Immunocompromised children and patients with chronic immune disorders represent a vulnerable population that often remains under-vaccinated due to concerns regarding vaccine safety [2]. However, children with type 1 diabetes mellitus, autoimmune pathologies, chronic kidney disease, and transplant recipients have an increased risk of severe infectious complications [1, 3, 5]. Therefore, developing a proper immunization strategy is critical to maintaining their health.
Immune Characteristics and Risks in Immunodeficient States
Metabolic regulation disorders or permanent limitations of immune system functions reduce the effectiveness of standard vaccines, causing a less pronounced protective response [1]. Nevertheless, the risk of severe infections in such patients vastly exceeds the potential risks from administering quality immunobiological agents [5]. For example, in type 1 diabetes mellitus, strictly adhering to the official childhood vaccination schedule is recommended, although the use of live vaccines requires separate discussion due to the viral nature of certain autoimmunity triggers [1].
Safety of Inactivated Vaccines
Inactive (inactivated) vaccines have a proven safety profile and effectively build an immune response in children with chronic inflammatory and immune diseases [2, 4]. Studies show that patients with juvenile idiopathic arthritis or systemic lupus erythematosus do not experience severe side effects or exacerbation of their underlying disease after receiving non-live vaccines, even while on biological therapy [4]. Similar data are confirmed for children with chronic kidney disease and inflammatory bowel disease [5, 7].
Vaccination Rules Before and After Organ Transplantation
A special approach is required when preparing for kidney and other organ transplants. Transplant candidates should be fully vaccinated for their age in accordance with standard schedules [3]. Following transplantation, vaccination (except for the influenza vaccine) is typically delayed by 3–6 months to minimize risks and achieve maximum immunogenicity [3]. At the same time, live vaccines are strictly contraindicated in patients with profound immunosuppression and transplant recipients [3, 4].
Overcoming Barriers and Increasing Vaccination Coverage
Low vaccination coverage among children with immunodeficiencies is often associated with a lack of awareness among relevant specialists, parental concerns, and irregular contact with pediatricians [2, 7]. To optimize the process, close coordination is necessary between pediatricians, immunologists, and subspecialists (nephrologists, gastroenterologists, rheumatologists). Timely formulation of an individualized schedule helps protect immunocompromised children from vaccine-preventable infections without threatening their stable condition.
Sources
- [1] Childhood Vaccinations and Type 1 Diabetes. PubMed
- [2] Advances in vaccinating immunocompromised children. PubMed
- [3] Vaccinations in pediatric kidney transplant recipients. PubMed
- [4] Vaccinations in juvenile chronic inflammatory diseases: an update. PubMed
- [5] Vaccine administration in children with chronic kidney disease. PubMed
- [7] Vaccinations in patients with inflammatory bowel disease. PubMed
Disclaimer: The information is for reference purposes and does not replace an in-person consultation with a pediatrician or specialist.