Some special situations, such as Prematurity,immunosuppression, pregnancy and exposure to infectious diseases increased the risk of diseases or adverse post-vaccination events or weak immuno response to vaccine . In these situations, special vaccines or special vaccination schedules are indicated, or vaccines should be postponed or even forbidden.

1. IMMUNIZATION
IN
SPECIAL SITUATIONS
Dr.Osama Arafa Abd EL Hameed
Consultant
of
Pediatrics & Neonatology
Head of Pediatrics Department
Port-Fouad Hospital
President of Port said Pediatrics Conference
By

4. `

5. Definitions
Vaccination: Process of inoculating the vaccine or the
antigen
Immunization: Process of inducing immune response,
humoral or cell mediated.
Seroconversion: Change from antibody negative state to
antibody positive state.
Seroprotection: The state of protection (from disease)
due to presence of humoral immunity or antibody
detectable in serum

6. Types of vaccines
Live attenuated bacterial- BCG.
Live attenuated viral – OPV, MEASLES, MMR,
VARICELLA
Killed or inactivated bacteria – DTPw
Killed or inactivated virus – IPV, RABIES, HAV
Toxoid – DT, TT
Capsular polysaccharide – Hib, PNEUMO, MENINGO
Viral subunit - HBsAg
Bacterial capsular polysaccharide –S.Typhi(Vi), Hib,
MENINGOCOCCAL, PNEUMOCOCCAL,
ACELLULAR PERTUSSIS

7. Cold chain
Cold Chain is a system of storing and transporting vaccine
at the recommended temperature range from the point of
manufacture to point of use.
Vital link in immunisation
If not maintained, vaccine efficacy will grossly suffer
Safe temp. zone – mandatory to maintain potency
Safe zone for short term storage (1-2 months)is 2-8 deg C. For
long term storage –20 degC is used only for
BCG,OPV,Measles/MMR

8.  The T series of vaccine(DPT,DT,TT),typhoid Vi, Hep B should
not be frozen as once frozen the aluminium salts used as
adjuvant will be desiccated and will act as irritantsterile
abcess.
 In order to provide potent and effective vaccine to the
beneficiaries a vast cold chain infrastructure is required, which
should have a network of Vaccine Stores, Walk-in-coolers (WIC),
Walk-in-freezers (WIF), Deep Freezers (DF), Ice lined
Refrigerators (ILR), Refrigerated trucks, Vaccine vans, Cold
boxes, Vaccine carriers and ice packs from national level to states
up to the out reach sessions.
 The cold chain system and vaccine flow in the country:- The
vaccines are transported from the manufacturer through air
transport under the temperature range of 2-8oC to the primary
vaccine stores (GMSDs/State head quarter).

11. VACCINE VIAL MONITORS
VVM is time and temperature sensitive coloured label.
Consists of temperature sensitive material.
Changes colour gradually on being exposed to heat.
Corresponds to heat induced damage to vaccine inside
the vial.
Do not give information about cold injury
Especially used for OPV which is most thermo labile
vaccine.

13. Generally speaking, vaccination schedules are meant for
healthy individuals under normal life conditions.
Some special situations, however, place individuals at
greater risk of becoming ill or presenting with adverse
post-vaccine events and may require specific vaccines or
vaccine schemes, or even indicate postponement or
contraindication of vaccination.
As follows, we shall discuss some special situations in
which the usual vaccine scheme may be modified,
postponed or reinforced.

15. IMMUNIZATION IN PRETERM/
LOW BIRTH WEIGHT INFANTS
 In principle, all vaccines may be administered as per schedule
according to the chronological age irrespective of birth weight
or period of gestation.
BCG
 BCG and birth dose of OPV can be safely and effectively given
to low birth weight and preterm babies after stabilization and
preferably at the time of discharge.
 Studies have shown that the take of BCG as assessed by
induration following mantoux test and lymphocyte migration
inhibition test (LMIT) is similar in preterm/low birth weight
babies whether given at discharge or later.

