Neutropenia and immunisation
पृष्ठभूमि
Neutropenia is a condition where a person has a lower than सामान्य number of neutrophils. Neutrophils are a type of white blood cell responsible for fighting bacterial and fungal infections. Neutropenia is an immunocompromising condition that can be acute (temporary) or chronic (longterm) और है caused by certain medications or therapies, autoimmune conditions, infections, or other medical conditions.
Neutropenia and vaccines
Due to their lowered immunity, मैंराividuals with eutropenia are more vulnerable to infectionएस and their complications, meaning protection is a priority. However, protection is complicated since some vaccines are contraindicated due to the risk of vaccineassociated disease. The following guidance refers to the immunisation of individuals with longterm या chronic neutropenia.
Recommendations
निष्क्रिय टीके
It is recommended and safe for people with chronic neutropenia to receive inactivated vaccines as per the routine National Immunisation Program (NIP) schedule. Given patients with neutropenia are at increased risk of bacterial infections, अतिरिक्त न्यूमोकोकल एre also recommended. वार्षिक मैंnfluenza vaccination is recommended for those aged 6 months and older.
Liveattenuated viral vaccines
Neutropenia itself is नहीं a contraindication to live‑attenuated viral vaccines, as patients with an isolated neutropenia would be expected to handle viral infections, and correspondingly live‑attenuated viral vaccines, in most circumstances.
In cases of an undefined neutropenia some caution should be exercised, given neutropenia can occur in the setting of conditions which also affect lymphocyte (another type of white blood cell) number and function.
A number of patients with chronic moderateगंभीर neutropenia (neutrophil count < 1×10^9/L) will not have a defined molecular defect; the cause may be unclear, or they may have suspected immune neutropenia for which there is no diagnostic test. In these patients, an evaluation for an underlying immune defect is recommended prior to administration of live‑attenuated viral vaccines (e.g. रोटावायरस, MMR और वैरीसेला). If there are no concerning features on history, examination or screening investigations, live‑attenuated viral vaccines are recommended, as per the NIP. If any abnormalities or concerns are raised, a formal immunology consult should be sought prior.
In patients for whom the neutropenia is expected to be transient, or further investigation is planned in the near future (e.g. bone marrow examination or molecular studies), consideration should be given to delaying live‑attenuated viral vaccines until this information is available.
Live‑attenuated viral vaccines are contraindicated in patients with other inborn errors of immunity, such as leucocyte adhesion disorder, Chediak–Higashi syndrome or other defects in cytolytic granule release.
Live‑attenuated bacterial vaccines
Live‑attenuated bacterial vaccines (for example, the mycobacterial बीसीजी vaccine, oral typhoid (Vivotif) vaccine) are generally contraindicated in patients with neutropenia, including those with some phagocytic cell defects. This is due to an increased risk of टीकाassociated adverse events in this group, including delayed healing at the BCG site. When indicated, typhoid protection can be provided by using the alternate inactivated vaccine (Typhim Vi).
If there is a high risk of tuberculosis exposure in an individual with neutropenia, such as travel to a endemic area to visit friends and relatives (VFR), BCG vaccine should be discussed with both an immunisation specialist and haematologist.
संसाधन
- Australian Immunisation Handbook: Phagocytic and neutrophil disorders: recommendations for vaccination
- Australian Immunisation Handbook: Risk conditions for Pneumococcal Disease
- ऑस्ट्रेलियन इम्युनाइजेशन हैंडबुक: उन लोगों के लिए टीकाकरण जो प्रतिरक्षा में अक्षम हैं
- 2013 IDSA Clinical practice guideline for vaccination of the immunocompromised host
- Medical advisory committee of the immune deficiency foundation: Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts 2014
- Canadian Immunisation Guide: Immunization of immunocompromised persons
- Martire B, Azzari C, Badolato R, Canessa C, Cirillo E, Gallo V, et al. Vaccination in immunocompromised host: Recommendations of Italian Primary Immunodeficiency Network Centers (IPINET). Vaccine. 2018;36(24):3541-54
लेखक: Luisa Clucas (Clinical Haematology Registrar, Royal Children’s Hospital), Anthea Greenway (Head of Clinical Haematology, Royal Children’s Hospital), Theresa Cole (Consultant, Allergy and Immunology, Royal Children’s Hospital), and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)
द्वारा समीक्षित: Nigel Crawford (MVEC Director) and Rachael McGuire (MVEC Education Nurse Coordinator)
तारीख: July 2025
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.
