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Immune Deficiency Foundation issues guidelines for vaccines in immunodeficient patients

The controversial issue of live viral or bacterial vaccines and whether they can be administered to immunodeficient patients in addition to neglectful routine immunizations prompted the Medical Advisory Committee of the Immune Deficiency Foundation to issue recommendations, according to recently published literature.

“These recommendations address the concern for immunodeficient patients acquiring infections from healthy subjects who have not been immunized or who are shedding live vaccine-derived viral or bacterial organisms,” William T. Shearer, MD, PhD, of Baylor College of Medicine and Texas Children’s Hospital, and colleagues wrote.

The group wrote that the transmission of infectious agents can occur within a hospital, clinic, home or any public setting, and it is particularly relevant in patients with impaired immunity.

“Immunodeficient children who have attained full immune reconstitution after bone marrow, blood, or cord blood stem cell transplantation might have sufficient T-cell responses to protect against exposures to horizontal viral infection, but careful evaluation of the degree of immune reconstitution of an HCT [hematopoietic stem cell transplantation]-treated immunodeficient patient must be made before live viral vaccines are administered,” researchers wrote.

Based on current literature, the researchers recommend that clinicians consider the following:

• educate parents and physicians about the need for maintaining herd immunity in the population at large;
• avoid live viral and bacterial vaccines in all patients with significant T- and beta-cell deficiencies;
• determine the degree of immune reconstitution in patients treated with HCT, enzyme therapy, or gene therapy before live vaccine treatment; and
• balance the exposure to infection from live vaccines and close contact-transmitted vaccine-derived infection in the immunoreconstituted child 

Disclosure: See the study for a full list of relevant financial disclosures.