背景

Children with neutropenia are at increased risk of bacterial and fungal infections. Preventing infections is this group is therefore a priority and we should be aiming to protect these children against vaccine preventable diseases (VPDs) according to the National Immunisation Program (NIP).

There is a lack of direct data to base vaccine recommendations in this group. This group of patients is not addressed in the Australian Immunisation Handbook. A number of international expert groups have however published recommendations in this area (see resources).

Inactivated vaccines are considered safe, and international guidelines recommend they be administered to patients with neutropenia as per routine immunisation schedules. Given patients with neutropenia are at increased risk of bacterial infections, some also recommend additional pneumococcal vaccines, as for patients at increased risk of invasive pneumococcal disease (IPD).

Live-attenuated viral vaccines are contraindicated in patients who are severely immunocompromised, due to the risk of unchecked viral replication and vaccine associated disease. Neutropenia itself, however, is not a contraindication to live-attenuated viral vaccines as patients with an isolated neutropenia would be expected to handle viral infections, and live-attenuated viral vaccines in most circumstances. International guidelines recommend these vaccines be given to patients with congenital or cyclical neutropenia, or neutropenia in general. However, some recommend against these vaccines in patients with undefined phagocytic cell defects or phagocytic cell defects undefined at a molecular level, and others recommend prior immunology review. This is because some conditions which affect neutrophil number or function may also affect lymphocyte number or function. Live-attenuated viral vaccines are contraindicated in patients with leucocyte adhesion disorder, Chediak Higashi syndrome or other defects in cytolytic granule release.

Live bacterial vaccines (including the BCG vaccine) are contraindicated in patients who are immunocompromised including those with some phagocytic cell defects. This is due to an increased risk of vaccine associated adverse events in this group.

Our recommendations are based on these international guidelines and local consensus.

建议

灭活疫苗

Inactivated vaccines are 受到推崇的 as per the NIP. We also recommend additional pneumococcal vaccines, as for patients at high risk of invasive pneumococcal disease (see resources).

Live-attenuated viral vaccines

Neutropenia itself is not a contraindication to live-attenuated viral vaccines. In cases of an undefined neutropenia some caution should be exercised, given neutropenia can occur in the setting of conditions which also affect lymphocyte number and function

For patients with congenital neutropenia or cyclical neutropenia caused by a known molecular defect (which is not associated with any other immune dysfunction), live-attenuated viral vaccines are 受到推崇的 as per the NIP.

A number of patients with chronic moderate-severe neutropenia (neutrophil count <1 x10^9/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 (see MVEC Flowchart: Live attenuated viral vaccines in patients with chronic neutropenia). 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 禁忌 in patients with leucocyte adhesion disorder, Chediak Higashi syndrome or other defects in cytolytic granule release.

Live bacterial vaccines

Live bacterial vaccines (e.g. the BCG vaccine, oral typhoid vaccine) are generally 禁忌 in patients with neutropenia. Typhoid protection can be provided by using an inactivated vaccine. If there is a high risk of Tuberculosis in an individual with neutropenia, BCG vaccine should be discussed with both an immunisation specialist and haematologist.

资源

 

作者： Luisa Clucas (Clinical Haematology Registrar, Royal Children’s Hospital), Anthea Greenway (Head of Clinical Haematology, Royal Children’s Hospital), Theresa Cole (Consultant, Allergy and Immunology, Royal Children’s Hospital), and Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute)

日期： 2021 年 8 月

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。

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