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).
