Combined T And B Cell Immunodeficiencies And Immune Dysregulation
Individuals with T cell or combined deficiency are particularly susceptible to infections with virtually all viruses and many bacteria. T cell defects may be severe or partial . Those with severe defects will not respond to any vaccines. Those with partial defects may have some response.
Inactivated vaccines
For those with severe combined immunodeficiency, administration of inactivated vaccines is not harmful, but will not provide protection.
Inactivated vaccines should be given to those with partial immunodeficiency although response may be suboptimal. Hepatitis B vaccine should be given at double the routine dose and using a routine 3- or 4-dose schedule. HPV vaccine should be given following routine age indications but using a 3-dose schedule regardless of age.
In addition to routine vaccines, individuals with partial T cell or combined defects should receive pneumococcal conjugate vaccine regardless of age, pneumococcal polysaccharide vaccine if 2 years of age or older, and one dose of Hib vaccine after age 5 years regardless of prior Hib vaccination history. Quadrivalent conjugate meningococcal vaccine is recommended and meningococcal B vaccine should be considered if 2 months of age or older. Inactivated influenza vaccine should be given annually, as Ig may not protect. However, humoral response may be reduced.
Live attenuated vaccines
Refer to Table 1, Table 2 and vaccine-specific chapters in Part 4 for additional information.
How Can I Learn More
- Ask your healthcare provider. He or she can give you the vaccine package insert or suggest other sources of information.
- Contact the Centers for Disease Control and Prevention : Call or visit CDC’s website at
Meningococcal Vaccine Information Statement. U.S. Department of Health and Human Services/Centers for Disease Control and Prevention National Immunization Program. 8/24/2018.
What Are The Risks From Meningococcal Vaccine
Most people have mild side effects from the vaccine, such as redness or pain where the shot was given. A vaccine, like any medicine, may cause serious problems, such as severe allergic reactions. This risk is extremely small. Getting the meningococcal vaccine is much safer than getting the disease.
You can learn more on the Vaccine Information Statements for meningococcal ACWY and meningococcal B.
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Symptoms Of Meningococcal Disease
Neisseria meningitidis can cause invasive meningococcal disease , which usually presents as meningitis and septicaemia. Septicaemia, either on its own or with meningitis, can be particularly severe. N. meningitidis can also cause other localised infections, although these are less common, including:74,84
- pneumonia
The clinical manifestations of meningococcal septicaemia and meningitis may be non-specific.
They can include:85
- rash
- headache
- vomiting
Not all symptoms or signs may be present at disease onset.
The characteristic rash of meningococcal disease does not disappear with gentle pressure on the skin, but the rash is not always present.
IMD can also present atypically as:
These atypical presentations are more common among certain serogroups, especially serogroup W.
Aboriginal And Torres Strait Islander People
Aboriginal and Torres Strait Islander people aged 2 months to 19 years are strongly recommended to receive MenACWY vaccine
Aboriginal and Torres Strait Islander people aged 2 months to 19 years are strongly recommended to receive MenACWY vaccine.
The dose schedule for MenACWY vaccine depends on the vaccine brand and the persons age when they start the vaccine course.
Infants aged < 9 months can receive 2 of the 3 MenACWY brands . Infants and children aged 9 months to 2 years can receive any of the 3 MenACWY vaccine brands, following the age-appropriate dosing schedule.
For all people aged 2 years, a single dose of MenACWY vaccine is recommended. In this age group, it is preferable to receive either Menveo or Nimenrix, rather than Menactra. If Menveo and Nimenrix are unavailable, Menactra can be given.
Aboriginal and Torres Strait Islander people aged 2 months to 19 years are strongly recommended to receive a course of MenB vaccine.
The dose schedule for MenB vaccine depends on the brand and the persons age when they start the vaccine course.
People aged 29 years should receive 2 doses of Bexsero, 8 weeks apart.
People aged 10 years can receive 2 doses of either MenB vaccine:
- 2 doses of Bexsero, with 8 weeks between doses, or
- 2 doses of Trumenba, with 6 months between doses
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What Is Meningococcal B Infection
Meningococcal B infection is caused by bacteria called meningococcal type B. It can cause serious and life-threatening infections including meningitis, an infection of the lining that covers the brain, and septicemia, an infection of the blood. Permanent complications of infection include brain damage and deafness. About 1 in 20 people who get sick may die.
Meningococcal infection is spread from person to person by coughing, sneezing, or close face-to-face contact. It can also be spread through saliva. Babies and young children can become sick through sharing soothers, bottles or toys used by other children. Older children and adults can become sick through activities such as kissing, or sharing food, drinks, cigarettes, lipstick, water bottles, and mouth guards used for sports or mouthpieces of musical instruments.
