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.
- Vaccinate before planned immunosuppression when feasible, respecting the minimum interval required between a live vaccine and treatment; never improvise an interval from memory.
- Reconcile product, date and dose number rather than recording only 'vaccinated'. Risk-based influenza, COVID-19, pneumococcal, shingles and other schedules change over time.
- Household contacts should receive routine vaccines, with specific advice around selected live products, because reducing exposure can indirectly protect the immunocompromised person.
- Vaccination does not remove the need for early assessment of fever, antimicrobial prophylaxis when indicated or post-exposure treatment for diseases such as measles, varicella or hepatitis B.
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.
MMR, varicella and several travel vaccines contain live organisms and require explicit immune-status assessment before administration.
Contact with measles, varicella, hepatitis B or another vaccine-preventable infection may require immunoglobulin, antiviral treatment or accelerated vaccination through a specialist pathway.
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.
- Document incomplete courses, future revaccination, response limitations and post-exposure instructions for primary and specialist care.