Special considerations

Almost all individuals can be safely vaccinated with all vaccines. In very few individuals, vaccination is contraindicated or should be deferred. Where there is doubt, rather than withholding vaccine, advice should be sought from an appropriate consultant paediatrician or physician, the immunisation co-ordinator or consultant in health protection.

For specific information on:

  • Pregnancy
  • Egg allergy
  • Immunosuppression
  • Deferral of immunisation

Please refer to Contraindications and special considerations (The Green Book; Chapter 6) and Immunisation of individuals with underlying medical conditions (The Green Book; Chapter 7)

For information on hepatitis A and B vaccination in drug users in primary care please see section 14.1 Vaccines and antisera

Clinically immunosuppressed

For information on Vaccination of Individuals with Uncertain or Incomplete Immunisation Status, please refer to Public Health England's summary

MHRA Drug Safety Update (April 2016): Live attenuated vaccines: avoid use in those who are clinically immunosuppressed

  • Live attenuated vaccines should not routinely be given to people who are clinically immunosuppressed (either due to drug treatment or underlying illness)
  • It is important for healthcare professionals who are administering a particular vaccine to be familiar with the contraindications and special precautions before proceeding with immunisation
  • Specialists with responsibility for an immunosuppressed patient who may be in a group eligible for a live attenuated vaccine should include in their correspondence with primary care a statement of their opinion on the patient's suitability for the vaccine
  • If primary care professionals are in any doubt as to whether a person due to receive a live attenuated vaccine may be immunosuppressed at the time, immunisation should be deferred until secondary care specialist advice has been sought, including advice from an immunologist if required
  • Remember that close contacts of immunosuppressed individuals should be fully immunised to minimise the risk of infection of vaccine-preventable diseases in immunosuppressed individuals

Hyposplenia / Asplenia / Splenectomy

Individuals who have absent or dysfunctioning spleens are at risk of overwhelming infections. Such individuals should receive certain vaccinations, be offered lifelong antibiotic prophylaxis and need to be aware of increased risk of zoonotic and travel associated infections.

Patients should receive the following vaccinations to help prevent infections to which they are particularly vulnerable:

  • Pneumococcal
  • Haemophilus influenzae type b and meningococcal C (Hib/MenC)
  • Meningococcal ACWY (Men ACWY) conjugate vaccine
  • Meningococcal B
  • Influenza (annual)

For further information, see local hospital guidance, and Immunisation of individuals with underlying medical conditions (The Green Book; Chapter 7)

Last updated: 26-11-2019


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