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...

...lists caring for immunocompromised patient...


...caring for immunocompromised patients shar...


Timing of Vaccination

...Timing of...

...ines should be administered prior to plann...


...ve vaccines should be administered ...

...oided within 2 weeks of initiation of immunos...


...ated vaccines should be administered ≥2...


Household Members (See Table 1)

...Househol...

...mmunocompetent household members of immunoco...

...or travel. (SR, M)21...


...d members of immunocompromised patients 6 months...

...activated influenza vaccine (IIV) o...

.... Live attenuated influenza vaccine...

...lude household members of an immunoc...

...ministered, contact between the immunoc...


...thy immunocompetent household members of immuno...

rotavirus vaccine in infants ages 2-7 mon...

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

...vaccine (ZOS). (SR, M)21881...

...receive vaccines for travel: yellow fever...

...oral typhoid vaccine. (SR, L)21881


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


...unocompromised patients should avoid handling dia...


.... Immunocompromised patients should avoid c...


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

...Table 1....

...Influenza, l...

...ster; (SR, L)2188...

...nated persons to avoid close contact with pe...


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


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


...virus, oral Shedding of...


...ral Shedding of Agent? (Sit...


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


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


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


International Travel

...ians may administer inactivated vaccines indi...


...low fever vaccine generally should NOT be ad...

...Asymptomatic HIV-infected adults with CD...

...ptomatic HIV-infected children age 9 mo...


...certain exceptions (eg, yellow fever...


Specific Vaccinations

...Specific Vacci...

...Varicella and Zos...

...given to immunocompetent patients without eviden...

...n be administered ≥4 weeks before init...

...schedule of VAR, separated by >4 weeks for pati...

...ld NOT be administered to highly i...

18. VAR can be considered for patients without evi...

.... VAR should be administered to eligible immunoc...

...hould be given to patients ≥60 years...

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

...should be administered to patients ...

...d NOT be administered to highly immuno...


...Infl...

...nfluenza vaccination with IIV is recommen...

except for patients who are very unlikely...

...o have received anti-B cell antibodies within 6 mo...

...uld NOT be administered to immunoco...


Special Populations

...Spe...

...Primary...

...Primary...

...nts with primary complement deficiencies shoul...

...ld should receive 1 dose of 13-valent p...

b. 6-18 years old with a classical pathwa...

...ears old with a classical pathway (C1,...

For those who have previously received 23-valent p...

...8. Patients ≥2 years of age with an...

...ren age 6 weeks through 18 months, administer a 4...

...rimary series of quadrivalent meni...

...ns >55 years of age, administer MPSV4 if they h...

...ents 9-23 months of age, administer the dos...

...s with a primary complement component deficienc...

...Phagocytic Cel...

...ocytic cell deficiencies include CGD (chronic gran...

...Patients with phagocytic cell deficiencies sh...

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

...tients ≥6 years of age with phagocyti...

33. Patients ≥2 years of age with...

...bacterial vaccines, such as bacillus Calmett...

...ve viral vaccines should be administered to patie...

...ve viral vaccines should NOT be administe...

...In...

...n the immune system resulting in defects of cytoki...

...ents with innate immune system defe...

...nts with innate immune system defects...

...advice should be sought on individual co...

...rial vaccines should NOT be administere...

...Live viral vaccines should NOT be admi...

...Minor Antibody De...

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

...with SPAD or ataxia-telangiectasia sho...

...≥2 years of age should receive PPSV23 ...

...oring of vaccine responses can be...

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

.... Inactivated vaccines other than...

...ents with suspected major antibody deficien...

...an be administered to patients with majo...

...should NOT be administered to patients with...

...ines (other than OPV) should NOT be admini...

...Combined I...

...For patients with suspected combined imm...

...h combined immunodeficiencies who are rece...

...s with combined immunodeficiencies and resi...

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

...th SCID, DiGeorge syndrome with CD3...


...HIV-Infected...

