2013 IDSA clinical practice guideline for vaccination of the immunocompromised host

• Live attenuated influenza vaccine (LAIV) is contraindicated.

Household members of immunosuppressed patients should receive vaccination guidance as well:

• Give yearly vaccination against influenza, preferably inactivated.

• Do not use oral polio vaccine.

• Those newly vaccinated against rotavirus should not have their dirty diapers handled by the immunosuppressed for at least 4 weeks following vaccination.

• Following varicella or ZOS vaccination, those individuals who develop skin lesions should avoid contact with the immunosuppressed until the lesions have cleared.

• MMR, yellow fever, and typhoid vaccinations are safe to receive.

The bottom line: Immunosuppression presents a quandary to the primary care physician with regard to the proper vaccination of both the patient and the household contacts of the patient. The IDSA recommendations nicely summarize vaccinations for such patients. In general, most patients will require an annual influenza vaccination, and their primary care physician should remain up to date on subsequent CDC recommendations, with special attention to the need for live attenuated and pneumococcal vaccinations.

Reference

Rubin, L.G., Levin, M.J., Ljungman, P., Davies, E.G., Avery, R., Tomblyn, M., Bousvaros, A., and Dhanireddy, S. (2013). 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin. Infect. Dis. 2014;58(3):e44-e100.

Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. Dr. Callahan is a second-year resident in the Family Practice Residency Program at Abington Memorial Hospital.