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Next we are going to talk about a special category of children and talk about immunization of immunocompromised children. In general, immunocompromising conditions are shown on this slide and those are subjects with malignancies, systemic steroids – 1 to 2 mg/kg per day of prednisone or equivalent, or a total of 20 mg per day – congenital immunodeficiencies, HIV infection or transplant recipients. That’s the population I’m talking about. With immunocompromised children, as a general rule, killed vaccines, inactivated vaccines, should be administered routinely and where you need to think about it is in regards to live vaccine. In general, we’ve talked about how they are generally contraindicated. Definitely should give IPV and not OPV for the subject and household contacts. The exception to live vaccines is MMR, and what’s not in your handout, varicella vaccine. Also varicella vaccine as well as MMR vaccine may be given to HIV infected children unless they are severely immunocompromised. If they are severely immunocompromised they should not receive MMR or varicella vaccine.
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Influenza vaccine may be indicated for immunocompromised children. Candidates for influenza vaccine include those with chronic diseases, immunocompromised individuals, and anyone at risk for Reye’s syndrome which may occur with influenza. And that would be, for example, subjects with JRA on long term aspirin therapy. And close contact of anybody with the above conditions and that’s because you can prevent them from coming in contact with influenza. Then age 6 months or older. Shouldn’t be used less than 6 months of age. The vaccine is inactivated, it’s trivalent, containing two strains of influenza A and one strain of influenza B. It changes yearly. You need to vaccinate yearly. The side effects of vaccination are mostly local reactions and the timing of vaccination should be in the fall of every year right before flu season starts. The schedule is here, included for completeness, but really I think if you know who should get influenza vaccine that’s the most important issue, not the exact schedule. You should know that it’s given greater than 6 months of age and that split virus only should be used less than 12 years of age, because that’s less reactagenic, less than 12 years of age. There is a whole virus and a split virus vaccine and both of those can be given after 12 years of age. There is no difference.
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Pneumococcal vaccine consists of 23 different serotypes of pneumococcus that are included in the vaccine. The usual side effects are local reactions and low-grade fever. This should be administered to children who are at least 2 years of age and older, who have conditions such as HIV infection, asplenia and nephrotic syndromes, CFS leaks, malignancy. These are all subjects who are at increased risk of pneumococcal, invasive pneumococcal disease. And also those with chronic diseases are at risk as well.
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