Immune Deficiency Foundation Issues New Recommendations for Vaccination of Immunodeficient Patients

Immunization with live viral or bacterial vaccines is known to be hazardous for vulnerable patient populations with serious immunodeficiencies of T-cell, B-cell, and phagocytic cell origin.¹ These patients are susceptible to infection transmitted either by a healthy subject who has not been immunized, or by a healthy subject who is shedding live vaccine-derived viral or bacterial organisms. This type of transmission is defined as close-contact spread of infectious diseases.¹

The Medical Advisory Committee of the Immune Deficiency Foundation recently released recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts.¹ They based their recommendations on two primary sources: The Red Book: 2012 Report of the Committee on Infectious Diseases² and the previous recommendations of the Centers for Disease Control and Prevention (CDC)³. A summary of their recommendations can be found below in Table 1.

Table 1. Recommendations for immunization of children and adolescents with primary immune deficiencies

Category	Example of specific immunodeficiency	Vaccine contraindications	Effectiveness
B-lymphocyte (humoral)	Severe antibody deficiencies (eg, X-linked agammaglobulinemia and CVID)	– Smallpox – LAIV – YF – Possibly measles – No data for varicella or rotavirus	– Uncertain, if it depends only on humoral response.
B-lymphocyte (humoral)	Less severe antibody deficiencies (eg, selective IgA deficiency and IgG subclass deficiencies)	– YF – BCG – Other live vaccines appear safe, but caution is urged.	– All vaccines are probably effective. – Immune response might be attenuated. – Pneumococcal vaccine and Hib are recommended.
T-lymphocyte (cell-mediated and humoral)	Complete defects (eg, severe combined immunodeficiency, complete DiGeorge syndrome)	– All live vaccines	– All vaccines are probably ineffective. – Pneumococcal vaccine and Hib are recommended.
T-lymphocyte (cell-mediated and humoral)	SCID given HCT	– Live virus and bacteria vaccines, depending on immune status	– Effectiveness depends on degree of immune suppression. – Pneumococcal, meningococcal, Hib vaccines are recommended.
T-lymphocyte (cell-mediated and humoral)	Partial defects (eg, most patients with DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia telangiectasia)	– Selected live vaccines (BCG and Ty21a S typhi vaccine)	– Effectiveness depends on degree of immune suppression. – Consider Hib vaccine if not given during infancy.
Complement	Persistent complement component, properdin, factor B deficiency	– None	– All routine vaccines are probably effective. – Pneumococcal and meningococcal are recommended.
Phagocytic function	Chronic granulomatous disease, leukocyte adhesion defects, myeloperoxidase deficiency	– Live bacterial vaccines	– All inactivated vaccines considered safe, probably effective.
IFN-gamma-IL-12 pathway defects	Predilection for BCG vaccine in acquired infections	– BCG	– No reported live attenuated viral vaccine-induced infection – Caution is urged.

Abbreviations: bacillus Calmette-Guerin (BCG), common variable immune deficiency (CVID), live attenuated influenza vaccine (LAIV), yellow fever (YF), Haemophilus influenzae type b (Hib), severe combined immunodeficiency disease (SCID)