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    Immunisation of Cardiac Patients and Specific Immunodeficient Conditions

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    anu
    This document provides vaccination guidelines for patients with chronic heart disease, DiGeorge syndrome, and asplenia. It recommends vaccines such as pneumococcal, varicella, hepatitis A, typhoid, meningococcal, and influenza for these high-risk groups. Specific schedules are outlined for chronic heart patients, including additional pneumococcal doses and use of inactivated influenza vaccines only. Guidelines also indicate that live vaccines are contraindicated for DiGeorge patients and that asplenia patients can receive most live attenuated vaccines except LAIV. The document aims to ensure these vulnerable groups receive necessary immunizations to prevent infection.

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    Immunisation of Cardiac Patients and Specific Immunodeficient Conditions

    Uploaded by

    anu
    128 views20 pages
    This document provides vaccination guidelines for patients with chronic heart disease, DiGeorge syndrome, and asplenia. It recommends vaccines such as pneumococcal, varicella, hepatitis A, typhoid, meningococcal, and influenza for these high-risk groups. Specific schedules are outlined for chronic heart patients, including additional pneumococcal doses and use of inactivated influenza vaccines only. Guidelines also indicate that live vaccines are contraindicated for DiGeorge patients and that asplenia patients can receive most live attenuated vaccines except LAIV. The document aims to ensure these vulnerable groups receive necessary immunizations to prevent infection.

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    immunisation in congenital heart disease patients

    Original Title

    Immunisation of cardiac patients and specific immunodeficient conditions

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    This document provides vaccination guidelines for patients with chronic heart disease, DiGeorge syndrome, and asplenia. It recommends vaccines such as pneumococcal, varicella, hepatitis A, typhoid, meningococcal, and influenza for these high-risk groups. Specific schedules are outlined for chronic heart patients, including additional pneumococcal doses and use of inactivated influenza vaccines only. Guidelines also indicate that live vaccines are contraindicated for DiGeorge patients and that asplenia patients can receive most live attenuated vaccines except LAIV. The document aims to ensure these vulnerable groups receive necessary immunizations to prevent infection.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    128 views20 pages

    Immunisation of Cardiac Patients and Specific Immunodeficient Conditions

    Uploaded by

    anu
    This document provides vaccination guidelines for patients with chronic heart disease, DiGeorge syndrome, and asplenia. It recommends vaccines such as pneumococcal, varicella, hepatitis A, typhoid, meningococcal, and influenza for these high-risk groups. Specific schedules are outlined for chronic heart patients, including additional pneumococcal doses and use of inactivated influenza vaccines only. Guidelines also indicate that live vaccines are contraindicated for DiGeorge patients and that asplenia patients can receive most live attenuated vaccines except LAIV. The document aims to ensure these vulnerable groups receive necessary immunizations to prevent infection.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Immunisation of cardiac

    patients and patients with


    asplenia /Di George Syndrome
    Overview of Immunisation
    • National Immunisation Schedule
    • IAP Immunisation Schedule
    • For Chronic heart disease patients
    • For Di George Syndrome
    • For functional or anatomic asplenia syndrome
    • Policy statement of AAP for cardiac surgical patients
    Additional vaccines in IAP
    • Pneumococcal
    • Varicella
    • Hepatitis A
    • Typhoid
    • Meningococcal
    • Influenza
    • HPV (Human Papilloma virus )
    Additional Vaccine for patients with Chronic
    heart disease
    • Extra 2 doses of pneumococcal vaccine with 23 valent Pneumococcal
    vaccine (given to children more than 2 years)
    • Use killed influenza vaccine only
    Vaccination schedule for patients with Chronic heart disease
    (particularly cyanotic congenital heart disease and cardiac
    failure) and chronic lung disease(AAP)

    1)Pneumococcal Conjugate(PCV)(vaccination recommended & additional doses may be


    necessary based on medical condition

    2)Influenza (Use only killed vaccine )


    3)Meningococcal (recommended for persons with an additional risk factor for which the vaccine
    would be indicated )

    4)Pneumococcal poly saccharide (PPSV23) (vaccination recommended & additional


    doses may be necessary based on medical condition )
    Pneumococcal vaccine

    • PCV13(PREVENAR 13)- approximate cost Rs 3801, minimum age 6 weeks


    • PPSV23(PNEUMOVAX 23)- approximate cost Rs 1600, minimum age 2 years

    Routine vaccination with PCV13


    • 4-dose series at 2, 4, 6, 12–15 months ( Rs 3801 x 4=15200)