16. IMMUNIZATION IN PRETERM/
LOW BIRTH WEIGHT INFANTS
HEPATITIS B
 Babies weighing > 2 kg: The birth dose of hepatitis B vaccine
can be administered at any time after birth.
 Babies weighing < 2 kg: The immunogenicity of the birth dose
of the vaccine has been shown to be suboptimal in some
studies. Hence the birth dose of hepatitis B vaccine in these
babies should be delayed till the age of 1 month.
Alternatively, these babies may also be given the first dose of
the vaccine at the time of discharge if consistent weight gain is
achieved.
 In babies less < 2 kg born to a hepatitis B positive mother:
Hepatitis B vaccine should be given along with HBIG within
12 hours of birth and 3 more doses at 1, 2 and 6 months are
recommended

17. IMMUNIZATION IN PRETERM/
LOW BIRTH WEIGHT INFANTS
ALL OTHER VACCINES
 Can be given as per chronologic age and have acceptable safety,
immunogenicity and efficacy. Full dose of the vaccines should be
used.
 Since preterm and LBW babies may have low muscle mass, the use
of needles with lengths of 5/8 inch or less is appropriate to ensure
effective, safe, and deep anterolateral thigh intramuscular
administration.
 As preterm, low birth weight babies have increased susceptibility to
infections, vaccines such as pneumococcal conjugate vaccines,
rotavirus and influenza should be offered if resources permit.

18. Breastfeeding and Vaccination
With 2 exceptions, neither inactivated nor live-virus vaccines
administered to a lactating woman affect the safety of breastfeeding
for women or their infants. Although live viruses in vaccines can
replicate in the mother, the majority of live viruses in vaccines have
been demonstrated not to be excreted in human milk.
 Varicella vaccine virus has not been found in human milk .
Although rubella vaccine virus has been excreted in human milk, the
virus usually does not infect the infant. If infection does occur, it is
well tolerated because the virus is attenuated .
Inactivated, recombinant, subunit, polysaccharide, and conjugate
vaccines, as well as toxoids, pose no risk for mothers who are
breastfeeding or for their infants.

19. Breastfeeding and Vaccination cont.
Breastfeeding is a contraindication for smallpox vaccination of the
mother because of the theoretical risk for contact transmission from
mother to infant.
Yellow fever vaccine should be avoided in breastfeeding women,
because 2 cases (one confirmed, one probable) of yellow-fever,
vaccine virus was recovered from the cerebrospinal fluid of the
infant, but the exact mode of transmission was not precisely
determined because vaccine virus was not recovered from breast milk
 Limited data indicate that breastfeeding can enhance the
response to certain vaccine antigens .There are no data to suggest
that passive transfer of antibodies in human milk can affect the
efficacy of live-virus vaccines. Breastfed infants should be
vaccinated according to the recommended schedule .

20. CORTICOSTEROIDS / OTHER
IMMUNOSUPPRESSIVE THERAPY
 Killed vaccines: They are safe but may be less efficacious.
 Live vaccines:
Children receiving oral corticosteroids in high doses: (prednisolone
> 2 mg/kg/day or for those weighing more than 10 kg, 20 mg/day or
its equivalent) for > 2 weeks should not receive live virus vaccines
until the steroids have been discontinued for at least one month.
Children on lesser dose of steroids or those on inhaled or topical
therapy: may be safely and effectively given their age appropriate
vaccines.
Children on immunosuppressive therapy other than
corticosteroids: should avoid live vaccines during therapy unless
benefits outweigh risks.

