Asplenia or Sickle Cell Diseases (Table 7)
113. Asplenic patients or those with sickle cell diseases should
receive vaccines including PCV13 for children <2 years of age as
recommended routinely for immunocompetent persons based on
the CDC annual schedule. None is contraindicated (SR-M) except
LAIV in patients with sickle cell disease (WR-VL).
114. PCV13 should be administered to asplenic patients or patients
with sickle cell diseases who are ≥2 years of age based on the CDC
annual schedule for children and as described in recommendations
27a-c (SR-VL to M).
115. PPSV23 should be administered to asplenic patients or patients
with a sickle cell disease who are ≥2 years of age (SR-L) with an
interval of ≥8 weeks after PCV13, and a second dose of PPSV23
should be administered 5 years later (SR-L).
116. For PPSV23-naive patients ≥2 years of age for whom a splenectomy
is planned, PPSV23 should be administered ≥2 weeks prior to
surgery (and following indicated dose[s] of PCV13) (SR-M) or ≥2
weeks following surgery (WR-L).*
117. One dose of Hib should be administered to unvaccinated persons
≥5 years of age who are asplenic or have a sickle cell disease
(WR-L).
27
Table 6. Vaccination of Persons With Chronic Inflammatory
Diseases on Immunosuppressive Medications
Footnotes
R, recommended—administer if not previously administered or not current; such patients may be at
increased risk for this vaccine-preventable infection
U, usual—administer if patient not current with recommendations for dose(s) of vaccine for
immunocompetent persons in risk and age categories
X, contraindicated.
a
Low-level immunosuppression includes treatment with prednisone <2 mg/kg with a maximum
of ≤20 mg/day; methotrexate ≤0.4 mg/kg per week; azathioprine ≤3 mg/kg per day; or
6-mercaptopurine ≤1.5 mg/kg per day. High-level immunosuppression regimens include treatment
with doses higher than those listed for low-dose immunosuppression, and biologic agents such as
tumor necrosis factor antagonists or rituximab.
b
Administer only if patient is nonimmune, not severely immunosuppressed, and the timing is
≥4 weeks prior to initiation of immunosuppressive medications.
c
For patients ≥19 years who have previously received PPSV23, PCV13 should be administered aer
an interval of ≥1 year aer the last PPSV23 dose (WR-L).
d
Administration of VAR can be considered for non–varicella-immune patients treated for chronic
inflammatory disease who are receiving long-term, low-dose immunosuppression (WR-VL).*
* is recommendation deviates from CDC ACIP recommendations.
