II. Grading: Immunosuppressants
- High Level Immunosuppression
- Biological Agent (e.g. Humira)
- Prednisone dose >=20 mg/day for >=14 days
- Low Level Immunosuppression
- Prednisone dose <=20 mg/day
- Minimal Immunosuppression (should not impact Immunization, may receive live Vaccination)
- Prednisone for <14 days
III. Precautions
- Inactivated Vaccines
- Not harmful, but immunodeficient patients may have reduced immunogenic response to Vaccines
- Best to time inactivated Vaccines at least 2 weeks before starting Immunosuppressants
- Do not delay indicated Vaccines in patients already immunodeficient
- Shingrix is safe in low Level Immunosuppression
- Shingrix efficacy and safety data are lacking in 2019, for those on High Level Immunosuppression
-
Live Vaccines
- See Live Attenuated Vaccine
- Avoid Live Vaccines (e.g. MMR, Varicella) for those on high level Immunosuppression
- Live Vaccines are best given at least 4 weeks before starting Immunosuppression
- Do not use Flumist (Live Attenuated Influenza Vaccine) for Immunocompromised patients
- Use inactivated infuenza Vaccine instead
- Do not use Zostavax (live Shingles Vaccine) in HIV Infection or high level Immunosuppression
- Shingrix (recombinant, inactivated Vaccine released 2018) has replaced Zostavax and is preferred
- See Zostavax for indications (e.g. prior to Immunosuppression medications)
IV. Prevention: Routine Vaccinations Recommended for patients on Immunosuppression
- Influenza Vaccine yearly
-
Prevnar 13 (followed by Pneumovax 23 at least 8 weeks later)
- Immunocompromised adults >=19 years old
-
Gardasil 9
- Give 3 doses (instead of 2 doses as used in standard series)
V. References
- (2019) Presc Lett 26(12): 68
- (2014) Presc Lett 21(2): 10