Vaccination of the Immunocompromised Host
Key Points
Key Points
- Impaired host defenses predispose patients to an increased rate or severity of vaccine-preventable infection.
- Such patients may also have greater exposure to pathogens due to frequent contact with medical environments.
- Data on safety, immunogenicity, and efficacy/effectiveness of vaccines for immunocompromised populations are limited.
- Immune system defects vary among and within categories of patients with immunodeficiency (eg, degree of immunodeficiency, nutritional status, immunosuppressive regimen), which may limit the generalizability of study findings.
- Inactivated vaccines can be administered to most immunocompromised patients, and live vaccines are contraindicated for most immunocompromised patients, with some important exceptions.
Responsibility for Vaccination
...onsibility for Vaccina...
...Specialists caring for immunocomp...
...Specialists caring for immunocompromised patients...
Timing of Vaccination
...g of Vaccination...
...ld be administered prior to planned...
.... Live vaccines should be administered ≥4...
...voided within 2 weeks of initiation of immu...
...tivated vaccines should be administered...
Household Members (See Table 1)
...hold Members (See Table 1)...
...etent household members of immunocompromis...
or for travel. (SR,...
...ousehold members of immunocompromised patient...
...ivated influenza vaccine (IIV) or (SR, H)2...
...e attenuated influenza vaccine (LAIV) pr...
...s include household members of an immu...
...administered, contact between the immunocompromis...
...ocompetent household members of immunocomp...
...otavirus vaccine in infants ages 2-7 months...
...vaccine (VAR), (SR, M)21881...
...oster vaccine (ZOS). (SR,...
...safely receive vaccines for travel: yellow feve...
...hoid vaccine. (SR, L)21881...
...l poliovirus vaccine (OPV) should NOT be admi...
.... Highly immunocompromised patients should avoi...
...promised patients should avoid contact w...
Table 1. Safety of Administration of Live Vaccines to Contacts of Immunocompromised Persons
...ty of Administration of Live Vaccines to Con...
...luenza, live, attenuated nasal...
...ster; (SR, L)21881...
...cinated persons to avoid close contact...
...Shedding of Agent? (Site) Transmis...
...rus, oral Shedding of Age...
..., oral Shedding of Agent? (Site)...
...Shedding of Agent? (Site) Tra...
Varicella Shedding of Agent? (S...
Yellow fever Shedding of Agent...
...Shedding of Agent? (Site) Tra...
International Travel
...ational Travel...
...linicians may administer inactivated vaccines i...
...ellow fever vaccine generally should NOT...
a. Asymptomatic HIV-infected adult...
...mptomatic HIV-infected children age 9 month...
...certain exceptions (eg, yellow fever vaccine and M...
Specific Vaccinations
...cific Vaccinations...
...icella and Zoster Vaccines...
...given to immunocompetent patients witho...
...f it can be administered ≥4 weeks before initia...
...edule of VAR, separated by >4 weeks for pati...
...VAR should NOT be administered to...
...8. VAR can be considered for patients without evid...
...d be administered to eligible immu...
...ld be given to patients ≥60 years of age if it...
...ZOS should be considered for varicel...
...uld be administered to patients ≥60 years o...
...OS should NOT be administered to highly im...
...nfluenza
...uenza vaccination with IIV is recom...
...tients who are very unlikely to respond...
...ve received anti-B cell antibodies within 6 mon...
...NOT be administered to immunocompromi...
Special Populations
...cial Populatio...
...ry (Congenital) Immunodeficiency Disorders...
Primary Complement Def...
...s with primary complement deficiencies sho...
...old should receive 1 dose of 13-valent...
...s old with a classical pathway (C1, C2, C...
...years old with a classical pathway (C1, C2, C3, C...
...hose who have previously received 23-valent pneum...
...atients ≥2 years of age with an...
...ildren age 6 weeks through 18 months, administer...
...primary series of quadrivalent meningococcal...
...or persons >55 years of age, administer...
...ients 9-23 months of age, administer the doses 3...
30. Patients with a primary complement componen...
Phagocytic Cell Deficiencies
...deficiencies include CGD (chronic gran...
