Vaccination of Household Contacts
16.12 Summary
Much is yet to be understood in regard to the pace of immune recovery after current chemotherapeutic regimens due to the lack of large, prospective stud- ies. Likely, due to multifactorial reasons, the tempo will be variable when considering the array of ages, diagnoses and treatment regimens employed in pediatric oncology. In settings with expansive vac- cine programs, immunocompromised children will be well protected from vaccine- preventable dis- eases due to herd immunity. In high-prevalence set- tings, vaccination during chemotherapy and periods of risk is more vital and further study is required as to the optimal timing and safety of such recommen- dations. Revaccination after chemotherapy is important although the optimal timing and extent of reimmunization is unclear. Large, randomized controlled trials are required to make fi rm deci- sions. Patients should be offered booster immuni- zation 3–6 months after therapy completion by either the pediatric oncologist or in concert with the general pediatrician. Prevention of exposure by stringent vaccination of household contacts and treatment of exposure with passive immunization are also important aspects of supportive care in regard to vaccine-preventable disease. References Abrahamsson J, Marky I, Mellander L 1995 Immunoglobulin levels and lymphocyte response to mitogenic stimulation in children with malignant dis- ease during treatment and follow-up. Acta Paediatr 84:177–182 Adler AL, Casper C, Boeckh M et al 2008 An outbreak of varicella with likely breakthrough disease in a pop- ulation of pediatric cancer patients. Infect Control Hosp Epidemiol 29:866–870 Alanko S, Pelliniemi TT, Salmi TT 1992 Recovery of blood B-lymphocytes and serum immunoglobulins after chemotherapy for childhood acute lymphoblastic leukemia. Cancer 69:1481–1486 Alanko S, Pelliniemi TT, Salmi TT 1994 Recovery of blood lymphocytes and serum immunoglobulins after treatment of solid tumors in children. Pediatr Hematol Oncol 11:33–45 Table 16.3 Vaccination recommendations in household contacts of immunocompromised patients a Vaccines that should be routinely given b Yearly inactivated infl uenza vaccine Live attenuated varicella vaccine in susceptible individuals Rotavirus vaccine per routine schedule All inactivatedkilled vaccines and measles-mumps- rubella per routine schedule Vaccines that are contraindicated Live attenuated infl uenza vaccine Oral poliovirus vaccine Smallpox vaccine Adapted from Centers for Disease Control and Prevention 1993 , American Academy of Pediatrics 2012a a Level of evidence 1C per Guyatt et al. 2006 ; see Preface b Live attenuated yellow fever vaccine may be given if necessary; unclear evidence for BCG and oral typhoid in high-risk settings 16 Immunization Practice in Pediatric Oncology Alanko S, Salmi TT, Pelliniemi TT 1995 Recovery of natural killer cells after chemotherapy for childhood acute lymphoblastic leukemia and solid tumors. Med Pediatr Oncol 24:373–378 Alavi S, Rashidi A, Arzanian MT et al 2010 Humoral immunity against hepatitis B, tetanus, and diphtheria following chemotherapy for hematologic malignan- cies: a report and review of the literature. Pediatr Hematol Oncol 27:188–194 Al-Jadiry MF, Al-Khafagi M, Al-Darraji AF et al 2013 High incidence of hepatitis B infection after treatment for paediatric cancer at a teaching hospital in Baghdad. East Mediterr Health J 19:130–134 Allen UD 2007 Immunizations for children with cancer. Pediatr Blood Cancer 49:1102–1108 Allen JB, Weiner LB 1981 Pneumococcal sepsis in child hood leukemia and lymphoma. Pediatrics 67: 292–295 Allison JE, Glezen WP, Taber LH et al 1977 Reactogenicity and immunogenicity of bivalent infl u- enza A and monovalent infl uenza B virus vaccines in high-risk children. J Infect Dis 156:S672–S676 American Academy of Pediatrics 2012a Active and pas- sive immunization: immunization in special clinical circumstances—immunocompromised children. In: Pickering LK ed Red book: 2012 report of the com- mittee on infectious diseases, 29th edn. American Academy of Pediatrics, Elk Grove Village American Academy of Pediatrics 2012b Summaries