Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

Abstract

The present uncertainty of which live viral or bacterial vaccines may be given to immune deficient patients and the growing neglect of societal adherence to routine immunizations has prompted the Medical Advisory Committee of the Immune Deficiency Foundation to issue recommendations based upon published literature and the collective experience of the committee members. These recommendations address the concern for immunodeficient patients acquiring infections from healthy individuals who have not been immunized or who are shedding live vaccine-derived viral or bacterial organisms. Such transmission of infectious agents may occur within the hospital, clinic, home, or at any public gathering. Collectively, we define this type transmission as close-contact spread of infectious disease that is particularly relevant in patients with impaired immunity who may develop infection when exposed to individuals carrying vaccine-preventable infectious diseases or who have recently received a live vaccine. Immunodeficient patients who have received therapeutic hematopoietic stem transplantation are also at risk during the time when immune reconstitution is incomplete or while they are on immunosuppressive agents to prevent or treat graft-versus-host disease. This review recommends the general education of what is known about vaccine-preventable or vaccine-derived diseases being spread to immunodeficient patients at risk for close-contact spread of infection, and describes the relative risks for a child with severe immunodeficiency. The review also recommends a balance between the need to protect vulnerable individuals with their social needs to integrate into society, attend school, and benefit from peer education.

Synonymous Deoptimization of Foot-and-Mouth Disease Virus Causes Attenuation In Vivo while Inducing a Strong Neutralizing Antibody Response

“…It is known that LAVs stimulate an excellent immune response that is comparable to that induced by infection with the WT pathogen (40). However, LAVs can be less safe than inactivated vaccines, since they can cause disease if inoculated at a high enough dose or in immunocompromised individuals (41). The difference between the dose needed to induce protection and the dose needed to induce disease is defined as the vaccine safety margin.…”

“…However, studies in vivo showed that the "leaderless virus" was too attenuated and induced only a limited immune response, not sufficient to protect cattle against homologous challenge (11). Interestingly, the leaderless virus behaved like WT virus when it was used like the traditional inactivated FMD vaccine (inactivated antigen in formulation with oil adjuvant), suggesting that the leaderless virus could be an alternative safer option for FMD vaccine production (11,40,41).…”

Investigation and management of primary immunodeficiency in South African children

“…For children with combined B-and T-cell deficiencies, such as SCID, all live vaccines are contraindicated, and for those with phagocytic disorders live bacterial vaccines are contraindicated. [11] Immunocompetent household contacts of PID patients should not receive smallpox or oral polio vaccine, because these vaccine virus strains may be transmitted to immunocompromised patients. Other vaccines may be administered to close contacts because they pose little risk of transmission to the PID patient.…”

“…Other vaccines may be administered to close contacts because they pose little risk of transmission to the PID patient. [11] Antimicrobial prophylaxis Several PIDs may benefit from antimicrobial prophylaxis. In milder antibody conditions, such as IgA deficiency or transient hypogammaglobulinaemia of infancy, recurrent infection may occasionally require short courses of prophylactic antibiotics.…”

A glance on recent progresses in diagnosis and treatment of primary immunodeficiencies/ Progrese recente în diagnosticul şi tratamentul imunodeficienţelor primare

“…However, clinical improvement might be observed even in absence of detectable increase of protective antibody levels and this has resulted in best practice statement from the UK (http://www.rcpch. ac.uk/sites/default/files/asset_library/Publications/I/Immunocomp.pdf; accessed June 2014) and uncertainties together with the growing neglect of societal adherence to routine immunizations has prompted the Medical Advisory Committee of the Immune Deficiency Foundation (US) to issue recommendations based on published literature and the collective experience of the committee members (83). The prophylactic vaccination of household members of these patients groups is highly recommended.…”