Pneumococcal Polysaccharide Vaccination in Pediatric Inflammatory Bowel Disease

Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review

Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.

Advances in vaccinating immunocompromised children

PURPOSE OF REVIEW

Immunocompromised children are a largely under-vaccinated population and are vulnerable to acquiring vaccine-preventable infections (VPIs). A variety of factors contribute to poor vaccine coverage including: severity of underlying illness, sporadic contact with primary care physicians, and lack of awareness among specialty providers regarding vaccination status. In this review, we report recent data regarding incidence of VPIs, new approaches to vaccine use, rates of vaccine coverage, and strategies to optimize vaccine administration in immunocompromised populations.

RECENT FINDINGS

Pediatric transplant recipients and patients with autoimmune disorders receiving novel biological therapies, represent growing immunocompromised patient populations. VPIs continue to be a concern for such patients. Underlying disease severity may limit efforts to immunize pediatric patients early in their disease process, prior to immunosuppression. Inactive vaccines are safe and immunogenic after the introduction of immunosuppression, but live vaccines are typically contraindicated. Emerging data support the safety and effectiveness of live vaccines in certain immunocompromised individuals. Care providers must remain vigilant in maintaining patients' vaccination status based on current vaccination guidelines, and create a multidisciplinary approach to optimizing vaccination.

SUMMARY

Immunocompromised children remain under-vaccinated and vulnerable to VPIs. Optimizing vaccines should be a priority for every provider caring for this population.