Chronic Inflammatory Disease Patients Taking
Immunosupporessants (Table 6)
105. Inactivated vaccines, including IIV, should be administered to
patients with chronic inflammatory illness treated with (SR-L to M)
or about to be treated with immunosuppressive agents (SR-M) as
for immunocompetent persons based on the CDC annual schedule.
106. PCV13 should be administered to adults and children with a chronic
inflammatory illness treated with immunosuppression as described
in the standard schedule for children and in recommendations
27a-c and Table 6 (SR-VL to M).
107. PPSV23 should be administered to patients ≥2 years of age
with chronic inflammatory illness with planned initiation of
immunosuppression (SR-L), low-level immunosuppression (SR-L),
and high-level immunosuppression (SR-VL). Patients should receive
PPSV23 ≥8 weeks after PCV13 and should receive a second dose of
PPSV23 5 years later (SR-L).
108. VAR should be administered to patients with chronic inflammatory
disease without evidence of varicella immunity (defined in
recommendation 15) (SR-M) ≥4 weeks prior to initiation of
immunosuppression (SR-L), if treatment initiation can be safely
delayed.
109. VAR should be considered for patients without evidence of varicella
immunity (defined in recommendation 15) treated for chronic
inflammatory disease with long-term, low-level immunosuppression
(WR-VL).*
110. ZOS should be administered to patients with a chronic
inflammatory disorder who are ≥60 years of age prior to initiation
of immunosuppression (SR-L) or while being treated with low-dose
immunosuppression (SR-VL), and to those who are 50-59 years of
age and varicella-positive prior to initiation of immunosuppression
(WR-L)* or while being treated with low-dose immunosuppression
(WR-VL).*
111. Other live vaccines should not be administered to patients with
chronic inflammatory diseases who are receiving maintenance
immunosuppression: LAIV (WR-VL); MMR in patients receiving
low-level (WR-VL) or high-level immunosuppression (WR-VL);
MMRV in patients receiving low-level (WR-VL) or high-level
immunosuppression (SR-VL).
112. Otherwise recommended vaccines, including IIV and HepB, should
not be withheld because of concerns about exacerbation of chronic
immune-mediated or inflammatory illness (SR-M).
25
