Among the greatest scientific advances in the past two centuries is the development of effective vaccines. Many diseases that used to be epidemic, causing illness and death are now able to be prevented. Despite their proven efficacy in the population at large, vaccines can be problematic for people with primary immunodeficiency diseases (PI). Since some types of PI interfere with the body’s ability to make antibodies in response to a vaccination, many would ask if it makes any sense or does any good to give vaccines to patients with PI. As part of the PI community, it’s important for you to have the facts about vaccines.
In April 2014, the IDF Medical Advisory Committee (MAC) published an article in The Journal of Allergy and Clinical Immunology called “Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts,” addressing the uncertainty regarding which vaccines can be given to patients with PI. The article also addressed the growing neglect of societal adherence to routine immunizations. IDF acknowledges the tremendous importance of the article and is grateful for the efforts of the MAC.
Not all people with PI have problems with vaccines. Those with phagocytic cell disorders, such as Chronic Granulomatous Disease (CGD) or with Complement Deficiencies, benefit from immunization. Patients with these types of innate immune disorders should absolutely receive vaccines to protect them.
However, people with T and B cell immunodeficiencies, such as Common Variable Immune Deficiency (CVID), Severe Combined Immune Deficiency (SCID) or Bruton’s agammaglobulinemia, are unable to develop protective immunity following vaccination, so the vaccines would not do them any good. Moreover, some vaccines may threaten the recipient. Live vaccines, such as the chicken pox vaccine (Varivax), measles, mumps, rubella (MMR), rotavirus, BCG, yellow fever, oral polio and the influenza nasal spray, could actually cause the disease it is supposed to prevent in individuals with these types of PI.
Infants with Severe Combined Immune Deficiency (SCID) are at the greatest risk for problems with live viral vaccines (LVV). Some live vaccine viruses can be found in the body fluids and stools of vaccinated normal individuals for up to two weeks following vaccination. Because of this, families should limit contact between individuals recently immunized with LVV’s and infants with SCID during that time.
For people with antibody deficiencies, immunoglobulin (Ig) replacement therapy is the standard of care. Ig provides these people with the antibodies that their own bodies cannot make, protecting them from vaccine preventable diseases.
For a person with PI, vaccines are an important weapon in the arsenal to prevent infection and stay healthy. People with PI, their parents and family members should consult their immunologist and primary care providers to determine the need for vaccination.
In all cases, parents and patients with PI should consult their healthcare providers for immunization recommendations and further information.
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