...Inactivated Vaccines...

IIV, (SR, H)218...

...in patients...

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

...eria toxoid, tetanus toxoid, acell...

..., reduced diphtheria toxoid, and red...

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

...accine (HepB), (SR, M)21881...

...itis A vaccine (HepA), (SR,...

...nactivated poliovirus vaccine (IPV), (SR, M)2...

...t human papillomavirus vaccine (HPV4)* in fe...

...uld be administered to HIV-infected patients ≥...

...should be administered to HIV-inf...

...HIV-infected adults with CD4 T-lymphocyte count...

...IV-infected adults with CD4 T-lymphocyte counts...

...be given ≥8 weeks after the indicated dose(s)...

...fected children who are >59 months of age and h...

...recommended for HIV-infected adults. (WR, L)21881...

...8. HIV-infected children age 11-18 years sh...

...e booster dose (third dose) should be g...

...MCV4 is administered to HIV-infecte...

...infected patients should receive HepB ser...

...on of high-dose HepB (40 μg/dose) for...

...olescents.* (WR, L)21881...

...two months after completion, they should be te...

If a postvaccination anti-HBs concentrat...

...be administered (alternative: 1 dose o...

...dose HepB (40 μg/dose)* (WR, L)21881...

...and high-dose HepB for adolescents* and adults. (...

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

...nally adopted HIV-infected children who had...

...ommended over bivalent human papillomavirus...

...Live Vaccin...

...d or -infected infants should receive rot...

...d patients should NOT receive LAIV. (WR, VL)...

...should be administered to clinically stable HIV-...

...patients ≥14 years without measles immunit...

...-infected children with a CD4 T-cell percent...

...r patients ≥14 years with a CD4 T-cell lymphocy...

...nfected patients should NOT receive qua...

...8. Varicella-nonimmune, clinically stable HIV-infe...

...years with ≥15% CD4 T-lymphocyte percentage, (...

...≥14 years with CD4 T-lymphocyte counts of ≥2...

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


...Table 2....

...H. influenzae ty...

U: age

...e 5–18 yc (SR, L)21881...

U: age

...age 5–18 yc (SR, L)2188...

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

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

...Hepatitis Bd...

...ela or No ImmunosuppressionR: (SR, M)2...

...h-Level ImmunosuppressionbR: (SR...

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

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

...Tdap...

...a or No ImmunosuppressionU: (SR, VL)...

...h-Level ImmunosuppressionbU: (SR...

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

...evel ImmunosuppressionbU: (SR, L)218...

...a or No ImmunosuppressionU: age 11-26 y (SR,...

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

...Influen...

...evela or No ImmunosuppressionU: (...

...mmunosuppressionbU: (SR, H)218...

...Influenza, live attenua...

...ow-Levela or No ImmunosuppressionX:f...

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

...MMR, liv...

...or No Immunosuppression...

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

...14 y (WR, VL)21881...

...l Immunosuppressionb

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

...14 y (SR, M)21881...

...MMRV, live

...a or No ImmunosuppressionX: (SR, VL)2188...

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

...Meningococcal conjugateg...

...Levela or No ImmunosuppressionU: age 11-18 y...

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

...P...

...or No Immunosuppression...

U: age...

...age 5 yh (SR, M)21...

...e 6-18 yh (SR, L)218...

R: age ≥19 yi (SR,...

...el Immunosuppressionb...

...age

...5 y (SR, M)2188...

R: age 6-18 y (SR, L)2...

...age ≥19 yi (SR, VL)2188...

Pneumococca...

...a or No ImmunosuppressionR: age ≥2...

...evel Immunosuppressionb...

...age 2-18 y (SR, M)2188...

...ult (CD4 T-lymphocytes...

...Poliovirus, inactivated...

...ow-Levela or No ImmunosuppressionU: (SR, M)21881...

...h-Level ImmunosuppressionbU: (SR,...

...Rotavirus, li...

...or No ImmunosuppressionU: (SR, L)21...

