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Immunizations - travel vaccinations - Management
Can people with immunosuppression receive travel vaccinations?

  • People with immunosuppression or HIV can be given inactivated vaccines (e.g. tetanus, injectable poliomyelitis, injectable typhoid, hepatitis A, meningococcal meningitis, rabies, Japanese encephalitis, tick-borne encephalitis).
  • The following immunosuppressed people should not receive live vaccinations:
    • People with evidence of severe primary immunodeficiency (e.g. severe combined immunodeficiency, Wiskott–Aldrich syndrome, and other combined immunodeficiency syndromes).
    • People currently being treated for malignant disease with immunosuppressive chemotherapy or radiotherapy, or who have terminated such treatment within the last 6 months.
    • People who have received a solid organ transplant and are currently on immunosuppressive treatment.
    • People who have received a bone marrow transplant, until at least 12 months after finishing all immunosuppressive treatment, or longer where the patient has developed graft-versus-host disease. The decision to vaccinate should depend upon the type of transplant and the immune status of the patient.
      • Further advice can be found in current guidance produced by the European Group for Blood and Marrow Transplantation (www.ebmt.org) and the Royal College of Paediatrics and Child Health (RCPCH, www.rcpch.ac.uk).
    • People receiving systemic high-dose steroids, until at least 3 months after treatment has stopped. This includes:
      • Children who receive prednisolone, at a daily dose (or equivalent) of 2 mg per kg body weight per day for at least 1 week, or 1 mg per kg body weight per day for 1 month.
      • Adults who receive at least 40 mg of prednisolone per day for more than 1 week.
      • Anyone on lower doses of steroids may be immunosuppressed and at increased risk from infections. In these cases, live vaccines should be considered with caution, after discussion with a relevant specialist physician.
    • People receiving other types of immunosuppressive drugs (e.g. azathioprine, ciclosporin, methotrexate, cyclophosphamide, leflunomide, and the newer cytokine inhibitors) alone or in combination with lower doses of steroids, until at least 6 months after terminating such treatment. Seek advice from the physician in charge or an immunologist.
  • Live vaccines e.g. yellow fever are usually contraindicated in persons with HIV infection and should not be given without specialist guidance (BHIVA guidance).
    • For more detailed information on which vaccines people with HIV infection can receive see the following guidelines from the British HIV Association www.bhiva.org (pdf).
Basis for recommendation
  • These recommendations are based on expert opinion from the published medical literature [BNF 52, 2006; DH, 2006c].
  • People with immunosuppression may not make a full antibody response to inactivated or live vaccinations. In addition there is a risk of generalized infection after receiving a live vaccine.
  • Fatal myeloencephalitis following yellow fever vaccination has been reported in an individual with severe HIV-induced immunosuppression. There are limited data, however, suggesting that yellow fever vaccine may be given safely to HIV-infected persons with a CD4 count that is greater than 200 and a suppressed HIV viral load.

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