The degree of altered immunocompetence in a patient should be determined by a physician. Additionally, if a non-live vaccine is administered during the period of altered immunocompetence, it might need to be repeated after immune function has improved. Non-live vaccines might best be deferred during a period of altered immunocompetence in this circumstance, the concern is with effectiveness and not safety. Vaccines might be less effective during the period of altered immunocompetence. This is primarily a safety concern, because persons who have altered immunocompetence and receive live vaccines might be at increased risk for an adverse reaction because of uninhibited growth of the attenuated live virus or bacteria. Administration of live vaccines might need to be deferred until immune function has improved. Certain conditions like asplenia and chronic renal disease also can cause altered immunocompetence.ĭetermination of altered immunocompetence is important to the vaccine provider because incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence therefore, certain vaccines (e.g., inactivated influenza vaccine, pneumococcal vaccines) are recommended specifically for persons with these diseases ( 2, 3). Primary and secondary immunodeficiencies might include a combination of deficits in both cellular and humoral immunity. The degree to which immunosuppressive drugs cause clinically significant immunodeficiency generally is dose related and varies by drug. Examples of secondary immunodeficiency include HIV infection, hematopoietic malignancies, treatment with radiation, and treatment with immunosuppressive drugs. Secondary immunodeficiency is acquired and is defined by loss or qualitative deficiency in cellular or humoral immune components that occurs as a result of a disease process or its therapy. Examples include congenital immunodeficiency diseases such as X-linked agammaglobulinemia, SCID, and chronic granulomatous disease. Primary immunodeficiencies generally are inherited and include conditions defined by an inherent absence or quantitative deficiency of cellular, humoral, or both components that provide immunity. The evidence supporting this guidance is based on expert opinion and arrived at by consensus.Īltered immunocompetence, a term often used synonymously with immunosuppression, immunodeficiency, and immunocompromise, can be classified as primary or secondary. This section incorporates general content from the Infectious Diseases Society of America policy statement, 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host ( 1), to which CDC provided input in November 2011.
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