Vaccination in Immunocompromised Host (ICH)

Abstract

Infectious disease (ID) are a major cause of morbidity and fatality in the ICH and moreover IDs may trigger underlying diseases or graft versus host disease (GVHD) and organ rejection.\n\nTo reduce risk, management of ID in ICH requires a comprehensive management from day 1, with (1) reduction of exposures: fewer social contacts; cocooning (vaccination of any close contacts); appropriate “low pathogen-diet”; avoiding environmental exposures (dust); (2) Detection of pre-existing risks (latent infections, vaccination history); (3) bearing in mind “expected IDs” by type and severity of immunosuppression.\n\nInactivated vaccines have similar reactogenicity and safety profiles in the ICH and health subjects; however due to reduced immunogenicity, efficacy may be reduced. \n\nLive vaccines are usually contraindicated as they may cause harm in severely immunocompromised patients; however, they can be considered based on an individual risk-benefit assessment with remaining immune functions in mind.\n\nIn some instances, post-exposure prophylaxis with immunoglobulins is effective, (“passive immunization”) specifically against measles and the varicella-zoster-virus. For the latter, antivirals can be used as an alternative.