- Prednisone and vaccines
Looking for:
Vaccines for COVID – your questions answered - Precautions |
Prednisone and vaccines -
- Prednisone and vaccines
Common questions about prednisolone tablets and liquid - NHS
Log in via Institution. Email alerts. Article Text. Article menu. Scientific Abstracts. Sailler 1 , A. Blancher 2 , F. Abravanel 3 , J. Izopet 4 , C. Bost 5 , E. Treiner 6 , N. Congy 7 , Y. Figure 1. Disclosure of Interests None declared. Statistics from Altmetric.
Read the full text or download the PDF:. The immunogenicity of higher doses of vaccine is unknown for this group, and firm recommendations on dosage cannot be made at this time The anti-Hbs response of such persons should be tested after they are vaccinated, and those who have not responded should be revaccinated with additional doses.
Routine immunization with the quadrivalent vaccine is recommended for certain high-risk groups, including persons with terminal complement component deficiencies and those with anatomic or functional asplenia. Persons splenectomized because of trauma or nonlymphoid tumors and those with inherited complement deficiencies have acceptable antibody responses to meningococcal vaccine, although its clinical efficacy has not been documented in these patients.
Corticosteroids, other immunosuppressive agents, and immunosuppressive illnesses can interfere with the development of active immunity and predispose the patient to developing rabies if exposed.
Immunosuppressive agents should not be administered during postexposure therapy, unless essential for the treatment of other conditions. When rabies postexposure prophylaxis is administered to persons receiving steroids or other immunosuppressive therapy, it is especially important that serum be tested for rabies antibody to ensure that an adequate response has developed.
Other vaccines containing killed antigens, including cholera, plague, and anthrax, do not pose a risk to immunocompromised persons and should be used for the same indications as for immunologically normal persons. Immunocompromised persons may benefit from protection by passive immunization. The use of immune globulin preparations in these patients is described below.
For immunocompromised persons, IG is indicated to prevent measles following exposure. If immediate protection against measles is required for immunocompromised persons with contraindications to measles vaccination, including exposed infants less than 1 year of age, passive immunization with IG, 0.
Exposed symptomatic HIV-infected and other severely immunocompromised persons should receive IG regardless of their previous vaccination status, because measles vaccine may not be effective in such patients and the disease may be severe. For immunocompromised persons, the recommended dose is 0. This corresponds to a dose of protein of approximately Because the amounts of protein administered are similar, high-dose IGIV may be as effective as IG administered intramuscularly.
However, no data are available concerning the effectiveness of IGIV in preventing measles. For immunocompromised persons receiving IG for measles prophylaxis 0.
For the prevention of hepatitis A, IG should be administered in the same dose and schedule to both immunocompromised and immunocompetent persons. The most important use of VZIG is for passive immunization of neonates and susceptible, severely immunocompromised persons after significant exposure to chickenpox or zoster. Immunocompromised patients who are exposed to varicella and receive VZIG may have lower rates of complications and infections.
Varicella-susceptible pregnant women may be at higher risk for serious complications than are adults in general. Of especial concern is the risk to the fetus when a woman develops varicella-zoster infection during the first half of pregnancy. Whether the fetus will be protected against development of malformations if VZIG is administered to a pregnant, susceptible woman after exposure is unknown.
When deciding to administer VZIG to an immunocompromised patient, the clinician must determine whether the patient is likely to be susceptible and whether the exposure is likely to result in infection.
The risks of VZIG administration appear to be negligible, but the costs of administration can be substantial. A physician should carefully evaluate the susceptibility of patients to varicella before administering VZIG. Both immunocompetent and immunocompromised adults and children who are believed to have had varicella on the basis of a carefully obtained history by an experienced interviewer can be considered immune. Laboratory determination of susceptibility to varicella is often impractical.
Modern antibody assays may detect either nonspecific antibody or antibody levels that may not be protective. Immunocompromised persons should receive HBIG for the same indications perinatal, needlestick, or sexual exposure to a person positive for hepatitis B surface antigen and in the same doses as immunocompetent persons.
References Infections in immunocompromised infants and children, section I. In: Disorders of host defense. Patrick CC, ed. New York: Churchill Livingstone, Approaches to immunization in the immunocompromised host. Infectious Disease Clinics of North America ; Vessal S, Kravis LP.