...s with phagocytic cell deficiencies...
...ldren 2-5 years of age should recei...
...ts ≥6 years of age with phagocytic cell de...
...ts ≥2 years of age with phagocytic cell...
...bacterial vaccines, such as bacillus C...
...e viral vaccines should be administered to pati...
...Live viral vaccines should NOT be a...
...e Cytokine or Cellular Activation Defects
...ects in the immune system resultin...
...Patients with innate immune system defect...
...ts with innate immune system defects...
39. Specialist advice should be sought on indiv...
...ial vaccines should NOT be administered to...
...Live viral vaccines should NOT be admini...
...ntibody Deficiencies...
...ith immunoglobulin A (IgA) deficiency or specific...
...Children with SPAD or ataxia-telangiectasia sh...
...of age should receive PPSV23 ≥8 weeks...
...nitoring of vaccine responses can be useful for...
...d NOT be administered to IgA-deficient pati...
...ibody Deficiencies in Patients Recei...
...vated vaccines other than IIV are NOT routinel...
...nts with suspected major antibody deficiencies,...
...V can be administered to patients with major...
...should NOT be administered to patients with major...
...ccines (other than OPV) should NOT be ad...
...Immunodeficiencies...
...patients with suspected combined immunodefi...
...or patients with combined immunodeficiencies...
...patients with combined immunodeficiencie...
...en with partial DiGeorge syndrome (pDG...
...Patients with SCID, DiGeorge syndrome with...
...cted Adults, Adolescents, and Children (S...
...ctivated Vaccin...
..., (SR, H)21881
PCV13 in patient...
...H. influenzae type b conjugate vaccine (Hib),...
...htheria toxoid, tetanus toxoid, acellular...
...etanus toxoid, reduced diphtheria toxoid...
...id, reduced diphtheria toxoid vaccine (Td),...
...vaccine (HepB), (SR, M)2188...
...A vaccine (HepA), (SR, M)21881...
...ted poliovirus vaccine (IPV), (SR, M)21881...
...drivalent human papillomavirus vacc...
...3 should be administered to HIV-infected...
...should be administered to HIV-infected chil...
...ted adults with CD4 T-lymphocyte counts of â‰...
and to HIV-infected adults with CD4 T-lymphocyte...
...e given ≥8 weeks after the indicated dose(...
...7. HIV-infected children who are >59 mont...
...commended for HIV-infected adults....
...HIV-infected children age 11-18 years sh...
...ter dose (third dose) should be given at age 16...
...MCV4 is administered to HIV-infected children...
59. HIV-infected patients should recei...
...consideration of high-dose HepB (40 μ...
...escents.* (WR, L)21881...
...o two months after completion, they...
...postvaccination anti-HBs concentra...
...d be administered (alternative: 1 dose of H...
...ose HepB (40 μg/dose)* (WR, L...
...nd high-dose HepB for adolescents* a...
...ing 20 μg of HBsAg (hepatitis B sur...
...rnationally adopted HIV-infected child...
62. HPV4 is recommended over bivalent h...
...e Vaccines...
...sed or -infected infants should receive r...
...patients should NOT receive LAIV. (WR, VL)2188...
...should be administered to clinically stable HI...
...infected patients ≥14 years without me...
66. HIV-infected children with a CD4 T...
...s ≥14 years with a CD4 T-cell lymphoc...
...IV-infected patients should NOT receiv...
...Varicella-nonimmune, clinically stable HI...
...e 9-13 years with ≥15% CD4 T-lymphocyte p...
...years with CD4 T-lymphocyte counts of ≥200...
...uld be separated by ≥3 months. (SR,...
...tion of Persons With HIV Infection...
...zae type b conjugate...
...age...
...–18 yc (SR, L)21881...
...age
...age 5–18 yc (SR, L)21...
Hepatitis A
...a or No ImmunosuppressionU: (SR, M)21881...
...munosuppressionbU: age 1 y (SR, M)21...
Hepatitis B...
...la or No ImmunosuppressionR: (SR, M)21881...
