From the Guidelines
Patients are considered mildly immunocompromised when they have conditions or are taking medications that partially suppress their immune system, such as those on low-dose corticosteroids (generally less than 20mg of prednisone daily or equivalent), certain immunosuppressive medications at lower doses, or those with controlled HIV infection with CD4 counts above 200 cells/mm³ 1.
Definition of Mild Immunocompromise
Mild immunocompromise typically includes individuals with diabetes, chronic kidney disease, chronic liver disease, or those on certain immunosuppressive medications at lower doses, such as methotrexate for rheumatoid arthritis.
- Elderly patients, as immune function naturally declines with age,
- Those with malnutrition or alcoholism are also considered mildly immunocompromised.
Key Considerations
These patients have an increased risk of infections compared to the general population but typically can still mount some immune response.
- They may experience more frequent or severe common infections and might take longer to recover,
- But they generally don't face the same extreme risks as severely immunocompromised individuals.
Clinical Implications
Healthcare providers should monitor these patients more closely for signs of infection and may consider earlier intervention when infections occur 1.
- The degree of immunosuppression for each patient is determined by the treating provider,
- And the ideal time to review a patient’s immunization status is at diagnosis, with regular follow-up as needed 1.
Vaccination Recommendations
Annual vaccination with inactivated influenza vaccine is recommended for immunocompromised patients aged ≥6 months, except for those who are very unlikely to respond 1.
- Live vaccines should not be administered to patients with certain phagocytic cell defects, such as leukocyte adhesion deficiency or defects of cytotoxic granule release 1.
Summary of Key Points
- Mild immunocompromise includes conditions or medications that partially suppress the immune system
- Patients with mild immunocompromise have an increased risk of infections but can still mount some immune response
- Healthcare providers should monitor these patients closely and consider earlier intervention when infections occur
- Vaccination recommendations vary depending on the degree of immunosuppression and the specific vaccine 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition of Mildly Immunocompromised Patients
Patients are considered to be mildly immunocompromised when they have a weakened immune system due to a condition or treatment, such as Human Immunodeficiency Virus (HIV) infection or immunosuppressive therapy.
- The degree of immunocompromise can be categorized as mild, moderate, or severe 2.
- Mildly immunocompromised patients tend to present late and with minimal symptoms, but the disease entities are the same ones seen in the general population 2.
Conditions Associated with Mild Immunocompromise
Several conditions are associated with mild immunocompromise, including:
- HIV infection, particularly those with a CD4 count under 200/mm3 3, 4, 5.
- Immunocompromised patients, such as those with cancer, inflammatory bowel diseases, psoriasis, primary immunocompromised patients, and inflammatory rheumatic diseases patients 3.
- Patients on immunosuppressive therapy, such as those with solid organ transplant recipients 3, 6.
Vaccination Recommendations for Mildly Immunocompromised Patients
Vaccination recommendations for mildly immunocompromised patients include:
- Pneumococcal and injectable influenza vaccines, which are recommended for all immunocompromised patients 3.
- Other inactivated vaccines, which are recommended only for high-risk patients 3.
- Live vaccines, which are usually contraindicated in patients under immunosuppressive therapy and/or in HIV patients with a CD4 count under 200/mm3 3.