Vaccination of the Immunocompromised Host
Key Points
Key Points
- 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
...ponsibility for Vaccination...
...caring for immunocompromised patients sh...
.... Specialists caring for immunocompromised patie...
Timing of Vaccination
Timing of Vaccin...
...uld be administered prior to planned immunosup...
...ive vaccines should be administered...
...uld be avoided within 2 weeks of initiation of...
...vaccines should be administered ≥2 weeks p...
Household Members (See Table 1)
...ousehold Members (See T...
...ocompetent household members of immunocompromis...
...for travel. (SR, M)21...
...ld members of immunocompromised patients 6...
...Inactivated influenza vaccine (IIV) o...
...e attenuated influenza vaccine (LAIV) provide...
...ptions include household members o...
...f administered, contact between the immuno...
...thy immunocompetent household members of immuno...
...ccine in infants ages 2-7 months, (SR, L)218...
...icella vaccine (VAR), (SR,...
...ter vaccine (ZOS). (SR, M)21881...
...hey can safely receive vaccines for travel:...
...yphoid vaccine. (SR, L)21881...
...poliovirus vaccine (OPV) should NOT be...
...nocompromised patients should avoid handling...
...ompromised patients should avoid con...
Table 1. Safety of Administration of Live Vaccines to Contacts of Immunocompromised Persons
...of Administration of Live Vaccines to C...
...live, attenuated nasal...
...ster; (SR, L)21881
...accinated persons to avoid close contact w...
...Shedding of Agent? (Site) Tr...
...oliovirus, oral Shedding of...
...al Shedding of Agent? (Site) Tran...
...Shedding of Agent? (Site)...
...Shedding of Agent? (Site) Tra...
...fever Shedding of Agent?...
...er Shedding of Agent? (Site)...
International Travel
...national Travel...
...ay administer inactivated vaccines indicated...
...w fever vaccine generally should NOT b...
...atic HIV-infected adults with CD4 T-cell lymp...
...Asymptomatic HIV-infected children age...
...ertain exceptions (eg, yellow fever vaccine and MM...
Specific Vaccinations
...ific Vaccinations
...ella and Zoster Vaccine...
...be given to immunocompetent patien...
...an be administered ≥4 weeks before in...
...ose schedule of VAR, separated by >4 weeks for pat...
...should NOT be administered to highly immunocompr...
...R can be considered for patients without e...
...d be administered to eligible immu...
...S should be given to patients ≥60 y...
...ZOS should be considered for varicella-posi...
...OS should be administered to patien...
23. ZOS should NOT be administered to highly im...
Influen...
...enza vaccination with IIV is recommended...
...atients who are very unlikely to respo...
...have received anti-B cell antibodies within 6...
.... LAIV should NOT be administered to im...
Special Populations
...l Populations...
...ital) Immunodeficiency Disorders
...rimary Complement Deficiencies
...with primary complement deficiencies shoul...
.... 2-5 years old should receive 1 dose of 13-vale...
...years old with a classical pathwa...
...s old with a classical pathway (C1...
...e who have previously received 23-valent...
...≥2 years of age with an early classica...
For children age 6 weeks through 1...
...ary series of quadrivalent meningococcal conjugat...
...s >55 years of age, administer MPSV4 if they hav...
...atients 9-23 months of age, administer t...
...with a primary complement component deficien...
...agocytic Cell Deficiencies...
Phagocytic cell deficiencies include...
...h phagocytic cell deficiencies should recei...
...ears of age should receive PCV13 as in recommenda...
...atients ≥6 years of age with phagocytic cell...
33. Patients ≥2 years of age with phagocyt...
...bacterial vaccines, such as bacill...
...ive viral vaccines should be adminis...
...accines should NOT be administered to patient...
...ate Cytokine or Cellular Activation D...
...s in the immune system resulting in d...
37. Patients with innate immune system defects re...
...nts with innate immune system defects resulti...
...list advice should be sought on individ...
