Title: Vaccination in patients with immunosuppression
Abstract: The possibility of having diseases which can be prevented with vaccines and having a severe disease is high in patients with primary (deficiency of cellular immunity, humoral immunity or both) or secondary (acquired, suppression of the cellular/ humaral immunity following morbidity or treatment) immunosupression.In patients with immune deficiency, the safety and efficiency of vaccines vary with the type and severity of immunosupression.Since studies related with efficiency and safety of vaccines in patients with immunosupression are limited and the guidelines related with administration of vaccines in these individuals are usually based on hypothetical information, "surveillance" studies should be pursued after vaccination.On the other hand, vaccination rates in individuals with immunosupression are not high because of insufficent knowledge of physicians about efficiency, safety and contraindications of vaccines (1). Degree of immunosupressionIndividuals with severe immunosupression: patients with combined primary immune deficiency (including severe combined immune deficiency), patients who receive cancer chemotherapy and/or radiotherapy, the first two months following solid organ transplantation, children with Human Immunodeficiency Virus (HIV) with CD4-T lymphocyte count below 15%, patients who have received high dose corticosteroids for a long term, individuals who receive biological immunomodulator agents.The degree of immunosupression in patients in whom hematopoetic stem cell transplantation has been performed varies according to the type of the donor, the type of transplantation (autologous, allogenic), problems which develop after transplantation and the treatment administered.Individuals with mild immunosupression: individuals who have received steroids for a period shorter than 14 days and at a low dose (<20 mg), asymptomatic patients with HIV with a CD4-T lynphocyte count of 15-24%, patients who receive low dose methotrexate (MTX: ≤0.4 mg/kg/week ), azathioprine ≤3 mg/kg/day, 6-mercaptopurine ≤1.5 mg/kg/day for maintenance chemotherapy for cancer (2). Live vaccinesAs a rule, severe systemic reactions may develop against vaccine strains in individuals with severe immunosupression and in individuals with unknown functions related with the immune system.Therefore, live viral vaccines (polio, MMR (measles, Vaccination in patients with immunosuppressionInvited Review