Vaccinating an Immunocompromised Child

Any illness associated with possible immune dysfunction during childhood requires a decision on the start and/or continuation of ongoing vaccination program according to national guidelines, as well as the decision on possible booster vaccination and vaccination with additional, registered vaccines. It is widely accepted that if a child with presumed or proven immune disorder might benefit from vaccination, this should not be delayed if its application is safe. Children with immune disorders vary in the degree of immunosuppression, susceptibility to infections and immune reactions after vaccination. Besides these, there are certain groups of children with diseases that increase their risk of infectious diseases even in the absence of specific immune disorders. In this article, we discuss the basic principles that should guide decisions for immunization of children with suspected or proven immune system disorder (primary or secondary). D childhood, we obtain the largest number of vaccines. Immune disorders resulting from inherited errors of immune system are rare diseases and very heterogeneous in their degree and type of immunosuppression, ranging from mild defects in immune function to severe, life-threatening conditions that usually affect multiple arms of the immune system (1). However, the advances of modern medicine made in treatment of malignant and inflammatory diseases and resulting in improved survival and morbidity rates, increased the proportion of children who have special vaccination needs (2). Regardless of the origin of immune dysfunction, primary or secondary, children vary in the degree of immunosuppression, susceptibility to infections and immune reactions after vaccination. These differences emphasize the necessity of careful examination of all three issues of importance in the vaccination of children: vaccine safety, vaccine efficacy and the potential benefit of particular vaccines in unique medical circumstances of each immunocompromised child (3). UNDERSTAND YOUR PATIENT’S CONDITION AND PERFORM CAREFUL ASSESSMENT OF RISKS VERSUS BENEFITS T clarify a given child’s immune status, his or her underlying diagnoses need to be considered and the degree of immunosuppression must be determined. There are at least six different groups of conditions and treatments that should be taken into account prior to any decision to vaccinate a child: 1) Primary immunodeficiency 2) Malignant and other diseases treated with chemotherapy and/or hemopoietic stem cell transplantation ALENKA GAGRO Children’s Hospital Zagreb Klai}eva 16, 10000 Zagreb E-mail: [email protected]