LAIV is an option for adults aged <49 years, except those who 1) have immunocompromising conditions, including human immunodeficiency virus (HIV) infection; 2) have anatomic or functional asplenia
; 3) are pregnant; 4) have close contact with or are caregivers of severely immunocompromised persons in a protected environment; 5) have received influenza antiviral medications in the previous 48 hours; or 6) have a cerebrospinal fluid leak or a cochlear implant.
SCD causes chronic hemolysis, hemolytic crisis, and infections that may precipitate hemolysis.2 Progressive vaso-occlusive damage to the spleen leads to a state of functional asplenia
together with other immune system dysfunctions.3 People with SCD are at high risk for complications of influenza and pneumococcal infections because they are susceptible to bacterial infections caused by encapsulated organisms (including Streptococcus pneumoniae and Haemophilus influenzae) due to their impaired splenic function, increased airway hyperactivity, and risk of acute chest syndrome following respiratory infections.4 Vaccination against pneumococcus, influenza, and haemophilus influenzae Type-B (HiB) is recommended for patients with SCD.5-7
Meningococcal vaccination guidelines also underwent several small changes pertaining to adults with anatomical or functional asplenia
and human immunodeficiency virus, among other risk factors.
In individuals with anatomic or functional asplenia
, meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate vaccine (MCV4-D, Menactra) should be given 4 weeks after the last dose of the pneumococcal conjugate vaccine (PCV13).
An autopsy showed hepatic panacinar necrosis, erythrophagocytosis of Kupffer cells, and severe decrease of splenic lymphoid tissue (functional asplenia
) with multiple drepanocytes and splenic sequestration, but no signs of yellow fever or malaria (online Technical Appendix Figure, http://wwwnc.cdc.gov/EID/article/22/5/15-1934-Techapp1.pdf).
TABLE 3 Using meningococcal B vaccines in those at high risk and during outbreaks (4) Recommend MenB vaccine for individuals >10 years of age who have any of the following risk factors: * persistent complement component deficiencies * anatomic or functional asplenia
* routine exposure to isolates of Neisseria meningitidis (ie, microbiologists) * exposure to a community experiencing a serogroup B meningococcal disease outbreak.
26, the panel voted 15-0 to recommend vaccination for the following groups of people over age 10 years at increased risk of serogroup B meningococcal disease: those with persistent complement deficiencies; anatomic or functional asplenia
, including people with sickle cell; microbiologists routinely exposed to Neisseria meningitidis isolates; and individuals, such as college students, at increased risk during an outbreak of serogroup B meningococcal disease.
Other risk factors for invasive pneumococcal infections include extremes of age; diabetes mellitus; chronic renal insufficiency; chronic liver disease; chronic pulmonary disease; anatomical or functional asplenia
; tobacco abuse; certain ethnic groups, such as Alaskan natives; and other immunosuppressive conditions, such as HIV and multiple myeloma.
(10) It has been said that SLE itself is a condition of functional asplenia
, in that there is impairment in the clearance of circulating immune complexes, in some cases due to chronic hemolysis, splenic infarction, rupture or atrophy.
Revaccination with MCV4 after 5 years is recommended for individuals who continue to be at risk for infection, such as adults with anatomic or functional asplenia
. However, it is not recommended for individuals whose only risk factor is continued on-campus residence.
Children with functional asplenia
and immune system impairment are at a risk of developing more fulminant pneumonia due to M.
* Adults above age 50 (for annual influenza vaccination) and above age 65 (for one-time pneumococcal vaccination) and above age 50 (for every ten-yearly tetanus-diphtheria toxoid booster) who are either healthy OR have medical conditions such as: heart disease, pulmonary disease, diabetes mellitus, liver disease, renal failure, alcoholism, immune suppression such as HIV and congenital immunodeficiency, anatomic or functional asplenia
(sickle cell disease, splenectomy), malignancies (lymphoma, leukemia, solid tumors), patients receiving immunosuppressants including steroids, bone marrow- and organ-transplant recipients.