Immunologic mechanisms responsible for adverse reactions to routine immunizations in children. Clin Pediatr ; Attenuated measles vaccine in children with acute leukemia. Am J Dis Child ; Measles vaccination death in a child with severe combined immunodeficiency: report of a case. Lab Investig ;A. Dysgammaglobulinemia complicated by disseminated measles. Br Med J ;2 Report of the Committee on Infectious Diseases, 22nd edition. Peter G, ed. Childhood immunization, vaccine-preventable diseases and infection with human immunodeficiency virus.
Pediatr Infect Dis J ; Invasive Haemophilus influenzae disease in adults. A prospective, population-based surveillance. CDC meningitis surveillance group. Ann Intern Med ; Invasive Haemophilus influenzae infections in men with HIV infection.
JAMA ; Poor antibody response after tetanus and pneumococcal vaccination in immunocompromised, HIV-infected patients. Clin Exp Immunol ;84 2 Antibody responses to bacterial toxoids in children infected with human immunodeficiency virus. J Pediatr ; Antibody responses after influenza and pneumococcal immunization in HIV-infected homosexual men.
Responses to pneumococcal vaccine among asymptomatic heterosexual partners of persons with AIDS and intravenous drug users infected with human immunodeficiency virus. J Infect Dis ; Poliovirus vaccination responses in HIV-infected patients: correlation with T4 cell counts. Schwebke J, Mujais S. Vaccination in hemodialysis patients editorial.
Int J Artif Organs ; The use of vaccine in renal failure. Clin Pharmacokin ; Risk of pneumococcal infections in renal transplant patients. Impact of infection control strategies on the incidence of dialysis-associated hepatitis in the United States. Pneumococcal capsular polysaccharide vaccination in adult chronic hemodialysis patients. J Lab Clin Med ; Pneumococcal vaccination in patients with chronic renal disease and renal allograft recipients.
Kidney Int ; Response to pneumococcal vaccine in renal transplant and hemodialysis patients. Arch Intern Med ; Pneumococcal vaccine immunization of patients with renal impairment. Proc Soc Exp Biol Med ; Revaccination of renal transplant and hemodialysis recipients with pneumococcal vaccine. Antibody response to polyvalent pneumococcal polysaccharide vaccine in diabetics. Pneumococcal immunization in adult diabetics.
Diabetes ; Influenza immunization in adults with diabetes mellitus. Diabetes Care ; Severe measles in immunocompromised patients. Sixbey JW. Routine immunization and the immunosuppressed child. Adv Pediatr Infect Dis ; Vaccine-associated poliomyelitis in a child with sex-linked agammaglobulinemia. Chronic progressive poliomyelitis secondary to vaccination of an immunodeficient child.
N Engl J Med ; Quinn TC. Interactions of the human immunodeficiency virus and tuberculosis and the implications for BCG vaccination. Rev Infect Dis Suppl 2, ;2:s Disseminated Mycobacterium bovis infection from BCG vaccination of a patient with acquired immunodeficiency syndrome. MMWR ; Arch Dis Child ; Disseminated vaccinia in a military recruit with human immunodeficiency virus HIV disease.
Response to influenza A vaccine among high-risk patients. South Med J ; Influenza immunization in immunosuppressed children. Influenza in patients with human immunodeficiency virus infection. Chest ; Impaired humoral and cell-mediated immune responses in dialyzed patients after influenza vaccination. Nephron ; Immunogenicity of inactivated influenza virus vaccine in chronic renal failure. Antibody responses to influenza vaccination in patients with chronic renal failure. Antibody response after influenza immunization in renal transplant patients receiving cyclosporine A or azathioprine.
Infect Immun ; Impairment of the immune response to influenza vaccination in renal transplant recipients by cyclosporine, but not by azathioprine. Transplantation ; Landesman SH, Schiffman G. Assessment of the antibody response to pneumococcal vaccine in high-risk populations.
Rev Infect Dis ;3:suppl:s Routine screening for viral hepatitis in chronic hemodialysis centers. Hepatitis surveillance report no. Atlanta: CDC, Hepatitis B vaccine in patients with chronic renal failure before dialysis. Hepatitis B virus infection and vaccination in children undergoing hemodialysis.
