Immunisation of cardiac

patients and patients with

asplenia /Di George Syndrome
Overview of Immunisation
• National Immunisation Schedule
• IAP Immunisation Schedule
• For Chronic heart disease patients
• For Di George Syndrome
• For functional or anatomic asplenia syndrome
• Policy statement of AAP for cardiac surgical patients
Additional vaccines in IAP
• Pneumococcal
• Varicella
• Hepatitis A
• Typhoid
• Meningococcal
• Influenza
• HPV (Human Papilloma virus )
Additional Vaccine for patients with Chronic
heart disease
• Extra 2 doses of pneumococcal vaccine with 23 valent Pneumococcal
vaccine (given to children more than 2 years)
• Use killed influenza vaccine only
Vaccination schedule for patients with Chronic heart disease
(particularly cyanotic congenital heart disease and cardiac
failure) and chronic lung disease(AAP)

1)Pneumococcal Conjugate(PCV)(vaccination recommended & additional doses may be

necessary based on medical condition

2)Influenza (Use only killed vaccine )

3)Meningococcal (recommended for persons with an additional risk factor for which the vaccine
would be indicated )

4)Pneumococcal poly saccharide (PPSV23) (vaccination recommended & additional

doses may be necessary based on medical condition )
Pneumococcal vaccine

• PCV13(PREVENAR 13)- approximate cost Rs 3801, minimum age 6 weeks

• PPSV23(PNEUMOVAX 23)- approximate cost Rs 1600, minimum age 2 years

Routine vaccination with PCV13

• 4-dose series at 2, 4, 6, 12–15 months ( Rs 3801 x 4=15200)

Catch-up vaccination with PCV13

1 dose for healthy children age 24–59 months with any incomplete PCV13 series
(Rs 3800)
Chronic heart disease (particularly cyanotic congenital heart disease and
cardiac failure); chronic lung disease (including asthma treated with high-
dose, oral corticosteroids); diabetes mellitus:

When both PCV13 and PPSV23 are indicated, administer PCV13 first. (4 x Rs 3800+2 x Rs 1600=
Rs 18400)
PCV13 and PPSV23 should not be administered during same visit.
Age 2–5 years
Any incomplete* series with: - 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior
PCV13 dose)
- Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and
administered 8 weeks apart)
No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)
Age 6–18 years
No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)(Rs 1600
Meningococcal Vaccine (Menactra -Meningococcal ACWY ) – for use in patients 9 months
to 55 years, approximate cost Rs 4950 ( 3x Rs 5000= Rs15000)
Influenza vaccine (Fluquadri-Quadrivalent inactivated Influenza Vaccine ) -minimum age 6
months Yearly seasonal administration - approximate cost Rs 1400
Varicella Vaccination (Zuvicella-Freeze dried Live attenuated)- approximate cost Rs 1690
Typhoid { Typhoid Conjugate vaccines(TCV) -- Typbar cost Rs 150, Enteroshield
approximate cost Rs 1821}
Rotavirus – live attenuated RV1( Rotavac - approximate cost Rs 689,Rotarix – Rs 1613)
Minimum age 6 weeks Maximum age 8 months
Hepatitis A (Biovac live attenuated , Havrix- Inactivated (killed ) Hepatitis A vaccine (Havrix)
approximate cost Rs1000
Vaccination schedule for patients with Di George Syndrome

All live vaccines(eg MMR ,varicella ,MMRV ,LAIV ,zoster ,yellow

fever ,Ty21a oral typhoid ,BCG ,rotavirus ,Live attenuated Hepatitis
A[Biovac] )are contraindicated

Havrix- Inactivated (killed ) Hepatitis A vaccine (Havrix) approximate

cost 1000
Fluquadri- Quadrivalent inactivated influenza vaccine can be given
Vaccination schedule for patients with Di
George Syndrome
Vaccination schedule for patients with Asplenia

• Asplenia patients should not receive live attenuated influenza vaccine

,but can receive other indicated live attenuated viral and live
attenuated bacterial vaccines.

• Practically same as our heart patients schedule

Downloaded from www.aappublications.org/news by guest on March 28, 2019
POLICY STATEMENT -AAP
The Care of Children With Congenital Heart Disease in Their Primary Medical Home M. Regina Lantin-Hermoso, MD, FAAP,
FACC,a Stuart Berger, MD, FAAP,b Ami B. Bhatt, MD, FACC,c Julia E. Richerson, MD, FAAP,d Robert Morrow, MD, FAAP,e
Michael D. Freed, MD, FAAP, FACC,f Robert H. Beekman III, MD, FAAP, FACC,g SECTION ON CARDIOLOGY, CARDIAC
SURGERY

Page 4
Special Immunization Needs and Infection Prevention
 
Preventing, identifying, and managing infections in children with CHD are primary roles of the PCP . Current, recent, or
upcoming anesthesia and surgery generally are not contraindications for immunization.‍16 Efforts should
be made to ensure vaccine administration during hospitalization or at discharge, when indicated and
age-appropriate.‍16 However, practice may vary because of concerns for a potential febrile response that
may mar the clinical picture or the ability to mount an immune response after cardiopulmonary bypass.
Because children with CHD may have a lowered capacity to resist and fight infections, comprehensive routine immunizations,17
including the recommended schedule for 13-valent conjugate pneumococcal vaccine, are important.‡ Patients with functional asplenia
should receive subsequent doses of 23-valent polysaccharide vaccine.‍18 Some children, particularly those with heterotaxy and asplenia
or nonfunctional polysplenia, will be at risk for encapsulated bacteremia, which may be prevented with daily antibiotic prophylaxis, at
least until 5 years of age.19,20 Recommendations for seasonal protection against respiratory syncytial virus (RSV) are available and
updated regularly. Ensuring herd immunity by vaccinating close contacts, especially against pertussis and seasonal influenza, is
recommended. Patients with DiGeorge syndrome would benefit from immunologic assessment of their T lymphocyte function. If a
patient is found to be significantly immunocompromised, consultation with an infectious disease specialist may be considered to
identify an appropriate vaccination strategy, because some patients should not receive live-virus vaccines.
Thank U