older man with hand over mouth

Our moral responsibility to protect the immunocompromised…

The argument that people have a moral responsibility to get vaccinated in order to protect the immunocompromised or severely ill who cannot be vaccinated is a bogus one. Even the immunocompromised are not exempt from vaccination. It is an immensely disingenuous line of reasoning, at best.

“Killed or inactivated vaccines do not represent a danger to immunocompromised persons and generally should be administered as recommended for healthy persons. For specific immunocompromising conditions (e.g., asplenia), such patients may be at higher risk for certain diseases, and additional vaccines, particularly bacterial polysaccharide vaccines {Haemophilus influenzae type b (Hib), pneumococcal and meningococcal}, are recommended for them. Frequently, the immune response of immunocompromised persons to these vaccine antigens is not as good as that of immunocompetent persons; higher doses or more frequent boosters may be required, although even with these modifications, the immune response may be suboptimal.

… Certain medical conditions, such as renal failure, diabetes, alcoholic cirrhosis, or asplenia, may increase the patient’s risk for certain diseases. Some antigens, particularly bacterial polysaccharide vaccines, are recommended for such patients. Frequently, the immune response of these patients to these antigens is not as good as that of immunocompetent persons, and higher doses or more frequent boosters may be required. Persons with these conditions are generally not considered immunosuppressed for the purposes of vaccination and should receive routine vaccinations with both live and inactivated vaccines according to the usual schedules.

… Immunocompromised children should receive Hib conjugate vaccines in the same dosage and schedule as for immunocompetent children.

… Because influenza may result in serious illness and complications for immunocompromised persons, vaccination is recommended and may result in protective antibody levels in many immunocompromised recipients.

…. Patients with chronic renal failure should receive annual influenza immunization.

…. Pneumococcal vaccine is recommended for use in persons greater than or equal to 2 years of age with chronic illnesses specifically associated with increased risk of pneumococcal disease or its complications (e.g., anatomic or functional asplenia {including sickle cell disease}, nephrotic syndrome, cerebrospinal fluid leaks, and conditions associated with immunosuppression, including HIV infection). Revaccination after 3-5 years should be considered for children with nephrotic syndrome, asplenia, or sickle cell anemia who would be less than or equal to 10 years old at revaccination.

… Pneumococcal vaccine is recommended for use in immunocompetent adults who are at increased risk of pneumococcal disease or its complications because of chronic illness (e.g., cardiovascular disease, pulmonary disease, diabetes mellitus, alcoholism, cirrhosis, or cerebrospinal fluid leaks).

Vaccination is also recommended for immunocompromised adults at increased risk of pneumococcal disease or its complications (e.g., persons with splenic dysfunction or anatomic asplenia, Hodgkin’s disease, leukemia, lymphoma, multiple myeloma, chronic renal failure, nephrotic syndrome, or conditions such as organ transplantation associated with immunosuppression). Revaccination should be strongly considered greater than or equal to 6 years after the first dose for those patients at highest risk of fatal pneumococcal infection (e.g., asplenic patients) or for those at highest risk of rapid decline in antibody levels (e.g., those with chronic renal failure, nephrotic syndrome, or transplanted organs).

…. Hepatitis B vaccination is recommended for susceptible hemodialysis patients. Although seroresponse to hepatitis B vaccine is lower in hemodialysis patients than in healthy persons, for those patients who do respond, hepatitis B vaccine will protect them from hepatitis B virus infection and reduce the necessity for frequent serologic screening. Hepatitis B vaccine is also indicated for patients whose renal disease is likely to lead to dialysis or transplantation.

… For patients undergoing hemodialysis and for other immunosuppressed patients, higher vaccine doses or increased number of doses are required.

… Routine immunization with the quadrivalent vaccine is recommended for certain high-risk groups, including persons with terminal complement component deficiencies and those with anatomic or functional asplenia.

… Other vaccines containing killed antigens, including cholera, plague, and anthrax, do not pose a risk to immunocompromised persons and should be used for the same indications as for immunologically normal persons.”

— CDC Advisory Committee on Immunization Practices (ACIP)

Courtesy: The Outliers


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