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Section 1. Active and Passive Immunization
IMMUNIZATION IN SPECIAL CLINICAL CIRCUMSTANCES
Immunocompromised Children
PRIMARY AND SECONDARY IMMUNE DEFICIENCIES
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The safety and effectiveness of vaccines in people with immune deficiency are determined by the nature and degree of immunosuppression. Immunocompromised people vary in their degree of immunosuppression and susceptibility to infection. Immunocompromised children represent a heterogeneous population with regard to immunization. Immunodeficiency conditions can be grouped into primary and secondary (acquired) disorders. Primary disorders of the immune system generally are inherited and include disorders of B-lymphocyte (humoral) immunity, T-lymphocyte (cell)-mediated immunity, complement, and phagocytic function. Secondary disorders of the immune system are acquired and occur in people with human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome, or malignant neoplasms; people who have undergone transplantation; and people receiving immunosuppressive or radiation therapy (see Table 1.13, p 71). Experience with vaccine administration in immunocompromised children is limited. In most situations, theoretic considerations are the only guide to vaccine administration, because experience with specific vaccines in people with a specific disorder is lacking. However, considerable data in HIV-infected infants provide reassurance about the low risk of adverse events in these patients after immunization.
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Live vaccines. In general, people who are severely immunocompromised or in whom immune status is uncertain should not receive live vaccines, either viral or bacterial, because of the risk of disease from the vaccine strains. Although precautions, contraindications, and suboptimal efficacy of immunizations in immunocompromised patients are emphasized, some immunocompromised children
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