Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Vaccinating immunosuppressed persons
Vaccinating patients who are immunosuppressed can be very tricky. Due to their compromised immune systems, vaccines could potentially do more harm than good. Vaccines can either be live (active) or inactivated. Giving an immunocompromised patient an inactivated is thought to be relatively safe for the patient. Examples of these vaccines are TDaP (Tettanus, Diphtheria, and Pertussis) and influenza vaccines. Since the virus has been killed, it does not pose a threat to the patient. However, the downside to this is the requirement of boosters and even with boosters, the immune response may not be optimal.
Live vaccines such as MMR (Measles, Mumps, Rubella) and OPV (Oral Polio Vaccine) should never be given to immunosuppressed patients. You would essentially be injected an active virus into a patient who will not be able to defend against it. Although there are speical rules and guidelines about each vaccination and how immunosuppressed a patient is, severely immunosuppressed person should never receive live vaccines.
Sources:
http://www.cdc.gov/mmwr/preview/mmwrhtml/00023141.htm
Doug- the article that I read outline different scenarios for the severity of immunosuppression for various vaccines. I thought that typically an inactivated vaccine would only contain fragmented pieces of a virus, thus not giving it a chance to mutate because it isn't a complete organism. I also am not sure how an immunocompromised patient would completely eradicate the vaccine without developing the immunological responses to it first. I'm sure the severity of compromise takes into count why that patient is compromised in the first place. As we learned, a patient doesn't have to necessarily have an congenital autoimmune disease, they could have been on long term corticosteroids. We know which cells are impacted by certain diseases, but we do not know how that applies to vaccination.
It is important to distinguish between inactive vaccines and live attenuated vaccines. The latter produce more robust responses but have more containdications.
Vaccinating an immunocompromised patient can also depend on the severity of their condition. Are there certain immune cells that are not working at all? Is it almost every aspect of their immune system that is not working as well as it should be? Another factor that must be carefully considered is can an immunocompromised patient that is being administered an inactivated vaccine eradicate that vaccine from their body? There is a chance that the inactivated vaccine can mutate back to the active form and infect the person if they cannot remove the vaccine from their system. While it is unlikely that an inactive vaccine will infect even an immunocompromised patient, even this consideration must be taken when dealing with these types of patients.