Needle anxiety and phobia
पृष्ठभूमि
Many children and adults find the experience of having a needle to be unpleasant. However, for some people the experience is much more difficult, presenting as a phobia characterised by both severe and persistent anxiety and fear. This patient group often avoids needlerelated experiences, including immunisation. However, avoiding immunisation leaves an individual susceptible to vaccinepreventable diseases that can cause serious illness, which may lead to other invasive and stressful medical interventions or ongoing health complications. Needle phobia can be a lifelong problem if not managed properly.
Similarly, individuals with autism spectrum disorder (ASD) or intellectual disability often find needle-related experiences and immunisation difficult. Reasons may include past experiences, previous medical trauma, and unfamiliar or overstimulating environments. This impacts immunisation rates and coverage in this patient group which is concerning as underlying causes for disability (e.g. prematurity) can increase vulnerability to vaccine-preventable infections and disease.
Recommendations
It is important to recognise that every needle-related experience will have an impact on future experiences.
Implementing the following strategies can minimise discomfort and stress and increase the support for people who find immunisation challenging. Utilising these strategies may also be helpful to prevent a fear of needles from developing into needle phobia. The best approach will vary depending on circumstances, and from person to person. Immunisation procedures work best when caregivers, immunisation providers and vaccine-recipients work together.
Before vaccination
Preparation
Making time before the procedure for the immunisation provider and parent/caregiver/support person to discuss the types of strategies to implement that will assist in the procedure going smoothly. The parent/caregiver/support person plays a vital role in the vaccination process because they know the vaccine-recipient best, including their past experiences, behaviours, communication methods, and what may be helpful. Preparing an individualised plan for how to approach the experience in advance, as well as having a backup plan and knowing when to abandon the attempt, will support everyone’s expectations at the appointment.
Reviewing the pre-immunisation checklist and discussing the expected side effects, any post-vaccination care required and gaining consent all in advance of the appointment will mean that there is less distraction and delay on the day.
Environment
It is generally recommended that children and adults with anxiety, intellectual disabilities or needle phobia avoid attending large scale vaccination sites for immunisation. These sites tend to be loud and busy which can increase distress. Smaller settings such as GP clinics are preferred as they are usually quieter and therefore less overwhelming. In addition, they do not have the same time constraints as busy clinics, alleviating the pressure to complete the procedure quickly.
Being able to dim the lights, reduce sounds, and having enough space for a person to move their body can support people who may be overwhelmed by the sensory stimulus as well as maintain staff safety.
Communication
It is important to consider the language used and the way to speak about immunisation with vaccine-recipients. Needle phobia is real, and it is okay for a person to be scared. Criticism can make the fear or anxiety worse.
It may be helpful for a carer/support person to inform a vaccine-recipient in advance about an upcoming appointment because the surprise may leave the person feeling a loss of control. How far in advance to provide this information is very dependent on the individual and is often based on a person’s age, past-experience, ability to understand the information. Keeping the conversation short and the information age/ability-appropriate is important. For example, using words like “arm medicine” or “vaccine” may be more helpful than “needle” or “injection”. Where possible, avoid telling someone to “be brave” as it may inadvertently encourage them to suppress their emotions.
Using clear (not ambiguous) and simple language and allowing pauses for information processing is helpful. Discussing one idea at a time also avoids overwhelming a person. Using a calm and low tone of voice can be soothing. Limiting choices or using “guided choices” can support the procedure by giving the vaccine-recipient control in the process. For example, asking a child “do you want to sit on mum’s lap or dad’s lap?” gives them some choice while controlling the outcome of sitting on someone’s lap.