21. Administration of Antimicrobial
Agents and Vaccines
 With a few exceptions, use of an antimicrobial agent does not
interfere with the effectiveness of vaccination. Antibacterial
agents have no effect on inactivated, recombinant subunit, or
polysaccharide vaccines or toxoids.
 They also have no effect on response to live, attenuated
vaccines, except live oral Ty21a typhoid and BCG vaccines.
Ty21a typhoid vaccine should not be administered to persons
receiving antimicrobial agents until 72 hours after the last dose
of antimicrobial
 If feasible, to avoid a possible reduction in vaccine
effectiveness, antibacterial drugs should not be started or
resumed until 1 week after the last dose of Ty21a.
Antimicrobial or immunosuppressive agents may interfere with
the immune response to BCG and should only be used under
medical supervision

22. MALIGNANCIES ON
CHEMOTHERAPY/ RADIOTHERAPY
 Influence of cancer per se on immune function is minimal and
does not contribute to a major extent in inducing
immunocompromised state.
 Total immunoglobulin concentrations, specific antibody
concentrations to already given vaccines are normal at the
time of diagnosis indicating that the effect of the cancer on the
adaptive immune system is likely to be small.
 However, chemotherapy for cancer causes major secondary
immunodeficiency.
 The effects of radiotherapy on immune function are likely to
be small in comparison to chemotherapy.

23. MALIGNANCIES ON CHEMOTHERAPY/
RADIOTHERAPY
 Patients aged ≥6 months with hematological malignancies or
solid tumor malignancies except those receiving anti-B-cell
antibodies or intensive chemotherapy, such as for induction or
consolidation chemotherapy for acute leukemia should receive
inactive influenza vaccine (IIV) annually.
 Pneumococcal conjugated vaccine (PCV) should be administered
to newly diagnosed children with hematological or solid
malignancies. PPSV23 should be administered to children aged ≥
2 years at least 8 weeks after PCV.
 Inactivated vaccines (other than IIV) recommended for
immunocompetent children can be considered for children who
are receiving maintenance chemotherapy.

24. MALIGNANCIES ON CHEMOTHERAPY/
RADIOTHERAPY
 However, vaccines administered during cancer chemotherapy
should not be considered valid doses unless there is
documentation of a protective antibody level.
 Live viral vaccines should not be administered during
chemotherapy.
 Three months after cancer chemotherapy, patients should be
vaccinated with inactivated vaccines and the live vaccines
for varicella, MMR as per schedule that is routinely
indicated for immunocompetent persons.
 In regimens that included anti-B-cell antibodies, vaccinations
should be delayed at least 6 months.

26. ASPLENIA OR HYPOSPLENIA
 Asplenia or hyposplenia may result from sickle cell disease or
radiation therapy involving spleen. Children with asplenia
/hyposplenia are at high risk of serious infections with
encapsulated organisms.
 Vaccination with pneumococcal (both conjugate and
polysaccharide),Hib, meningococcal and typhoid vaccines is
indicated in addition to all routine vaccines.
 Planned splenectomy: vaccination should be initiated at least
2 weeks prior to splenectomy for achieving a superior
immunologic response.
 Emergency splenectomy: vaccination given 2 weeks after
splenectomy is associated with a superior functional antibody
response as compared to vaccination immediately following
surgery.
 All live vaccines may be safely given.

27. CONGENITAL
IMMUNODEFICIENCY
Severe B cell immunodeficiency: (X linked agammaglobulinemia)
 Live vaccines including OPV, BCG, oral typhoid, and live attenuated
influenza are contraindicated.
 Measles and varicella vaccines may be given but are ineffective due to
concomitant immunoglobulin therapy.
 Inactivated vaccines may be given but are ineffective.
Less severe B cell deficiencies: (IgA and IgG subclass deficiency)
 Only OPV is contraindicated.
Severe T cell immunodeficiencies: (SCID)
 All live vaccines are contraindicated and all vaccines are ineffective.
 Patients who have received live vaccines especially BCG prior to
diagnosis face an increased risk of complications including disseminated
BCG disease.

28. CONGENITAL
IMMUNODEFICIENCY
Combined immunodeficiencies: (Di George syndrome, Wiskott
Aldrich and Ataxia telangiectasia)
 Inactivated vaccines may be given.
 Live vaccines are contraindicated.
Complement deficiencies:
 All vaccines may be safely given.
 pneumococcal, Hib and meningococcal vaccines are particularly
indicated.
Phagocyte defects: Chronic granulomatous disease
 Only live bacterial vaccines are contraindicated, other vaccines
may be safely and effectively given.