...erial vaccines should NOT be administered to pat...
...accines should NOT be administered to patie...
...tibody Deficiencies...
...th immunoglobulin A (IgA) deficiency o...
...ldren with SPAD or ataxia-telangiectasi...
...e ≥2 years of age should receive...
...Monitoring of vaccine responses can be use...
...OPV should NOT be administered to...
...ntibody Deficiencies in Patients Receiving Immuno...
...ted vaccines other than IIV are NOT rou...
...patients with suspected major antibody def...
...administered to patients with major antibody...
...should NOT be administered to patients with majo...
...ccines (other than OPV) should NOT b...
...d Immunodeficiencies...
...patients with suspected combined imm...
...ents with combined immunodeficiencies who are...
...ts with combined immunodeficiencies and residual...
...Children with partial DiGeorge syndrome (p...
...th SCID, DiGeorge syndrome with CD3 T-ce...
HIV-Infected Adults, Adolescents, and Chi...
...ivated Vaccines...
...V, (SR, H)21...
...V13 in patients...
...ae type b conjugate vaccine (Hib),...
...oid, tetanus toxoid, acellular pertussis vac...
..., reduced diphtheria toxoid, and reduced acellular...
...toxoid, reduced diphtheria toxoid vaccine (Td...
...B vaccine (HepB), (SR, M)21881...
...s A vaccine (HepA), (SR, M)21...
...ed poliovirus vaccine (IPV), (SR, M)21881...
...lent human papillomavirus vaccine...
...13 should be administered to HIV-infected patient...
...3 should be administered to HIV-infected chi...
...V-infected adults with CD4 T-lympho...
...HIV-infected adults with CD4 T-lymphocy...
...3 should be given ≥8 weeks after the indica...
...IV-infected children who are >59 months of ag...
...is NOT recommended for HIV-infected adults. (WR,...
...nfected children age 11-18 years should receive a...
...le booster dose (third dose) should be gi...
...administered to HIV-infected child...
...ed patients should receive HepB ser...
...deration of high-dose HepB (40 μg/dose...
...cents.* (WR, L)21881...
...ths after completion, they should be te...
...cination anti-HBs concentration of ≥10 mI...
...istered (alternative: 1 dose of HepB a...
...epB (40 μg/dose)* (WR, L)21881...
...children and high-dose HepB for adolescen...
...pB containing 20 μg of HBsAg (hepatitis B s...
...nternationally adopted HIV-infected chil...
...PV4 is recommended over bivalent human papillom...
...e Vaccines...
...HIV-exposed or -infected infants should receiv...
...infected patients should NOT receive LAIV...
...hould be administered to clinicall...
and HIV-infected patients ≥14 years without meas...
...IV-infected children with a CD4 T-cell percentage...
...patients ≥14 years with a CD4 T-cell...
...IV-infected patients should NOT rec...
...ella-nonimmune, clinically stable HIV-infe...
...ge 9-13 years with ≥15% CD4 T-lymphocy...
...age ≥14 years with CD4 T-lymphocyte counts of...
...oses should be separated by ≥3 months....
.... Vaccination of Persons With HIV Infect...
...zae type b conjugate...
...age...
...5–18 yc (SR, L)21881...
U: age...
...e 5–18 yc (SR, L)21881...
...epatitis A
...ela or No ImmunosuppressionU: (SR...
...munosuppressionbU: age 1 y (SR, M)21881...
...epatitis B...
...ow-Levela or No ImmunosuppressionR:...
...munosuppressionbR: (SR, M)21881...
...TaP...
...ow-Levela or No ImmunosuppressionU: (SR, M)2188...
...igh-Level ImmunosuppressionbU: (SR, M)2188...
...dap
...No ImmunosuppressionU: (SR, VL)21881...
...l ImmunosuppressionbU: (SR, VL)21881...
Td
...vela or No ImmunosuppressionU: (SR, L)2...
...mmunosuppressionbU: (SR, L)21881...