...vel ImmunosuppressionbR: (SR, M)2188...
...TaP
...ow-Levela or No ImmunosuppressionU: (SR, M)...
...munosuppressionbU: (SR, M)21881...
Tdap
...a or No ImmunosuppressionU: (SR, VL)21881...
...el ImmunosuppressionbU: (SR, VL)21881...
Td
...or No ImmunosuppressionU: (SR, L)21881...
...mmunosuppressionbU: (SR, L)21881...
...PV4e
...No ImmunosuppressionU: age 11-26 y (SR, VL)21881...
...nosuppressionbU: age 11-26 y (SR, VL)2...
...za, inactivated...
...or No ImmunosuppressionU: (SR, H)21881...
...gh-Level ImmunosuppressionbU: (SR, H...
...za, live attenuated...
...No ImmunosuppressionX:f (WR, VL)21881...
...l ImmunosuppressionbX: (WR, VL)21881...
...R, live...
...Levela or No Immunosuppressio...
...12 mo to 13 y (SR, M)21881...
...ge ≥14 y (WR, VL)21881...
...Level Immunosuppressionb
...age 12 mo to 13 y (SR,...
...≥14 y (SR, M)21881...
...V, live...
...w-Levela or No ImmunosuppressionX: (SR, V...
...-Level ImmunosuppressionbX: (S...
Meningococcal conjugate...
...la or No ImmunosuppressionU: age 11-18 y (SR, M)...
...-Level ImmunosuppressionbU: age 11-18...
...eumococcal conjugate (PCV13)...
...ow-Levela or No Immunos...
U: ag...
...5 yh (SR, M)21881...
...18 yh (SR, L)21881...
...≥19 yi (SR, L)21881
...igh-Level Immunosuppress...
...age...
...5 y (SR, M)21881...
...ge 6-18 y (SR, L)21...
...: age ≥19 yi (SR, VL)21881...
...neumococcal polysaccharide (PPSV23)j...
...-Levela or No ImmunosuppressionR: age...
...-Level Immunosuppress...
...age 2-18 y (SR, M)218...
...(CD4 T-lymphocytes...
Poliovirus, inactiv...
Low-Levela or No ImmunosuppressionU: (SR, M)218...
...evel ImmunosuppressionbU: (SR, M)21881
...virus, live
...No ImmunosuppressionU: (SR, L)21881...
...h-Level ImmunosuppressionbU: (WR,...
...cella, liv...
...la or No Immunosuppression...
...ge 1-8 y (SR, H)21881...
...e ≥9 y (SR, VL)21881...
...-Level ImmunosuppressionbX: (SR, M)21...
...oster, l...
...evela or No Immunosuppression...
X: age...
...‰¥60 yk, l (WR, L)2188...
...igh-Level ImmunosuppressionbX: (SR, M)...
...ded—administer if not previously admini...
...HepB (40 µg) should be considered for...
...olescents (WR, L)21881...
...ed over HPV2 because of its activity against g...
i For patients ≥19 years of age with HIV who...
...should be administered 8 weeks or longer after i...
...Vaccination can be considered for patien...
...For patients not vaccinated with varice...
...ancer (See Tab...
...s ≥6 months of age with hematologica...
...lid tumor malignancies (SR, L)21...
...those receiving anti-B cell antibodies* (SR, M...
or intensive chemotherapy, such as for indu...
.... PCV13 should be administered to newly diagnosed...
...lignancies (SR, VL)21881...
...with malignancies (SR, VL)21881...
...d in recommendations 27a-c. (, )21881...
...e administered to adults and child...
...ctivated vaccines (other than IIV) recomm...
...ver, vaccines administered during ca...
...ess there is documentation of a protectiv...
...vaccines should NOT be administered...
...g 3 months following cancer chemotherapy,...
...vaccines VAR, (WR, VL)21881...
...R, (SR, L)218...
...d MMRV (WR, VL)2188...
...e CDC annual schedule routinely ind...
...egimens included anti-B cell antibodies, vacci...
...ble 3. Vaccination of Patients With Cance...