Acta Pediatr Scand ; Antibody to human immunodeficiency virus HIV and suboptimal response to hepatitis B vaccination. MMWR No. RR An original paper copy of this issue can be obtained from the Superintendent of Documents, U. Contact GPO for current prices. Department of Health and Human Services. Severely Immunocompromised, Non-HIV-Infected Persons Severe immunosuppression not associated with HIV can be the result of congenital immunodeficiency, leukemia, lymphoma, generalized malignancy or therapy with alkylating agents, antimetabolites, radiation, or large amounts of corticosteroids 1- 3.
Medical Conditions Associated Only with Special Indications for Vaccines Certain medical conditions, such as renal failure, diabetes, alcoholic cirrhosis, or asplenia, may increase the patient's risk for certain diseases. Renal Failure Patients with renal failure have an increased risk of infection with a variety of pathogens, particularly pneumococcus and hepatitis B Diabetes Although several in vitro tests of immunologic function are known to be abnormal among diabetic patients, these defects may be of little clinical importance.
Alcoholic Cirrhosis Patients with alcoholism and alcoholic liver disease have an increased incidence of infections, especially pneumonia. Asplenia Persons who have anatomic or functional asplenia have an increased risk for fulminant bacteremia, associated with a high mortality rate.
Oral Polio Vaccine OPV OPV should not be used to immunize immunocompromised patients, their household contacts, or nursing personnel in close contact with such patients; eIPV is recommended for such persons. Typhoid Vaccine Live, attenuated TY21a typhoid vaccine should not be administered to immunocompromised persons, including those known to be infected with HIV. Yellow Fever Vaccine Yellow fever vaccine virus poses a theoretical risk of encephalitis to those with severe immunosuppression or known HIV infection, and such patients should not receive the vaccine.
Vaccinia The only persons for whom vaccinia vaccine is recommended are laboratory personnel working with orthopox viruses and certain health-care workers involved in clinical trials of vaccinia recombinant vaccines.
Haemophilus influenzae b Conjugate Vaccine Hib Immunocompromised children should receive Hib conjugate vaccines in the same dosage and schedule as for immunocompetent children. Influenza Vaccine Because influenza may result in serious illness and complications for immunocompromised persons, vaccination is recommended and may result in protective antibody levels in many immunocompromised recipients Pneumococcal Vaccine Pneumococcal vaccine is recommended for use in persons greater than or equal to 2 years of age with chronic illnesses specifically associated with increased risk of pneumococcal disease or its complications e.
Hepatitis B Vaccine Hepatitis B vaccination is recommended for susceptible hemodialysis patients. Meningococcal Vaccine Routine immunization with the quadrivalent vaccine is recommended for certain high-risk groups, including persons with terminal complement component deficiencies and those with anatomic or functional asplenia.
Rabies Vaccine Corticosteroids, other immunosuppressive agents, and immunosuppressive illnesses can interfere with the development of active immunity and predispose the patient to developing rabies if exposed. Other Killed Antigens Other vaccines containing killed antigens, including cholera, plague, and anthrax, do not pose a risk to immunocompromised persons and should be used for the same indications as for immunologically normal persons. Hepatitis B Immune Globulin HBIG Immunocompromised persons should receive HBIG for the same indications perinatal, needlestick, or sexual exposure to a person positive for hepatitis B surface antigen and in the same doses as immunocompetent persons.
Back to Prednisolone tablets and liquid. Steroids mimic the effects of stress hormones your body naturally produces in your adrenal glands. The adrenal glands sit on top of your kidneys. When prescribed in doses higher than your body's usual levels, steroids like prednisolone dampen inflammation. This can reduce the symptoms of inflammatory conditions, such as arthritis and asthma.
Steroids also damp down your immune system, which can help in autoimmune conditions like rheumatoid arthritiswhere your immune system mistakenly attacks your own body. This can vary. For some health problems, you will feel better after a couple of days. However, for certain problems or conditions you may not feel any better even though the medicine is helping you. This may be the case if you're taking prednisolone to stop your symptoms getting worse or to prevent a problem happening for example after an organ transplant.
