What are the management recommendations for Vaccine-Preventable Diseases (VPD) or Valproic acid (VPA)?

Management of Vaccine-Preventable Diseases (VPD)

Core Vaccination Strategy for Healthcare Workers and High-Risk Populations

Healthcare workers and public-safety workers require comprehensive vaccination against vaccine-preventable diseases due to their occupational exposure risk, with hepatitis B vaccination being mandatory for those with blood or body fluid contact. 1

Priority Vaccinations for Healthcare Workers

• Hepatitis B vaccination is essential for all healthcare and public-safety workers with potential exposure to blood or blood-contaminated body fluids, as HBV infection represents a major occupational hazard with significant transmission risk from percutaneous and permucosal exposures 1

• Measles, mumps, and rubella (MMR) vaccination requires evidence of two doses of live measles vaccine for healthcare workers born in 1957 or later, as these workers face increased risk of measles exposure in healthcare facilities 1

• Annual influenza vaccination is required for all healthcare workers, particularly those caring for elderly patients (≥65 years) who should also receive pneumococcal polysaccharide vaccine 1

• Varicella vaccination should be considered for healthcare workers who have direct contact with contaminated dressings or infectious material, particularly in settings involving recombinant vaccinia virus clinical trials 1

Live Vaccine Contraindications in Immunocompromised Patients

Live vaccines are absolutely contraindicated in severely immunocompromised patients with IBD or other immune-mediated inflammatory diseases receiving immunosuppressive therapy, as uncontrolled viral replication may cause disease. 1

• Live vaccines (measles, mumps, rubella, rotavirus, smallpox, chickenpox, yellow fever, BCG) must be avoided in patients on immunosuppressive medications including corticosteroids, thiopurines, biologics, JAK inhibitors, and combination therapies 1

• Patients receiving high-dose corticosteroids (≥2 mg/kg body weight or ≥20 mg/day prednisone equivalent) for ≥2 weeks should wait at least 3 months after discontinuation before receiving live virus vaccines 1

• Patients with leukemia in remission may receive live-virus vaccines only after chemotherapy has been terminated for at least 3 months 1

Safe Vaccination Approaches for Immunocompromised Patients

• Killed/inactivated vaccines do not cause infection in immunodeficient patients and can be administered safely, though immune response may be suboptimal 1

• Close household contacts of immunodeficient patients should receive all recommended vaccines except live oral poliovirus, as horizontal transmission risk exists primarily with poliovirus but is minimal with other live vaccines 1

• Patients with primary immunodeficiency who have achieved full immune reconstitution after hematopoietic stem cell transplantation may receive live viral vaccines, but only after careful immunological evaluation confirms adequate T cell responses 1

Special Populations Requiring Modified Vaccination Schedules

Adults ≥65 years require completed primary diphtheria-tetanus toxoid series (three doses of Td with specific timing: first two doses ≥4 weeks apart, third dose 6-12 months after second), annual influenza vaccine, and single-dose pneumococcal polysaccharide vaccine. 1

• Revaccination with pneumococcal vaccine should be strongly considered ≥6 years after first dose for asplenic patients or those with rapid antibody decline (transplant recipients, chronic renal failure, nephrotic syndrome) 1

• Elderly patients require reduced starting doses and slower titration when initiating medications like valproic acid due to decreased clearance and increased free fraction (44% increase) 2

Vaccination Timing and Chemotherapy Considerations

• Vaccination during active chemotherapy or radiation therapy must be avoided due to poor antibody response 1

• Patients vaccinated while on immunosuppressive therapy or within 2 weeks before starting therapy should be considered unimmunized and revaccinated ≥3 months after therapy discontinuation 1

Critical Misconceptions to Avoid

• Short-term corticosteroid use (<2 weeks), low-to-moderate doses, alternate-day treatment, physiologic replacement doses, or topical/aerosol/intra-articular administration do NOT contraindicate live virus vaccines 1

• Aerosol steroid therapy has no documented evidence of increased severe reactions to live vaccines and should not delay vaccination 1

Herd Immunity and Community Protection

Maintaining high vaccination coverage in the general population is critical for protecting immunocompromised individuals who cannot receive live vaccines, as herd immunity prevents community transmission of vaccine-preventable diseases. 1

• Family members and close contacts of immunodeficient patients must complete all recommended immunizations to create a protective barrier, with the sole exception being live oral poliovirus vaccine 1

• The alarming increase in non-immunized persons threatens to return epidemic patterns of vaccine-preventable diseases that were previously controlled 1

Occupational Risk Assessment Algorithm

1. Identify blood/body fluid exposure frequency - determines hepatitis B vaccination necessity 1
2. Assess patient contact type - healthcare workers with direct patient contact require MMR evidence 1
3. Evaluate age and birth year - persons born ≥1957 require two-dose measles documentation 1
4. Review immunosuppression status - determines live vaccine eligibility 1
5. Monitor annual requirements - influenza vaccination required yearly for all healthcare workers 1