Neutropenia and immunisation

Lý lịch

Neutropenia is a condition where a person has a lower than Bình thường number of neutrophils. Neutrophils are a type of white blood cell responsible for fighting bacterial and fungal infections. Neutropenia is an immunocompromising condition cái đó can be acute (temporary) or chronic (long

term) Và là caused by certain medications or therapies, autoimmune conditions, infections, or other medical conditions.

Neutropenia and vaccines

Due to their lowered immunity, Tôithứividuals with

eutropenia are more vulnerable to infectionS and their complications, meaning protection is a priority. However, protection is complicated since some vaccines are contraindicated due to the risk of vaccine

associated disease. The following guidance refers to the immunisation of individuals with long

term hoặc chronic neutropenia.

khuyến nghị

vắc xin bất hoạt

It is recommended and safe for people with chronic neutropenia to receive inactivated vaccines as per các routine National Immunisation Program (NIP) schedule. Given patients with neutropenia are at increased risk of bacterial infections, thêm vào phế cầu khuẩn

Mộtre also recommended. Hàng năm Tôinfluenza vaccination is recommended for those aged 6 months and older.

Live

attenuated viral vaccines

Neutropenia itself is không 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 moderate

nghiêm trọng 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. virus rota, MMR Và thủy đậu). 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 chống chỉ định 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 BCG vaccine, oral typhoid (Vivotif) vaccine) are generally chống chỉ định in patients with neutropenia, including those with some phagocytic cell defects. This is due to an increased risk of vắc xin

associated 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.

Tài liệu

• Australian Immunisation Handbook: Phagocytic and neutrophil disorders: recommendations for vaccination
• Australian Immunisation Handbook: Risk conditions for Pneumococcal Disease
• Cẩm nang Tiêm chủng Úc: Tiêm chủng cho người suy giảm miễn dịch
• 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