Taking prednisolone for many months or years can have several harmful effects on your body. It can lead to:. If you have to take prednisolone for a long time, there are steps you can take to stay as healthy as possible. If you're taking steroid medicines such as prednisolone your adrenal glands may not make as much of some of the hormones your body needs such as cortisol known as the stress hormone. This is known as adrenal insufficiency. It's more likely to happen if you take high doses for a long time especially tablets and injections or if you regularly use different kinds of steroids at the same time such as a steroid nasal spray and a steroid inhaler.
Your doctor or pharmacist will assess your risk of adrenal insufficiency based on the type and dose of steroids you're taking, and may recommend that you carry an emergency steroid card red card. The card is the size of a credit card and fits in your wallet or purse. If you need any medical or dental treatment, or are having surgery or an invasive procedure, show your steroid emergency card to your doctor or dentist.
This is important so they know you are having steroid treatment and can give you extra steroids as needed. If you're taking prednisolone for longer than 3 weeks, or you've been prescribed a high dose of more than 40mg daily, your doctor or pharmacist will give you a blue steroid treatment card.
It tells you how you can reduce the risks of side effects. It also gives details of your doctor, how much prednisolone you take and how long the treatment will last. For most health problems, these steroids are very similar to prednisolone in terms of how well they work and how safe they are.
Taking prednisolone makes you more likely to catch infections such as flucoronavirus COVIDthe common cold and chest infections. Keep away from people with an infectious disease, especially measleschickenpox or shingles. If you have never had these illnesses they could make you very ill. Tell your doctor straight away if you come into contact with someone who has an infectious disease such as measles, chickenpox or shingles.
Your doctor may be able to prescribe a medicine to protect you. Taking prednisolone lowers your immune system. If you have a "live" vaccine, like the Zostavax shingles vaccinewhile you are taking prednisolone your immune system might not be able to cope with it.
This may lead to an infection. Non-live vaccines, like the coronavirus COVID vaccinethe injected flu vaccine or the Shingrix shingles vaccine, are safe to have while you're taking prednisolone.
Prednisolone will not affect any type of contraception including the combined pill or emergency contraception. Prednisolone does not make you sleepy and so it's usually safe to drive or ride a bike while taking this medicine.
However, do not drive, cycle or operate machinery if your eyesight is affected. It's thought that real liquorice increases the amount of prednisolone in the body and also increases the risk of low potassium. Page last reviewed: 24 February Next review due: 24 February Common questions about prednisolone tablets and liquid. How does prednisolone work?
Ask your doctor what you can expect. It can lead to: thinner bones osteoporosis poorly controlled diabetes eyesight problems slower growth in children and teenagers If you have to take prednisolone for a long time, there are steps you can take to stay as healthy as possible.
Take regular exercise and make sure you get enough calcium in your diet to help strengthen your bones. Calcium-rich foods include milk, cheese and leafy greens. To check your bones, your doctor may arrange for you to have an occasional bone scan. If you have diabetesyou may need to check your blood glucose more often. Your doctor can advise you about this. To reduce the chances of eyesight problems, visit an optometrist every 12 months to check for high pressure in your eye glaucoma and cataracts.
Make sure that children and teenagers have their height monitored regularly by a doctor so that any changes in their growth can be picked up promptly.
Emergency steroid card If you're taking steroid medicines such as prednisolone your adrenal glands may not make as much of some of the hormones your body needs such as cortisol known as the stress hormone. Important: Important If you need any medical or dental treatment, or are having surgery or an invasive procedure, show your steroid emergency card to your doctor or dentist.
There are other steroids available, including: deflazacort dexamethasone methylprednisolone prednisone For most health problems, these steroids are very similar to prednisolone in terms of how well they work and how safe they are. Important: Important Tell your doctor straight away if you come into contact with someone who has an infectious disease such as measles, chickenpox or shingles.
Some vaccines are not suitable for you while you are taking prednisolone. If you need any vaccinations, mention that you are taking a steroid. Yes, you can drink alcohol while taking prednisolone. Do not eat real liquorice while taking prednisolone.
