[Vaccinations in immunosuppressed patients]

In immune deficiency of any cause, immunization is of great interest to avoid preventable infectious diseases but the risk of adverse events and suboptimal immunologic responses has to be considered. For live, attenuated vaccines, the main risks are post-immunization complications, especially in severely immunocompromised people. For killed or inactivated vaccines, there are no contra-indications, but the immune response is reduced, leading to consider higher vaccine doses or more frequent boosters. However, the response to such modifications of vaccine schedules has not been systematically evaluated and definitive recommendations cannot be made at this time. In addition, in HIV infection, the effect of vaccination on viral replication has to be evaluated. In developing countries some live vaccines are still recommended in HIV+ children because of the prevalence of the target-diseases (measles, poliomyelitis, tuberculosis...) and the rarity of vaccine complications.