29. CHRONIC DISEASES
 Children with chronic neurologic, endocrinologic (diabetes), liver, renal,
hematologic, cardiac, pulmonary and gastrointestinal disease are at
increased risk of infections.
 Live vaccines may be given safely in these children.
 These children should be offered pneumococcal, hepatitis A, varicella,
influenza and rotavirus vaccines.
 The immunogenicity, efficacy and duration of protection of vaccines are
lower than healthy children and hence if indicated higher antigen content/
more doses (hepatitis B), assessment for antibody response and frequent
boosters (hepatitis A and B) are recommended.
 It is important to stress the role of hepatitis A vaccine in patients with liver
disease, pertussis booster in those with stable neurologic disease.
 Children with severe cardiac and pulmonary diseases should receive
pneumococcal and annual influenza vaccines.

31. CHILDREN WITH HISTORY OF
ALLERGY
 First time immunization with any vaccine is contraindicated in
children with history of serious hypersensitivity/ anaphylaxis to
any of vaccine components.
 The package label should always be checked for vaccine
constituents which in addition to antigen include stabilizers/
buffers, preservatives, antibiotics and residue from the
manufacturing process.
 Children with history of serious egg allergy should not receive
influenza and yellow fever vaccines but can safely receive other
vaccines including measles and MMR vaccines.

32. CHILDREN WITH HISTORY OF
ALLERGY
 Children with history of any hypersensitivity are at increased
risk for allergic reactions with inactivated mouse brain
Japanese Encephalitis vaccines and thus should be
monitored carefully.
 Children who have had a serious hypersensitivity
reaction/anaphylaxis to a particular vaccine must never
receive it again. A mild reaction is not a contraindication to
vaccination.
 In any case all children should be watched for at least 15
minutes after vaccination for allergy and resuscitation
equipment should be kept standby.

34. CHILDREN WITH BLEEDING DISORDERS
OR
THOSE RECEIVING ANTICOAGULANTS
 These children are at increased risk for bleeding after intramuscular
injection.
 When vaccines recommended to be given only by the IM route are
to be given, vaccination can be scheduled shortly after administration
of clotting factor replacement. A 23 gauge or smaller needle should
be used for the vaccination and firm pressure without rubbing should
be applied to the site for at least 5–10 minutes.
 Alternately, vaccines recommended for intramuscular injection could
be administered subcutaneously to persons with a bleeding disorder
if the immune response and clinical reaction to these vaccines are
expected to be comparable by either route of injection, such as Hib
conjugate vaccine, IPV, pneumococcal polysaccharide vaccine, etc.

35. IMMUNIZATION DURING
ACUTE ILLNESS
Moderate or severe acute illness:
 Immunization during acute illness may lead to lower
immunogenicity or vaccine failure. Hence, vaccination
should be postponed and parents instructed to return for
vaccination when the illness resolves.
 Vaccination is also postponed to avoid superimposing
vaccine reaction on the underlying illness and to mistakenly
attribute a manifestation of underlying illness to
vaccination.
Minor illness:
 However, vaccination opportunity should not be missed
during like upper respiratory tract infections, mild diarrhea
and otitis media.

36. P
R
E
G
N
A
N
C
Y

37. IMMUNIZATION IN PREGNANCY
Live vaccines:
 Generally contraindicated in pregnant women.
 The yellow fever vaccine should be avoided in pregnant
women as far as possible. However, if travel is unavoidable,
the vaccine should be given as the risks of infection outweigh
the risks of vaccination (preferably in the 1st trimester).
 Measles, MMR and varicella vaccines are contraindicated
in pregnancy and pregnancy should be avoided for 4 weeks
after vaccination.

38. IMMUNIZATION IN PREGNANCY
 If the vaccine is inadvertently given during pregnancy or
pregnancy occurs within 4 weeks of vaccination,
termination of pregnancy is not warranted.
 Small cohort studies show no increased rates of congenital
abnormalities in infants born to mothers inadvertently
vaccinated in pregnancy.
 Measles, MMR and varicella vaccines can be safely given to
contacts of pregnant women as these vaccines do not spread
from vaccine to contacts.
 Smallpox vaccine is the only vaccine known to be harmful
to the fetus.