HPV4...
...o ImmunosuppressionU: age 11-26 y (SR, VL)21881...
...h-Level ImmunosuppressionbU: age 11-26 y (SR, V...
...za, inactivated
...Levela or No ImmunosuppressionU: (SR, H...
...mmunosuppressionbU: (SR, H)218...
...uenza, live attenuated
...or No ImmunosuppressionX:f (WR, VL)21881...
...ImmunosuppressionbX: (WR, VL)21881...
...R, liv...
...or No Immunosuppression
...age 12 mo to 13 y (SR, M)21...
...≥14 y (WR, VL)21881...
...vel Immunosuppressionb...
...ge 12 mo to 13 y (SR, M)...
X: age ≥14 y (SR, M)...
...V, live...
...ela or No ImmunosuppressionX: (SR, VL)21881...
...ImmunosuppressionbX: (SR, VL)2188...
...eningococcal conjugateg...
...vela or No ImmunosuppressionU: age...
...igh-Level ImmunosuppressionbU: age...
...ccal conjugate (PCV13)...
...ow-Levela or No Immunosuppress...
U: ag...
...age 5 yh (SR, M)21881...
...e 6-18 yh (SR, L)21881...
...‰¥19 yi (SR, L)21881...
High-Level Immunosuppressionb
...age...
...e 5 y (SR, M)21881
R: age 6-18 y (SR,...
...e ≥19 yi (SR, VL)21881...
...coccal polysaccharide (PPSV23)j
...No ImmunosuppressionR: age ≥2 y (SR, M...
High-Level Immunosuppr...
...-18 y (SR, M)21881...
...adult (CD4 T-lymphocyte...
...ovirus, inactivated...
...Levela or No ImmunosuppressionU: (SR,...
...h-Level ImmunosuppressionbU: (SR, M)2188...
Rotavirus,...
...No ImmunosuppressionU: (SR, L)21881...
...ImmunosuppressionbU: (WR, VL)2188...
...aricella, l...
...or No Immunosuppression...
...age 1-8 y (SR, H)21881...
...≥9 y (SR, VL)218...
...ImmunosuppressionbX: (SR, M)21881...
Zoster, liv...
...Levela or No Immunosuppress...
...: age...
...≥60 yk, l (WR, L)2188...
...igh-Level ImmunosuppressionbX: (SR, M)21881...
...—administer if not previously admin...
...h-dose HepB (40 µg) should be considered...
...adolescents (WR, L)21881...
...preferred over HPV2 because of its a...
...or patients ≥19 years of age with HIV wh...
...should be administered 8 weeks or longer after i...
...nation can be considered for patie...
...not vaccinated with varicella vaccine....
...ancer (See Table 3...
...6 months of age with hematological m...
...mor malignancies (SR, L)2188...
...receiving anti-B cell antibodies* (S...
...emotherapy, such as for induction or cons...
...d be administered to newly diagnosed adu...
...r solid malignancies (SR, VL...
...children with malignancies (SR, VL)...
...ribed in recommendations 27a-c. (, )21881...
...administered to adults and children ≥2...
...vaccines (other than IIV) recommended for immun...
...owever, vaccines administered duri...
...re is documentation of a protective...
...al vaccines should NOT be administered...
...onths following cancer chemotherapy,...
and the live vaccines VAR,...
...R, (SR, L)218...
and MMRV (WR, VL)218...
...ng to the CDC annual schedule routinely indicated...
...included anti-B cell antibodies, vac...
...Vaccination of Patients With Ca...
.... influenzae type b...
...ring ChemotherapyaU: (WR, L)21881...
...ting ≥3 Months Postchemotherapy and ≥6 M...
...patitis...
...or During ChemotherapyaU: (WR, L)21...
...≥3 Months Postchemotherapy and ≥6 Months...
...epatitis...
...to or During ChemotherapyaU: (WR,...
...≥3 Months Postchemotherapy and...
...: (SR, M)21881
...lts (SR, VL)21881...
