Background

Childhood cardiac disease can be congenital or acquired. Congenital cardiac disease describes a number of conditions including malformations of the heart, major blood vessels or heart valves. Approximately 1 in 100 babies born in Australia each year will have some form of congenital heart disease. Acquired cardiac disease can include rheumatic heart disease or cardiac disease secondary to Kawasaki disease.

Children with underlying cardiac disease are at increased risk of complications of vaccine preventable diseases when compared to children who do not have cardiac disease. This can be exacerbated by an increased risk of exposure due to the need for frequent health care appointments and hospital stays. Those at highest risk include children with cyanotic heart disease or cardiac failure.

Vaccine recommendations

Children with cardiac disease can safely receive vaccines according to the National Immunisation Program (NIP) vaccine schedule. Additional vaccines such as pneumococcal, influenza and COVID-19 vaccines are also recommended (see Table 1).

Family members and household contacts are recommended to be up to date with all vaccines including pertussis, annual influenza and COVID-19 vaccines. Close contacts of children with cardiac disease can receive live-attenuated vaccines without the need for additional precautions.

Table 1: Vaccine recommendations for children with cardiac disease

Vaccine Recommendation
Influenza Annual influenza vaccines are recommended from 6 months of age. Two doses of age-appropriate vaccines are required in the first year of vaccination for children < 9 years.
Pneumococcal An additional pneumococcal conjugate vaccine (Prevenar 13®) is recommended at 6 months of age (or at diagnosis, whichever is later). A pneumococcal polysaccharide vaccine (Pneumovax 23®) should be given at 4 years of age (minimum 8 weeks post Prevenar13, whichever is later), followed by another dose at least 5 years later (max. 2 doses in a lifetime).
COVID-19 Children with cardiac disease are at a greater risk of severe COVID disease. A primary course of COVID-19 vaccines are recommended for children aged 5 and above with further booster doses recommended for those aged ≥ 16 years.
Travel vaccines Specialist travel advice should be sought when travelling overseas, particularly to high risk areas for vaccine preventable diseases.

Children with cardiac disease who are to undergo a transplant should also receive further vaccines as part of their workup prior to transplant.

Immunisation queries should be directed to the treating doctor and/or the Royal Children’s Hospital Immunisation Service.

Vaccine precautions

Precautions are recommended when vaccinating children with cardiac disease in the following circumstances:

  • in children who are immunocompromised, live-attenuated vaccines may be contraindicated
  • children who have received blood products/and or immunoglobulin may need to delay vaccination
  • if children are also asplenic or have hyposplenism, further additional vaccines are recommended
  • children for whom cardiac surgery is indicated:
    • before surgery – inactivated vaccines can be administered up until 1 week prior to surgery, live-attenuated vaccines can be administered up until 3 weeks prior to surgery (e.g. MMR, varicella)
    • vaccines indicated following surgery should be delayed for at least one week due to the potential for confusing expected vaccine side effects with post-operative complications.

Resources

Author: Kirsten Mitchell (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Reviewed by: Francesca Machingaifa (MVEC Education Nurse Coordinator) and Rachael McGuire (MVEC Education Nurse Coordinator)

Date: May 9, 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy. You should not consider the information in 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.