39. IMMUNIZATION IN PREGNANCY
Inactivated vaccines:
 All inactivated vaccines may be safely given during
pregnancy
 Influenza and hepatitis B are other vaccines of importance
in pregnant women can be given.
 Rabies vaccine should be administered to pregnant women
if indicated and is safe.

40. IMMUNIZATION IN PREGNANCY
TT in pregnancy:
1. Unimmunized:
 2 doses of TT at least one month apart should be given during
pregnancy so that protective antibodies in adequate titers are
transferred to the newborn for prevention of neonatal tetanus.
 The first dose should be administered at the time of first contact/ as
early as possible and the second dose of TT should be administered
1 month later and at least 2 weeks before delivery.
 A single dose of TT would suffice for subsequent pregnancies that
occur in the next 5 years; thereafter, 2 doses of TT would again be
necessary.

41. IMMUNIZATION IN PREGNANCY
2. Fully immunized: Five childhood doses (3 primary doses plus two
boosters) and one adolescent booster Tdap: No further doses are
necessary in pregnancy.
3. Partially immunized:
 Three primary doses: 2 doses during the 1st pregnancy are
indicated. The 2nd pregnancy requires 1 more dose and gives
lasting protection for the reproductive years.
 Three primary and one childhood booster: 1 dose each in the first
and second pregnancy provide lasting protection.
 Three primary and two childhood boosters: Only 1 dose in the first
pregnancy provides lasting protection.

42. IMMUNIZATION IN PREGNANCY
Tdap during pregnancy:
 A single dose of Tdap during the third trimester (preferred
during 27 through 36 weeks gestation) regardless of number of
years from prior Td or Tdap vaccination.
 Tdap has to be repeated in every pregnancy irrespective of the
status of previous immunization (with Tdap).
 Even if an adolescent girl who had received Tdap one year
prior to becoming pregnant will have to take it since there is
rapid waning of immunity following pertussis immunization.

43. IMMUNIZATION IN PREGNANCY
Passive immunization:
 Passive immunization with immunoglobulin containing
preparations is safe in pregnancy.
 All pregnant women should be evaluated for immunity to
rubella, varicella and hepatitis B and those found susceptible
should be vaccinated immediately after delivery.
 All pregnant women should be tested for HbsAg and if found
HBsAg-positive should be followed carefully to ensure that the
infant receives HBIG and begins the hepatitis B vaccine
series no later than 12 hours after birth and completes the
recommended hepatitis B vaccine series on schedule.

44. IMMUNIZATION IN LACTATION
Inactivated vaccines:
 All inactivated vaccines whether conjugated, toxoid, or subunit vaccines are
safe in breast feeding women and pose no harm to the babies.
Live vaccines:
 Although live vaccines multiply in the body of the mother, most pose no
harm to the babies as they are generally not excreted in breast milk.
 Rubella vaccine may be excreted in milk but does not infect the baby or if it
all causes mild asymptomatic infection.
 The only exception to live vaccine use is yellow fever vaccine.
Transmission of the yellow fever vaccine virus through breast milk and
resulting in infantile meningoencephalitis has been described.
 Hence, yellow fever vaccine should be avoided in breast feeding mothers. If
mandatory, then breast feeding should be interrupted for the 10 day post-
vaccination viremic period.

45. MISSED IMMUNIZATION/
UNKNOWN IMMUNIZATION STATUS
 In case of unknown immunization status, the child should be
considered unimmunized and vaccinated accordingly.
 Self-reported doses should not be accepted in the absence of
documentation with the exception of influenza and PPSV
vaccines.
 Serologic testing is also an option in patients with uncertain
status but is usually not cost effective, may reduce compliance
and may result in missed opportunities for vaccination.

