Immunizations for the Immunocompromised Child

Although immunocompromised children are unlikely to have optimal immune responses to vaccines, some will benefit from immunization. They should receive inactivated vaccines that are routinely recommended for immunocompetent children plus pneumococcal and influenza immunizations. Live viral and bacterial vaccines are contraindicated with the exception of MMR. It may be given to children infected with HIV who do not have severe immunosuppression. The timing of immunizations is generally the same for immunocompromised and normal children. However, the MMR schedule in children infected with HIV is accelerated, with 2 doses given 1 month apart. Susceptible children whose immunosuppression is related to a temporary condition should be vaccinated after immune dysfunction has resolved. The question of revacination for children infected with HIV who are receiving effective antiretroviral therapy is under investigation, but no specific recommendations are currently available.