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Vaccination of the Immunocompromised Host

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1 Some recommendations in this guideline have not been addressed by the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC), or deviate from their recommendations, and are marked by an asterisk (*). Î Impaired host defenses predispose patients to an increased rate or severity of vaccine-preventable infection. Î Such patients may also have greater exposure to pathogens due to frequent contact with medical environments. Î Data on safety, immunogenicity, and efficacy/effectiveness of vaccines for immunocompromised populations are limited. Î Immune system defects vary among and within categories of patients with immunodeficiency (eg, degree of immunodeficiency, nutritional status, immunosuppressive regimen), which may limit the generalizability of study findings. Î Inactivated vaccines can be administered to most immunocompromised patients, and live vaccines are contraindicated for most immunocompromised patients, with some important exceptions. Responsibility for Vaccination 1. Specialists caring for immunocompromised patients share responsibility with the primary care provider for ensuring that appropriate vaccinations are administered to immunocompromised patients (SR-L).* 2. Specialists caring for immunocompromised patients share responsibility with the primary care provider for recommending appropriate vaccinations for household members of immunocompromised patients (SR-VL).* Timing of Vaccination 3. Vaccines should be administered prior to planned immunosuppression if feasible (SR-M). 4. Live vaccines should be administered ≥4 weeks prior to immunosuppression (SR-L) and should be avoided within 2 weeks of initiation of immunosuppression (SR-L).* 5. Inactivated vaccines should be administered ≥2 weeks prior to immunosuppression (SR-M).

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