Vaccination Recommendations for the Immunocompromised Adult Patient
DOI:
https://doi.org/10.20344/amp.22966Keywords:
Immunocompromised Host, Transplant Recipients, Vaccination, VaccinesAbstract
The manuscript collates indications for vaccination in immunocompromised adults based on recommendations from leading international institutions. These individuals have increased vulnerability to vaccine-preventable infectious diseases, and their immune response to vaccination is often weaker than that of immunocompetent individuals. Therefore, whenever possible, it is important to assess vaccine response (serological or other). Emphasis is placed on adapting vaccination to the net state of immunosuppression, following a careful evaluation of risks, indications, contraindications, and the optimal timing for administration. Whenever feasible, vaccination should be carried out before the initiation of pharmacological immunosuppression, prior to splenectomy, or before receiving a solid organ transplant. Immunocompromised individuals are categorised into groups such as those with immune-mediated inflammatory diseases, individuals who have undergone splenectomy, recipients of solid organ or haematopoietic transplants, people living with HIV, and those with congenital immunodeficiencies (inborn errors). The article describes vaccination recommendations for different clinical scenarios and types of immunosuppression. Vaccines against respiratory viral diseases, including influenza, COVID-19, and respiratory syncytial virus, as well as hepatitis A and B, varicella-zoster, and vaccines protecting against encapsulated bacteria such as pneumococci, meningococci, and Haemophilus influenzae, are discussed. Some vaccination recommendations in the context of travel and post-exposure prophylaxis in high-risk situations are included. The article also addresses the importance of vaccinating household contacts and healthcare professionals for additional protection. Finally, it highlights that ongoing advancements in vaccines and vaccination guidelines require continuous updates.
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References
Infectious Diseases Society of America, Centers for Disease Control and Prevention. General best practice guidelines for immunization: altered immunocompetence. [consultado 2025 jan 03]. Disponível em: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/ immunocompetence.html.
Public Health Agency of Canada. Immunization of immunocompromised persons: Canadian immunization guide. [consultado 2025 fev 05]. Disponível em: https://www.canada.ca/en/public-health/ services/publications/healthy-living/canadian-immunization-guidepart- 3-vaccination-specific-populations/page-8-immunizationimmunocompromised- persons.html.
Australian Technical Advisory Group on Immunisation. Australian immunisation handbook: vaccination for people who are immunocompromised. 2022. [consultado 2025 fev 05]. Disponível em: https://immunisationhandbook.health.gov.au/contents/ vaccination-for-special-risk-groups/vaccination-for-people-who-areimmunocompromised# page-history.
Immunisation Advisory Centre. Vaccination of special groups. [consultado 2025 fev 05]. Disponível em: https://www.immune.org.nz/ immunisation/programmes/special-groups.
Direção-Geral da Saúde. Norma n.o 018/2020 de 27/09/2020 - programa nacional de vacinação 2020. Lisboa: DGS; 2020.
Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev. 2020;16:442-9. DOI: https://doi.org/10.2174/1573399815666191024085838
Espi M, Koppe L, Fouque D, Thaunat O. Chronic kidney diseaseassociated immune dysfunctions: impact of protein-bound uremic retention solutes on immune cells. Toxins. 2020;12:300. DOI: https://doi.org/10.3390/toxins12050300
Crooke SN, Ovsyannikova IG, Poland GA, Kennedy RB. Immunosenescence and human vaccine immune responses. Immun Ageing. 2019;16:25. DOI: https://doi.org/10.1186/s12979-019-0164-9
Fishman JA. Infection in organ transplantation. Am J Transplant. 2017;17:856-79. DOI: https://doi.org/10.1111/ajt.14208
Agência Europeia de Medicamentos. Resumo das características do medicamento - IMVANEX. [consultado 2025 mar 03]. Disponível em: https://ec.europa.eu/health/documents/communityregister/ 2022/20220722156674/anx_156674_pt.pdf.
