Close contacts

According to the committee, “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.” However, close contacts can receive other standard vaccines because viral shedding is unlikely, so risk of infection to an immunocompromised patient is low.

The committee emphasized that close contacts should receive annual immunizations with inactivated influenza vaccine, as well as scheduled periodic pertussis vaccine (Tdap); pneumococcal vaccine; measles, mumps and rubella (MMR) vaccine; and varicella vaccine for older contacts whose routine immunizations may not be up to date.

Pregnant women should routinely receive only the Tdap and inactivated influenza vaccines. However, mothers without up-to-date immunization history and with a child at high risk for primary immunodeficiency should receive pneumococcal, Hib, and meningococcal vaccines, so that maternally transferred IgG antibodies can confer protection on the baby until his/her immune status is determined.

Loss of herd immunity in the general population

According to the committee, the public has become “complacent” with the rare occurrence of potential deadly childhood infections, mistakenly believing these diseases to be permanently eradicated. Concerns about potential adverse effects of vaccines have further discouraged some parents from vaccinating their children. Consequently, there has been a disturbing resurgence of these childhood illnesses. Without herd immunity to the infectious epidemics of the past, non-immunized individuals might spread these conditions to immunocompromised children– especially in crowded living conditions.

Integrating the immunoreconstituted immunodeficient child into society

It is understandable that parents with an immunocompromised child would wish to isolate the child, so as to protect him or her from potential exposure to infectious agents. Nevertheless, parents are encouraged to maintain a balance with the needs of the child to develop socially and educationally. The authors note that “development of the child as a social being is extremely important” and urge “long-term systematic follow-up of these patients to make possible early recognition, effective measurement, and proper school interventions.”

Conclusion

The authors conclude that the “development of immunization for common bacterial and viral infections has represented a major advance in the battle against microbial organisms that constantly threaten the welfare of humankind and particularly the pediatric population.” They note that “special caution and considerations must be made for subjects with primary immunodeficiency disorders.” The authors recommend three websites for further information about the management of immunodeficient children.

Resources for information about management of immunodeficient children

References

1. Medical Advisory Committee of the Immune Deficiency Foundation, Shearer WT, Fleisher TA, Buckley RH, et al. Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts. J Allergy Clin Immunol. 2014 Mar 3. [Epub ahead of print].

2. American Academy of Pediatrics. Immunization in special clinical circumstances. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village (IL): American Academy of Pediatrics; 2012. pp. 74-90.

3. Lindegren ML, Kobrynski L, Rasmussen SA, et al. Applying public health strategies to primary immunodeficiency diseases: a potential approach to genetic disorders. MMWR Recomm Rep 2004;53(1):1–29.