What vaccines are recommended for an 11-year-old who is immunocompromised?

Recommended Vaccines for an 11-Year-Old Immunocompromised Child

For an 11-year-old who is immunocompromised, inactivated vaccines are generally safe and recommended, while live vaccines should be avoided due to the risk of vaccine-related disease. 1

Recommended Inactivated Vaccines

• Haemophilus influenzae type b conjugate (Hib): Recommended for immunocompromised children aged 5-18 years, which is beyond the age when it's routinely given to immunocompetent children 1

• Hepatitis A: Recommended for all immunocompromised children aged ≥1 year 1

• Hepatitis B: Recommended for all immunocompromised children, with consideration of high-dose formulation (40 μg) for better immune response 1

• Diphtheria, tetanus, acellular pertussis (DTaP/Tdap): Recommended for all immunocompromised children according to routine schedule 1

• Human papillomavirus (HPV): Recommended for immunocompromised children aged 11-26 years (quadrivalent HPV4 is preferred) 1

• Inactivated influenza vaccine (IIV): Strongly recommended annually for all immunocompromised children ≥6 months 1, 2

  • High-dose influenza vaccine may be considered for immunocompromised children on immunosuppressive medications, though it's typically only licensed for adults ≥65 years 3, 4

• Meningococcal conjugate vaccine (MCV4): Recommended for all immunocompromised children aged 11-18 years 1

• Pneumococcal vaccines:

  • Pneumococcal conjugate vaccine (PCV13): Recommended for all immunocompromised children 1
  • Pneumococcal polysaccharide vaccine (PPSV23): Recommended for immunocompromised children aged ≥2 years, to be given ≥8 weeks after PCV13, with a second dose 5 years later 1

• Inactivated polio vaccine (IPV): Recommended for all immunocompromised children 1

Vaccines to Avoid (Live Vaccines)

• Live attenuated influenza vaccine (LAIV): Contraindicated in immunocompromised children 1, 2

• Measles, mumps, and rubella (MMR): Contraindicated in highly immunocompromised children 1, 2

• Varicella vaccine: Contraindicated in highly immunocompromised children 1, 2

• Measles-mumps-rubella-varicella (MMRV) combination: Contraindicated in immunocompromised children 1

• Rotavirus vaccine: Generally contraindicated in highly immunocompromised children, though may be considered in some cases with mild immunosuppression 1

Special Considerations

• Timing of vaccination: If possible, vaccines should be administered before planned immunosuppression 1, 2

  • Inactivated vaccines should be given ≥2 weeks before immunosuppression 1
  • Live vaccines should be given ≥4 weeks before immunosuppression and avoided within 2 weeks of starting immunosuppression 1

• Household vaccination: All household members of immunocompromised children should be fully vaccinated to create a "circle of protection" 1, 2

  • Household members can safely receive most vaccines, including inactivated vaccines and most live vaccines (except oral polio vaccine) 1, 5
  • Annual influenza vaccination is particularly important for household members 1, 2

• Serological monitoring: Consider checking antibody titers after vaccination to confirm adequate immune response, especially for critical vaccines 6

Common Pitfalls to Avoid

• Delaying all vaccinations: Even with impaired immune responses, inactivated vaccines can still provide some protection and should not be withheld 7, 8

• Administering live vaccines: Live vaccines pose significant risks to immunocompromised patients and should be avoided unless the level of immunosuppression is minimal and the risk of natural infection is high 1, 9

• Overlooking specialized vaccines: Immunocompromised children often need additional vaccines beyond the standard schedule, such as meningococcal B vaccine or pneumococcal vaccines at non-standard ages 6

• Neglecting household vaccination: Failure to vaccinate household members can leave the immunocompromised child vulnerable to preventable infections 1, 2