46. UNIMMUNIZED CHILD
VISIT SUGGESTED VACCINES
First Measles/MMR if >12mths
DTwP1/DTaP1/Tdap if ≥7years
OPV1/IPV1 (if < 5years)
Hib1 (if < 5 years)
Hep B1
Second- after
1 month of 1st visit
BCG(if < 5years)
DTwP2/DTaP2/Td if ≥7years
OPV2
Hib 2
Hep B2
Third –after 2 month
of 1st visit
OPV3/IPV2
MMR if >12 months
Typhoid if > 2years
Fourth –after 6 month
of 1st visit
DTwP3/DTaP3/Td if ≥7years
OPV4/IPV3
Hep B3

47. CATCH-UP IMMUNIZATION
 Vaccination catch up regimens should preferably be individualized.
 Any number of vaccines live/ inactivated may be given on the same
day either singly or as combination vaccines maintaining a gap of 5 cm
between different vaccines.
 Inactivated vaccines can be given at any time in relation to any other
live/ inactivated vaccines.
 If not given on the same day, a gap of 4 weeks should be maintained
between two live injectable vaccines, especially MMR and varicella
and also yellow fever and live attenuated influenza vaccines.
 However OPV, rotavirus and oral typhoid vaccines may be given at
any time in relation to any live/ inactivated vaccine.
 For catch-up immunization, doses should preferably be given at the
minimum possible interval to entail early protection.

48. INTERCHANGEABILITY OF BRANDS
 There is sufficient data that brands of Hib, hepatitis B and
hepatitis A may be safely interchanged with no compromise on
immunogenicity and efficacy.
 However, data for immunogenicity of vaccination with different
brands of DTaP is lacking.Hence,vaccination with DTaP should be
completed with the same brand.
 However, if previous brand is not known or no longer available,
any brand may be used and vaccination should not be delayed or
cancelled.

49. IN RELATION TO ANTIBODY CONTAINING
PRODUCTS
Live vaccines:
 Blood (e.g., whole blood, packed red blood cells, and plasma) and other
antibody-containing blood products (e.g., immune globulin, hyperimmune
globulin, and IGIV) can inhibit the immune response to live vaccines such
as, measles and rubella vaccines for ≥3 months.
 The effect of blood and immune globulin preparations on the response to
mumps and varicella vaccines is unknown; however, commercial immune
globulin preparations contain antibodies to these viruses.
 Other live vaccines like Ty21a typhoid, rotavirus, yellow fever, LAIV, and
zoster vaccines may be administered at any time before, concurrent with, or
after administration of any immune globulin, hyperimmune globulin, or
intravenous immune globulin (IGIV).

50. IN RELATION TO ANTIBODY CONTAINING
PRODUCTS
 The length of time that interference with injectable live-virus
vaccine can persist after the antibody-containing product depends
upon the amount of antigen-specific antibody contained in the
product.
 Therefore, after an antibody-containing product is received, live
vaccines (other than oral Ty21a typhoid, LAIV, rotavirus zoster,
and yellow fever) should be delayed until the passive antibody has
degraded.
 If a dose of injectable live-virus vaccine (other than yellow fever
and zoster) is administered after an antibody-containing product
but at an interval shorter than recommended, the vaccine dose
should be repeated unless serologic testing is feasible and
indicates a response to the vaccine.

52. IN RELATION TO ANTIBODY CONTAINING
PRODUCTS
 Although passively acquired antibodies can interfere with the
response to rubella vaccine, the low dose of anti-Rho(D)
globulin administered to postpartum women has not been
demonstrated to reduce the response to the rubella vaccine.
 Because of the importance of rubella and varicella immunity
among women of child-bearing age, the postpartum vaccination
of women without evidence of immunity to rubella or varicella
with MMR or varicella vaccines should not be delayed because
of receipt of anti-Rho(D) globulin or any other blood product
during the last trimester of pregnancy or at delivery.
 These women should be vaccinated immediately after giving
birth and, if possible, tested ≥ 3 months later to ensure
immunity to rubella and measles.

