Vaccination of Specific Groups

Abstract

While the UK immunisation schedule is a national immunisation policy for the general population, several groups of patients and persons require a different approach to be taken. For example, some groups of patients cannot safely receive certain vaccine because they may be allergic (anaphylaxis) to some vaccine components and some patients cannot receive, e.g. live attenuated vaccines because they are severely immunocompromised. Other patients require additional vaccines to protect them from vaccine preventable diseases because they are immunocompromised in some way, e.g. asplenia. The following groups require special consideration: ● Pregnant women; ● Severely immunocompromised patients; ● Asplenic patients or those with dysfunctional spleens; ● Severe allergy to vaccine components; ● healthcare workers (HCWs); ● Patients with certain chronic medical conditions; ● Morbid obesity; and ● Persons travelling abroad, especially to developing countries. In general, giving vaccines to pregnant women is not recommended due to the potential risk of medicines and vaccines harming the foetus. Specifically, live attenuated vaccines should not be given to pregnant women. It is relatively safer to give inactivated/killed vaccines to pregnant women, but most vaccines can and should be postponed until after delivery. However, in the UK it is recommended that pregnant women receive two particular vaccines during pregnancy in order to protect the mother and foetus from avoidable harm. These are the inactivated influenza vaccine and a vaccine against Bordetella pertussis infection. For these two vaccines, the benefits of vaccination for the pregnant women and the foetus or newborn baby outweigh any theoretical risks of harm. Severely immunocompromised patients should not receive live attenuated vaccines due to a risk of uncontrolled viral replication resulting in clinical disease. Patients who are considered to be severely immunocompromised include: ● Severe primary immunodeficiency, e.g. severe combined immunodeficiency; ● Patients receiving cancer chemotherapy and those within six months of completing chemotherapy; ● Patients who have received a solid organ transplant and are on immunosuppressive therapy; ● Patients who have received a bone marrow transplant until twelve months after all immunosuppressive therapy has stopped; and ● Patients receiving high-dose systemic corticosteroids until at least three months after treatment ends.