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.
- 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