of infectious diseases: measles. In: Pickering LK ed Red book: 2012 report of the committee on infectious diseases varicella-zoster, 29th edn. American Academy of Pediatrics, Elk Grove Village American Academy of Pediatrics 2012c Summaries of infectious diseases: infections. In: Pickering LK ed Red book: 2012 report of the committee on infectious diseases, 29th edn. American Academy of Pediatrics, Elk Grove Village, IL American Academy of Pediatrics 2006 Summaries of infectious diseases: infections. In: Pickering LK ed Red book: 2006 report of the committee on infectious diseases, 27th edn. American Academy of Pediatrics, Elk Grove Village, IL Asano Y, Yoshikawa T, Suga S et al 1993 Postexposure prophylaxis of varicella in family contact by oral acy- clovir. Pediatrics 92:219–222 Azuma E, Nagai M, Qi J et al 1998 CD4+ T-lymphocytopenia in long-term survivors following intensive chemotherapy in childhood cancers. Med Pediatr Oncol 30:40–45 Banatvala JE, Van Damme P 2003 Hepatitis B vac- cine—do we need boosters? J Viral Hepat 10:1–6 Bate J, Patel SR, Chisholm J et al 2010a Immunisation practices of paediatric oncology and shared care oncology consultants: a United Kingdom survey. Pediatr Blood Cancer 54:941–946 Bate J, Yung CF, Hoschler K et al 2010b Immunogenecity of pandemic H1N1 2009 vaccine in children with can- cer in the United Kingdom. Clin Infect Dis 51:e95–e104 Baytan B, Gunes AM, Gumay U 2008 Effi cacy of primary hepatitis B immunization in children with acute lymphoblastic leukemia. Indian Pediatr 45: 265–270 Bektas O, Karadeniz C, Oguz A et al 2007 Assessment of the immune response to trivalent split infl uenza vac- cine in children with solid tumors. Pediatr Blood Cancer 49:914–917 Berberoğlu S, Büyükpamkcu M, Sarialioglu F et al 1995 Hepatitis B vaccination in children with cancer. Pediatr Hematol Oncol 12:171–178 Bhat N, Wright JG, Broder KR et al 2005 Infl uenza- associated deaths among children in the United States, 2003–2004. N Engl J Med 353:2559–2567 Biggar RJ, Christiansen M, Rostgaard K et al 2009 Immunoglobulin subclass levels in patients with non- Hodgkin lymphoma. Int J Cancer 124:2616–2620 Bisgard KM, Kao A, Leake J et al 1998 Haemophilus infl uenzae invasive disease in the United States, 1994– 1995: near disappearance of a vaccine-preventable childhood disease. Emerg Infect Dis 4:229–237 Brodtman DH, Rosenthal DW, Redner A et al 2005 Immunodefi ciency in children with acute lympho- blastic leukemia after completion of modern aggres- sive chemotherapeutic regimens. J Pediatr 146: 654–661 Brunell PA, Gershon AA, Hughes WT et al 1972 Prevention of varicella in high risk children: a collab- orative study. Pediatrics 50:718–722 Brydak LB, Rokicka-Milewska R, Jackowska T 1996 Kinetics of humoral response in children with acute lymphoblastic leukemia immunized with infl uenza vaccine in 1993 in Poland. Pediatr Hematol Oncol 13:231–238 Brydak L, Rokicka-Milewska R, Machala M et al 1998 Immunogenicity of subunit trivalent infl uenza vaccine in children with acute lymphoblastic leukemia. Pediatr Infect Dis J 17:125–129 Cakir FB, Timur C, Yoruk A et al 2012 Seroconversion status after single dose and double doses of varicella vaccination in children with leukemia. Pediatr Hematol Oncol 29:191–194 Caniza MA, Hunger SP, Schrauder A et al 2012 The controversy of varicella vaccination in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 58:12–16 Carr S, Allison KJ, Van De Velde L et al 2011 Safety and immunogenicity of live attenuated and inactivated infl uenza vaccines in children with cancer. J Infect Dis 204:1475–1482 Caver TE, Slobod KS, Flynn PM et al 1998 Profound abnormality of the BT lymphocyte ratio during che- motherapy for pediatric acute lymphoblastic leuke- mia. Leukemia 12:619–622 Centers for Disease Control and Prevention 1993 Recommendations of the Advisory Committee on Immunization Practices ACIP: use of vaccines and immune globulins in persons with altered immuno- competence. MMWR Recomm Rep 42:1–24Parts
» Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Introduction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» History and Physical Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Defi ning the Risk for Serious