Equipment and distraction
Making sure that any equipment required is easily accessible. Needing to pause during the procedure to locate equipment can increase a person’s anxiety about the experience and possibly lead to an unsuccessful attempt. This includes any equipment required for distraction to reduce anxiety (e.g. bubbles, toys, books, music).
The application of local anaesthetic cream or patches to the site should be done a minimum of 45 minutes prior to appointment (available for purchase from chemists) and may help to settle a person’s fear of pain.
During the procedure
Positioning
A person should never be restrained for a procedure. However, a comfort hold, provided with consent, can offer a supportive and secure cuddle for the vaccine-recipient and help them to feel safe in the process. Comfort holds also reduce the likelihood of needle-stick injury for the vaccine-recipient and immunisation provider.
Positioning the vaccine-recipient appropriately also supports good visualisation of the injection site. It is important to remove tight clothing to expose the entire limb and ensure safe and accurate injection technique.
Stimming (e.g. rocking or flapping) should be supported because they are behaviours that a person finds soothing during stressful situations. If stimming is stopped or prevented this will increase anxiety and distress and compromise the safety of the procedure.
Administration
Preparing the vaccine prior to the vaccine-recipient entering the treatment room and keeping it out of sight can help minimise distress. This includes keeping the vaccine to your side or behind your back until the very moment of injection.
Some people will benefit from a countdown or other indication of timing to avoid an extended period of anxiety not knowing when the injection will occur.
Keeping any conversations as short as possible will reduce anticipation and therefore prevent escalation of anxieties. Where possible, vaccine recipients should be encouraged to look away as watching the injection can cause distress. Observing the injection can also result in a vasovagal reaction (faint) which can further fuel anxiety and fear when facing future injections. Instead focusing on age/ability-appropriate distraction measures (e.g. bubbles, toys, book, song, tv), closing eyes or even wearing an eye mask can be helpful.
Do not rush the vaccine-recipient to accept the vaccine as this will likely lead to an unsuccessful attempt. There should be a low threshold for referral to specialist immunisation clinics for sedation in the case of vaccine-recipients with autism spectrum disorder (ASD) and some intellectual disabilities.
Post-procedure
Praise the effort
It is important to praise the vaccine-recipient (and carer/support person) for their efforts. Even if the vaccination attempt was unsuccessful, even entering the vaccine space is an achievement for someone with a phobia. Saying something like “You tried and even got as far as rolling up your sleeve, that’s amazing!” will have a huge impact on their confidence to try again next time.
Rewards can be helpful in creating positive memories about the vaccine experience and can build confidence and acceptance for future encounters. Though care needs to be taken not to add pressure/stress by using the reward as a motivator for getting the vaccine in; a threat of not getting a reward is unhelpful.
Reflection
After any vaccination attempt for someone with needle anxiety or phobia, it is important to reflect on the things that helped and the things that didn’t. A conversation between immunisation provider, care/support person +/- vaccine recipient will ensure that each perspective is considered. Documenting this will assist in the success of future attempts.
Additional support
While some people with needle phobia can be vaccinated in the community with support and safeguards in place, other may require specialist treatment to undergo vaccination.
Specialist trained psychologists and more recently hypnotherapists have had significant success in giving an individual mechanisms and strategies to help overcome or manage their needle phobia. Considering either pathway is recommended as a long-term strategy to overcome needle phobia.
बेहोश करने की क्रिया
If immunisation attempts are unsuccessful in the community, a referral for vaccines to be administered under sedation may be considered.
Victorian paediatric services
- The Royal Children’s Hospital – Referrals for this service can be sent to नर्स प्रैक्टिशनर टीकाकरण वीia [email protected]
- Monash Health – Referrals can be submitted as a हेल्थलिंक रेफरल
- परिवार टीकाकरण और यात्रा विशेषज्ञ (FITS) – Make an appointment via webpage / web referral
Victorian adult services
- Monash Health – Referrals can be submitted as a हेल्थलिंक रेफरल
If you are based in another Australian jurisdiction, contact your local specialist immunisation service for advice about accessing sedation.
