title: 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 can be given to immunodeficient 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 on published literature and the collective experience of the committee members. These recommendations address the concern for immunodeficient patients acquiring infections from healthy subjects who have not been immunized or who are shedding live vaccine-derived viral or bacterial organisms. Such transmission of infectious agents can occur within the hospital, clinic, or home or at any public gathering. Collectively, we define this type of transmission as close-contact spread of infectious disease that is particularly relevant in patients with impaired immunity who might have an infection when exposed to subjects 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 receiving 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 subjects and their social needs to integrate into society, attend school, and benefit from peer education.
authors.affiliation: Baylor College of Medicine and Texas Children's Hospital, Houston, Tex. Electronic address: wtsheare@TexasChildrensHospital.org.
authors.forename: William T
authors.initials: WT
authors.lastname: Shearer
authors.affiliation: National Institutes of Health Clinical Center, Bethesda, Md.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Fleisher
authors.affiliation: Duke University School of Medicine, Durham, NC.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Buckley
authors.affiliation: University of Iowa and Iowa City Veterans Affairs Medical Center, Iowa City, Iowa.
authors.forename: Zuhair
authors.initials: Z
authors.lastname: Ballas
authors.affiliation: State University of New York, Children's Hospital of Buffalo, Buffalo, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Ballow
authors.affiliation: Immune Deficiency Foundation, Columbia, Md.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Blaese
authors.affiliation: Boston Children's Hospital, Boston, Mass.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Bonilla
authors.affiliation: University of Tennessee Health Science Center and St Jude Children's Research Center, Memphis, Tenn.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Conley
authors.affiliation: Mt Sinai Medical Center, New York, NY.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cunningham-Rundles
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Alexandra H
authors.initials: AH
authors.lastname: Filipovich
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago.
authors.forename: Ramsay
authors.initials: R
authors.lastname: Fuleihan
authors.affiliation: National Jewish Health, Denver, Colo.
authors.forename: Erwin W
authors.initials: EW
authors.lastname: Gelfand
authors.affiliation: Miami Children's Hospital, Miami, Fla.
authors.forename: Vivian
authors.initials: V
authors.lastname: Hernandez-Trujillo
authors.affiliation: National Institute of Allergy and Infectious Diseases, Bethesda, Md.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Holland
authors.affiliation: Private practice, Shelburne, Vt.
authors.forename: Richard
authors.initials: R
authors.lastname: Hong
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Lederman
authors.affiliation: National Institute of Allergy and Infectious Diseases, Bethesda, Md.
authors.forename: Harry L
authors.initials: HL
authors.lastname: Malech
authors.affiliation: All Seasons Allergy, Asthma & Immunology, Shenandoah, Tex.
authors.forename: Stephen
authors.initials: S
authors.lastname: Miles
authors.affiliation: Boston Children's Hospital, Boston, Mass.
authors.forename: Luigi D
authors.initials: LD
authors.lastname: Notarangelo
authors.affiliation: Seattle Children's Hospital, Seattle, Wash.
authors.forename: Hans D
authors.initials: HD
authors.lastname: Ochs
authors.affiliation: Baylor College of Medicine and Texas Children's Hospital, Houston, Tex.
authors.forename: Jordan S
authors.initials: JS
authors.lastname: Orange
authors.affiliation: University of California San Francisco, San Francisco, Calif.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Puck
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: John M
authors.initials: JM
authors.lastname: Routes
authors.affiliation: UCLA School of Medicine, Los Angeles, Calif.
authors.forename: E Richard
authors.initials: ER
authors.lastname: Stiehm
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Sullivan
authors.affiliation: Seattle Children's Hospital, Seattle, Wash.
authors.forename: Troy
authors.initials: T
authors.lastname: Torgerson
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Jerry
authors.initials: J
authors.lastname: Winkelstein
mesh_terms: D001424:Bacterial Infections / Q000276:immunology / Q000517:prevention & control / Q000635:transmission*; D001428:Bacterial Vaccines / Q000009:adverse effects* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016867:Immunocompromised Host; D007153:Immunologic Deficiency Syndromes; D062690:Vaccines, Live, Unattenuated / Q000009:adverse effects* / Q000276:immunology; D014765:Viral Vaccines / Q000009:adverse effects* / Q000276:immunology; D014777:Virus Diseases / Q000276:immunology / Q000517:prevention & control / Q000635:transmission*
chemical_list: D001428:Bacterial Vaccines; D062690:Vaccines, Live, Unattenuated; D014765:Viral Vaccines
keywords: Live viral and bacterial vaccines; cellular immune reconstitution; primary immunodeficiency disease; severe combined immunodeficiency disease