Immunizations in adult immunocompromised patients: which to use and which to avoid

Immunization is important to protect immunocompromised patients from preventable infectious disease but is often underused. Although live vaccines are contraindicated for most immunocompromised patients, many killed or component vaccines are safe and recommended. Vaccines may sometimes induce suboptimal immunogenicity, but even partial protection may benefit severely ill patients.

Vaccines against Streptococcus pneumoniae and influenza are strongly recommended for most immunosuppressed patients. When possible, immunization series should be completed before procedures that require or induce immunosuppression, such as organ transplantation or chemotherapy. If this is not possible, the patient may mount only a partial immune response, but even this partial response can be beneficial. Patients who undergo allogeneic bone marrow' transplantation lose preexisting immunities against a variety of diseases and should be revaccinated. In many situations, family members should be vaccinated to protect the patient. However, oral live polio vaccine should be avoided because it may carry the risk of infecting the patient.