पृष्ठभूमि

Individuals who are immunocompromised have a weakened immune system, resulting in a decreased ability to fight infections. There are many different causes of immunocompromise, including having certain medical conditions (e.g. autoimmune diseases, cancer, anatomical or functional asplenia, HIV), being a transplant recipient or advancing age. There are also certain medications that can suppress the immune system, sometimes known or immunosuppressive therapies (e.g. corticosteroids, disease-modifying anti-rheumatic drugs [DMARDs] or cancer therapies).

The term immunosuppression is often used interchangeably with the term immunocompromise. People with a fully functioning immune system can be referred to as immunocompetent.

इम्यूनोसप्रेशन और टीके

Vaccination is particularly important for those who are immunocompromised, due to the increased risk of developing severe disease (which can lead to hospitalisation, intensive care admission or death) if exposed to vaccine-preventable diseases. In people who are immunocompromised, protection from vaccines can be suboptimal as the body is not as easily able to respond to the vaccine. Therefore, additional doses of vaccines may be recommended. Conversely, some vaccines (live-attenuated vaccines) may be contraindicated due to the potential risk of vaccine-related disease.

Taking a thorough patient history prior to vaccination is recommended to determine an individual’s degree of immunocompromise/immunosuppression and to formulate an individualised vaccination strategy.

टीकाकरण का समय

Vaccination may need to be planned with the treating specialist. In some instances, the timing of immunosuppressive therapies may be altered to maximise the response to vaccines. In other circumstances, the intervals between vaccine doses may be altered to accommodate treatment regimes.

In some instances, vaccines can be given pre-emptively to people who anticipate immunosuppression in the future (e.g. a patient undergoing a planned splenectomy should be immunised prior to surgery).

Recommendations

एलive-attenuated vaccines must not be given to immunocompromised individuals without consultation with a treating specialist. The following मैंnformation outlines एसpecific टीका recommendations के लिए पीeople who are immunosuppressed.

  • इन्फ्लूएंजा

    Every year, different strains of इंफ्लुएंजा circulate in the community. Annual vaccines are updated to protect against the strains anticipated to be circulating. People with immunocompromise may be more vulnerable to influenza and associated secondary infections. As such, annual influenza immunisation is recommended and funded for all people with immunosuppression aged over 6 months.  

    There are precautions relating to influenza vaccines and patients who are receiving treatment with checkpoint inhibitors. Specific information can be found in The Australian Immunisation Handbook.

  • न्यूमोकोकल

    People with immunosuppression  have the highest risk of experiencing invasive न्यूमोकोकल disease. They are recommended and funded to receive extra pneumococcal vaccine doses in addition to the doses recommended for immunocompetent people. The timing of vaccination, number of doses required, and type of vaccine (s) depend on the person’s age, and their medical and immunisation history.  

    For more information, refer to एमवीईसी: न्यूमोकोकल

  • मेनिंगोकोक्सल

    People receiving certain therapies or with specific medical conditions (particularly those with अस्प्लेनिया) are recommended and funded to receive a primary course of meningococcal B and ACWY vaccines. Depending on the age at which the course is commenced, a primary course for immunocompromised individuals may consist of more doses than a primary course recommended for immunocompetent individuals. Following this, booster doses are recommended for some individuals with specified medical conditions or treatment that increase their risk of invasive meningococcal disease (IMD).

    For more information, refer to the एमवीईसी: मेनिंगोकोक्सल

  • Herpes zoster (shingles)

    Zoster presents more commonly (and is more likely to present on repeated occasions) in people with immunocompromise compared to immunocompetent people. 

    Vaccination with a 2-dose course of the vaccine Shingrix is required for adequate protection against zoster. Shingrix is funded on the NIP for people aged over 18 years with history of haemopoietic stem cell transplant, solid organ transplant, blood cancer and advanced or untreated HIV (and for immunocompetent First Nations Australians aged 50 years and over, and other immunocompetent people aged 65 years and over). 

    Other individuals who are immunocompromised or will soon become immunocompromised can privately purchase a course of Shingrix from 18 years of age. Duration of protection may be limited, so consideration should be given to timing administration to mitigate the greatest risk of disease.  

    For more information, refer to the एमवीईसी: ज़ोस्टर

  • COVID-19

    COVID-19 vaccination is strongly recommended for all immunosuppressed individuals aged 6 months and older due to an increased risk of developing severe disease. A 3-खुराक प्राथमिक पाठ्यक्रम इष्टतम सुरक्षा के लिए सिफारिश की जाती है (प्रतिरक्षा सक्षम लोगों के लिए 2-खुराक पाठ्यक्रम की तुलना में)। एक प्राथमिक पाठ्यक्रम के बाद, बूस्टर खुराक are also recommended for some individuals. 