Introduction And General Principles
Individuals may be immunocompromised as a result of a congenital condition, an illness or medications that suppress immune function. In general, immunocompromised persons are more susceptible to vaccine-preventable infections and may have severe infections. The safety and effectiveness of vaccines in immunocompromised persons are determined by the type of immunodeficiency and degree of immunosuppression. Each immunocompromised person is different and presents unique considerations regarding immunization. The relative degree of immunodeficiency is variable depending on the underlying condition, the progression of disease and use of immunosuppressive agents. Immunodeficiency can also vary over time in many people and the decision to recommend for or against a particular vaccine will depend upon a case-by-case analysis of the risks and benefits. There is potential for serious illness and death if immunocompromised people are under-immunized and every effort should be made to ensure adequate protection through immunization however, inappropriate use of live vaccines can cause serious adverse events in some immunocompromised people as a result of uncontrolled replication of the vaccine virus or bacterium.
The following recommendations reflect general best practices and are subject to individual considerations and new evidence as it arises.
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What If There Is A Severe Reaction
What should I look for?
Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or unusual behavior. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness– usually within a few minutes to a few hours after the vaccination.
What should I do?
If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get to the nearest hospital. Otherwise, call your doctor.
Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System . Your doctor should file this report, or you can do it yourself through the VAERS web site at , or by calling .
VAERS does not give medical advice.
Vaccine Certificate Should Be Given Aadhaar Card
We are back to counting cases and variants as the spectre of Omicron haunts the world. But the responses, including many in India, have been short-sighted, full of counterproductive panic and reminiscent of some of the early mistakes of 2020.
Except, today we have many more tools to fight the virusknowledge of its airborne nature, confirmation that masks in closed indoor places can help, awareness that opening a window can make a difference in a classroom, therapeutic pills of varying success, and above all, vaccines.
Dr Angelique Coetzee, the South African doctor who first detected Omicron, told me she found it on a random rapid-antigen test. That in itself should be a warning against the needless RT-PCR tests travellers are being subjected to at both departure and destination, creating a mass congregation at airports themselves.
Most importantly, she saidand this is now being confirmed by doctors worldwidethat feedback from South African doctors is that the symptoms of Omicron are mild, there is no respiratory failure, no plummeting oxygen levels, good self-recovery by day 6 and most critically, vaccinated patients are doing well at getting better.
The lesson, if there is any left to be learnt, is an immediate mandating of vaccines. I understand that coercion is anathema to public health specialists. But when you consider that 12.5 crore Indians are yet to receive their scheduled second jab, their freedom ends where all of society is being damaged.
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Nature Of The Disease
Meningococcal disease is caused by the bacterium Neisseria meningitidis. The bacterium is commonly known as meningococcus.
There are 13 known meningococcal serogroups, distinguished by differences in surface polysaccharides of the bacteriums outer membrane capsule. Globally, serogroups A, B, C, W-135 and Y most commonly cause disease.
Schedule For Children Who Are More Likely To Get Meningitis
Younger kids will need a vaccine if they’re at a greater risk of getting meningitis because they:
- Have complement component deficiency, a rare immune system disease
- Have spleen damage or had their spleen removed
- Live in an area that had a meningitis outbreak
- Take drugs that affect their immune system
- Travel to a country where meningitis is common
For these cases, doctors strongly recommend MenACWY for kids ages 2 months to 10 years. The number of doses and boosters your child needs depends on their health, age, and how long they stay at risk for the disease. For example, a child with spleen damage will be at risk longer than someone who travels for a week to a country where meningitis is common. Check with your doctor to find out what your child needs.
Doctors also recommend that kids ages 10 and older with these risks get the standard doses of MenB.
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Summary Of Use During Lactation
The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to meningococcal vaccine. Immunization of the mother during the third trimester of pregnancy markedly increases the amount of meningococcal antibodies in breastmilk. Breastfed infants should be vaccinated according to the routine recommended schedules.
Special Considerations For Concomitant Use Of Menactra And Dtap
Children can receive Menactra® before or concomitantly with diphtheria and tetanus toxoids and acellular pertussis vaccines. This timing avoids interference with the immunologic response to the meningococcal vaccine antigens that occurs when administering Menactra® after DTaP. Alternatively, children can receive Menveo® or MenQuadfi®, regardless of timing of DTaP vaccination.
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Persons With Chronic Diseases
Asplenia
Two doses of Men-C-ACYW vaccine are recommended for persons with anatomic or functional asplenia, including sickle cell disease. When elective splenectomy is planned, all recommended vaccines should ideally be completed at least 2 weeks before surgery if only one dose can be given before surgery, the second dose should be given 8 weeks after the first dose, with a minimum interval of 4 weeks. In the case of an emergency splenectomy, two doses of vaccine should ideally be given beginning 2 weeks after surgery but can be given earlier, before discharge, if the person might not return for vaccination after discharge. Persons one year of age and older with asplenia who have not received Men-C-ACYW vaccine should receive two doses administered 8 weeks apart, with a minimum interval of 4 weeks. In addition, 4CMenB or MenB-fHBP vaccine should be offered. Periodic booster doses with Men-C-ACYW vaccine are also recommended.