Evidence showed that with the dose of up to 20 mg/day prednisone or equivalents, the response to inactivated vaccines could not be suppressed, and these. Q: Should vaccines be withheld for patients on steroids? per day of prednisone for 2 or more weeks as sufficiently immunosup-. Q: Should vaccines be withheld for patients on steroids? per day of prednisone for 2 or more weeks as sufficiently immunosup-. Some vaccines are not suitable for you while you are taking prednisolone. Taking prednisolone lowers your immune system. If you have a "live" vaccine, like the. Evidence showed that with the dose of up to 20 mg/day prednisone or equivalents, the response to inactivated vaccines could not be suppressed, and these. When rabies postexposure prophylaxis is administered to persons receiving steroids or other immunosuppressive therapy, it is especially important that serum be tested for rabies antibody to ensure that an adequate response has developed. The first is a brief summary of principles for vaccinating immunocompromised persons. However, because patients with longstanding diabetes mellitus often have cardiovascular, renal, and other end-organ dysfunction, one-time pneumococcal vaccination and annual influenza vaccination are recommended. People who have a third dose will be offered their booster after three months. If you have questions about this, talk to your doctor. Revaccination of renal transplant and hemodialysis recipients with pneumococcal vaccine.Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq cdc. Type Accommodation and the title of the report in the subject line of e-mail. MMWR ;42 No. This statement summarizes current recommendations by the Advisory Committee on Immunization Practices ACIP on the use of active and passive immunization for persons with altered immunocompetence. The purpose of this statement is to make ACIP recommendations more accessible for clinicians by consolidating them into a single document.
ACIP statements on individual vaccines or immune globulins should be consulted for more details on safety and efficacy and on the epidemiology of the diseases. Recommendations on immunization following bone marrow transplantation will be published in a separate ACIP statement. These recommendations are for use in the United States and its territories and are appropriate for the epidemiologic setting and program priorities of these areas.
Other organizations, particularly the Expanded Programme on Immunization of the World Health Organization, have made different recommendations, particularly with respect to the use of oral polio vaccine OPV and Bacille Calmette-Guerin BCG for immunocompromised persons. Those recommendations are appropriate for populations, particularly in developing countries, with higher risks of exposure to wild poliovirus infection and tuberculosis.
This statement is divided into four sections. The first is a brief summary of principles for vaccinating immunocompromised persons. The second section discusses how specific immunocompromising conditions may alter recommendations for vaccination. The third section discusses each vaccine and how recommendations for use may be altered in immunocompromised persons. The final section contains summary tables on the use of vaccines and immune globulins, arranged by immunocompromising condition.
The degree to which an individual patient is immunocompromised should be determined by a physician. Severe immunosuppression can be due to a variety of conditions, including congenital immunodeficiency, human immunodeficiency virus HIV infection, leukemia, lymphoma, generalized malignancy or therapy with alkylating agents, antimetabolites, radiation, or large amounts of corticosteroids.
For some of these conditions, all affected persons will be severely immunocompromised; for others, such as HIV infection, the spectrum of disease severity due to disease or treatment stage will determine the degree to which the immune system is compromised. The responsibility for determining whether a patient is severely immunocompromised ultimately lies with the physician. Killed or inactivated vaccines do not represent a danger to immunocompromised persons and generally should be administered as recommended for healthy persons.
For specific immunocompromising conditions e. Frequently, the immune response of immunocompromised persons to these vaccine antigens is not as good as that of immunocompetent persons; higher doses or more frequent boosters may be required, although even with these modifications, the immune response may be suboptimal.
Steroid therapy usually does not contraindicate administration of live-virus vaccines when such therapy is short term less than 2 weeks ; low to moderate dose; long-term, alternate-day treatment with short-acting preparations; maintenance physiologic doses replacement therapy ; or administered topically skin or eyes , by aerosol, or by intra-articular, bursal, or tendon injection. The exact amount of systemic corticosteroids and the duration of their administration needed to suppress the immune system of an otherwise healthy child are not well defined.
Corticosteroids used in greater than physiologic doses also may reduce the immune response to vaccines. Physicians should wait at least 3 months after discontinuation of therapy before administering a live-virus vaccine to patients who have received high-dose, systemic steroids for greater than or equal to 2 weeks. For practical considerations, persons with immunocompromising conditions may be divided into three groups:. Persons with conditions that cause limited immune deficits e.
These groups differ primarily in the recommendations for use of live-virus vaccines, which are contraindicated for all persons in group A, for some vaccines and some persons in group B, and are not contraindicated in group C. Severe immunosuppression not associated with HIV can be the result of congenital immunodeficiency, leukemia, lymphoma, generalized malignancy or therapy with alkylating agents, antimetabolites, radiation, or large amounts of corticosteroids 1- 3.
