Vaccination in immunocompromised children: Part 2

There may be certain situations where even immunocompromised need to be given vaccines, even if a suboptimal immune response is expected…

Mammalian bites & Rabies

Thorough wound management and antisepsis accompanied by local infiltration of rabies immunoglobulin followed by anti-rabies vaccination is given.
Even category II exposures should receive rabies immunoglobulin
In addition to 5 doses of anti-rabies vaccine, a 6th dose on day 90 is also mandatory.

Wounds & Tetanus Toxoid

In a clean, minor wound – Td/TdaP booster regardless of immunization status is recommended,

All other wounds – Td/TdaP + Tetanus Immuno Globulin.

Varicella Exposure

Under ideal circumstances VZV IgG levels should be assessed at the time of exposure and children with less than protective levels, varicella zoster immunoglobulin (VZIg) should be offered (Dose 0-5 years 250 mg, 6-10 years 500 mg, 11-14 years 750 mg, ≥15 years 1000 mg given by slow intramuscular injection).
Alternatively, human normal immunoglobulin at 0.2g/kg can be given intravenously
In case both the above are unaffordable high dose oral acyclovir prophylaxis (age <2 years 200 mg QID, 2-6 years 400 mg QID, >6 years 800 mg QID) has to be started from day 7 and continued till day 21 from the time of exposure.

Influenza Vaccine 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