Refer to Table 1 for vaccination recommendations of high risk individuals due to underlying conditions. Refer to Booster doses and re-immunization for additional information and Immunization of Persons with Chronic Diseases in Part 3 for additional general information.
Cdc Does Not Routinely Recommend A Menb Vaccine For All Teens And Young Adults However All Teens May Get Vaccinated Preferably At 16 To 18 Years Old
Serogroup B meningococcal disease is relatively rare. Outbreaks have occurred at several U.S. colleges during the past decade. CDCs current recommendation gives people access to MenB vaccines to help prevent this uncommon, but serious illness. However, clinicians and parents should discuss the risk of the disease and weigh the risks and benefits of vaccination. Available data suggest these vaccines are safe and provide protection, but that protection decreases fairly quickly after vaccination.
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Where Can I Find These Vaccines
Your clinician is usually the best place to receive recommended vaccines for you or your child.These vaccines are part of the routine childhood immunization schedule. Therefore, vaccines for children and teens are regularly available at
- Pediatric and family practice offices
- Community health clinics
If your clinician does not have these vaccines for adults, ask for a referral.
Vaccines may also be available at
- Pharmacies
- Health departments
- Other community locations, such as schools and religious centers
Federally funded health centers can also provide services if you do not have a regular source of health care. Locate one near youexternal iconexternal icon. You can also contact your state health department to learn more about where to get vaccines in your community.
When receiving any vaccine, ask the provider to record the vaccine in the state or local registry, if available. This helps clinicians at future encounters know what vaccines you or your child have already received.
Use Of Saliva Testing Of Antibody Levels Against Meningococcal Serogroups For Monitoring Meningococcal Vaccine Responses
The authors stated that a drawback of this study was that only samples of children aged 10 to 15years were used here to identify the salivary thresholds. Thus, these salivary thresholds as surrogate of protection have to be validated in other large meningococcal vaccine trials, preferably studies that include participants with a wide age range. furthermore, samples were collected only up to 1 year after vaccination. Whether saliva samples could be used as a surrogate of protection in the long-term after vaccination has to be examined as well.
Code Code Description
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Administration With Other Vaccines
Clinicians may administer MenACWY and MenB vaccines during the same visit, but at a different injection site, if feasible. Clinicians can also administer meningococcal and other vaccines during the same visit, but at a different injection site, if feasible. Administer each vaccine with a separate syringe.
How And When Should You Receive The Meningococcal Vaccine
In most cases, adults only need one dose. But if you remain at risk, you may need a booster.
Some adults may need another type of meningitis vaccine, the serogroup B meningococcal vaccine, if they are exposed to this virus through work or travel or if they have a damaged or missing spleen, or certain immune system disorders.
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Healthy Infants And Children
One dose of Men-C-C vaccine is recommended in unimmunized children less than 5 years of age. One dose of Men-C-C vaccine may be considered for children 5 to 11 years of age if they have not previously been immunized as infants or toddlers. Immunization with 4CMenB vaccine or MenB-fHBP may be considered on an individual basis, depending on individual preferences, regional serogroup B epidemiology and strain susceptibility.
Who Should Not Get Meningococcal Vaccine Or Should Wait
Tell the person who is giving you the vaccine:
- If you have any severe, life-threatening allergies.
- If you have ever had a life-threatening allergic reactionafter a previous dose of meningococcal ACWY vaccine, or if you have a severe allergy to any part of this vaccine, you should not get this vaccine. Your provider can tell you about the vaccine’s ingredients.
- Not much is known about the risks of this vaccine for a pregnant woman or breastfeeding mother. However, pregnancy or breastfeeding are not reasons to avoid MenACWY vaccination. A pregnant or breastfeeding woman should be vaccinated if she is at increased risk of meningococcal disease.
- If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you.
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Problems That Could Happen After Getting Any Injected Vaccine
- People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell the clinician if you or your child feel dizzy, have vision changes, or have ringing in the ears.
- Some people get severe pain in the shoulder and have difficulty moving the arm where the clinician gave a shot. This happens very rarely.
- Any medicine can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses. These reactions happen within a few minutes to a few hours after the vaccination.
- As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.
What Are The Possible Side Effects Of Meningococcal Vaccines
Some of the most common side effects are swelling, redness, and pain at the site of the injection, along with headache, fever, or tiredness. Serious problems, such as allergic reactions, are rare.
The meningococcal vaccines contains only a small piece of the germ, so it can’t cause meningococcal disease.
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Rare Side Effects Of Meningococcal Immunisation
There is a very small risk of a serious allergic reaction to any vaccine. This is why you are advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation in case further treatment is required.
If any other reactions are severe and persistent, or if you are worried, contact your doctor for further information.