...vel ImmunosuppressionbU: (WR, VL)21881...

...V...

...w-Levela or No Immunosuppression...

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

U: age ≥9 y (SR, VL)...

...l ImmunosuppressionbX: (SR, M)...

...Zoster, l...

...vela or No Immunosuppression...

X: ag...

...e ≥60 yk, l (WR, L)2188...

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

...recommended—administer if not previ...

...igh-dose HepB (40 µg) should be considered for a...

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

...referred over HPV2 because of its activity...

...ients ≥19 years of age with HIV who have pr...

...be administered 8 weeks or longer after...

...on can be considered for patients 50 t...

...patients not vaccinated with varicella vaccine....


...Cancer (See Tab...

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

or solid tumor malignancies (...

...e receiving anti-B cell antibodies* (SR,...

...ive chemotherapy, such as for indu...

...V13 should be administered to newly...

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

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

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

...administered to adults and children...

...ed vaccines (other than IIV) recommended for...

...ever, vaccines administered during cancer chem...

...s there is documentation of a protective...

...accines should NOT be administered during c...

...Starting 3 months following cancer chemotherapy...

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

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

...RV (WR, VL)21881...

...rding to the CDC annual schedule routinely indicat...

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


...Table 3. V...

...H. i...

...to or During ChemotherapyaU: (WR, L)21...

...onths Postchemotherapy and ≥6 Mont...

...Hepatitis A...

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

...nths Postchemotherapy and ≥6 Months...

...He...

...ring ChemotherapyaU: (WR, L)21881...

...nths Postchemotherapy and ≥6 Months After...

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

...dults (SR, VL)21881

...DTaP, T...

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

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

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

...adults with acute lymphoblastic leukemia o...

...HP...

...to or During ChemotherapyaU: age 11-...

...arting ≥3 Months Postchemotherapy and ≥6 Mont...

...I...

...uring ChemotherapyaU (SR, L)U (SR-...

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

...Influenza,...

...ing ChemotherapyaX: (WR, VL)21881...

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

...MMR, live

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

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

...MMRV, live...

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

...arting ≥3 Months Postchemotherap...

...Meningococcal conj...

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

...ing ≥3 Months Postchemotherapy and ≥6 Months A...

...P...

...o or During Chemotherapya...

...SR, L)21881...

...age ≥6 yd (SR, VL)21881...

...nths Postchemotherapy and ≥6 Months After Anti...

...Pneumococca...

...r to or During ChemotherapyaR: age ≥2 y (SR, L)...

...ing ≥3 Months Postchemotherapy an...

...Poliovirus, inact...

...ing ChemotherapyaU: (WR, L)21881...

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

...Rotavirus, live...

...During ChemotherapyaX: (SR, VL)21881...

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

...Varicell...

...During ChemotherapyaXc (SR, M)21...

...rting ≥3 Months Postchemotherapy a...

...Zoster, live...

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

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

R, recommended—administer if not previou...

...r inactivated influenza vaccine (IIV) a...

...r solid tumor malignancies (SR, L)21881

except those receiving anti–B-cell a...

Administrations of inactivated vaccines...

...accines administered while receiving cancer...

...be administered ≤3 months after chemoth...

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

...Although MMR has been given safely 3 months...

...ents ≥19 years of age who have pr...


...Hematopoietic Stem Cell T...

...Donors and Patient...

...CT donor should be current with routinely recom...

...RV, VAR, and ZOS administration should...

Vaccination of the donor for the benef...

...5. Prior to HSCT, candidates should r...

...when the interval to the start of...

...2 weeks for inactivated vaccines. (SR, M)21881...

...nimmune HSCT candidates ≥12 mont...

...HSCT Pati...

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

...o persons ≥6 months of age starting...

...arting at 4 months if there is a commun...

...en 6 months through 8 years of age who are recei...

...nister 3 doses of PCV13 to adults and...

...hs after HSCT a dose of PPSV23 should...