    Catch-up vaccination with PCV13


    1 dose for healthy children age 24–59 months with any incomplete PCV13 series
    (Rs 3800)
    Chronic heart disease (particularly cyanotic congenital heart disease and
    cardiac failure); chronic lung disease (including asthma treated with high-
    dose, oral corticosteroids); diabetes mellitus:

    When both PCV13 and PPSV23 are indicated, administer PCV13 first. (4 x Rs 3800+2 x Rs 1600=
    Rs 18400)
    PCV13 and PPSV23 should not be administered during same visit.
    Age 2–5 years
    Any incomplete* series with: - 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior
    PCV13 dose)
    - Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and
    administered 8 weeks apart)
    No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)
    Age 6–18 years
    No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)(Rs 1600
    Meningococcal Vaccine (Menactra -Meningococcal ACWY ) – for use in patients 9 months
    to 55 years, approximate cost Rs 4950 ( 3x Rs 5000= Rs15000)
    Influenza vaccine (Fluquadri-Quadrivalent inactivated Influenza Vaccine ) -minimum age 6
    months Yearly seasonal administration - approximate cost Rs 1400
    Varicella Vaccination (Zuvicella-Freeze dried Live attenuated)- approximate cost Rs 1690
    Typhoid { Typhoid Conjugate vaccines(TCV) -- Typbar cost Rs 150, Enteroshield
    approximate cost Rs 1821}
    Rotavirus – live attenuated RV1( Rotavac - approximate cost Rs 689,Rotarix – Rs 1613)
    Minimum age 6 weeks Maximum age 8 months
    Hepatitis A (Biovac live attenuated , Havrix- Inactivated (killed ) Hepatitis A vaccine (Havrix)
    approximate cost Rs1000
    Vaccination schedule for patients with Di George Syndrome

    All live vaccines(eg MMR ,varicella ,MMRV ,LAIV ,zoster ,yellow


    fever ,Ty21a oral typhoid ,BCG ,rotavirus ,Live attenuated Hepatitis
    A[Biovac] )are contraindicated

    Havrix- Inactivated (killed ) Hepatitis A vaccine (Havrix) approximate


    cost 1000
    Fluquadri- Quadrivalent inactivated influenza vaccine can be given
    Vaccination schedule for patients with Di
    George Syndrome
    Vaccination schedule for patients with Asplenia

    • Asplenia patients should not receive live attenuated influenza vaccine


    ,but can receive other indicated live attenuated viral and live
    attenuated bacterial vaccines.

    • Practically same as our heart patients schedule


    Downloaded from www.aappublications.org/news by guest on March 28, 2019
    POLICY STATEMENT -AAP
    The Care of Children With Congenital Heart Disease in Their Primary Medical Home M. Regina Lantin-Hermoso, MD, FAAP,
    FACC,a Stuart Berger, MD, FAAP,b Ami B. Bhatt, MD, FACC,c Julia E. Richerson, MD, FAAP,d Robert Morrow, MD, FAAP,e
    Michael D. Freed, MD, FAAP, FACC,f Robert H. Beekman III, MD, FAAP, FACC,g SECTION ON CARDIOLOGY, CARDIAC
    SURGERY

    Page 4
    Special Immunization Needs and Infection Prevention
     
    Preventing, identifying, and managing infections in children with CHD are primary roles of the PCP . Current, recent, or
    upcoming anesthesia and surgery generally are not contraindications for immunization.‍16 Efforts should
    be made to ensure vaccine administration during hospitalization or at discharge, when indicated and
    age-appropriate.‍16 However, practice may vary because of concerns for a potential febrile response that
    may mar the clinical picture or the ability to mount an immune response after cardiopulmonary bypass.
    Because children with CHD may have a lowered capacity to resist and fight infections, comprehensive routine immunizations,17
    including the recommended schedule for 13-valent conjugate pneumococcal vaccine, are important.‡ Patients with functional asplenia
    should receive subsequent doses of 23-valent polysaccharide vaccine.‍18 Some children, particularly those with heterotaxy and asplenia
    or nonfunctional polysplenia, will be at risk for encapsulated bacteremia, which may be prevented with daily antibiotic prophylaxis, at
    least until 5 years of age.19,20 Recommendations for seasonal protection against respiratory syncytial virus (RSV) are available and
    updated regularly. Ensuring herd immunity by vaccinating close contacts, especially against pertussis and seasonal influenza, is
    recommended. Patients with DiGeorge syndrome would benefit from immunologic assessment of their T lymphocyte function. If a
    patient is found to be significantly immunocompromised, consultation with an infectious disease specialist may be considered to
    identify an appropriate vaccination strategy, because some patients should not receive live-virus vaccines.
    Thank U

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