Virus replication after administration of live, attenuated-virus vaccines can be enhanced in severely immunocompromised persons In general, these patients should not be administered live vaccines, with the exceptions noted below. In addition, OPV should not be administered to any household contact of a severely immunocompromised person. Measles-mumps-rubella MMR vaccine is not contraindicated for the close contacts including health-care providers of immunocompromised persons.
Persons with leukemia in remission who have not received chemotherapy for at least 3 months are not considered severely immunosuppressed for the purpose of receiving live-virus vaccines 7.
When cancer chemotherapy or immunosuppressive therapy is being considered e. Vaccination during chemotherapy or radiation therapy should be avoided because antibody responses are suboptimal.
Patients vaccinated while on immunosuppressive therapy or in the 2 weeks before starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy. Passive immunoprophylaxis with immune globulins may be indicated for immunocompromised persons instead of or in addition to vaccination see discussion under use of immune globulins.
When exposed to a vaccine-preventable disease such as measles, severely immunocompromised children should be considered susceptible regardless of their history of vaccination.
In general, persons known to be HIV infected should not receive live-virus or live-bacteria vaccines. However, evaluation and testing for HIV infection of asymptomatic persons are not necessary before decisions concerning vaccination with live-virus vaccines are made. Limited studies of MMR vaccination among both asymptomatic and symptomatic HIV-infected patients have not documented serious or unusual adverse events see discussion under MMR vaccine 8.
Therefore, MMR vaccination is recommended for all children and for adults when otherwise indicated, regardless of their HIV status. Pneumococcal vaccine is indicated for all HIV-infected persons greater than or equal to 2 years of age. Children less than 2 years of age with known HIV infection should receive Hib vaccine according to the routine schedule. Clinicians deciding whether to administer Hib vaccine to HIV-infected persons should take into consideration the individual patient's risk of Hib disease and the effectiveness of the vaccine for these persons.
In some settings, the incidence of Hib disease may be higher among HIV-infected adults than non-HIV-infected adults 9,10 , and the disease can be severe in these patients. In general, symptomatic HIV-infected children and adults have suboptimal immunologic responses to vaccines 8, The response to both live and killed antigens may decrease as the HIV disease progresses 8. However, the response to higher doses of vaccine and the persistence of antibody in HIV-infected patients have not been systematically evaluated.
Although higher doses or more frequent boosters may be considered for these patients, firm recommendations cannot be made at this time. Certain medical conditions, such as renal failure, diabetes, alcoholic cirrhosis, or asplenia, may increase the patient's risk for certain diseases.
Some antigens, particularly bacterial polysaccharide vaccines, are recommended for such patients. Frequently, the immune response of these patients to these antigens is not as good as that of immunocompetent persons, and higher doses or more frequent boosters may be required.
Persons with these conditions are generally not considered immunosuppressed for the purposes of vaccination and should receive routine vaccinations with both live and inactivated vaccines according to the usual schedules. Patients with renal failure have an increased risk of infection with a variety of pathogens, particularly pneumococcus and hepatitis B The efficacy of pneumococcal vaccination for some of these patients, including those on dialysis, may be considerably lower than for immunocompetent patients 20,21 , their antibody levels may be lower 22 , and they may require repeat vaccination 23,24 or an increased dose of vaccine.
Because secondary antibody responses are less affected than primary antibody responses, immunization strategies should be formulated early in the course of progressive renal disease. This approach is particularly important if transplantation and chronic immunosuppressive therapy are being considered.
Nephrotic syndrome is the renal disease most clearly associated with an increased risk for pneumococcal infection. See the discussion under Influenza and Hepatitis B vaccine for recommendations on the use of those antigens.
Although several in vitro tests of immunologic function are known to be abnormal among diabetic patients, these defects may be of little clinical importance. However, because patients with longstanding diabetes mellitus often have cardiovascular, renal, and other end-organ dysfunction, one-time pneumococcal vaccination and annual influenza vaccination are recommended.
