Vaccinations in Primary and Secondary Immunodeficiencies Including Asplenia

Most individuals are able to tolerate vaccinations as per the recommended schedule without incident. However, those with immunodeficiencies are at increased risk of recurrent, severe, and/or recalcitrant infections which may be reduced or prevented with the use of appropriate vaccinations. Determining which vaccines are appropriate for provision of protection against infection requires an understanding of any underlying immune defects as well as resulting infection risk. Furthermore, understanding the mechanism of immunodeficiency can also help to identify those vaccinations which are contraindicated due to risk of infection. Individuals with common variable immunodeficiency (CVID) are at increased risk of infection with encapsulated bacteria and should be given a particular set of vaccinations. Individuals with CVID also may present with autoimmune disorders such as immune thrombocytopenia (ITP). ITP can result in either functional asplenia or in complications requiring surgical splenectomy. Those with asplenia should be vaccinated appropriately in order to protect against encapsulated bacteria similar to those in CVID. However, there are some important differences to note between the indicated and contraindicated vaccines for individuals with CVID and asplenia. Those with CVID who develop the complication of asplenia should be approached carefully when considering the appropriate vaccinations given the combined, although somewhat overlapping, immunodeficiency.