背景

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.

免疫抑制和疫苗

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.

疫苗接种时机

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).

建议

Live-attenuated vaccines must not be given to immunocompromised individuals without consultation with a treating specialist. The following 我nformation outlines 秒pecific 疫苗 recommendations 为了 people who 是 immunosuppress编辑.

  • 流行性感冒

    Every year, different strains of 流感 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 The Australian Immunisation Handbook.

  • 肺炎球菌

    People with immunosuppression  have the highest risk of experiencing invasive 肺炎球菌 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：肺炎球菌

  • 脑膜炎球菌

    People receiving certain therapies or with specific medical conditions (particularly those with 无脾) 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 微血管内皮细胞： 脑膜炎球菌

  • 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：带状疱疹

  • 新冠肺炎

    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 3剂初级课程 建议使用以获得最佳保护（与免疫能力强的人的 2 剂疗程相比）。完成初级课程后， 加强剂量 are also recommended for some individuals. 

    For more information, refer to MVEC：COVID-19

  • 人乳头瘤病毒 (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)

禁忌疫苗

减毒活疫苗 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).

表 1：免疫抑制患者的禁忌疫苗和需要考虑的替代方案

WordPress Tables Plugin

^国家免疫计划 (NIP) 的常规管理
#仅针对特定患者组推荐的疫苗
¥available vaccine for those at higher risk of infection (e.g. travel)
不适用 没有可用的替代疫苗

无意中注射了减毒活疫苗

If an immunocompromised individual is inadvertently administered a live-attenuated vaccine, 迅速行动 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  赛维克. 

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. 

防范措施

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 微血管内皮细胞： Immunosuppression in pregnancy and infant vaccine recommendations

家庭联系人

免疫抑制个体的家庭接触者应及时接种所有疫苗，并建议每年接种流感疫苗和 COVID-19 疫苗。 

家庭接触者接种减毒活疫苗（包括轮状病毒和水痘疫苗）是安全的。在处理轮状病毒疫苗接种者的脏尿布时，应始终保持彻底的手部卫生，以尽量减少疫苗病毒传播的风险。水痘疫苗接种后，接种者身上出现的任何水痘样水疱都应被遮盖，直至结痂。 

其他注意事项

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

资源

作者： Georgina Lewis（默多克儿童研究所 SAEFVIC 临床经理）、Francesca Machingaifa（MVEC 教育护士协调员）和 Rachael McGuire（MVEC 教育护士协调员）

评论： Sally Gordon (MVEC Senior Research Fellow) and Rachael McGuire (MVEC Education Nurse Coordinator)

日期: December 2023

本章节内的材料将随着新信息和新疫苗的出现而进行更新。墨尔本疫苗教育中心（MVEC）职员定期审阅材料的准确性。

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.