Vaccination in Children With Immune Deficiency

Vaccinations are very important for a child. When the doctors send you back home with your newborn, they send you with a vaccination card or a list of vaccinations for the next few years of your child’s life. These vaccinations are given to protect your child against specific diseases and infections. Many parents may have questions about vaccination in children with immune deficiency.

What is Immune Deficiency in Children?

Babies have almost no immunity at birth. They are protected by the mother’s immunity they gain in the birth canal and all the vaccinations the mother has taken. Their immunity develops slowly as they are exposed to the environment and all the pathogens in it.

Some children do not develop this immunity as expected. The immune system could be slow, inefficient, or in some cases, even absent. When the immune system is not able to perform its duties of protecting the child from various foreign invaders, it is deficient.

Children with a weakened immune system that does not fight against foreign invaders and successfully protect the body are said to be immunocompromised or immune-compromised. It means the child is more vulnerable than other children their age, to contracting various infections.

Reasons For Immune Deficiency in a Child

A child’s immunity can be deficient due to the following reasons.

1. Born With It

Some children are born with a compromised immune system or even close to a completely absent immune system. This is usually genetic, meaning the child can inherit a defective gene from one or both parents, resulting in a compromised immune system. These are called primary immunodeficiency disorders. This can be in the form of an absent immune system or an autoimmune disease. There are various treatments that can help different diseases related to the immune system. Disorders like Severe Combined Immune Deficiency (SCID) need urgent treatment with a bone marrow transplant.

2. Develop It

Some children develop autoimmune diseases during the course of their lives. This can again be a defective gene that decides to act up now rather than from birth, or it could be environmental exposures. The reason for these autoimmune diseases is again unknown.

These children can develop autoimmune diseases or auto-inflammatory diseases like Lupus, Juvenile Idiopathic Arthritis, Inflammatory Bowel Disease, or even Cancer.

3. Due to Therapies

Autoimmune diseases cause the immune system to malfunction. It starts attacking the healthy cells. So, immunosuppressants are given to reduce the reaction of the immune system. Due to medications and such treatments, the child’s immunity is compromised and does not effectively fight against infections and diseases, like it’s meant to. Now, stopping these medicines might help the immune system fight better but it will get back to attacking the healthy cells too.

[Read : My Child Has an Autoimmune Disease]

Are Vaccines Safe For Children With Immune Deficiency?

Yes, they are. Vaccines provide the acquired immunity we all need to fight and protect ourselves against all the pathogens and infections around us. Children with an immune deficiency need this protection more than healthy children. They are already more prone to infections than healthy children.

So, are all vaccines safe for children with immune deficiency? No. Children with a compromised immune system are at risk when it comes to Live vaccines. However, these children are more prone to infections and diseases. So it is important to protect them. Vaccines have been proved to be the most effective way of protecting children against deadly or serious infections that are recurrent in nature. So, children with Immune deficiency need to receive these vaccines too.

You cannot give them the regular vaccines that are given to healthy children. In some cases, they need to be given inactive pathogen particles instead of the live ones, and sometimes they need more dosages to provoke the immune system.

Even if the response is low, some vaccines have to be given to these children – probably in higher dosage and frequency. The children will also need constant monitoring to check if the antibodies are present in the body; else they might need a booster dose.

Yes, there is a risk of heightened side effects to the vaccine or more suffering by the child immediately after the vaccine, but these vaccines become the necessary evil in such children’s lives.

As long as the vaccine uses non-live pathogens, it is completely safe for the child but may not be very effective. When live pathogens are used out of no alternate options, the child will have to be monitored closely and carefully.

When Should You Vaccinate Your Child With Immune Deficiency?

Vaccines are given at specific times in a child’s life. If you have noticed, the hospital gives you a vaccination list along with the recommended timeline for each of those vaccines and you must adhere to the schedule. But this will change if your child has an immune deficiency.

They are more or less the same. The vaccine order and the age recommendations will be very similar. The dosage and the number of booster shots might differ for certain vaccines.

Factors affecting the vaccination schedule for kids with immune deficiency

Underlying autoimmune or immune compromising disease that is being treated.
Medications given for the current disease being treated (certain medicines will not react well with vaccinations).
Severity of the underlying disease (if the child is affected severely or if the immune system is very weak).
Number of doses of the vaccination completed so far and the ones missed (since few will have to be in order, vaccines can get carried over).
The age of the child (certain vaccines have to be given within a particular age, if they are missed, the doctor will have to decide the next course of action).
Some vaccines will have to have more antigen for immune-compromised children.
Whether the vaccine is a live vaccine (live pathogens are mostly avoided for immune-compromised children).
Primary physician (some doctors might be hesitant to vaccinate a child with compromised immunity).
Specialized physician who is treating the immunity compromising disease.
The number of immunosuppressants being given (if the immune system is heavily compromised to control the underlying disease, vaccines might have to wait until the immune system is stronger or at least not interfere with).
Changes in vaccination guidelines.
Introduction of newer and more effective vaccines that can work better for immune-compromised children.

Do They Experience Any Vaccines Side Effects?

Many children experience mild side effects to certain vaccines, especially those with a live pathogen. When the live pathogen particles are injected into the body, the immune system recognizes them and starts producing antibodies to fight the foreign invader.
Some children may experience a mild fever, a rash at the injection site, or just fatigue. This is the body showing that the immune system is active and is fighting to keep the child safe.

In the case of immune deficiency in children, the immune system is already weak. Adding a live pathogen to this combination might complicate things further. This is why live vaccines are not recommended for children with immune deficiency unless there is no other alternative.