...TaP, Tdap
...o or During ChemotherapyaU: (WR, L)218...
...ng ≥3 Months Postchemotherapy and...
...-18 y (SR, M)21881...
...lts with acute lymphoblastic leukemia...
...PV...
...o or During ChemotherapyaU: age 11-26...
...≥3 Months Postchemotherapy and ≥6 Months Af...
...luenza, inactivate...
...rior to or During ChemotherapyaU (SR, L)U (SR-...
...g ≥3 Months Postchemotherapy and â‰...
...luenza, live attenuated...
...o or During ChemotherapyaX: (WR, VL)21881...
...≥3 Months Postchemotherapy and ≥6...
..., live...
...rior to or During ChemotherapyaX:c (SR,...
...Months Postchemotherapy and ≥6 Mon...
...MRV, liv...
...or During ChemotherapyaX:c (SR, M)21881...
...Months Postchemotherapy and ≥6 Months Af...
...coccal conjugate...
...ing ChemotherapyaU (WR, L)21881...
...≥3 Months Postchemotherapy and ≥6 Mo...
...al conjugate-13 (PCV13)...
...or During Chemotherapya...
...R, L)21881
...age ≥6 yd (SR, VL)21881...
...ting ≥3 Months Postchemotherapy and ≥6 Months...
...ccal polysaccharide (PPSV23...
...ing ChemotherapyaR: age ≥2 y (SR, L)21881...
...Months Postchemotherapy and ≥6 Month...
...rus, inactivated...
...r to or During ChemotherapyaU: (WR, L)21881...
...Months Postchemotherapy and ≥6 Months A...
...avirus, live...
...uring ChemotherapyaX: (SR, VL)21881...
...tarting ≥3 Months Postchemotherapy and ≥...
Varicella, liv...
...to or During ChemotherapyaXc (SR, M)21881...
...rting ≥3 Months Postchemotherapy an...
...oster, l...
...ior to or During ChemotherapyaX:c (SR, VL...
...3 Months Postchemotherapy and ≥6 Mon...
...mended—administer if not previously adm...
...inister inactivated influenza vaccine (IIV)...
...solid tumor malignancies (SR, L)2...
...receiving anti–B-cell antibodies such as rituxi...
...ons of inactivated vaccines other than II...
...r, vaccines administered while rece...
...administered ≤3 months after chemother...
...≥19 years of age with HIV who have previ...
...Although MMR has been given safely 3 months aft...
...or patients ≥19 years of age who have previou...
...tic Stem Cell Transplant (See Table 4)...
...rs and Patients Before Transplantation
...onor should be current with routinel...
..., VAR, and ZOS administration should...
...ation of the donor for the benefit of the recipien...
.... Prior to HSCT, candidates should recei...
and when the interval to the start o...
...eeks for inactivated vaccines. (SR, M)...
...HSCT candidates ≥12 months of age should rec...
...nts Post-transplantation...
.... Administer 1 dose of IIV annually. (SR, M)218...
to persons ≥6 months of age starting 6 mon...
...at 4 months if there is a community outbreak of...
...children 6 months through 8 years of age w...
...inister 3 doses of PCV13 to adults and chil...
...after HSCT a dose of PPSV23 should be given provid...
...ients with chronic GVHD a fourth dos...
...9. Administer 3 doses of Hib start...
...2 doses of MCV4 starting 6-12 months after HSCT st...
...minister 3 doses of tetanus/diphtheri...
...children...
...tients 7 years and older, administratio...
...ely, administer a dose of Tdap followed...
or 2 doses of Td. (WR,...
82. Administer 3 doses of HepB starting at 6-1...
...nation anti-HBs concentration of ≥10 mIU...
...dose of HepB after which anti-HBs is tested...
...e (40 μg)* (WR, L)21881...
...r children and high dose for adolescents*...
...ster 3 doses of IPV starting 6-12 mo...
...Consider administration of 3 doses of...