...patients with chronic GVHD a fourth dose...

...dminister 3 doses of Hib starting at...

...ter 2 doses of MCV4 starting 6-12 months...

...dminister 3 doses of tetanus/diphtheria-c...

For children...

...or patients 7 years and older, administration o...

...ively, administer a dose of Tdap follo...

...s of Td. (WR, L)21881...

...Administer 3 doses of HepB starting at...

...a postvaccination anti-HBs concentration...

...ive: 1 dose of HepB after which anti-HBs i...

...dose (40 μg)* (WR, L)21881...

...nd high dose for adolescents* and adults (S...

...Administer 3 doses of IPV starting 6-12...

...ider administration of 3 doses of HP...

...minister live vaccines to HSCT patients with...

...Administer a 2-dose series of MMR t...

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

...inister a 2-dose series of VAR starting 2...


...Table 4. Vacc...

...H. influenzae typ...

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

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

...Hepati...

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

...ost-HSCTR: 2 doses (WR, L)at ≥6 mo pos...

...Hepa...

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

...-HSCTR: 3 doses (SR, M)at 6–12 mo post-tx21881...

...DTaP, DT, Td,...

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

Post-HSCT

...age...

...≥7 y: DTaP* 3 doses (WR, VL)at ...

...dap, followed by either 2 doses DT* or 2 dos...

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

...HPV

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

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

...In...

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

...ost-HSCT...

...post-tx (SR, VL)if community outbreak;21881...

...6 mo post-tx (SR, M)21881...

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

...-HSCTX: (WR, VL)21881

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

...st-HSCTX:b (SR, L...

...MMRV, live...

...CTU:a (WR, VL)2188...

...st-HSCTX: (SR, VL)21...

...Meningococcal...

...SCTU: (SR, VL)21...

...-HSCTR: age 11-18 y: 2 doses (SR, L)at 6-1...

...Pneumococc...

Pre-HSCTR:c (SR, L)2...

...-HSCTR: 3 doses (SR, L)at 3-6 mo posttx21881...

...Pneumococcal polys...

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

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

...Po...

Pre-HSCTU: (SR, VL)21...

...R: 3 doses (SR, M)at ≥3 mo post-tx21...

...Rotavirus, live...

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

...SCTX: (WR, VL)2188...

...Varice...

...HSCTU:a (SR, L)218...

...-HSCTX:d (SR, L)218...

...Zo...

...e-HSCT...

...age 50–59 y* (WR, VL)21881...

...≥60 y (SR, L)21881...

Post-H...

...59 y* (SR, L)21881...

...≥60 y (SR, L)21881...

...recommended—administer if not previously admin...

...tnotes to Table 4

...e vaccines should not be administere...

...inister to adolescents and adults (SR, L...

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

c If not previously administere...

...varicella-seronegative, the timing is ≥24...

...the patient is not severely immunosupp...


...Solid Organ Transplant...

...Donor...

...ing donors should be current with vaccines based o...

but MMR, MMRV, VAR, and ZOS administrati...

...ation of donors solely for the recipie...

...nd children with chronic or end-stage kidney,...

...0. The following persons should receive PCV13 as i...

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

...ith end-stage kidney disease should rece...

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

...3 and PPSV23 are indicated, PCV13 should be compl...

...egative SOT candidates should receive a HepB se...

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

...accination anti-HBs concentration of ≥1...

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

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

...gh dose for adolescents* and adults. (SR, L)218...

...is A–unvaccinated, undervaccinated, or serone...

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

...ombined HepA-HepB vaccine can be used for SOT cand...

...hould be administered to SOT candidates ag...

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

...antation is delayed (and the child is not re...

.... VAR should be administered to SO...

...an be administered to varicella-naive SOT cand...

Optimally, 2 doses should be administe...

...SOT candidates age ≥60 years (SR...

...a-positive (as defined in recommendati...

...SOT Recipients...