Some of the side effects a child with an immune deficiency can experience are:

Fatigue
Fever
Headaches
Body ache
Rashes at the injection site
Chills
Joint Pain
Swollen lymph nodes

These are common side effects any child can have after a vaccination. In most cases, these side-effects can be very mild and subside on their own, in a few days’ time.

In case of immune deficiency, the parents need to be more vigilant. If you notice your child is having severe symptoms or reactions to the vaccination, you need to consult your child’s doctor immediately. It can be very tempting to just ignore the side effects or wait for them to subside, but this wait could cause complications. It is always advisable to consult your child’s doctor immediately and if they feel it is nothing to be alarmed about, you can relax too.

When Should You Not Vaccinate Your Child With Immune Deficiency?

Though vaccinations are a necessity and highly recommended even for those children with an immune deficiency, here are some instances when you should avoid vaccinations for them.

The underlying disease is active.
Children are on immunosuppressants to control the underlying disease.
They have had a severe reaction to the previous dose of this vaccine.
They are on other drugs that may interfere with the efficacy of the vaccine.
The medical association or governing bodies have declared certain vaccines as unfit or unsafe for children with immune deficiency.
Even if your doctor has given a go-ahead for certain vaccines but you notice a sudden flare-up or the underlying disease, or new symptoms, you need to consult the doctor again. They need to check the child thoroughly.

In most cases, the primary care physician who administers the vaccines will be different from the specialist treating your child’s disease. You need to find a primary care physician who is ok with vaccinating children with immune deficiency. Only then can there be a correlation between what both doctors advise.

Common Vaccines For Children With Immune Deficiency

Let’s take a closer look at certain vaccines and the situations in which they are recommended for children with immune deficiency.

1. Pneumococcal

This is an invasive disease, which can have a fatal ending if not caught and treated in time. The vaccine for this disease is advised for children before they turn five years old. For children with immune deficiency also, this vaccine is recommended, irrespective of their age. Since the disease can have a fatal ending, it is important to protect the children against this, in the most effective manner possible.

[Read : Pneumococcal Vaccine For Babies]

2. Influenza

A disease that is most preventable by vaccines. Many children diagnosed with influenza are hospitalized and are sometimes even in critical care. Due to its capability to spread easily and the severe impact it has on children, this vaccine is recommended for all children, especially for those with immune deficiency. Doctors recommend giving this vaccine to immune-compromised children, as early as 6 months. The idea is to prevent the disease completely rather than treat it after infection.

Preventing influenza can help prevent secondary pneumococcal infections. However, children with an immune deficiency should receive only the killed variant of this vaccine and not the live vaccine.

[Read : Importance of Influenza Vaccine for Children Pre-Monsoon During COVID Times]

3. Meningococcal

HIV patients, asplenic patients, and those with a completely absent or deficient immune system are advised to take this vaccine. The majority of the vaccination guidelines recommend 2 doses of the MCV-4 vaccine. Additional booster doses may be needed in children with immune deficiency.

4. MenACWY Vaccine

This vaccine is advised for children between the ages of 2 months and 10 years if they have an issue with their immune system. It can be immune deficiency, HIV, sickle cell disease, or even complement component deficiency. Similarly, for children older than 10 years, who have an immunity disorder, the MenB vaccination is recommended.

5. COVID Vaccines

Available vaccines against SARS-COV-2 (including Covaxin and Covishield) are non-live vaccines and can be safely given to patients with immune deficiency.

Should You Avoid Any Vaccines For Your Kid?

Live Active Vaccines contain Live pathogens in a weakened state, to help the immune system produce antibodies to fight the invaders without any complication. These live vaccines have to be avoided as much as possible for children with compromised immunity. This is because the immune system is weak and further weakened by immunosuppressants and other medications.

Patients with primary immunodeficiency like SCID, live vaccines can be a big risk. Live vaccines like BCG vaccine (given to protect against tuberculosis) can cause serious complications in children with SCID and must be avoided.

It must be noted that children with immune deficiency have to be very careful and be under constant monitoring for the few weeks following vaccination. In case of a new rash or fever within 4 weeks of the vaccine, they need to seek medical attention immediately.

Examples of live vaccines include BCG, OPV, MMR, Varicella vaccine, etc

Things to Remember While Getting Your Child Vaccinated

Here are a few things you can do even in this situation.

Stay up-to-date with all vaccine recommendations. This will require a lot of reading, fact-checking, checking with doctors, etc. If you keep yourself well informed about all the details, you can discuss your concerns better with your doctor.
Check vaccination records and collect relevant information such as when is the next vaccination due; what is the time frame within which the vaccine has to be given; what are the alternatives; are there any new vaccines?
Document vaccination responses for future references. When you give your doctor all data and records about how your child reacted to vaccinations, they can decide better about the next vaccine.
Follow-up with the doctor. If they inform you the vaccination can be considered after a few months or after a particular point in the treatment, you need to follow it up with the doctor. You cannot expect the doctor to remember and follow through with it.
Ensure all house members are vaccinated and are not a threat to your unvaccinated child. Many diseases are communicable and by ensuring people around your child are safe; you can ensure better safety for them.

Vaccines are important to prevent certain diseases and protect children from harmful pathogens. Most of the vaccines are designed to last a lifetime. Only a few require regular booster doses. In the case of children with immune deficiency, booster doses are a necessity.

These children can indeed get their vaccines like regular healthy children, but it needs to be in a controlled setting and they need to be under constant supervision. While certain vaccines must be avoided in children with serious immune defects; most vaccines are safe and indeed very important to protect children with weak or no immunity.

Vaccination in Children With Immune Deficiency

What is Immune Deficiency in Children?