Which vaccinations are recommended for patients with known immunosuppression, and how should I manage their immunization schedule?

Patients with known immunosuppression are recommended to receive specific vaccinations to reduce their risk of infections, with careful management of their immunization schedule to ensure safety and efficacy. Recommended vaccines include pneumococcal vaccines (PCV13 or PPV23), annual influenza vaccine, and hepatitis B vaccine where appropriate, depending on the underlying cause of immunosuppression NICE CKS. For example, those with immunosuppression due to disease or treatment should receive pneumococcal vaccines and annual flu vaccination NICE CKS.

Live vaccines are generally contraindicated in immunosuppressed patients due to the risk of vaccine-related infection; this includes vaccines such as BCG, oral typhoid, and cholera vaccines NICE CKS,NICE CKS. In HIV-positive individuals, live vaccines should be avoided unless under specialist advice, and vaccination plans should be coordinated with HIV specialists NICE CKS,NICE CKS.

Varicella vaccination is recommended for non-immune close contacts of immunosuppressed patients to reduce transmission risk, with two doses spaced 4–8 weeks apart for children aged 1 year or older; varicella and MMR vaccines should be spaced by at least 4 weeks if not given simultaneously NICE CKS.

Immunization schedules for immunosuppressed patients should be individualized, ideally coordinated with specialist input, especially in complex cases such as children undergoing chemotherapy or HIV infection, to optimize timing and vaccine choice NICE CKS[Moulik et al. 2019]. Vaccines should be administered intramuscularly or subcutaneously as appropriate, with attention to bleeding risk in patients with coagulopathies NICE CKS.

Documentation and follow-up are essential to ensure vaccine doses are completed and adverse reactions monitored, with clear communication to patients and carers about the benefits and risks of vaccination NICE CKS,NICE NG218.