...5. Do not administer live vaccines to HSCT pa...
...Administer a 2-dose series of MMR to measles-s...
and to measles-seronegative children (SR, M)2188...
...inister a 2-dose series of VAR starting 24 months...
...cinations Prior to or After Allogenei...
...enzae type b conjugate...
...TU: (SR, M)21881...
...3 doses (SR, M)at 6 mo post-tx21881...
...atitis A
...e-HSCTU: (SR, VL...
...oses (WR, L)at ≥6 mo post-tx21881...
...atitis B
...SCTU: (SR, L)21881
...HSCTR: 3 doses (SR, M)at 6–12 mo po...
DTaP, DT, Td, Td...
...SCTU: (SR, L)21881...
...t-HSCT...
R: ag...
...DTaP* 3 doses (WR, VL)at ≥6 mo post-tx21881...
..., followed by either 2 doses DT* or...
...T, Td (WR, L)...
...PV...
...TU: age 11-26 y (SR, VL)...
Post-HSCTU: 3 doses at ≥6 mo post-tx (WR, VL)...
...luenza, inactivated...
...TU: (SR, L)21881...
...st-HSCT
...4 mo post-tx (SR, VL)if community outbreak;...
...se ≥6 mo post-tx (SR, M)21...
...enza, live attenuat...
...TX: (WR, VL)21881...
...st-HSCTX: (WR, VL)21...
MMR, live
...-HSCTU:a (SR, VL)...
...CTX:b (SR, L)21881...
...RV, live...
...U:a (WR, VL)21881...
...t-HSCTX: (SR, VL)218...
...ococcal conjugate...
...TU: (SR, VL)21881...
...HSCTR: age 11-18 y: 2 doses (SR, L)at 6-12 mo...
...mococcal conjugate (PCV13)...
...CTR:c (SR, L)218...
...doses (SR, L)at 3-6 mo posttx21881...
...mococcal polysaccharide (PPS...
...SCTR:c (SR, VL)21881...
...ost-HSCTR: ≥12 mo post-tx if no GVHD (SR...
...ovirus, inactivated
...TU: (SR, VL)21881...
...TR: 3 doses (SR, M)at ≥3 mo post-tx21881...
...tavirus, li...
...CTX: (WR, VL)21881...
...ost-HSCTX: (WR, VL)...
...aricella, li...
...TU:a (SR, L)21881
Post-HSCTX:d (SR, L)21881
Zoster, li...
Pre-HS...
...e age 50–59 y* (WR, VL)2188...
...:a age ≥60 y (SR, L)21881...
Post-HS...
...e 50–59 y* (SR, L)218...
...≥60 y (SR, L)218...
...mended—administer if not previousl...
...ootnotes to Tab...
...e vaccines should not be administe...
...nister to adolescents and adults (SR, L)218...
...o children (SR, M)21...
...If not previously administered.
...varicella-seronegative, the timing is ≥...
...if the patient is not severely immunosuppressed...
...rgan Transplant (See Table 5)...
...tients Before Transplantation...
...iving donors should be current with vac...
...V, VAR, and ZOS administration should...
...ion of donors solely for the recip...
...lts and children with chronic or end-stage...
...following persons should receive PCV13 as...
...nd children age ≥2 years old who are SOT candid...
Patients with end-stage kidney disease should...
...dults and children ≥2 years of age with en...
...both PCV13 and PPSV23 are indicated, PCV1...
...HBs–negative SOT candidates should...
...n hemodialysis and age ≥20 years they s...
...stvaccination anti-HBs concentration of ≥1...
...1 dose of HepB after which anti-HBs is tested*) s...
...dose* for children (WR, L)21881...
and the high dose for adolescents* and adults. (...
...“unvaccinated, undervaccinated, or seron...
...2 years. (SR, M)should receive a HepA...
...Combined HepA-HepB vaccine can be us...
94. HPV series should be administered...
...SOT candidates 6-11 months of age can receive MMR...