Leung J, Anderson TC, Dooling K, Xie F, Curtis JR. Recombinant zoster vaccine uptake and risk of flares among older adults with immunemediated inflammatory diseases in the US. Arthritis Rheumatol. 2022;74:1833-41. DOI: https://doi.org/10.1002/art.42261
Nakafero G, Grainge MJ, Myles PR, Mallen CD, Zhang W, Doherty M, et al. Association between inactivated influenza vaccine and primary care consultations for autoimmune rheumatic disease flares: a self-controlled case series study using data from the Clinical Practice Research Datalink. Ann Rheum Dis. 2019;78:1122-6. DOI: https://doi.org/10.1136/annrheumdis-2019-215086
Machado PM, Lawson-Tovey S, Strangfeld A, Mateus E ,Hyrich KL, Gossec L, et al. Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry. Ann Rheum Dis. 2022;81:695-709. DOI: https://doi.org/10.1136/annrheumdis-2021-221490
Lenfant T, Jin Y, Kirchner E, Hajj-Ali RA, Calabrese LH, Calabrese C. Safety of recombinant zoster vaccine: a retrospective study of 622 rheumatology patients. Rheumatology. 2021;60:5149-157. DOI: https://doi.org/10.1093/rheumatology/keab139
Stevens E, Weinblatt ME, Massarotti E, Griffin F, Emani S, Desai S. Safety of the zoster vaccine recombinant adjuvanted in rheumatoid arthritis and other systemic rheumatic disease patients: a single center’s experience with 400 patients. ACR Open Rheumatol. 2020;2:357-61. DOI: https://doi.org/10.1002/acr2.11150
Kroger A, Bahta L, Long S, Sanchez P. General best practice guidelines for immunization. best practices guidance of the advisory Committee on immunization practices. [consultado 2025 mar 03]. Disponível em: https://www.cdc.gov/vaccines/hcp/imz-best-practices/?CDC_AAref_ Val=https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index. html.
See KC. Vaccination for the prevention of infection among immunocompromised patients: a concise review of recent systematic reviews. Vaccines. 2022;10:800. DOI: https://doi.org/10.3390/vaccines10050800
Shapiro JR, Corrado M, Perry J, Watts TH, Bolotin S. The contributions of T cell-mediated immunity to protection from vaccine-preventable diseases: a primer. Hum Vaccin Immunother. 2024;20. DOI: https://doi.org/10.1080/21645515.2024.2395679
Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, et al. Vaccination guidelines for patients with immune-mediated disorders on immunosuppressive therapies. J Cutan Med Surg. 2019;23:50-74. DOI: https://doi.org/10.1177/1203475418811335
Centers for Disease Control and Prevention. Special situations. 2024. [consultado 2025 set 10]. Disponível em: https:// www.cdc.gov/vaccines/ hcp/imz-best-practices/special-situations.html.
Bader MS, McKinsey DS. Postexposure prophylaxis for common infectious diseases. Am Fam Physician. 2013;88:25-32.
Lachiewicz AM, Srinivas ML. Varicella-zoster virus post-exposure management and prophylaxis: a review. Prev Med Rep. 2019;16:101016. DOI: https://doi.org/10.1016/j.pmedr.2019.101016
UK Health Security Agency. Guidelines on post-exposure prophylaxis (PEP) for varicella or shingles. 2025. [consultado 2025 mar 05]. Disponível em: https://khub.net/documents/135939561/1148216158/ Guidelines+on+post-exposure+prophylaxis+%28PEP%29+for+varic ella+or+shingles+%28February+2025%29UKHSA-guidelines-on-VZpost- exposure-prophylaxis-February2025.pdf/e8ba9019-00a4-2546- a6a3-d83c12fd3b00?t=1740412523759.
Danziger-Isakov L, Kumar D. Vaccination in solid organ transplantation. Am J Transplant. 2013;13:311-7 DOI: https://doi.org/10.1111/ajt.12122
UK Health Security Agency. Varicella. In: Immunisation against infectious disease: the green book. 2021. [consultado 2025 mar 05]. Disponível em: https://www.gov.uk/government/publications/postexposure- prophylaxis-for-chickenpox-and-shingles.
