Synopsis
Plan safe, timed and effective vaccination for adults with altered immunity by defining the immune defect, separating live from non-live vaccines and coordinating doses with immunosuppressive treatment.
- Define why immunity is altered: malignancy, transplantation, biological therapy, corticosteroid exposure, HIV, asplenia and primary immune deficiency create different vaccine restrictions and expected responses.
- Non-live vaccines cannot cause infection from replication and are generally safe, but responses may be weaker during profound immunosuppression; timing should maximise benefit without delaying essential treatment.
- Live vaccines may replicate and cause disease in significant immunosuppression. Check the current Green Book, product information and specialist plan before administration.
Key red flags
Recent chemotherapy, stem-cell or solid-organ transplantation, B-cell-depleting therapy and intensive combination immunosuppression markedly alter vaccine safety, timing and response.
Investigation priorities
Establish product, date, dose number and documented reaction across primary, hospital and patient-held records.
Management branches
Immunosuppressive therapy is planned and there is time to improve protection safely.
- Reconcile vaccines and infection history, define the regimen and planned start date and identify risk-based and routine gaps using current Green Book chapters.
- Give indicated non-live and specialist-approved live vaccines at the required interval before therapy, without delaying urgent cancer or immune treatment inappropriately.
Key medicines
Inactivated influenza vaccineGive the current programme-recommended intramuscular adult product and schedule each influenza season for the eligible risk group.
Recombinant zoster vaccineGive the current Green Book risk-based two-dose intramuscular schedule, using the interval specified for immunocompromised adults.