...uenzae type b conjugate...
...or to or During ChemotherapyaU: (WR,...
...ng ≥3 Months Postchemotherapy and ≥6...
...epatitis A...
...rior to or During ChemotherapyaU:...
...¥3 Months Postchemotherapy and ≥6 M...
...patitis B...
...o or During ChemotherapyaU: (WR, L)218...
...‰¥3 Months Postchemotherapy and ≥6 Mont...
...(SR, M)21881...
...adults (SR, VL)218...
...aP, Tdap...
...to or During ChemotherapyaU: (WR, L)21881...
...≥3 Months Postchemotherapy and ≥6 Mo...
...e 0-18 y (SR, M)218...
...with acute lymphoblastic leukemia or lymphoma (W...
HPV
...to or During ChemotherapyaU: age 11-26 y (...
...Months Postchemotherapy and ≥6 Months After A...
...luenza, inactivated...
...r During ChemotherapyaU (SR, L)U (SR-L to M)2...
...≥3 Months Postchemotherapy and â...
...enza, live attenuate...
...r to or During ChemotherapyaX: (WR, V...
...nths Postchemotherapy and ≥6 Months After Anti...
...R, live...
...During ChemotherapyaX:c (SR, M)21881...
...¥3 Months Postchemotherapy and ≥6...
...RV, live
...r During ChemotherapyaX:c (SR, M)21881...
...≥3 Months Postchemotherapy and ≥6 Months A...
...gococcal conjugate...
...r During ChemotherapyaU (WR, L)...
...onths Postchemotherapy and ≥6 Mo...
...ococcal conjugate-13 (PCV13)...
...or to or During Chemoth...
...(SR, L)21881...
R: age ≥6 yd (SR,...
...arting ≥3 Months Postchemotherapy and â‰...
...l polysaccharide (PPSV23)...
...or During ChemotherapyaR: age ≥2 y (SR, L)21...
...g ≥3 Months Postchemotherapy and â‰...
...rus, inactivated...
...to or During ChemotherapyaU: (WR, L)21881...
Starting ≥3 Months Postchemotherapy...
...otavirus, live...
...uring ChemotherapyaX: (SR, VL)21881...
...g ≥3 Months Postchemotherapy and ≥6 Mont...
...cella, live...
...uring ChemotherapyaXc (SR, M)21881...
...nths Postchemotherapy and ≥6 Months After Anti...
...er, live...
...During ChemotherapyaX:c (SR, VL)21881...
...≥3 Months Postchemotherapy and ≥6 Months A...
...”administer if not previously administered or no...
...ster inactivated influenza vaccine (...
...mor malignancies (SR, L)21881...
...ceiving anti–B-cell antibodies such as ritu...
Administrations of inactivated vaccines...
...nes administered while receiving cancer che...
...V can be administered ≤3 months aft...
...nts ≥19 years of age with HIV who have previo...
...MMR has been given safely 3 months...
...nts ≥19 years of age who have prev...
...Stem Cell Transplant (See Table 4)...
...d Patients Before Transplantati...
...The HSCT donor should be current with...
...VAR, and ZOS administration should be...
...f the donor for the benefit of the recipient...
.... Prior to HSCT, candidates should...
...when the interval to the start of...
...eks for inactivated vaccines. (SR, M)21881...
...une HSCT candidates ≥12 months o...
...Patients Post-transplant...
...1 dose of IIV annually. (SR, M)21881...
...persons ≥6 months of age starting 6 mo...
...at 4 months if there is a communit...
...6 months through 8 years of age who...
...r 3 doses of PCV13 to adults and children sta...
...2 months after HSCT a dose of PPSV23 should be...
For patients with chronic GVHD a fourth dose of PC...
...nister 3 doses of Hib starting at 6-...
...2 doses of MCV4 starting 6-12 months after HSC...
...r 3 doses of tetanus/diphtheria-cont...
...children...
...7 years and older, administration of 3 dose...
...ernatively, administer a dose of T...
...of Td. (WR, L)21881...
...Administer 3 doses of HepB starting at 6-...
