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Addressing immunization gaps in children with congenital heart disease - a narrative review
Diana Jecan-Toader1,2, Cristina Filip3,4, Simona Sorana Căinap1,2
12 Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Insights
Children with congenital heart disease (CHD) need timely vaccinations. Standard and supplemental immunizations are recommended, with special considerations for surgery, immunocompromised status, or high-risk patients requiring monitoring.
Area of Science:
- Pediatrics
- Immunology
- Cardiology
Background:
- Vaccination programs significantly reduce infectious disease burden globally.
- Vaccination rates in children with congenital heart disease (CHD) are often suboptimal.
- Immunization is crucial for protecting vulnerable pediatric populations.
Purpose of the Study:
- To address challenges in childhood immunization for patients with CHD.
- To provide guidance on optimal immunization practices for CHD patients.
- To ensure adequate protection against vaccine-preventable diseases in this cohort.
Main Methods:
- Review of current vaccination guidelines and expert recommendations.
- Analysis of specific considerations for CHD patients, including immunocompetence and health status.
- Identification of supplemental vaccines and prophylaxis relevant to CHD.
Main Results:
- Standard immunization is recommended for immunocompetent CHD patients.
- Supplemental vaccines (rotavirus, varicella, meningococcus, hepatitis A, influenza) are advised.
- RSV prophylaxis with palivizumab is recommended for hemodynamically significant CHD.
Conclusions:
- Tailored vaccination schedules are necessary for CHD patients, considering clinical status and treatments.
- Special attention is required for patients undergoing surgery or with compromised immunity.
- Close monitoring post-vaccination is advised for high-risk CHD individuals.
Abstract:
Vaccination programs have had a pivotal part in the successful reduction of global morbidity and mortality of infectious diseases. Despite their undeniable success, vaccination rates among children with congenital heart disease (CHD) remain suboptimal. This article aims to address the challenges surrounding immunization in CHD patients and provide guidance for immunization practices within this population. Most experts advocate for adherence to standard immunization practices in CHD patients who are immunocompetent and in good health. Supplemental vaccinations against rotavirus, varicella, meningococcus, hepatitis A and influenza are recommended. RSV prophylaxis with palivizumab is advisable in patients with hemodynamically significant CHD during winter season. However, special considerations are warranted in specific situations, such as around cardiac surgery or in patients who are immunocompromised. Furthermore, adjustments to the vaccination schedule might be necessary for patients who require antithrombotic prophylaxis or blood transfusions. Lastly, special attention should be given to individuals at a high risk of decompensation after immunization, who might require close parental or medical monitoring for up to 72 hours post-vaccination.
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