Pneumococcal vaccine is safe and effective for these patients and does not interfere with insulin levels or glucose control 25, Patients receiving either insulin or oral antidiabetic agents respond normally to influenza vaccination without impairment of diabetic control Patients with alcoholism and alcoholic liver disease have an increased incidence of infections, especially pneumonia.
Such patients have many defects in host defenses, although the clinical importance of any one defect as measured in the laboratory is often uncertain. Many of these patients have leukopenia, decreased complement activity, chemotactic defects, and impaired cell-mediated immunity. In cirrhotic patients, portosystemic shunting can diminish the clearance of bacteria and increase the severity of infection.
Patients with alcoholism or alcoholic liver disease should receive one-time pneumococcal and yearly influenza vaccination. Persons who have anatomic or functional asplenia have an increased risk for fulminant bacteremia, associated with a high mortality rate. Polyvalent pneumococcal vaccine is recommended for all asplenic persons greater than or equal to 2 years of age.
In some instances, reimmunization with pneumococcal vaccine is indicated see discussion under Pneumococcal vaccine. Quadrivalent meningococcal polysaccharide vaccine also should be administered to asplenic children greater than or equal to 2 years of age.
Immunization with Hib vaccine should be initiated in infancy at the same dosage and schedule as recommended for otherwise healthy children.
Hib vaccines are immunogenic in splenectomized adults and may be considered for this group. When elective splenectomy is planned, vaccination with pneumococcal, meningococcal, and Hib vaccines should precede surgery by at least 2 weeks, if possible. MMR vaccine should not be administered to severely immunocompromised persons.
MMR should be considered for all symptomatic HIV-infected persons who would otherwise be eligible for measles vaccine, since measles can affect these patients severely Evaluation and testing for HIV infection of asymptomatic children are not necessary before decisions concerning immunization with live-virus vaccines are made. Limited studies of MMR vaccination among both asymptomatic and symptomatic HIV-infected patients have not documented serious or unusual adverse events 8.
If there is risk of exposure to measles, single-antigen measles vaccine should be administered at months of age with a second dose of MMR at greater than 12 months of age.
Severely immunocompromised patients and symptomatic HIV-infected patients who are exposed to measles should receive immune globulin IG , regardless of prior vaccination status. The recommended dose of IG for measles prophylaxis of immunocompromised persons is 0. The immunogenicity of measles vaccine is decreased if vaccine is administered less than 6 months after IG. OPV should not be used to immunize immunocompromised patients, their household contacts, or nursing personnel in close contact with such patients; eIPV is recommended for such persons.
Immunocompromised patients may be unable to limit replication of vaccine virus effectively, and administration of OPV to children with congenital immunodeficiency has resulted in severe, progressive neurologic involvement Although a protective immune response to eIPV in the immunocompromised patient cannot be assured, the vaccine is safe and may confer some protection.
If OPV is inadvertently administered to a household or intimate contact regardless of prior immunization status of an immunocompromised patient, close contact between the patient and the recipient of OPV should be avoided for approximately 1 month after vaccination, the period of maximum excretion of vaccine virus.
Because of the possibility of immunodeficiency in other children born to a family in which there has been one such case, OPV should not be administered to a member of a household in which there is a history of inherited immunodeficiency until the immune status of the recipient and other children in the family is documented. BCG vaccine is strongly recommended for infants and children with negative tuberculin skin tests who are a at high risk of intimate and prolonged exposure to persistently untreated or ineffectively treated patients with infectious pulmonary TB, cannot be removed from the source of exposure, and cannot be placed on long-term preventive therapy; or b continuously exposed to persons with TB who have bacilli resistant to isoniazid and rifampin.
BCG should be administered with caution to persons in groups at high risk for HIV infection or persons known to be severely immunocompromised. Although limited data suggest that the vaccine may be safe for use for asymptomatic children infected with HIV 33 , BCG vaccination is not recommended for HIV-infected adults or for persons with symptomatic disease Until further research can clearly define the risks and benefits of BCG vaccination for this population, vaccination should be restricted to persons at exceptionally high risk for tuberculosis infection.
HIV-infected persons thought to be infected with M. Live, attenuated TY21a typhoid vaccine should not be administered to immunocompromised persons, including those known to be infected with HIV.
Parenteral inactivated vaccine is a theoretically safer alternative for this group.
Comments
Post a Comment