Adult Immunizations for Immunocompromised Patients in the Primary Care Setting

PERAMPANEL (FYCOMPA®): A NOVEL ANTI-EPILEPTIC DRUG he Advisory Committee on Immunization Practices (ACIP) Recommended Adult Immunization Schedule1 for the United States can be generally summarized in a table by recommended vaccine and indicated age group. However, several vaccines have additional, non-age-based indications due to patient-specific risk factors. Furthermore, recent updates have been made to the recommendation schedule to provide further protection for specific patient populations. One population with different immunization needs are the immunosuppressed. Patients with immunosuppressive disorders or those on immunosuppressive medication regimens have more complex immunization needs than patients who are considered immunocompetent. Subsequently, these patients require additional vaccinations to protect themselves from preventable illnesses. While vaccination rates have improved overall in recent years, they still remain low in these patients. A number of conditions encountered in the primary care setting are considered immunosuppressive: post -transplant patients, those with HIV and patients with immune-mediated diseases are just a few of the conditions that can increase the risk of infection.2-4 While the immunization needs of pre-transplant patients and those with active cancer are important, they are not commonly managed in the primary care setting and therefore are not discussed further in this review. Patients who are post-kidney, post-liver and post-heart transplant are referred to as solid organ transplant recipients, whereas patients who have received a bloodor marrow-derived hematopoietic stem cell transplant are referred to as a hematopoietic cell transplant (HCT) recipients. Diseases that are considered immune -mediated include rheumatoid arthritis (RA), irritable bowel disease (IBD), plaque psoriasis, and psoriatic arthritis. The Box lists commonly prescribed immunosuppressing medications. The purpose of this review is to describe the immunocompromised states for which patients would benefit from an enhanced or alternate immunization schedule.