53. IN RELATION TO ANTIBODY CONTAINING
PRODUCTS
 Interference might occur if administration of an antibody
containing product becomes necessary after administration of
MMR or varicella vaccines. Usually, vaccine virus replication
and stimulation of immunity occurs 1–2 weeks after vaccination.
 If the interval between administration of any of these vaccines and
subsequent administration of an antibody-containing product is <
14 days, vaccination should be repeated after the
recommended interval unless serologic testing indicates a
protective antibody response.

56. IN RELATION TO ANTIBODY
CONTAINING PRODUCTS
Inactivated Vaccines:
 Antibody-containing products interact less with inactivated
vaccines, toxoids, recombinant subunit, and polysaccharide
vaccines than with live vaccines.
 Therefore, administering inactivated vaccines and toxoids either
simultaneously with or at any interval before or after receipt of
an antibody-containing product should not substantially impair
development of a protective antibody response (exception
administration of RIG 7 days after rabies vaccine).
 The vaccine or toxoid and antibody preparation should be
administered at different sites using the standard recommended
dose. Increasing the vaccine dose volume or number of
vaccinations is not indicated or recommended.

57. IMMUNIZATION IN THE
IMMUNOCOMPROMISED
 The immunocompromised are in greater need for vaccines as they are more
susceptible to infections. But at the same time the immunogenicity/ efficacy is
lower and risk of adverse effects with live vaccines is higher.
 However, vaccination in an immunocompromised is rather safe than often
perceived.
 General principles for vaccination of the immunocompromised are:
1. All inactivated vaccines can be given but immunogenicity and efficacy may be lower.
2. In severe immunodeficiency, all live vaccines are contraindicated. In mild /
moderate immunodeficiency, live vaccines may be given if benefits outweigh the
risks. Patients administered live vaccines inadvertently prior to diagnosis of
immunodeficiency should be watched for vaccine related adverse effects.
3. Ideally, antibody titers should be checked post-immunization on regular basis, and
regular boosters may be administered if needed.
4. Higher doses, greater number of doses should be given if indicated (hepatitis B)

58. IMMUNIZATION IN THE
IMMUNOCOMPROMISED
5. For major/ contaminated wounds tetanus immunoglobulin is
required in addition to TT even if 3 or more doses of TT have
been received in the past.
6. Household contacts of immunocompromised should not receive
transmissible vaccines such as OPV but can safely receive other
non-transmissible live vaccines such as MMR and varicella. All
household contacts should be fully immunized including
varicella and influenza to reduce risk of transmission to the
immunocompromised.
7. Some vaccines including pneumococcal, varicella, hepatitis A,
inactivated influenza vaccines should be given if resources
permit.

59. VACCINATION STRATEGIES FOR
TRAVELLERS
 There cannot be single schedule for the administration of immunizing
agents which may be applicable to all travellers.
 With considering individual traveller's immunization history, the countries
to be visited, the type and duration of travel, and the availability of time
for vaccination before departure a tailored made schedule should be
suggested to travellers.
 The time period may vary depending on type of vaccine and number of
doses required for immunity to develop. At times usual vaccination
schedule may have to vary marginally to meet the requirement of the
travellers.
 If full vaccination is not possible, partial vaccination may be done with
advice to complete the schedule after reaching the destination country.

60. In the Nutshell
Some special situations, such as
Prematurity,immunosuppression, pregnancy
and exposure to infectious diseases increased
the risk of diseases or adverse post-vaccination
events or weak immuno response to vaccine .
In these situations, special vaccines or special
vaccination schedules are indicated, or
vaccines should be postponed or even
forbidden.

61. In the Nutshell
In general, toxoid or inactivated vaccines can
be used, considering the possibility of
insufficient immune response.
For immunosuppressed patients, in
accordance with the type of
immunosuppression, live virus or bacterial
vaccines should be avoided, because of the
risk of vaccine agent spread.
 Immunization should include not only the
patient, but his/her home and day-care
contacts as well.

62. Port said Pediatrics conference 2015

63. Thanks
MumDoctor