IAP has guidelines for vaccination of children in situations, where a child is considered to be immunocompromised and an appropriate immune response to a vaccine is not mounted. These scenarios are –
On Corticosteroids/other immunosuppressive therapy
Children receiving oral corticosteroids in high doses (prednisolone 2 mg/kg/day or for those weighing more than 10 kg, 20 mg/day or its equivalent) for >2 weeks should not receive live virus vaccines until the steroids have been discontinued for at least 1 month. Children on lesser dose of steroids or those on inhaled or topical therapy may be safely and effectively given their age appropriate vaccines.
Basic principles to be followed
- Live vaccines are contraindicated during and for 6 months after end of chemotherapy/immunosuppression.
- Non-live vaccines are also best given after 6 months from end of treatment for durable immunity.
- Annual inactivated influenza vaccine is the only vaccine recommended for all children during chemotherapy
- Hepatitis B vaccine is recommended only for previously unimmunized children with risk of transfusion associated transmission. 4 doses are recommended : 0,1,2 & 12 months (double dosage).
Guidelines Vaccinations of the Sibling or any other close contact of family
- Sibling immunization should continue uninterrupted except for oral polio vaccine which needs to be substituted by the injectable vaccine.
- Inactivated influenza vaccine is recommended for all contacts
- Varicella vaccine is encouraged for all contacts.
- OPV is contraindicated including pulse polio doses.
- Sibling should receive inactivated poliovirus vaccine (IPV) and if OPV is either given by mistake or given because there is no other option, then the sibling should remain away from index child for at least 2 weeks.