...ation anti-HBs concentration of ≥10 mIU/mL is...
...dose of HepB after which anti-HBs is tested*) usi...
...r high dose (40 μg)* (WR...
...d high dose for adolescents* and adults (SR, L)2...
...3. Administer 3 doses of IPV starting 6-12 months...
...sider administration of 3 doses of...
...ot administer live vaccines to HSC...
...inister a 2-dose series of MMR to measles...
...s-seronegative children (SR, M)21881...
...Administer a 2-dose series of VAR starti...
...tions Prior to or After Allogeneic or A...
...nfluenzae type b conju...
...SCTU: (SR, M)21881...
...doses (SR, M)at 6 mo post-tx21881...
Hepatiti...
...re-HSCTU: (SR, VL)...
...: 2 doses (WR, L)at ≥6 mo post-tx21881...
Hepatitis...
Pre-HSCTU: (SR, L)21881
...st-HSCTR: 3 doses (SR, M)at 6–12 mo...
DTaP, DT, Td, Tda...
...TU: (SR, L)21881...
...st-HSC...
R: age...
...age ≥7 y: DTaP* 3 doses (WR, VL)...
...se Tdap, followed by either 2 doses DT* or...
...Td (WR, L)21881...
...PV
...TU: age 11-26 y (SR, VL)21...
Post-HSCTU: 3 doses at ≥6 mo post-tx (WR, VL)2...
...fluenza, inactiva...
Pre-HSCTU: (SR, L)2188...
Post-HS...
...post-tx (SR, VL)if community outbreak...
...¥6 mo post-tx (SR, M)21881...
...fluenza, live attenua...
...re-HSCTX: (WR, VL)...
...st-HSCTX: (WR, VL)...
...MR, li...
Pre-HSCTU:a (SR,...
...HSCTX:b (SR, L)21881...
...MRV, live
...re-HSCTU:a (WR, VL)2...
...HSCTX: (SR, VL)21881...
...coccal conjugate...
...SCTU: (SR, VL)2188...
...t-HSCTR: age 11-18 y: 2 doses (SR, L)at 6-12 mo...
...cal conjugate (PCV13)
...HSCTR:c (SR, L)21881...
...3 doses (SR, L)at 3-6 mo posttx21881...
...coccal polysaccharide (PPSV23)...
Pre-HSCTR:c (SR,...
...st-HSCTR: ≥12 mo post-tx if no GVHD (SR...
...liovirus, inactiva...
...CTU: (SR, VL)21881...
...doses (SR, M)at ≥3 mo post-tx21881...
...avirus, liv...
...HSCTX: (WR, VL)21881...
...SCTX: (WR, VL)21881...
...ella, live
...CTU:a (SR, L)21881
...CTX:d (SR, L)21881...
...oster, l...
...re-HSCT...
...a,e age 50–59 y* (WR, VL)21...
...age ≥60 y (SR, L)2188...
...st-HSCT...
...–59 y* (SR, L)21881...
...¥60 y (SR, L)21881...
...mmended—administer if not previously administ...
...tnotes to Table...
...live vaccines should not be administered unless t...
...o adolescents and adults (SR, L)21881...
...nd to children (SR, M)218...
...If not previously administ...
...ster if varicella-seronegative, the timi...
...Consider if the patient is not severely immunosup...
...d Organ Transplant (See Table 5)...
...ients Before Transplantation...
88. Living donors should be current with vaccines...
...MR, MMRV, VAR, and ZOS administration should be...
...ination of donors solely for the recipientâ...
...and children with chronic or end-stage kidne...
...wing persons should receive PCV13 as in recommen...
...1. Adults and children age ≥2 years old who...
...ts with end-stage kidney disease should rece...
...nd children ≥2 years of age with end-stage...
...th PCV13 and PPSV23 are indicated, PCV13 s...
...“negative SOT candidates should receive a HepB...
...n hemodialysis and age ≥20 years they should r...
...stvaccination anti-HBs concentratio...
...tive: 1 dose of HepB after which anti-HBs is...
...h dose* for children (WR, L)21881...