98. Vaccination should be withheld from SOT...

...cept that IIV can be administered ≥1 mo...

...e-appropriate inactivated vaccine series s...

...ding IIV. (SR, M)(Table 5)2188...

100. PCV13 should be administered starting 2-...

...T patients ≥2 years of age, 1 dose of PP...

...should be considered for chronic hepatitis B-inf...

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

except for VAR in children without...

...tion should not be withheld because of concern a...


...Table 5. Vacci...

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

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

...Hepatitis...

...transplan...

...e 12-23 mo (SR, M)2188...

...≥2 y (SR, M)21881...

...6 Months PosttransplantR: if not c...

...Hepatitis B...

Pretransp...

U: age 1-18 y (SR, M)218...

...age ≥18 y (SR, M)...

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

...DTaP, T...

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

...Months PosttransplantU: if not completed pretrans...

...HPV

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

...–6 Months Posttransplant...

U: females age 11-26 y (SR,...

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

...Inf...

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

...rting 2–6 Months PosttransplantU:b...

...Influenza...

...plantX: (WR, L)21881...

...onths PosttransplantX: (WR, L)2188...

...MMR, live...

...transplant...

R:c age 6-11 mo (WR, VL...

...e ≥12 mo (SR, M)21881...

...rting 2–6 Months PosttransplantX: (...

...MMRV, live...

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

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

...Meningococc...

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

...Months PosttransplantU: (SR, M)21...

...Pneumococcal conjuga...

...retranspla...

...: age

...ge ≥6 ye (SR, VL)21881...

...6 Months Posttransplant...

...2-5 y (SR, M)21881...

...if not administered pretransplante...

...Pneumoc...

...ansplantR: age ≥2 y (SR, M)21881

...arting 2–6 Months PosttransplantR:...

...Poliovirus, in...

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

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

...Rotavirus...

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

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

Pretransp...

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

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

...onths PosttransplantX:g (SR, L)21881...

...Zost...

...transplan...

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

U:i age ≥60 y (SR,...

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

...ed—administer if not previously administ...

...hepatitis B vaccine for hepatitis B-i...

...administered to SOT recipients despite inten...

c Administer only if patient is not imm...

...ts ≥19 years who have previously recei...

...minister only if patient is not immunosupp...


...Chronic Infl...

...05. Inactivated vaccines, including IIV, should b...

...e treated with immunosuppressive agents. (SR,...

...CV13 should be administered to adult...

...ld be administered to patients ≥2 years of...

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

...high-level immunosuppression. (SR, VL)21...

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

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

...ks prior to initiation of immunosuppression, (S...

...VAR should be considered for patient...

...ould be administered to patients with a c...

...hile being treated with low-dose i...

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

...ng treated with low-dose immunosuppressi...

...vaccines should NOT be administered t...

...s receiving low-level (WR, VL)21881...

...igh-level immunosuppression, (WR, VL)21...

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

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

...12. Otherwise recommended vaccines, includin...


...Table 6. Vaccina...

...H. influenza...

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

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

...vel ImmunosuppressionaU: (SR, L)21881...

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

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

...el ImmunosuppressionaU: (SR, L)21881...

...Hepatitis B

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

...w-Level ImmunosuppressionaU: (S...

...el ImmunosuppressionaU: (SR, L)21881...

...DTaP,...

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

...l ImmunosuppressionaU: (SR, L)21881...

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

...HPV

...unosuppressionU: age 11-26 y (SR,...

...mmunosuppressionaU: age 11-26 y (SR, L)2188...

...vel ImmunosuppressionaU: age 11-26 y...

...Influenza, in...

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

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

High-Level ImmunosuppressionaU: (S...

...Influenza, live attenua...

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

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

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

...MMR, l...

...nned ImmunosuppressionU:b (SR, M...

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

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

...MMRV, live...

...ed ImmunosuppressionU:b (SR, L)21881

...ow-Level ImmunosuppressionaX: (WR, VL)21...

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

...Men...