...ansplantation is delayed (and the child...
...hould be administered to SOT candidates witho...
...an be administered to varicella-na...
...2 doses should be administered ≥3 months apart....
...candidates age ≥60 years (SR, M)21881...
...ricella-positive (as defined in rec...
...Recipients
98. Vaccination should be withheld...
...can be administered ≥1 month after trans...
...Standard age-appropriate inactivated vaccine seri...
...cluding IIV. (SR, M)(Table 5)2...
...13 should be administered starting...
...01. For SOT patients ≥2 years of age, 1 dos...
...uld be considered for chronic hepatitis B-...
...and VAR should generally not be administere...
...R in children without evidence of immunity...
...04. Vaccination should not be withheld because...
...able 5. Vaccinations Prior to or After Solid Organ...
...zae type b conjugate...
...plantU: (SR, M)21881...
...€“6 Months PosttransplantU: (SR, M)21881...
...patitis...
Pretranspla...
...2-23 mo (SR, M)2188...
...age ≥2 y (SR, M)218...
...arting 2–6 Months PosttransplantR: if not compl...
Hepatitis B
Pretransplant
...1-18 y (SR, M)21881...
...: age ≥18 y (SR, M)2...
...6 Months PosttransplantR: if not completed pr...
...aP, Tdap
...transplantU: (SR, M)2...
...ng 2–6 Months PosttransplantU: if not c...
...PV
...splantU: females age 11-26 y (SR, M)21881...
...arting 2–6 Months Posttransplant
...: females age 11-26 y (SR, M)...
...les age 11-26 y (SR, L)21881...
...uenza, inactiva...
...plantU: (SR, M)2188...
...€“6 Months PosttransplantU:b (SR, M)218...
...nza, live attenuated
...retransplantX: (WR, L)21881
...ng 2–6 Months PosttransplantX: (WR, L)218...
...R, live...
...etransplant...
...:c age 6-11 mo (WR, VL)21...
...age ≥12 mo (SR, M)21881...
...onths PosttransplantX: (SR, L)21881...
...V, live...
...nsplantU:d (SR, M)21881...
...arting 2–6 Months PosttransplantX: (SR, L)...
...eningococcal conju...
...ransplantU: (SR, M)21881...
...ng 2–6 Months PosttransplantU: (SR, M)21881...
...ccal conjugate (PCV13)...
...transplan...
...age...
...age ≥6 ye (SR, VL)218...
...–6 Months Posttransplant...
...age 2-5 y (SR, M)218...
...‰¥6 y, if not administered pretransplan...
...umococcal polysaccharide (PPSV2...
...nsplantR: age ≥2 y (SR,...
...ing 2–6 Months PosttransplantR: age ≥2 y, if...
...virus, inactivat...
...ansplantU: (SR, M)2188...
...2–6 Months PosttransplantU: (SR, M)21881...
...otavirus, l...
PretransplantU:c (SR, M)21...
...2–6 Months PosttransplantX: (SR, L)218...
...ella, live...
...retransplant
R:f age 6-11 mo (WR, VL)2...
...(SR, L)218...
...ng 2–6 Months PosttransplantX:g (SR, L)...
...ter, live...
...ransplant...
...age 50-59 y (WR, L)2...
...‰¥60 y (SR, M)21881
...Months PosttransplantX: (SR, L)21881...
...mended—administer if not previously administere...
...itis B vaccine for hepatitis B-infected live...
...y be administered to SOT recipients despite inten...
...Administer only if patient is not immunosuppre...
...ients ≥19 years who have previously rece...
...ister only if patient is not immunosuppressed and...
...mmatory Disease Patients Taking Immunosuppo...
...activated vaccines, including IIV, should be...
or about to be treated with immunosuppressiv...
...uld be administered to adults and chil...
...V23 should be administered to patien...
...-level immunosuppression, (SR, L)...
...d high-level immunosuppression. (S...
...nts should receive PPSV23 ≥8 weeks afte...