...se for adolescents* and adults. (SR, L...
...s A–unvaccinated, undervaccinated, or se...
...ears. (SR, M)should receive a HepA series.21881...
...ombined HepA-HepB vaccine can be us...
...4. HPV series should be administered to SOT...
...5. SOT candidates 6-11 months of age can...
...ntation is delayed (and the child is not receivin...
96. VAR should be administered to SOT candidates w...
...nistered to varicella-naive SOT candidates 6...
...lly, 2 doses should be administered ≥3 mon...
...candidates age ≥60 years (SR, M)21881...
...la-positive (as defined in recommendation 22) can...
...T Recipients...
...ion should be withheld from SOT recipients d...
except that IIV can be administered ≥...
...ndard age-appropriate inactivated vaccine series...
...V. (SR, M)(Table 5)21881...
...should be administered starting 2-...
...r SOT patients ≥2 years of age, 1 dose of P...
...should be considered for chronic hepat...
...03. MMR and VAR should generally no...
...ept for VAR in children without evi...
...tion should not be withheld because of conc...
...ccinations Prior to or After Solid Organ Tra...
.... influenzae type b conjugate
...lantU: (SR, M)21881...
...€“6 Months PosttransplantU: (SR, M)21881...
...epatitis...
Pretransp...
...age 12-23 mo (SR,...
...age ≥2 y (SR, M)21881...
...onths PosttransplantR: if not completed pr...
...epatitis B...
...etransplant
...-18 y (SR, M)21881...
...age ≥18 y (SR, M)2...
...ing 2–6 Months PosttransplantR: if no...
...aP, Tdap...
...lantU: (SR, M)21881...
...€“6 Months PosttransplantU: if not completed pretr...
...PV...
...ansplantU: females age 11-26 y (SR, M)21...
...2–6 Months Posttransplant...
...es age 11-26 y (SR, M)218...
...males age 11-26 y (SR, L)218...
...enza, inactivated...
...etransplantU: (SR, M)2...
...Months PosttransplantU:b (SR, M)2...
...luenza, live atten...
PretransplantX: (WR, L...
...2–6 Months PosttransplantX: (WR, L...
...R, live
Pretranspl...
...6-11 mo (WR, VL)21881...
...ge ≥12 mo (SR, M)21881...
...rting 2–6 Months PosttransplantX: (SR, L)21881...
...RV, live...
...ransplantU:d (SR, M)...
...rting 2–6 Months PosttransplantX: (SR, L)2...
...eningococcal conju...
...ransplantU: (SR, M)21881...
...2–6 Months PosttransplantU: (SR, M...
...ccal conjugate (PCV13...
...transplant
U: ag...
...ge ≥6 ye (SR, VL)21...
...€“6 Months Posttransplant...
...age 2-5 y (SR, M)21881...
...y, if not administered pretransplante (SR...
...mococcal polysaccharide (PPSV...
...R: age ≥2 y (SR, M)21881...
...arting 2–6 Months PosttransplantR: age ≥...
...irus, inactivated...
...transplantU: (SR, M)21881...
...rting 2–6 Months PosttransplantU: (SR, M)21881...
...irus, live...
...retransplantU:c (SR, M)21881
Starting 2–6 Months PosttransplantX...
Varicella, live
...transplan...
...6-11 mo (WR, VL)21881...
...:d (SR, L)2...
Starting 2–6 Months PosttransplantX:g (SR...
...oster, live
Pretransp...
...50-59 y (WR, L)21881...
...≥60 y (SR, M)218...
...–6 Months PosttransplantX: (SR, L)21881...
..., recommended—administer if not previ...
...patitis B vaccine for hepatitis B-infected live...
...e administered to SOT recipients despite...
...inister only if patient is not immunosu...
...≥19 years who have previously received PPSV23, P...
...Administer only if patient is not immunosuppre...
...nic Inflammatory Disease Patients T...
...vaccines, including IIV, should be administered...
...treated with immunosuppressive agents. (SR, M)...
...ld be administered to adults and childr...
...PPSV23 should be administered to patients ≥2...