» Initial Laboratory Evaluation Diagnostic Evaluation
» Chest Radiography CXR A supine CXR may identify pleural effusions,
» Computed Tomography CT Radiographic Imaging
» Magnetic Resonance Imaging MRI
» Positron Emission Tomography PET
» Aspergillus Galactomannan GMN Biomarkers for Invasive
» 1,3-β- Biomarkers for Invasive
» Polymerase Chain Reaction PCR
» Viral Studies Diagnostic Evaluation
» Invasive Procedures: Diagnostic Evaluation
» Adult FN Guidelines Empiric Management
» Monotherapy Versus Combination Therapy
» Which Monotherapy to Choose A Cochrane review of antipseudomonal beta-
» Alterations in Initial Empiric FN Antibiotic Management
» Outpatient Management of FN Although there remains a lack of one uniform
» Choice of Empiric Antifungal Therapy
» Duration of Antimicrobial Empiric Management
» Endovascular Sources Empiric Management
» Adjunctive Treatment Empiric Management
» Emergence of Resistant Empiric Management
» Red Blood Cell Administration
» Granulocyte Transfusion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hemolytic Transfusion Risks of Blood Product
» Infection and Sepsis Risks of Blood Product
» Allergic Reactions Risks of Blood Product
» Febrile Nonhemolytic Risks of Blood Product
» Transfusion-Related Acute Risks of Blood Product
» Transfusion-Associated Risks of Blood Product
» Iron Overload Risks of Blood Product
» Laboratory Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» General Management Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Alkalinization Urinary alkalinization has been a long-standing
» Allopurinol Allopurinol inhibits xanthine oxidase, an enzyme
» Rasburicase Rasburicase, recombinant urate oxidase, converts
» Renal Interventions Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pathophysiology Superior Vena Cava
» History and Physical Exam SVCSSMS should be suspected in a patient
» Imaging Studies The diagnosis of SVCSSMS is often made on
» Other Studies Tissue is required to make a defi nitive diagnosis
» Treatment Superior Vena Cava
» History and Physical Exam Small pericardial effusions are frequently asymp-
» Imaging and Other Studies The presence of a pericardial effusion can be
» History and Physical Exam Many patients with small pleural effusions are
» Imaging Studies When a pleural effusion is suspected, a chest
» History and Physical Exam Patients with pheochromocytoma typically have
» Laboratory Studies The diagnosis of pheochromocytoma is best made
» Imaging Studies Clinical Presentation
» Pulmonary Leukostasis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Presentation Spinal Cord Compression
» Differential Diagnosis Spinal Cord Compression
» Imaging MRI of the spine can help narrow the differential
» Surgery Surgery in spinal cord compression can be uti-
» Radiation Therapy The advantages of external beam radiation ther-
» Outcomes Spinal Cord Compression
» Presentation Altered Mental Status
» Initial Management Altered Mental Status
» Metabolic The metabolic causes of AMS or seizure in pedi-
» Chemotherapy-Associated Neurotoxicity Differential Diagnosis
» Posterior Reversible Encephalopathy Syndrome
» Outcomes Altered Mental Status
» Initial Management Increased Intracranial
» Soft Tissue A large meta-analysis of published data suggests
» Cerebrospinal Fluid Hydrocephalus is an excess of CSF within the
» Hemorrhage and Thrombosis Differential Diagnosis
» Idiopathic Intracranial Hypertension Differential Diagnosis
» Presentation of Stroke Cerebrovascular Disease
» Differential Diagnosis Cerebrovascular Disease
» Etiology of Stroke in Pediatric
» Ischemic Stroke After an ischemic stroke is diagnosed, the patient
» Hemorrhagic Stroke Hematomas can expand over several hours from
» Acute Lymphoblastic Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Myelogenous Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Promyelocytic Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Chronic Myelogenous Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Tumor Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Leukapheresis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hyperhydration Other Treatment Modalities
