It seems to be a big surprise to many folks, but kids can get most vaccines when they are immunosuppressed. In fact, they sometimes get extra some extra vaccines, like Pneumovax, because the “incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence.”
They should also get all of their vaccines if they are around someone who is immunosuppressed.
Surprised?
Vaccines While Immunosuppressed
Which vaccines your kids can get while they are immunosuppressed is going to depend greatly on the reason why they are immunosuppressed.
Are they getting chemotherapy?
Did they just get a stem cell transplant?
Were they born with a specific immunodeficiency, like X-linked agammaglobulinemia, selective IgA deficiency, severe combined immunodeficiency, or chronic granulomatous disease?
Whatever the reason, they likely won’t get a medical exemption to skip all of their vaccines.
“Killed vaccines will not cause infection in immunodeficient or any other children. The fear of increased community-acquired vaccine-preventable diseases should lead to adherence to and completion of recommended immunization schedules in the community to reinforce herd immunity, such that all vaccine-preventable diseases become exceedingly rare.”
Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts
In most cases, immunocompromised kids can get all inactivated vaccines. It is only live vaccines that could pose a problem. Even then, it depends on the specific immunodeficiency as to whether avoiding live vaccines is necessary.
For example, after chemotherapy and a stem cell transplant, kids can usually get live vaccines.
Your doctors can review the latest guidelines to come up with a safe vaccination plan for your child with an immune system problem. If necessary, consultation with an infectious diseases or immunology specialist can also be helpful.
Don’t overlook other causes of possible immunosuppression when getting vaccinated, like taking daily oral steroids for more than two weeks, certain biologic immune modulators, or other medications like methotrexate, azathioprine, 6-mercaptopurine.
“Limited evidence indicates that inactivated vaccines generally have the same safety profile in immunocompromised patients as in immunocompetent individuals. However, the magnitude, breadth, and persistence of the immune response to vaccination may be reduced or absent in immunocompromised persons.”
2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host
And keep in mind that just because they can and should get vaccinated, it doesn’t mean that their vaccines are going to work as well as in someone who isn’t immunocompromised.
That’s why herd immunity is so important for these kids.
Vaccines for Close Contacts of Immunocompromised People
What about people who come into contacts with kids and adults who are immunocompromised?
Can they get vaccines?
“Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.”
Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts
Yes, close contacts can get vaccinated, especially since we don’t use the oral polio vaccine in the United States anymore.
There are some exceptions for the smallpox vaccine, which few people get, and Flumist, but only in very specific situations, including a recent hematopoietic stem cell transplant.
Worried about shedding?
You should be worried about getting a vaccine-preventable disease and giving it to those around you with immune system problems. That’s the real risk!
And no, you are not being selfish to expect those around you to get vaccinated.
Vaccines are safe and necessary – for all of us.
More on Vaccines While Immunosuppressed
- Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts
- 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host
- Fearless Defenders of the Immunocompromised Patient
- Vaccinations and Immunocompromised Children
- CDC – Altered Immunocompetence Guidelines for Immunizations (ACIP)
- AAP – Immunization in Immunocompromised Children (Red Book)
- Study – Population Prevalence of Diagnosed Primary Immunodeficiency Diseases in the United States
- CDC – HIV Among Pregnant Women, Infants, and Children
- Immunization of Immunocompromised Persons (Canada)
- Guide to vaccinations for the immunosuppressed patient (UK)
- Vaccination of immunocompromised persons (Australia)
- WHO – Immunizing the immunocompromised
- My son has cancer. He can’t go into day care because of unvaccinated children.
- When It’s Not a Choice: Measles and Leukemia
- Clallam Co. woman dies of measles
- My Daughters’ Lives Depend on Community Immunity
- A Boy Who Had Cancer Faces Measles Risk From The Unvaccinated
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- Did Children’s Minnesota Expose Cancer Patients to Measles?
- Children with cancer: stories from the 2011 measles outbreaks
- Chickenpox hits young cancer patient, despite vaccination
- B.C. parent speaks out about vaccinations after nearly losing a child to Chickenpox