...AR should be administered to patients with...
...weeks prior to initiation of immunos...
...VAR should be considered for patie...
...OS should be administered to patients with a...
...e being treated with low-dose immunosuppr...
...nd to those who are 50-59 years of age and va...
...being treated with low-dose immunosuppression.* (...
...e vaccines should NOT be administered to patients...
MMR in patients receiving low-level (WR...
...igh-level immunosuppression, (WR, VL)21881...
...d MMRV in patients receiving low-lev...
...h-level immunosuppression. (SR, VL)21881...
...recommended vaccines, including IIV and H...
...Vaccination of Persons With Chronic Inflamma...
...influenzae type b conjuga...
...mmunosuppressionU: (SR, M)2...
...ImmunosuppressionaU: (SR, L)2...
...el ImmunosuppressionaU: (SR, L)21881...
...epatitis A...
...mmunosuppressionU: (SR, M)21881...
...munosuppressionaU: (SR, L)21881...
...ImmunosuppressionaU: (SR, L)2188...
...epatitis...
...ImmunosuppressionU: (SR, M)21881...
...ImmunosuppressionaU: (SR, L)21881...
...el ImmunosuppressionaU: (SR, L)21881...
...aP, Td, T...
...anned ImmunosuppressionU: (SR, M)21881...
...Level ImmunosuppressionaU: (SR, L)21881...
...el ImmunosuppressionaU: (SR, L)21881...
HPV
...nosuppressionU: age 11-26 y (SR, M)21881...
...vel ImmunosuppressionaU: age 11-26 y (SR, L)21881...
...vel ImmunosuppressionaU: age 11-26 y (SR...
...luenza, inactiva...
...anned ImmunosuppressionU: (SR, M)21881...
...mmunosuppressionaU: (SR, M)21...
...h-Level ImmunosuppressionaU: (S...
...luenza, live attenu...
...nned ImmunosuppressionX: (WR, VL)218...
...-Level ImmunosuppressionaX: (WR, VL)2188...
High-Level ImmunosuppressionaX: (W...
...R, liv...
...mmunosuppressionU:b (SR, M)21...
...nosuppressionaX: (WR, VL)21881...
...mmunosuppressionaX: (WR, VL)21881...
...MRV, liv...
Planned ImmunosuppressionU:b (SR, L)2...
...ImmunosuppressionaX: (WR, VL)21881...
...nosuppressionaX: (SR, VL)21881
...ococcal conjugate...
...anned ImmunosuppressionU: (SR, M)218...
...Level ImmunosuppressionaU: (SR, M)21881...
...l ImmunosuppressionaU: (SR, L)21881
...ccal conjugate (PCV1...
...unosuppressionR:c (SR, M)21881...
...Level Immunosuppressiona...
...age
...‰¥6 yc (SR, VL)2188...
...l Immunosuppressiona...
...age...
...ge ≥6 yc (SR, VL)21881...
...cal polysaccharide (PPSV23)...
...mmunosuppressionR: age ≥2 y (SR, L)2188...
Low-Level ImmunosuppressionaR: age ≥2 y (SR,...
...-Level ImmunosuppressionaR: age ≥2 y (SR, VL)...
...iovirus, inactiv...
...ImmunosuppressionU: (SR, M)21881...
Low-Level ImmunosuppressionaU...
...el ImmunosuppressionaU: (SR, L)2188...
...virus, live...
...d ImmunosuppressionU: (SR,...
...el ImmunosuppressionaX: (WR, VL)2188...
...ImmunosuppressionaX: (WR, VL)218...
...aricella, live...
...osuppressionU:d (SR, M)21881...
...el ImmunosuppressionaX:d (WR, VL)21881...
...ImmunosuppressionaX: (SR, M)21881...
...ster, live...
...ed Immunosuppressi...
R: age 50-59 y* (WR...
...ge ≥60 y (SR, L)2188...
...l Immunosuppressiona...