» Hydroxyurea Other Treatment Modalities
» Cranial Irradiation Other Treatment Modalities
» Pseudohyperkalemia Hyperleukocytosis has been noted to cause pseudo-
» Pseudohypoxemia Due to the rapid consumption of oxygen by leu-
» Pseudohypoglycemia Consumption of glucose by excess leukocytes
» Pseudothrombocytosis Leukemic blast lysis can lead to cell fragmenta-
» Transfusion Practice with Other Supportive Care
» Anesthetic Procedures Other Supportive Care
» Neutropenic Enterocolitis Gastrointestinal Infection
» Perirectal Abscess Gastrointestinal Infection
» Gastrointestinal Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pancreatitis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Bowel Obstruction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Abdominal Compartment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» ALL Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Other Malignancies Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Central Venous Catheters Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diagnosis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nociceptive Pain Types of Pain
» Neuropathic Pain Types of Pain
» World Health Organization Pharmacologic Treatment
» Intermittent Opioid Use Pharmacologic Treatment
» Long-Acting Opioids Pharmacologic Treatment
» Breakthrough Dosing Pharmacologic Treatment
» Opioid Rotation Pharmacologic Treatment
» Patient-Controlled Analgesia Pharmacologic Treatment
» Constipation Side Effects of Opioids
» Nausea and Vomiting Nausea and vomiting are rare opioid side effects
» Pruritus Pruritus is a common side effect of opioid use
» Sedation Side Effects of Opioids
» Confusion and Agitation Renal and hepatic function should be checked
» Respiratory Depression When dosed appropriately, opioids rarely result
» Myoclonus Patients receiving very high doses of opioids for
» Urinary Retention Urinary retention can be caused by any opioid but
» Calcium Channel Blockers Neuropathic Pain
» Serotonin and Norepinephrine Neuropathic Pain
» Tricyclic Antidepressants Neuropathic Pain
» Interventional Techniques Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vincristine-Related Peripheral Oncology-Specifi c Pain
» Osteonecrosis Oncology-Specifi c Pain
» Post-lumbar Puncture Oncology-Specifi c Pain
» Mucositis Pain Oncology-Specifi c Pain
» Pathophysiology of Emesis Chemotherapy-Induced
» Principles of Emesis Control in the Cancer Patient
» Emetogenicity of Chemotherapy Chemotherapy-Induced
» Dopamine Receptor Antagonists Classes of Antiemetics
» Corticosteroids Classes of Antiemetics
» Cannabinoids The plant Cannabis contains more than 60 differ-
» Other Antiemetic Agents Antihistamines
» Alternative Therapies Ginger Classes of Antiemetics
» Management of CINV Management of CINV Table
» Special Considerations Anticipatory Nausea and Vomiting
» Radiation-Induced Nausea Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Initiation The initiation stage occurs immediately following
» Primary Damage Response Pathophysiology of Oral Mucositis
» Signal Amplifi cation Pathophysiology of Oral Mucositis
» Ulceration Ulceration is the phase with the most clinical sig-
» Healing Pathophysiology of Oral Mucositis
» Clinical Course of Oral Mucositis
» Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Palifermin Prevention and Treatment
» Low-Level Laser Therapy Prevention and Treatment
» Glutamine Prevention and Treatment
» Cryotherapy Prevention and Treatment
» Oral Care Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Infections Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nutrition Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Dietary Counseling Nutrition Intervention
» Appetite Stimulants Nutrition Intervention
» Enteral Tube Feeding Nutrition Intervention
» Parenteral Nutrition Nutrition Intervention
» Nutrition and Survivorship Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Neutropenia Hematologic Toxicity
» Management of Thrombocytopenia Hematologic Toxicity
» Management of Anemia Hematologic Toxicity
» Somnolence Syndrome Central Nervous System
» Lhermitte’s Sign Central Nervous System
