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With improving survival rates after treatment of childhood malignancy, an increase in hematopoietic stem cell (HSCT) and solid organ transplantation, and the use of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infections, the population of immunocompromised children who have special vaccination needs is burgeoning. Understanding the degree of immune recovery of these children is important in guiding vaccine administration. Inactivated vaccines can be administered safely to persons who have altered immunocompetence, but the effectiveness of such vaccines may be suboptimal. Inactivated influenza immunization should be administered annually to immunosuppressed children 6 months of age and older before each influenza season. In general, severely immunocompromised children should not receive live vaccines, either viral or bacterial, because of the risk of disease caused by vaccine strains. Oral polio virus vaccine and live bacterial vaccines, such as bacillus Calmette-Guérin (BCG) and Salmonella typhi Ty21, are contraindicated for immunocompromised patients as well as their household contacts. Household contacts and other close contacts of persons who have altered immunocompetence, however, should receive all other age-appropriate vaccines, including the live oral rotavirus vaccines.
Although many children who undergo HSCT …
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