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Section 1. Active and Passive Immunization
Immunization in Special Clinical Circumstances
Immunocompromised Children
Primary and Secondary Immune DeficienciesCorticosteroids
Hematopoietic Stem Cell and Other Transplant Recipients
Solid Organ Transplant Recipients
HIV Infection (See Also Human Immunodeficiency Virus Infection, p 380)
Children with Asplenia or Functional Asplenia
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PRIMARY AND SECONDARY IMMUNE DEFICIENCIES
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, usually as single-gene disorders; may involve any part of the immune defenses, including B-lymphocyte (humoral) immunity, T-lymphocyte (cell)-mediated immunity, complement, and phagocytic function as well as other, unique abnormalities of innate immunity; and share the common feature of susceptibility to infection. 22 Secondary disorders of the immune system are acquired and occur in people with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) or malignant neoplasms; people who have undergone transplantation or splenectomy; people receiving immunosuppressive, antimetabolic, or radiation therapy; and people with a variety of other illnesses, such as severe malnutrition, protein loss, and uremia (see Table 1.14, p 74). Published studies of experience with vaccine administration in immunocompromised children are limited. In most situations, theoretical considerations are the primary guide to vaccine administration, because experience with specific vaccines in people with a specific disorder is lacking. However, considerable experience in HIV-infected children provides reassurance about the low risk of adverse events in these children after immunization.
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View this table: [in a new window] | Table 1.14. Immunization of Children and Adolescents With Primary and Secondary Immune Deficiencies |
LIVE VACCINES In general,
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