    For more information, refer to एमवीईसी: कोविड-19

  • मानव पेपिलोमावायरस (एचपीवी)

    People with immunocompromise (with the exception of those with asplenia and hyposplenia) are recommended to receive a 3-dose course of HPV vaccination to ensure adequate protection. This is in contrast to the recommended single dose for immunocompetent individuals aged 9 to 25 years (funded for all adolescents in year 7 of high school).

    For more information, refer to MVEC: Human papillomavirus (HPV)

प्रतिबंधित टीके

जीवित-क्षीण टीके are contraindicated for most immunocompromised individuals due to the risk of adverse events or vaccine-related disease. In some instances, an alternate inactivated vaccine may be available for use (see table 1).

तालिका 1: इम्यूनोसप्रेस्ड रोगियों में प्रतिबंधित टीके और विचार करने के लिए वैकल्पिक विकल्प

WordPress Tables Plugin

^नियमित रूप से राष्ट्रीय टीकाकरण कार्यक्रम (एनआईपी) पर प्रशासित
#अनुशंसित टीका केवल चुनिंदा रोगी समूह के लिए
¥available vaccine for those at higher risk of infection (e.g. travel)
एन/ए कोई वैकल्पिक टीका उपलब्ध नहीं है

लाइव-एटेन्यूएटेड वैक्सीन का असावधानीपूर्वक प्रशासन

If an immunocompromised individual is inadvertently administered a live-attenuated vaccine, शीघ्र कार्रवाई is required. Medical review by an infectious diseases specialist or immunisation expert must be facilitated and the appropriate management commenced (e.g., anti-viral therapy, monitoring etc.). 

The vaccine recipient must be informed of the incident and have a clear understanding of its implications, including any signs and symptoms to monitor for. The error must also be reported to the relevant authority to ensure appropriate follow up and support can be provided. In Victoria, this service is  सैफविक. 

If the error occurs out of hours, seek specialist advice from the individual’s treating specialist or an infectious diseases specialist at your local tertiary hospital. 

एहतियात

Mothers who are receiving immunosuppressive therapy and breastfeeding (or those who received immunosuppressive medication during pregnancy) should seek advice from a Specialist Immunisation Clinic around the safety of live-attenuated vaccines for their child (e.g. oral rotavirus vaccine or BCG).

See एमवीईसी: Immunosuppression in pregnancy and infant vaccine recommendations

घरेलू संपर्क

इम्यूनोसप्रेस्ड व्यक्तियों के घरेलू संपर्क सभी टीकों के साथ अद्यतन होने चाहिए और वार्षिक इन्फ्लूएंजा टीकाकरण के साथ-साथ COVID-19 टीके प्राप्त करने की सिफारिश की जाती है। 

घरेलू संपर्कों के लिए जीवित-क्षीण टीके (रोटावायरस और वैरिकाला सहित) प्राप्त करना सुरक्षित है। वैक्सीन-वायरस के संचरण के जोखिम को कम करने के लिए रोटावायरस वैक्सीन प्राप्तकर्ताओं की गंदी लंगोट को संभालते समय पूरी तरह से हाथ की स्वच्छता हमेशा की जानी चाहिए। वैरिकाला टीकाकरण के बाद टीके पर होने वाले किसी भी वैरिकाला-जैसे फफोले को तब तक ढंका जाना चाहिए जब तक कि वे खत्म न हो जाएं। 

Other precautions

For further information related to specific conditions and vaccination, refer to the Australian Immunisation Handbook. 

संसाधन

लेखक: जॉर्जीना लेविस (नैदानिक प्रबंधक, SAEFVIC, मर्डोक चिल्ड्रन रिसर्च इंस्टीट्यूट), फ्रांसेस्का मचिंगाइफा (एमवीईसी एजुकेशन नर्स कोऑर्डिनेटर) और राचेल मैकगायर (एमवीईसी एजुकेशन नर्स कोऑर्डिनेटर)

समीक्षित: Sally Gordon (MVEC Senior Research Fellow) and Rachael McGuire (MVEC Education Nurse Coordinator)

तारीख: December 2023

नई जानकारी और टीके उपलब्ध होते ही इस अनुभाग की सामग्रियों को अद्यतन किया जाता है। मेलबर्न वैक्सीन एजुकेशन सेंटर (MVEC) कर्मचारी सटीकता के लिए नियमित रूप से सामग्रियों की समीक्षा करते हैं।

You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.