...immunosuppression, (SR, L)21881...
...nd high-level immunosuppression. (SR, VL)218...
...uld receive PPSV23 ≥8 weeks after PCV13 and s...
...R should be administered to patients with chro...
...eeks prior to initiation of immunosuppressio...
...VAR should be considered for patients...
.... ZOS should be administered to pati...
...eing treated with low-dose immunosuppression, (S...
...ose who are 50-59 years of age and varicel...
...ile being treated with low-dose immunosuppre...
...ive vaccines should NOT be administered to patie...
...ts receiving low-level (WR, VL)21881...
...immunosuppression, (WR, VL)21881...
...RV in patients receiving low-level...
...mmunosuppression. (SR, VL)21881...
...se recommended vaccines, including IIV a...
...Vaccination of Persons With Chronic Inflammator...
.... influenzae type b conju...
...munosuppressionU: (SR, M)21881...
...unosuppressionaU: (SR, L)21881
...igh-Level ImmunosuppressionaU: (SR, L...
...epatitis A
...ImmunosuppressionU: (SR, M)2188...
...nosuppressionaU: (SR, L)21881...
...mmunosuppressionaU: (SR, L)21881...
...patitis B...
...lanned ImmunosuppressionU: (SR, M)...
...w-Level ImmunosuppressionaU: (SR, L)...
...mmunosuppressionaU: (SR, L)21881...
... Td, Tdap...
...anned ImmunosuppressionU: (SR, M)2...
...nosuppressionaU: (SR, L)21881...
...el ImmunosuppressionaU: (SR, L)21...
HPV
...ImmunosuppressionU: age 11-26 y (SR, M)21881...
...munosuppressionaU: age 11-26 y (SR, L)21881...
...el ImmunosuppressionaU: age 11-26 y (SR, VL)...
Influenza, inactiva...
...nosuppressionU: (SR, M)21881...
...Level ImmunosuppressionaU: (SR, M)2188...
...ImmunosuppressionaU: (SR, M)21881...
...fluenza, live attenuated...
...anned ImmunosuppressionX: (WR, VL)2...
...Level ImmunosuppressionaX: (WR, VL)21881...
...ImmunosuppressionaX: (WR, VL)21881
...MR, live
...nned ImmunosuppressionU:b (SR, M)2...
...el ImmunosuppressionaX: (WR, VL)21...
...evel ImmunosuppressionaX: (WR, VL)218...
...RV, live
...lanned ImmunosuppressionU:b (SR, L)2188...
...w-Level ImmunosuppressionaX: (WR...
...vel ImmunosuppressionaX: (SR, VL)21881...
...coccal conjugate...
...anned ImmunosuppressionU: (S...
...munosuppressionaU: (SR, M)21881...
...vel ImmunosuppressionaU: (SR, L)21881...
Pneumococcal conjugate (PCV13)
...ed ImmunosuppressionR:c (SR, M)2188...
...el Immunosuppressiona...
...: age...
...age ≥6 yc (SR, VL)21881...
...vel Immunosuppressiona...
...: age...
...≥6 yc (SR, VL)21881...
...ococcal polysaccharide (PPSV23...
...ned ImmunosuppressionR: age ≥2 y (SR, L)218...
...munosuppressionaR: age ≥2 y (SR,...
...nosuppressionaR: age ≥2 y (SR, V...
Poliovirus, inacti...
...munosuppressionU: (SR, M)21881
...w-Level ImmunosuppressionaU: (...
...gh-Level ImmunosuppressionaU: (SR,...
...otavirus, li...
...ed ImmunosuppressionU: (SR, M)21...
...Level ImmunosuppressionaX: (WR, VL)21881...
...vel ImmunosuppressionaX: (WR, VL)21881...
...ella, live...
...osuppressionU:d (SR, M)21881...
...mmunosuppressionaX:d (WR, VL)21881...
High-Level ImmunosuppressionaX: (SR, M)2188...
...ter, live...
...Immunosuppression
...0-59 y* (WR, L)2188...
...age ≥60 y (SR, L...
