[Vaccination of immunocompromised individuals: Expert opinion - update 2026]

Immunosuppression of various origins is associated with an increased risk of infections and infection-triggered morbidity and mortality. Vaccination, therefore, plays a central role in the care of immunosuppressed individuals by protecting against vaccine-preventable diseases.Based on the available evidence as well as immunological and theoretical considerations, an expert statement on vaccination in immunocompromised individuals was first formulated in 2016. These recommendations have herewith been comprehensively updated and expanded. The aim is to provide a practice-oriented, indication- and therapy-specific guidance document for clinical care. A practical chart accompanying the present vaccination recommendation, which also functions as a decision tree for implementation, facilitates orientation within the document.The document includes an introductory section outlining fundamental aspects of immunosuppression and addressing immunological and organizational issues relevant to vaccination planning, application, and control of vaccination responsiveness. In addition, current developments regarding relevant vaccines are reviewed.Subsequently, a systematic overview of immunosuppressive agents commonly used across medical specialties is provided. These agents are categorized according to their degree of immunosuppression and the associated infection risks. Standardized vaccination schedules are provided and assigned to the respective drug classes to facilitate a structured approach in clinical practice. The decision on vaccination eligibility of these patients can only be made based on a comprehensive assessment of the underlying disease and the planned or ongoing immunosuppressive therapy.Special clinical situations-including circumstances in which vaccination cannot be performed, as well as travel-related vaccinations in the context of immunosuppression-are addressed in separate chapters. To ensure long-term relevance, the document refers to continuously updated external sources throughout, which are compiled at the end.This document acts as general recommendation without a claim of completeness. The specific procedure in clinical practice can be adapted to the clinical context, and the reader is referred to the respective professional societies.