8
Special Populations
36. Live viral vaccines should not be administered to patients with
leukocyte adhesion deficiency, defects of cytotoxic granule
release such as Chediak-Higashi syndrome (see Combined
Immunodeficiencies), or any other undefined phagocytic cell defect
(SR-L).
Innate Cytokine or Cellular Activation Defects
Innate defects in the immune system resulting in defects of cytokine
generation, cytokine response, or cellular activation include defects
of the interferon-γ/interleukin 12 axis.
37. Patients with innate immune system defects resulting in defects of
cytokine generation/response or cellular activation should receive
all inactivated vaccines based on the CDC annual schedule (SR-VL).
38. For patients with innate immune system defects resulting in defects
of cytokine generation/response or cellular activation, PCV13
should be administered as in recommendations 27a-c
(WR to SR-VL to L).
39. Specialist advice should be sought on individual conditions
concerning use of live vaccines in patients with innate immune
system defects resulting in defects of cytokine generation/
response or cellular activation/inflammation generation (SR-L).
40. Live bacterial vaccines should NOT be administered to patients
with defects of the interferon-γ/interleukin 12 pathways (SR-M).
41. Live viral vaccines should NOT be administered to patients with
defects of interferon (α or γ) production (SR-L).
Minor Antibody Deficiencies
42. Patients with immunoglobulin A (IgA) deficiency or specific
polysaccharide antibody deficiency (SPAD) should receive all
routine vaccinations based on the CDC annual schedule, provided
that other components of their immune system are normal (SR-L).
43. Children with SPAD or ataxia-telangiectasia should receive PCV13
as described in recommendations 27a-c (WR to SR-VL to L). Those
≥2 years of age should receive PPSV23 ≥8 weeks after indicated
doses of PCV13 and a second dose of PPSV23 5 years later (SR-L).
44. Monitoring of vaccine responses can be useful for assessing the
degree of immunodeficiency in patients with minor antibody
deficiencies and the level of protection (WR-M).
45. OPV should NOT be administered to IgA-deficient patients (SR-L).