...w-Level Immunosuppressiona
...: age 50-59 y* (WR, V...
...e ≥60 y (SR, VL)21881...
...gh-Level ImmunosuppressionaX: (WR, VL)21...
...—administer if not previously administered or no...
...ents ≥19 years who have previously rece...
...inistration of VAR can be considered for nonâ€...
* These recommendations deviate fro...
...splenia or Sickle Cell Diseases (See...
...lenic patients or those with sickl...
...in patients with sickle cell disease....
...PCV13 should be administered to asplenic pati...
...PSV23 should be administered to asplenic patient...
...th an interval of ≥8 weeks after PCV13, and a...
...PPSV23--naive patients ≥2 years of age f...
...¥2 weeks following surgery.* (WR, L)21881...
...se of Hib should be administered to unvaccinated...
...al vaccine should be administered to pati...
...endation 29 except that MCV4--D should not be ad...
...MCV4 (or MPSV4 for those >55 years of age...
...tomic Barrier Defects (See Ta...
...children with profound deafness scheduled to...
...Patients with a cochlear implant, with...
...atients ≥24 months of age with a cochlear impla...
...nd PPSV23 should be administered ≥2...
...able 7. Vaccination of Persons With Asplenia or...
...luenzae type b conju...
...enia or a Sickle Cell Disease...
U: age
...age ≥5 y (WR, L)2...
...ochlear Implantsa or CSF LeakU: (SR...
Hepatitis...
...ckle Cell DiseaseU: (SR, M)21881...
...Implantsa or CSF LeakU: (SR, M)...
Hepatitis B
...r a Sickle Cell DiseaseU: (SR, M)21...
...Implantsa or CSF LeakU: (SR, M)21881...
DTaP, Td, Tda...
...or a Sickle Cell DiseaseU: (SR, M)21881...
...tsa or CSF LeakU: (SR, M)21881...
HP...
...enia or a Sickle Cell DiseaseU: (SR, M)21881
...Implantsa or CSF LeakU: (SR, M)21881...
...uenza, inactiva...
...a Sickle Cell DiseaseU: (SR, M)21881
...lear Implantsa or CSF LeakU: (SR,...
...za, live attenuated...
...splenia or a Sickle Cell DiseaseX: (WR, VL)21881
...ntsa or CSF LeakU: (SR, M)21881...
...MR, liv...
...enia or a Sickle Cell DiseaseU: (SR,...
...mplantsa or CSF LeakU: (SR, M)21881...
...MRV, li...
...or a Sickle Cell DiseaseU: (SR, M)...
...Implantsa or CSF LeakU: (SR, M)21881...
...ngococcal conjugate...
...a Sickle Cell DiseaseR: age 2-55 yb (SR,...
...antsa or CSF LeakU: (SR, M)21881...
...coccal polysaccharide...
...or a Sickle Cell DiseaseR: age >55 yb (...
...tsa or CSF LeakU: (SR, M)21881...
...al conjugate (PCV13)
...splenia or a Sickle Cell Dise...
U: ag...
...age ≥6 yd (SR, VL)21881...
...hlear Implantsa or CS...
...age...
...: age ≥6 yd (SR, L)...
Pneumococcal polysaccharide...
...Sickle Cell DiseaseR: age ≥2 ye (SR...
...lear Implantsa or CSF LeakR: age ≥2 ye...
...ovirus, inactivated...
...ckle Cell DiseaseU: (SR, M)21881...
...plantsa or CSF LeakU: (SR, M)21881...
...virus, live...
...nia or a Sickle Cell DiseaseU: (SR, M)21881...
...ntsa or CSF LeakU: (SR, M)21881...
...aricella, live...
...enia or a Sickle Cell DiseaseU: (SR, M)21881...
...tsa or CSF LeakU: (SR, M)21881...
...oster, li...
...or a Sickle Cell DiseaseU: (SR, M)21881...
...ntsa or CSF LeakU: (SR, M)21881...
...d—administer if not previously admi...
...ot previously been administered. For...
...er 8 or more weeks after indicated dose(s...