Influenza Vaccination in Immunocompromised Patients

Key Recommendations

• The American Academy of Pediatrics recommends that patients with chronic disorders, including hematologic conditions, should be prioritized for vaccination because they are at increased risk for influenza-related complications 4, 5, 6
• The Centers for Disease Control and Prevention strongly recommends annual influenza vaccination for all persons ≥6 months with underlying medical conditions that predispose them to complications 7, 8, 9

Vaccine Selection

• The Infectious Diseases Society of America recommends using inactivated influenza vaccine (IIV4) only, administered intramuscularly at 0.5 mL per dose in the deltoid muscle, for patients with neutropenia 1, 2
• The American Academy of Pediatrics advises against using live attenuated influenza vaccine (LAIV/FluMist) in immunocompromised patients, including those with neutropenia 3, 2

Safety Considerations

• The Infectious Diseases Society of America states that inactivated vaccines are safe in neutropenia, with no contraindications for inactivated vaccines in patients with phagocytic cell defects or neutropenia 2
• The Centers for Disease Control and Prevention notes that the vaccine cannot cause influenza as it contains inactivated (killed) virus 7

Important Contraindications to Rule Out

• The American Academy of Pediatrics and the Centers for Disease Control and Prevention advise that the only absolute contraindication to check for is previous severe allergic reaction (anaphylaxis) to any influenza vaccine component 3, 5, 10

Timing and Administration

• The Centers for Disease Control and Prevention recommends vaccinating as soon as vaccine is available, ideally by end of October 9, 1
• The American Academy of Pediatrics states that minor illnesses with or without fever are not contraindications, and vaccination should proceed unless moderate-to-severe febrile illness is present 3, 6, 10