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Vaccination in primary immunodeficiency disorders

Vaccination in primary immunodeficiency disorders
Vaccine Combined immunodeficiency syndromes Antibody deficiency Patients receiving IgG Diseases of immune dysregulation Phagocytic cell disorders Diseases of innate immunity Autoinflammatory disorders Complement deficiency Phenocopies Immuno
suppression
Severe Mild* Severe Mild Replacement Immuno
modulatory
CGD and neutropenia LAD and cytotoxic granule defects Invasive bacterial infections Invasive viral infections Mycobacterial infections
Inactivated/subunit
DTaP B A B A B B A A A A A A A A A B
HAV B A B A B A A A A A A A A A A B
HBV B A B A B B A A A A A A A A A B
HIB B A B A B A A A A E A A A E AΔ B
HPV B A A A A A A A A A A A A A A B
Influenza (IM/SC) B A A A A A A E A A A A A A A A
Meningococcal B A B A A A A A A E A A A E AΔ B
Serogroup B meningococcal vaccine B A B A A A A A A E A A A E AΔ B
Pneumococcal conjugate vaccine B A B A B A A A A E A A A E AΔ B
Pneumococcal polysaccharide B A B A B A A A A E A A A E AΔ B
Polio (IM) B A B A B B A A A A A A A A A B
Anthrax B A A A A A A A A A A A A A A A
JE B A B A B A A A A A A A A A A B
Typhoid (IM) B A B A B A A A A A A A A A A B
Rabies B A A A A A A A A A A A A A A A
Zoster (recombinant)§ B A B A B B A A A A A A A A A B
Live-attenuated
Influenza C C C C C A C C C C C C C C C¥ C
MMR C D C D C B A A C A C A A A D¥ C
Polio (oral) C C C C C A A A C A C A A A D¥ C
Rotavirus C C C D C A A A C A C A A A D¥ C
Varicella C D C D C B A A C A C A A A D¥ C
Herpes zoster C D C D C B A A C A C A A A D¥ C
Adenovirus C C C C C D C C C C C C C C C¥ C
Smallpox C C C D C A A A C A C A A A D¥ C
Typhoid C C C C C C C C C C C C C C C¥ C
Yellow fever C C C C C D D A C A C A A A D¥ C
BCG C C D D D D D C C D D C A A D¥ C
A: No possibility of harm; benefit possible; administration recommended; use according to routine schedule.
B: No possibility of harm; benefit unlikely; administration not recommended.
C: Possibility of harm (significant); benefit unlikely; administration not recommended.
D: Possibility of harm (small); benefit likely; administration recommended.
E: Administration recommended for therapeutic benefit.
IgG: immunoglobulin G; CGD: chronic granulomatous disease; LAD: leukocyte-adhesion deficiency; DTaP: diphtheria, tetanus toxoids, and acellular pertussis vaccine; HAV: hepatitis A virus; HBV: hepatitis B virus; HIB: Haemophilus influenzae type B; HPV: human papilloma virus; IM: intramuscular; SC: subcutaneous; JE: Japanese encephalitis; MMR: measles-mumps-rubella; BCG: Bacille Calmette-Guérin; MMRV: measles-mumps-rubella-varicella.
* Patients with partial defects (eg, most patients with DiGeorge syndrome, hyperimmunoglobulin M syndrome, Wiskott-Aldrich syndrome, and others). Patients with ≥500 CD3+ T lymphocytes/mm3 ≥200 CD8+ T lymphocytes/mm3, and normal mitogen response should receive MMR and varicella vaccine (but not MMRV).
¶ High-level immunosuppression.
Δ Patients with atypical hemolytic uremic syndrome who receive eculizumab should receive the same schedule of pneumococcal, HIB, and meningococcal vaccines as patients with primary complement deficiency and asplenia.
◊ All patients should receive postexposure regimen of rabies vaccine, and patients with severe immunosuppression should be assessed for antibody response.
§ Live zoster vaccine is no longer available in the United States.
¥ Patients with Mendelian susceptibility to mycobacterial disease due to autoantibodies to interferon-gamma should not receive live bacterial vaccines. Patients with autoantibodies to type 1 interferon should not receive live viral vaccines.
‡ These recommendations are for pre-exposure, if indicated; however, no absolute contraindication for smallpox vaccine in postexposure settings.
Reproduced from: Sobh A, Bonilla FA. Vaccination in primary immunodeficiency disorders. J Allergy Clin Immunol Pract 2016; 4:1066. Table used with the permission of Elsevier Inc. All rights reserved.
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