...age 50-59 y* (WR, VL)218...
...e ≥60 y (SR, VL)2...
...l ImmunosuppressionaX: (WR, VL)21881...
...—administer if not previously administered or no...
...r patients ≥19 years who have previously r...
...stration of VAR can be considered fo...
...endations deviate from CDC ACIP recomm...
...ickle Cell Diseases (See Table 7)
...splenic patients or those with sickle cell di...
...AIV in patients with sickle cell disease. (WR,...
...should be administered to asplenic patients or...
115. PPSV23 should be administered t...
...l of ≥8 weeks after PCV13, and a...
...PPSV23--naive patients ≥2 years of age for...
or ≥2 weeks following surgery.* (WR, L)21...
...Hib should be administered to unvaccinated...
...eningococcal vaccine should be adm...
as in recommendation 29 except that MCV4--...
...ate with MCV4 (or MPSV4 for those >55 years...
...ic Barrier Defects (See Table 7...
...nd children with profound deafness schedul...
...Patients with a cochlear implant, with profound de...
...s ≥24 months of age with a cochlear impla...
...PCV13 and PPSV23 should be administ...
Table 7. Vaccination of Persons With Asp...
...nfluenzae type b conjuga...
Asplenia or a Sickle Cell...
...: age
...≥5 y (WR, L)218...
...mplantsa or CSF LeakU: (SR, M)2...
...atitis A
...lenia or a Sickle Cell DiseaseU: (SR, M)21881...
...tsa or CSF LeakU: (SR, M)21881...
...patitis B...
...or a Sickle Cell DiseaseU: (SR, M)21881...
...lantsa or CSF LeakU: (SR, M)21881...
...P, Td, Tdap
...splenia or a Sickle Cell DiseaseU: (SR,...
...lear Implantsa or CSF LeakU: (SR, M)2...
...PV...
...Sickle Cell DiseaseU: (SR, M)21881...
...lear Implantsa or CSF LeakU: (SR,...
...za, inactivated...
...nia or a Sickle Cell DiseaseU: (SR, M)21881...
...ear Implantsa or CSF LeakU: (SR, M...
Influenza, live attenua...
...or a Sickle Cell DiseaseX: (WR, V...
...Implantsa or CSF LeakU: (SR,...
...MR, live...
Asplenia or a Sickle Cell DiseaseU: (SR,...
...antsa or CSF LeakU: (SR, M)21881...
MMRV, li...
...enia or a Sickle Cell DiseaseU:...
...chlear Implantsa or CSF LeakU:...
...ingococcal conjugate...
...enia or a Sickle Cell DiseaseR: age 2-55 yb...
...Implantsa or CSF LeakU: (SR, M)21...
...coccal polysaccharide...
...splenia or a Sickle Cell DiseaseR: age...
...plantsa or CSF LeakU: (SR, M)21...
...cal conjugate (PCV13)...
...a or a Sickle Cell Disease...
U: ag...
...¥6 yd (SR, VL)21881...
...r Implantsa or CSF Leak...
...age...
...≥6 yd (SR, L)21881
...neumococcal polysaccharide (PP...
...splenia or a Sickle Cell DiseaseR:...
...plantsa or CSF LeakR: age ≥2 ye (SR, M)...
...oliovirus, inactivated...
Asplenia or a Sickle Cell DiseaseU: (SR...
...antsa or CSF LeakU: (SR, M)21881...
...irus, live...
...lenia or a Sickle Cell DiseaseU: (SR, M)21881...
...ochlear Implantsa or CSF LeakU: (SR, M)21881
...aricella, l...
...splenia or a Sickle Cell DiseaseU: (...
...lear Implantsa or CSF LeakU: (S...
Zoster, liv...
...r a Sickle Cell DiseaseU: (SR, M)218...
...Implantsa or CSF LeakU: (SR, M)21881...
...recommended—administer if not prev...
...has not previously been administered. Fo...
...ister 8 or more weeks after indicat...