Pediatric infectious disease chief authors new vaccination guideline for immunocompromised patients

December 5, 2013, North Shore-Long Island Jewish Health System

A new guideline released Thursday by the Infectious Diseases Society of America (IDSA) notes that most people with compromised immune systems are especially vulnerable to illness and should receive the flu shot and other vaccinations. The guideline, entitled "Clinical Practice Guideline for the Vaccination of the Immunocompromised Host," was authored by Lorry G. Rubin, MD, director of the pediatric infectious diseases at Cohen Children's Medical Center of New York in New Hyde Park, NY, and professor of pediatrics at the Hofstra North Shore-LIJ School of Medicine, and will be published online Thursday in Clinical Infectious Diseases.

The new guideline aims to aid primary care physicians and specialists who treat (people with compromised immune systems, such as those with cancer, HIV infection and Crohn's disease), and those who live with immunocompromised patients.

"The guideline provides 'one-stop shopping' for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for all vaccinations, from influenza to chicken pox," said Dr. Rubin. "Previously, the recommendations were difficult to retrieve because in most cases information had to be accessed individually by vaccine rather than by the category of patient disease."

The new guideline includes recommendations for most available vaccinations, ranging from hepatitis A, measles, mumps and rubella and other childhood vaccinations to those for influenza, pneumococcus and herpes zoster. It applies to patients with congenital immune deficiencies, HIV/AIDS, cancer, solid organ transplant (such as kidney and liver), stem cell transplant, chronic inflammatory conditions (such as rheumatoid arthritis and Crohn's disease), sickle cell disease and asplenia, cochlear implants, and cerebrospinal fluid (CSF) leaks. The guideline notes that most immunocompromised patients six months or older should receive the annual influenza shot, but should not receive the live attenuated influenza vaccine that comes in the form of a nasal spray. Patients receiving intensive chemotherapy or who have received anti-B-cell antibodies in the previous six months are unlikley to benefit from a .

The panel that developed the guideline includes adult and pediatric specialists in gastroenterology, immunology, , hematology, oncology, rheumatology and stem-cell and solid-organ transplantation. In addition to Dr. Rubin, the panel includes: Myron J. Levin, MD, Per Ljungman, MD, PhD, E. Graham Davies, MD, Robin Avery, MD, Marcie Tomblyn, MD, Athos Bousvaros, MD, Shireesha Dhanireddy, MD, Lillian Sung, MD, PhD, Harry Keyserling, MD, and Insoo Kang, MD.

The vaccination of immunocompromised patient guideline will be available in mobile device, pocket-sized quick-reference editions, and on the IDSA website http://www.idsociety.org.

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