IN IMMUNOCOMPROMISED STATE

Any state (that lowers the body’s resistance to infection) such as :

  • HIV Positive/ AIDS
  • Congenital Immunodeficiency (present from birth)
  • Children suffering from leukemia (blood cancer) and malignant tumors
  • Children on Immunosuppressive therapy – Post Bone marrow transplant, Post kidney transplant, etc.

Recommendation by WHO for Immunisation in HIV Infected Children

Vaccine Known Asymptomatic Known Symptomatic
BCG Yes* No
DPT/DTaP Yes Yes
OPV Yes No
Measles/MMR Yes Yes
Hepatitis B Yes Yes

WHO: World Health Organization;

*For regions where risk of TB is high.

Recommendation by AAP*/ACIP** for Immunisation in HIV Positive Children.

It remains the same in asymptomatic and symptomatic children.

Vaccine HIV Positive child
BCG No
DPT/DTaP Yes
OPV No
Measles/MMR Yes
IPV Yes
Hepatitis B Yes
HiB Yes
Pneumococcal Yes
Influenza Yes
Varicella Consider
Hepatitis A Yes

AAP*: American Academy of Pediatrics

ACIP**: Advisory Committee on Immunisation Practices

. In other immunocompromised states (apart from HIV), the live attenuated (weakened) virus vaccines are normally contraindicated.The following vaccines should not be given:

  • OPV
  • BCG
  • Measles/MMR
  • Oral Typhoid vaccine

There being one exception, the Varicella vaccine (Chicken Pox Vaccine). It must be considered in such children, inspite of the fact that it is a live vaccine because these children are very susceptible to Herpes Zoster and Chicken Pox infections.

Moreover, care should be taken that the household contacts of such Immunocompromised patients should not receive OPV. They should be given IPV instead.

Passive Immunisation with the immunoglobulin preparations are useful in such cases as a precautionary measure after exposure.

Immunisation in children receiving corticosteroids

  1. Children receiving high dose of corticosteroids (2 mg/kg/day) for more than 14 days should not receive live vaccines until steroid has been discontinued for at least 1 month. The following vaccines should not be given:
    • OPV
    • BCG
    • Measles/MMR
    • Oral Typhoid vaccine
    • Low doses of steroid
    • Topical steroids
  2. However, following are not contraindications for live virus vaccine.
    • Inhaled steroid therapy
    • Topical steroids
    • Inhaled steroid therapy