...tsa or CSF LeakU: (SR, M)21881...

...Rotavirus, live...

...ia or a Sickle Cell DiseaseU: (SR, M)21881...

...lear Implantsa or CSF LeakU: (SR, M)21881...

...Varicella, live...

Asplenia or a Sickle Cell DiseaseU...

...ntsa or CSF LeakU: (SR, M)21881...

...Zoster, live...

Asplenia or a Sickle Cell DiseaseU: (SR, M)...

...ochlear Implantsa or CSF LeakU: (SR, M)2188...

...mended—administer if not previously admini...

...has not previously been administered. For pati...

e Administer 8 or more weeks after indicated...