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

...evel ImmunosuppressionaU: (SR,...

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

...Pneumococcal c...

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

...ow-Level Immunosuppressi...

...age

...: age ≥6 yc (SR, VL)218...

High-Level Immunosup...

...: age...

...age ≥6 yc (SR, VL...

...Pneumococcal...

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

...vel ImmunosuppressionaR: age ≥2 y (SR, L)...

...osuppressionaR: age ≥2 y (SR, VL)218...

...Poliovirus, inactiv...

...ned ImmunosuppressionU: (SR, M)2...

...munosuppressionaU: (SR, M)21881

...evel ImmunosuppressionaU: (SR, L)21881...

...Rot...

Planned ImmunosuppressionU: (SR, M)2...

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

...mmunosuppressionaX: (WR, VL)21881

...Varic...

...osuppressionU:d (SR, M)21881...

...evel ImmunosuppressionaX:d (WR, VL)21...

...Level ImmunosuppressionaX: (SR, M)21881...

...Zoste...

...d Immunosuppression...

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

...ge ≥60 y (SR, L)21881

...ow-Level Immunosuppres...

...age 50-59 y* (WR, VL)2188...

...: age ≥60 y (SR, VL)21881

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

...nded—administer if not previously adm...

...19 years who have previously received PPS...

...tion of VAR can be considered for no...

...mmendations deviate from CDC ACIP rec...


...Asplenia or Sickle Cell...

...Asplenic patients or those with sickle cell...

...xcept LAIV in patients with sickle cell dis...

...13 should be administered to asplenic patients or...

...23 should be administered to asplenic patients...

...val of ≥8 weeks after PCV13, and a...

...PSV23--naive patients ≥2 years of age for whom a...

...s following surgery.* (WR, L)21881...

...17. One dose of Hib should be administered to...

...coccal vaccine should be administered to...

...recommendation 29 except that MCV4--D should...

...cinate with MCV4 (or MPSV4 for those >...


...Anatomic Barrier...

...9. Adults and children with profound deafness s...

...with a cochlear implant, with profoun...

...atients ≥24 months of age with a cochlear im...

...PPSV23 should be administered ≥2 weeks pr...


...Table 7. Vaccinatio...

...H. influenzae ty...

...splenia or a Sickle Cell Dis...

...: age...

...≥5 y (WR, L)21881...

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

...Hepatitis...

...enia or a Sickle Cell DiseaseU:...

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

...Hepatitis B...

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

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

...DTaP, Td, Td...

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

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

...splenia or a Sickle Cell DiseaseU: (SR, M)218...

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

...Influenza, inactivated...

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

...Implantsa or CSF LeakU: (SR, M)21...

...In...

...plenia or a Sickle Cell DiseaseX: (WR, VL)218...

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

...MMR, liv...

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

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

...MMRV, live...

...Sickle Cell DiseaseU: (SR, M)218...

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

...Meningococcal con...

...ia or a Sickle Cell DiseaseR: age 2-55 yb (SR...

...hlear Implantsa or CSF LeakU: (...

...Meningococcal...

...r a Sickle Cell DiseaseR: age >55 yb (SR, L)21...

...ntsa or CSF LeakU: (SR, M)21881...

...Pneumococcal conjugate...

...plenia or a Sickle Cell...

...age...

...6 yd (SR, VL)21881

...r Implantsa or CSF Lea...

U: ag...

...: age ≥6 yd (SR, L)2...

...Pneumococcal polysacc...

...splenia or a Sickle Cell DiseaseR: age ≥2...

...chlear Implantsa or CSF LeakR: ag...

...Poliovirus, inacti...

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

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

...Rotavirus, live...

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

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

...Varicella,...

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

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

Zoster...

Asplenia or a Sickle Cell DiseaseU:...

...ntsa or CSF LeakU: (SR, M)21881...

...administer if not previously administered or not...

...PCV13 has not previously been administ...

...ister 8 or more weeks after indicat...