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):e44-100. DOI: https://doi.org/10.1093/cid/cit684
Martire B, Azzari C, Badolato R, Canessa C, Cirillo E, Gallo V, et al. Vaccination in immunocompromised host: recommendations of italian primary immunodeficiency network centers (IPINET). Vaccine. 2018;36:3541-54. DOI: https://doi.org/10.1016/j.vaccine.2018.01.061
Stosor V, Zembower TR, editors. Infectious complications in cancer patients. Vol 161. Cham: Springer International Publishing; 2014. DOI: https://doi.org/10.1007/978-3-319-04220-6
Furer V, Rondaan C, Heijstek MW, Agmon-Levinet N, Assen S, Bijl M, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79:39-52. DOI: https://doi.org/10.1136/annrheumdis-2019-215882
Klotz L, Havla J, Schwab N, Hohlfeld R, Barnett M, Reddel S, et al. Risks and risk management in modern multiple sclerosis immunotherapeutic treatment. Ther Adv Neurol Disord. 2019;12:175628641983657. DOI: https://doi.org/10.1177/1756286419836571
Grebenciucova E, Pruitt A. Infections in patients receiving multiple sclerosis disease-modifying therapies. Curr Neurol Neurosci Rep. 2017;17:88. DOI: https://doi.org/10.1007/s11910-017-0800-8
Kucharzik T, Ellul P, Greuter T, Rahier J, Verstockt B, Abreu C, et al. ECCO Guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease. J Crohns Colitis. 2021;15:879- 913. DOI: https://doi.org/10.1093/ecco-jcc/jjab052
Winthrop KL, Mariette X, Silva JT, Benanu E, Calabrese LH, Dumusc A, et al. ESCMID study group for infections in compromised hosts (ESGICH) consensus document on the safety of targeted and biological therapies: an infectious diseases perspective (soluble immune effector molecules [II]: agents targeting interleukins, immunoglobuli. Clin Microbiol Infect. 2018;24:S21-40. DOI: https://doi.org/10.1016/j.cmi.2018.02.002
Lenti MV, Luu S, Carsetti R, Osier F, Ogwang R, Nnodu OE, et al. Asplenia and spleen hypofunction. Nat Rev Dis Primers. 2022;8:71. DOI: https://doi.org/10.1038/s41572-022-00399-x
Luu S, Spelman D, Woolley IJ. Post-splenectomy sepsis: preventative strategies, challenges, and solutions. Infect Drug Resist. 2019;12:2839- 51. DOI: https://doi.org/10.2147/IDR.S179902
Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet. 2011;378:86-97. DOI: https://doi.org/10.1016/S0140-6736(10)61493-6
Lizamma A, Merlin R, Bency X, Princy J, Kumari R, Gaddam L. Microscopic study of human spleen in different age groups. Int J Res Med Sci. 2017;3:1701-6.
Chong J, Jones P, Spelman D, Leder K, Cheng AC. Overwhelming post-splenectomy sepsis in patients with asplenia and hyposplenia: a retrospective cohort study. Epidemiol Infect. 2017;145:397-400. DOI: https://doi.org/10.1017/S0950268816002405
Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. J Br Surg. 1991;78:1031-8. DOI: https://doi.org/10.1002/bjs.1800780904
Bonanni P, Grazzini M, Niccolai G, Paolini D, Varone O, Bartoloni A, et al. Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother. 2017;13:359-68. DOI: https://doi.org/10.1080/21645515.2017.1264797
South Australian Expert Advisory Group on Antimicrobial Resistance. Splenectomy vaccination and antimicrobial prophylaxis (adult) clinical guideline. 2019. [consultado 2024 jan 10]. Disponível em: https://www. sahealth.sa.gov.au/wps/wcm/connect/7d9c4800412ad856b9d6bfe8f09f e17d/Clinical_Guideline_Splenectomy_Vaccination%2B%26%2BAntim icrobial_Prophylaxis_v1.2.pdf?MOD=AJPERES&CACHEID=ROOTWO RKSPACE-7d9c4800412ad856b9d6bfe8f09fe17d-p4gFnEL.
