title: Vaccination recommendations for the adult immunosuppressed patient: A systematic review and comprehensive field synopsis.
abstract: BACKGROUND
  Immunosuppressed patients are at risk of severe viral infections-related complications. National and international vaccination guidelines have been developed to decrease the mortality risk associated with these infections. However, a summary of these guidelines and the value of immunisation in this population is missing.
  
  
  OBJECTIVE
  To summarize specific guidelines regarding vaccination in immunosuppressed patients.
  
  
  METHODS
  We performed a literature search based on last update vaccine guidelines in immunosuppressed adult patients published between 1/1/2005-1/31/2016 in English or French language using PubMed, Cochrane and Embase, as well as relevant medical society websites.
  
  
  RESULTS
  Of the 389 citations identified, 12 guidelines were selected Three additional guidelines were selected by searching on the websites from medical societies of each specialty. 15 guidelines were included, involving 19 medical societies issued from the US (n = 6), international collaboration (n = 3), UK (n = 2), Canada (n = 1), Australia (n = 1), France (n = 1), and Germany (n = 1). These guidelines provide recommendations on vaccination in asplenic patients (n = 5), cancer patients (n = 4), HIV patients (n = 5), hematopoietic stem cell recipients (n = 4), inflammatory bowel diseases patients (n = 5), psoriasis patients (n = 4), primary immunocompromised patients (n = 3), inflammatory rheumatic diseases patients (n = 6), and solid organ transplant recipients (n = 5). All guidelines recommended pneumococcal and injectable influenza vaccines. Other inactivated vaccines were recommended only in high risk patients. Live vaccines were usually contraindicated in patients under immunosuppressive therapy and/or in HIV patients with a CD4 count under 200/mm3.
  
  
  CONCLUSIONS
  Pneumococcal and injectable influenza are the two essential vaccines recommended in all immunocompromised patients. Other inactivated vaccines are only indicated in high risk patients. Live vaccines are usually contraindicated.
authors.affiliation: Department of Gastroenterology and Hepatology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lopez
authors.affiliation: Université Paris Sud, INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.affiliation: Sorbonne Paris Cité Université Paris Diderot, INSERM U1163, Institut Imagine, Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Bachelez
authors.affiliation: Pediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mère Enfant Hospital, INSERM U1111, Hospices Civils de Lyon, Université Lyon 1, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Belot
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Dijon University Hospital and INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bonnotte
authors.affiliation: Service de Médecine Interne et Immunologie Clinique, Université de Lille, Centre national de référence Maladies systémiques et auto-immunes rares, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.affiliation: Dermatologist, 6, Rue du Helder, 64200, Biarritz, France.
authors.forename: Morad
authors.initials: M
authors.lastname: Lahfa
authors.affiliation: University Paris Descartes, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, AP-HP, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Cochin Teaching Hospital, AP-HP, 75014, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Loulergue
authors.affiliation: Laboratory of Immunology and Immunomonitoring, CIC 1408 INSERM, GIMAP EA3064, University Hospital of Saint-Etienne, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Paul
authors.affiliation: Service de Gastroentérologie, CHU de Saint-Etienne, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
authors.affiliation: Department of Rheumatology, Reference Center for Rare Autoimmune Diseases, Division of Internal Medicine, Hautepierre Hospital, University Hospital of Strasbourg, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mariela
authors.initials: M
authors.lastname: Blum
authors.affiliation: Department of Gastroenterology and Department of Biomedical Sciences, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.affiliation: IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
authors.affiliation: Department of Gastroenterology and Hepatology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France. Electronic address: peyrinbiroulet@gmail.com.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D000328:Adult; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D007252:Influenza Vaccines / Q000276:immunology*; D007251:Influenza, Human / Q000276:immunology* / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000276:immunology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000276:immunology*; D017410:Practice Guidelines as Topic; D014611:Vaccination; D014613:Vaccines, Attenuated / Q000276:immunology*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines; D014613:Vaccines, Attenuated
keywords: Guideline; Immunocompromised; Vaccine