» Skin Complications Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Mucositis Head and Neck
» Ear Complications Head and Neck
» Laryngeal Complications Head and Neck
» Dysphagia and Esophagitis Gastrointestinal
» Nausea, Vomiting and Anorexia
» Pneumonitis Major Organ Infl ammation
» Pericarditis Major Organ Infl ammation
» Hepatitis Major Organ Infl ammation
» Nephropathy Major Organ Infl ammation
» Cystitis Major Organ Infl ammation
» Risk Stratifi cation Prevention of Bacterial
» Adult Data Antimicrobial Approaches
» Pediatric Data Data regarding the utility of bacterial prophylaxis
» Risks of Prophylaxis Prevention of Bacterial
» Guidelines and Current Usage of Antibacterial Prophylaxis
» Protocols for Line Placement and Care
» Antibiotic and Ethanol Locks
» Chlorhexidine Cleansing Chlorhexidine gluconate CHG is a bactericidal
» Future Directions Prevention of Bacterial
» Risk Stratifi cation Prevention of Fungal
» Approaches to Antifungal Prophylaxis
» Guideline Recommendations for Antifungal Prophylaxis
» Limitations of Current Options for Antifungal Prophylaxis
» Risks of Prophylaxis Prevention of Fungal
» Biomarkers Prevention of Fungal
» Future Directions Prevention of Fungal
» Risk Stratifi cation Prevention of Pneumocystis
» Approaches to PCP Prophylaxis
» Summary of the Recommendations
» Future Directions Prevention of Pneumocystis
» Postexposure Chemoprophylaxis Prevention of Viral Infections
» Suppressive Therapy Prevention of Viral Infections
» Future Directions Prevention of Viral Infections
» Hand Hygiene Infection Control Practices
» Mandatory Vaccination Infection Control Practices
» Hospital Isolation Practices Infection Control Practices
» Visitor Screening Policies Infection Control Practices
» Work Restriction Infection Control Practices
» Cytomegalovirus CMV Status of Transfused Blood
» Treatment of Myelosuppression with
» Prevention of Febrile Neutropenia, Delay
» Treatment of Febrile Neutropenia
» Treatment of Myelosuppression Clinical Usage of Myeloid Growth Factors
» Comparison of Granulocyte Colony-Stimulating Factor
» Optimal Dosing Adult guidelines recommend dosing of 5 mcgkg
» Route of Administration Optimal Administration of Colony-Stimulating Factors
» Optimal Timing Optimal Administration of Colony-Stimulating Factors
» Erythropoietin Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Interleukin-11 Platelet Growth Factors
» Thrombopoietin Receptor Agonists Platelet Growth Factors
» Immune Status Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Status During Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Recovery After Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immunization Practice Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diphtheria, Tetanus, and Acellular Pertussis
» Pneumococcal Conjugate Vaccine Recommendations
» Hemophilus Infl uenzae Type b
» Inactivated Infl uenza Vaccine Although in a Cochrane review Goossen et al.
» 2009 H1N1 Pandemic Vaccine Seven studies have reported on effi cacy of the
» Live Attenuated Infl uenza Vaccine
» Meningococcal Conjugate Vaccine Recommendations
» Varicella Zoster Virus Recommendations
» Recommendations Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Treatment of Hypogammaglobulinemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vaccination of Household Contacts
» Peripherally Inserted Central Catheter
» External Tunneled Central Venous Catheter
» Implanted Port Types of Central Venous
» Catheter Insertion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Exit Site Infection Infection
» Prevention of Infection Infection
» Drug Precipitate or Lipid Residue Occlusion Thrombotic Occlusion
» Evaluation of Catheter- Related Thrombosis
» Treatment of Catheter- Related Thrombosis
» Special Considerations During Anticoagulation Therapy
» Contraindications of Anticoagulant Therapy
» Skin Antisepsis Catheter Maintenance
» Central Venous Catheter Dressings
» Hub Care Catheter Maintenance
» Central Venous Catheter Flushing and Locking
» Chlorhexidine Bathing Chlorhexidine has been shown to be effective in
» Antiseptic Needleless Connectors and Antiseptic
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