संसाधन
- प्रक्रियात्मक दर्द प्रबंधन के लिए रॉयल चिल्ड्रेन हॉस्पिटल क्लीनिकल प्रैक्टिस दिशानिर्देश
- रॉयल चिल्ड्रन्स हॉस्पिटल कंफर्ट किड्स- बच्चों के लिए
- द रॉयल चिल्ड्रन हॉस्पिटल बी पॉजिटिव: इम्युनाइजेशन
- Immunisation Foundation of Australia: Overcoming your fear of needles a guide for adults
- Immunisation Foundation of Australia: Tips for children with needle phobia a guide for parents
- आरसीएच किड्स हेल्थ इंफो पॉडकास्ट: सुइयों का डर। क्या मदद करता है?
- बातचीत: क्या आपका बच्चा सुइयों से डरता है? यहां बताया गया है कि उन्हें अपने COVID वैक्सीन के लिए कैसे तैयार किया जाए
- Medi Ready Kids
- Meg Foundation
लेखक: Georgie Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (MVEC Education Nurse Coordinator) and Lynn Addlem (Nurse Practitioner, RCH Immunisation Service)
द्वारा समीक्षित: राचेल मैकगायर (MVEC शिक्षा नर्स समन्वयक)
तारीख: September 2025
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.
न्यूरोलॉजिक और न्यूरोडेवलपमेंटल स्थितियां
There are a number of neurological conditions that are associated with an increased risk of vaccine preventable diseases. These include:
- Epilepsy and seizure disorders
- Developmental delay and intellectual disability
- Cerebral palsy
- Neuromuscular disorders
- Hydrocephalus and children with ventricular-peritoneal shunts
Children with any of these underlying conditions should have routine vaccinations according to the Australian National Immunisation Program Schedule.
In children where epilepsy is unstable, or there is a progressive neurological disorder of unclear aetiology, specialist consultation is recommended to advise on the appropriate vaccination course. In Victoria, referrals for this service should be made to सैफविक.
Influenza vaccination
All children with neurologic and neurodevelopmental conditions are at high risk of severe and complicated influenza infection.
This includes disorders that do not have an obvious compromise in respiratory function such as intellectual disability and epilepsy. Influenza infection can also markedly increase seizures in children with epilepsy.
These children should all be offered annual influenza vaccination from 6 months of age. Two doses are required in the first year the vaccine is received if less than 9 years of age [see Resources].
Pneumococcal vaccination
Children with CSF leaks and intracranial shunts are at higher risk of invasive pneumococcal disease. This includes brain inflammation (meningitis) and blood infection (bacteraemia). These children should be offered additional vaccines, including an extra pneumococcal conjugate vaccine to optimise protection. See the Pneumococcal chapter in the Australian Immunisation Handbook for the latest recommendations [see Resources]
Human Papillomavirus (HPV) Vaccination
Transmission of the HPV virus is primarily through sexual intercourse and can also occur via non- penetrative sexual contact.
There is some evidence for potential virus transmission via viral particles on hands.
HPV infection is associated with the potential development of serious disease such as cervical and anogenital cancers. The infection is also the primary cause of anogenital warts.
As transmission can be varied, children with neurodevelopmental conditions should be offered HPV vaccination as per the routine secondary school program.
संसाधन
- The Australian Immunisation Handbook: Pneumococcal chapter
- HPV Cancer Council
- MVEC: Influenza Vaccine Recommendations
- MVEC: Human Papilloma Virus (HPV)
- एमवीईसी: सैफविक
लेखक: Teresa Lazzaro (Paediatrician, Immunisation Service, Royal Children’s Hospital Melbourne)
तारीख: September 2018
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।
आपको इस साइट की जानकारी को अपने व्यक्तिगत स्वास्थ्य या अपने परिवार के व्यक्तिगत स्वास्थ्य के लिए विशिष्ट, पेशेवर चिकित्सा सलाह नहीं मानना चाहिए। टीकाकरण, दवाओं और अन्य उपचारों के बारे में निर्णय सहित चिकित्सा संबंधी चिंताओं के लिए, आपको हमेशा एक स्वास्थ्य देखभाल पेशेवर से परामर्श लेना चाहिए।