Lý lịch

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.

Ức chế miễn dịch và vắc-xin

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.

thời gian tiêm phòng

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).

khuyến nghị

live-attenuated vaccines must not be given to immunocompromised individuals without consultation with a treating specialist. The following Tôinformation outlines Specific vắc xin recommendations people who are immunosuppressbiên tập.

  • Cúm

    Every year, different strains of cúm 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 Sổ tay Chủng ngừa Úc.

  • phế cầu khuẩn

    People with immunosuppression  have the highest risk of experiencing invasive phế cầu khuẩn 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 MVEC: Phế cầu khuẩn

  • não mô cầu

    People receiving certain therapies or with specific medical conditions (particularly those with thiếu lá lách) 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 MEC: não mô cầu

  • 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 MVEC: Zoster

  • 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 Liệu trình cơ bản 3 liều được khuyến nghị để bảo vệ tối ưu (so với liệu trình 2 liều cho những người có khả năng miễn dịch). Sau một khóa học sơ cấp, liều tăng cường are also recommended for some individuals. 

    For more information, refer to MVEC: COVID-19

  • Vi rút u nhú ở người (HPV)

    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)

vắc xin chống chỉ định

Vắc xin sống giảm độc lực 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).

Bảng 1: Các vắc-xin chống chỉ định ở bệnh nhân bị ức chế miễn dịch và các lựa chọn thay thế cần cân nhắc

WordPress Tables Plugin

^được quản lý thường xuyên trong Chương trình Chủng ngừa Quốc gia (NIP)
#vắc-xin được khuyến nghị chỉ dành cho nhóm bệnh nhân được chọn
¥available vaccine for those at higher risk of infection (e.g. travel)
N/A không có vắc xin thay thế

Vô ý tiêm vắc-xin sống giảm độc lực

If an immunocompromised individual is inadvertently administered a live-attenuated vaccine, hành động kịp thời 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  SAEFVIC. 

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. 

Các biện pháp phòng ngừa

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 MEC: Immunosuppression in pregnancy and infant vaccine recommendations

Địa chỉ liên hệ hộ gia đình

Những người tiếp xúc trong gia đình của những người bị ức chế miễn dịch nên được cập nhật tất cả các loại vắc-xin và được khuyến nghị tiêm vắc-xin cúm hàng năm cũng như vắc-xin COVID-19. 

Những người tiếp xúc trong gia đình có thể tiêm vắc-xin sống giảm độc lực (bao gồm vi-rút rota và thủy đậu) là an toàn. Phải luôn thực hiện vệ sinh tay kỹ lưỡng khi xử lý tã bẩn của người được tiêm vắc-xin rotavirus để giảm thiểu nguy cơ lây truyền vi-rút vắc-xin. Bất kỳ vết phồng rộp nào giống như thủy đậu xuất hiện trên người được tiêm vắc-xin sau khi tiêm vắc-xin thủy đậu đều phải được che lại cho đến khi chúng đóng vảy. 

Other precautions

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

Nguồn tài liệu

Các tác giả: Georgina Lewis (Giám đốc lâm sàng, SAEFVIC, Viện nghiên cứu trẻ em Murdoch), Francesca Machingaifa (Điều phối viên y tá giáo dục MVEC) và Rachael McGuire (Điều phối viên y tá giáo dục MVEC)

Đã đánh giá: Sally Gordon (MVEC Senior Research Fellow) and Rachael McGuire (MVEC Education Nurse Coordinator)

Ngày: December 2023

Tài liệu trong phần này được cập nhật khi có thông tin mới và có vắc-xin. Nhân viên của Trung Tâm Giáo Dục Vắc-xin Melbourne (MVEC) thường xuyên xem xét độ chính xác của các tài liệu.

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.