{"id":10785,"date":"2021-08-31T10:09:16","date_gmt":"2021-08-31T00:09:16","guid":{"rendered":"https:\/\/mvec.mcri.edu.au\/?post_type=references&p=10785"},"modified":"2025-07-31T10:20:16","modified_gmt":"2025-07-31T00:20:16","slug":"neutropenia-vaccine-recommendations-for-children-with-chronic-neutropenia","status":"publish","type":"references","link":"https:\/\/mvec.mcri.edu.au\/hi\/references\/neutropenia-vaccine-recommendations-for-children-with-chronic-neutropenia\/","title":{"rendered":"Neutropenia and immunisation"},"content":{"rendered":"
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\u092a\u0943\u0937\u094d\u0920\u092d\u0942\u092e\u093f<\/h2>\n

Neutropenia is a condition where a person has a <\/span>lower<\/span> than<\/span> \u0938\u093e\u092e\u093e\u0928\u094d\u092f<\/span> number of neutrophils<\/span>. <\/span>Neutrophils are <\/span>a type of white blood cell<\/span> responsible for fighting bacterial and fungal infections. <\/span>Neutropenia <\/span>is an immunocompromising condition<\/a><\/span>\u00a0that <\/span>can be<\/span> acute <\/span>(<\/span>temporary<\/span>) <\/span>or chronic <\/span>(long<\/span>

<\/div><\/span>term) <\/span>\u0914\u0930 <\/span>\u0939\u0948<\/span> caused by <\/span>certain medications<\/span> or therapies, autoimmune conditions<\/span>, <\/span>infections<\/span>, or other medical conditions.<\/span><\/span><\/p>\n

Neutropenia and vaccines<\/h2>\n

Due to their lowered immunity, <\/span><\/span>\u092e\u0948\u0902<\/span><\/span><\/span>\u0930\u093e<\/span>iv<\/span>id<\/span>uals <\/span>with <\/span>

<\/div><\/span>eutropenia are more vulnerable to infection<\/span>\u090f\u0938<\/span> and their complications<\/span>, m<\/span>eaning <\/span>protection is a priority<\/span>. However, <\/span>protection is<\/span> complicated<\/span>\u00a0since<\/span> some vaccines are contraindicated due <\/span>to the risk of vaccine<\/span>
<\/div><\/span>associated disease.<\/span> The following guidance <\/span>refers to the immunisation of individuals with<\/span> long<\/span>
<\/div><\/span>term<\/span> \u092f\u093e <\/span><\/span>chron<\/span>ic neutropenia<\/span><\/span><\/strong>.<\/span><\/span><\/p>\n

Recommendations<\/h2>\n

\u0928\u093f\u0937\u094d\u0915\u094d\u0930\u093f\u092f \u091f\u0940\u0915\u0947<\/h3>\n

It is reco<\/span>mmended and <\/span>safe <\/span>for people with chronic neutropenia to receive i<\/span>nactivated vaccines<\/span> as per <\/span>the <\/span>routine <\/span>National I<\/span>mmunisation <\/span>Program (NIP)<\/span><\/a> schedule. Given patients with neutropenia are at increased risk of bacterial infections, <\/span>\u0905\u0924\u093f\u0930\u093f\u0915\u094d\u0924<\/span> \u0928\u094d\u092f\u0942\u092e\u094b\u0915\u094b\u0915\u0932<\/span><\/a>

<\/div><\/span> \u090f<\/span>re also recommended<\/span>.<\/span> \u0935\u093e\u0930\u094d\u0937\u093f\u0915 <\/span>\u092e\u0948\u0902<\/span>nfluenza<\/span><\/a> vaccination is recommended <\/span>for those aged 6 months <\/span>and older.<\/span><\/span><\/p>\n

Live<\/span>
<\/div><\/span>attenuated viral vaccines<\/span><\/span><\/h3>\n

Neutropenia itself is <\/span>\u0928\u0939\u0940\u0902 <\/span><\/b>a contraindication to live\u2011attenuated viral vaccines<\/a>, as patients with an isolated neutropenia would be expected to handle viral infections, and correspondingly live\u2011attenuated viral vaccines, in most circumstances.<\/span><\/p>\n

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.<\/span><\/p>\n

A number of patients with chronic moderate<\/span>

<\/div><\/span>\u0917\u0902\u092d\u0940\u0930<\/span> neutropenia (neutrophil count < 1×10^<\/span>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\u2011attenuated viral vaccines (e.g. \u0930\u094b\u091f\u093e\u0935\u093e\u092f\u0930\u0938<\/a>, MMR<\/a> \u0914\u0930 \u0935\u0948\u0930\u0940\u0938\u0947\u0932\u093e<\/a>). If there are no concerning features on history, examination or screening investigations, live\u2011attenuated viral vaccines are recommended, as per the NIP. If any abnormalities or concerns are raised, a formal immunology consult should be sought prior.<\/span><\/p>\n

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\u2011attenuated viral vaccines until this information is available.<\/span><\/p>\n

Live\u2011attenuated viral vaccines are <\/span>contraindicated<\/span><\/b> in patients with other inborn errors of immunity, such as leucocyte adhesion disorder, Chediak\u2013Higashi syndrome or other defects in cytolytic granule release.<\/span><\/p>\n

Live\u2011attenuated bacterial vaccines<\/span><\/b><\/h3>\n

Live\u2011attenuated bacterial vaccines (for example, the mycobacterial \u092c\u0940\u0938\u0940\u091c\u0940<\/a> vaccine, oral typhoid<\/a> (Vivotif) vaccine) are generally <\/span>contraindicated<\/span><\/b> in patients with neutropenia, including those with some phagocytic cell defects. This is due to an increased risk of \u091f\u0940\u0915\u093e<\/span>

<\/div><\/span>associated<\/span><\/span>\u00a0adverse 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). <\/span><\/p>\n

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.<\/span><\/p>\n<\/div>

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\u0938\u0902\u0938\u093e\u0927\u0928<\/h2>\n