Danziger-Isakov L, Kumar D. Vaccination of solid organ transplant candidates and recipients: Guidelines from the American society of transplantation infectious diseases community of practice. Clin Transplant. 2019;33:e13563. DOI: https://doi.org/10.1111/ctr.13563
Hilgendorf I, Freund M, Jilg W, Einsele H, Gea-Banacloche J, Greinix H, et al. Vaccination of allogeneic haematopoietic stem cell transplant recipients: report from the International Consensus Conference on Clinical Practice in chronic GVHD. Vaccine. 2011;29:2825-33. DOI: https://doi.org/10.1016/j.vaccine.2011.02.018
Cordonnier C, Labopin M, Chesnel V, Ribaud P, De La Camara R, Martino R, et al. Randomized study of early versus late immunization with pneumococcal conjugate vaccine after allogeneic stem cell transplantation. Clin Infect Dis. 2009;48:1392-401. DOI: https://doi.org/10.1086/598324
Carpenter PA, Englund JA. How I vaccinate blood and marrow transplant recipients. Blood. 2016;127:2824-32 DOI: https://doi.org/10.1182/blood-2015-12-550475
Cordonnier C, Ljungman P, Juergens C, Maertens J, Selleslag D, Sundaraiyer V, et al. Immunogenicity, safety, and tolerability of 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine in recipients of allogeneic hematopoietic stem cell transplant aged ≥2 years: an open-label study. Clin Infect Dis. 2015;61:313-23. DOI: https://doi.org/10.1093/cid/civ287
Langedijk AC, van Aalst M, Meek B, van Leeuwen EM, Zeerleder S, Meijer E, et al. Long-term pneumococcal vaccine immunogenicity following allogeneic hematopoietic stem cell transplantation. Vaccine. 2019;37:510-5. DOI: https://doi.org/10.1016/j.vaccine.2018.11.053
Cordonnier C, Labopin M, Chesnel V, Ribaud P, Camara Rde L, Martino R, et al. Immune response to the 23-valent polysaccharide pneumococcal vaccine after the 7-valent conjugate vaccine in allogeneic stem cell transplant recipients: results from the EBMT IDWP01 trial. Vaccine. 2010;28:2730-4. DOI: https://doi.org/10.1016/j.vaccine.2010.01.025
Papi A, Ison MG, Langley JM, Lee DG, Leroux-Roels I, Martinon-Torres F, et al. Respiratory syncytial virus prefusion f protein vaccine in older adults. New Eng J Med. 2023;388:595-608. DOI: https://doi.org/10.1056/NEJMoa2209604
Walsh EE, Pérez Marc G, Zareba AM, Falsey AR, Jiang Q, Patton M, et al. Efficacy and safety of a bivalent RSV prefusion f vaccine in older adults. New Eng J Med. 2023;388:1465-77. DOI: https://doi.org/10.1056/NEJMoa2213836
Bastidas A, de la Serna J, El Idrissi M, Oostvogels L, Quittet P, López- Jiménez J, et al. Effect of recombinant zoster vaccine on incidence of herpes zoster after autologous stem cell transplantation. JAMA. 2019;322:123. DOI: https://doi.org/10.1001/jama.2019.9053
Geretti AM, Brook G, Cameron C, Chadwick D, French N, Heyderman R, et al. British HIV association guidelines on the use of vaccines in HIV - positive adults 2015. HIV Med. 2016;17:S2-81. DOI: https://doi.org/10.1111/hiv.12424
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, Infectious Diseases Society of America. AIDS info immunizations for preventable diseases in adults and adolescents with HIV. 2023. [consultado 2025 fev 24]. Disponível em: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelinesadult- and-adolescent-opportunistic-infections/immunizations.
Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, et al. Primary care guidance for persons with human immunodeficiency virus: 2020 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021;73:e3572-605. DOI: https://doi.org/10.1093/cid/ciaa1391
European AIDS Clinical Society. EACS Guidelines version 12.0. 2023. [consultado 2025 set 23]. Disponível em: https://www.eacsociety.org/ media/guidelines-12.0.pdf.
Brodszki N, Frazer-Abel A, Grumach AS, Kirschfink M, Litzman J, Perez E, et al. European Society for Immunodeficiencies (ESID) and European Reference Network on Rare Primary Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA) complement guideline: deficiencies, diagnosis, and management. J Clin Immunol. 2020;40:576-91. DOI: https://doi.org/10.1007/s10875-020-00754-1
American Academy of Pediatrics. Immunization and other considerations in immunocompromised children. In: Red Book: 2024–2027 Report of the Committee on Infectious Diseases. 33rd ed. Illinois: American Academy of Pediatrics; 2024.
Bonilla FA. Update: vaccines in primary immunodeficiency. J Allerg Clin Immunol. 2018;141:474-81. DOI: https://doi.org/10.1016/j.jaci.2017.12.980
Bastard P, Michailidis E, Hoffmann HH, Chbihi M, Le Voyer T, Rosain J, et al. Auto-antibodies to type I IFNs can underlie adverse reactions to yellow fever live attenuated vaccine. J Experiment Med. 2021;218:e20202486 DOI: https://doi.org/10.1084/jem.20202486
Kabir A, Alizadehfar R, Tsoukas CM. Good’s syndrome: time to move on from reviewing the past. Front Immunol. 2022;12:815710. DOI: https://doi.org/10.3389/fimmu.2021.815710
Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63:1-30.
Toubiana J, Okada S, Hiller J, Oleastro M, Lagos Gomez M, Aldave Becerra JC, et al. Heterozygous STAT1 gain-of-function mutations underlie an unexpectedly broad clinical phenotype. Blood. 2016;127:3154-64. DOI: https://doi.org/10.1182/blood-2015-11-679902
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