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IDSA Issues New Guidelines for Vaccination of Immune-compromised People


The Infectious Diseases Society of America (IDSA) this month released new recommendations for vaccinations for people with HIV and other immune-compromising conditions. The guidelines were published in the December 4, 2013, advance edition of Clinical Infectious Diseases.

An international panel of experts prepared the evidenced-based vaccination guidelines for use by primary care and specialist providers caring for immune-compromised adults and children and their household contacts. The authors acknowledged that in some areas there is only limited evidence and more research is needed.

The guidelines include sections covering HIV-positive people, individuals with genetic immune deficiencies, bone marrow stem cell and solid organ transplant recipients, and people taking cancer chemotherapy or other immune-suppressing medications.

Below is an edited excerpt from an IDSA press release describing the new guidelines in more detail.

Vaccination Important for Immunocompromised Patients

New IDSA Guideline Provides Vaccine Recommendations for People with HIV Infection, Cancer and Other Conditions

Arlington, VA -- December 5, 2013 -- People with compromised immune systems -- such as those with cancer, HIV infection, and Crohn’s disease -- are especially vulnerable to illness and most should receive the flu shot and other vaccinations, notes a new guideline released by the Infectious Diseases Society of America (IDSA). Vaccination rates tend to be lower in patients with compromised immune systems in part because their physicians may be concerned about safety and effectiveness.

Written to address a void in comprehensive recommendations for vaccinations of all different types of immunocompromised patients, the "Clinical Practice Guideline for the Vaccination of the Immunocompromised Host" will be published online Dec. 5 in Clinical Infectious Diseases. The new guideline is particularly helpful for primary care physicians and specialists who treat immunocompromised patients. It also provides recommendations for vaccination of people who live with immunocompromised patients.

"The guideline provides 'one-stop shopping' for clinicians caring for children and adults with compromised immune systems and includes recommendations and evidence for all vaccinations, from influenza to chicken pox," said Lorry G. Rubin, MD, director of the Division of Pediatric Infectious Diseases at the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park, professor of pediatrics at Hofstra North Shore-LIJ School of Medicine and lead author of the guideline. "Previously, the recommendations were difficult to retrieve because in most cases information had to be accessed individually by vaccine rather than by the category of patient disease."

The guideline includes recommendations for most available vaccinations, ranging from hepatitis A, measles, mumps and rubella (MMR) and other childhood vaccinations to those for influenza, pneumococcus, and herpes zoster. The guideline notes most immunocompromised patients six months or older should receive the annual influenza shot, but should not receive the live attenuated influenza vaccine that comes in the form of a nasal spray. Patients receiving intensive chemotherapy or who have received anti-B-cell antibodies in the previous six months are unlikely to benefit from a flu shot.

The guideline covers patients with:

  • Congenital immune deficiencies;
  • Cancer;
  • Solid organ transplant (such as kidney and liver);
  • Stem cell transplant;
  • Chronic inflammatory conditions (such as rheumatoid arthritis and Crohn’s disease);
  • Sickle cell disease and asplenia [spleen removal];
  • Cochlear implants;
  • Cerebrospinal fluid (CSF) leaks.

The guideline panel includes adult and pediatric specialists in gastroenterology, immunology, infectious diseases, hematology, oncology, rheumatology and stem-cell and solid-organ transplantation. In addition to Dr. Rubin, the panel includes: Myron J. Levin, MD, Per Ljungman, MD, PhD, E. Graham Davies, MD, Robin Avery, MD, Marcie Tomblyn, MD,Athos Bousvaros, MD, Shireesha Dhanireddy, MD, Lillian Sung, MD, PhD, Harry Keyserling, MD, and Insoo Kang, MD.As with other IDSA guidelines, the vaccination of immunocompromised patient guideline will be available in mobile device and pocket-sized quick-reference editions. These and other guideline related products will be made available on the IDSA website at


LG Rubin, MJ Levin, P Ljungman, et al. 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host. Clinical Infectious Diseases. December 4, 2013 (Epub ahead of print).

Other Source

IDSA. Vaccination Important for Immunocompromised Patients. Press release. December 5, 2013.