Role of Vaccination in Immune Compromised Patients – Dr Dipu TS

Vaccination plays a pivotal role in protecting
immunocompromised individuals from potential infections, given their
compromised immune status. The effectiveness of vaccines, however, largely
depends on the robustness of the immune system, presenting a significant
challenge in this context.

Immunocompromised persons are at an elevated risk of
contracting infections, underscoring the critical need for vaccination as a key
mitigation strategy. Yet, the weakened immune response typical of such
individuals may not suffice to prevent vaccine-preventable diseases,
highlighting a unique and pressing dilemma.

Historical successes in vaccination, such as
the cowpox vaccine’s cross-immunity to smallpox, demonstrate the importance of
a responsive immune system to the effectiveness of vaccinations. This principle
applies equally to the immunocompromised, for whom achieving a sufficient
immune response through vaccination can be particularly challenging.

The
administration of live vaccines, which are attenuated strains designed to
enhance immunity without causing disease in immunocompetent individuals, poses
a significant risk. In immunocompromised patients, the replication of these
strains could proceed unchecked, leading to severe health implications, thereby
rendering live vaccines like MMR, Polio, and Varicella unsuitable for this
population.

The limitations in vaccine options for
immunocompromised individuals further complicate their protection strategy.
Ensuring the persistence of immunity poses an additional hurdle; even when an
immune response is initially achieved, sustaining the vaccine’s effectiveness
over time can be challenging.

This underscores the importance of monitoring
specific immune responses, such as antibodies and T-cell mediated reactions,
and the necessity for repeated vaccine boosters to counteract the decline in
immunity. For certain conditions, such as after a splenectomy, revaccination
protocols are specifically recommended to maintain protective immunity levels.

Preventing vaccine-preventable diseases is
paramount for the immunocompromised, as the failure to do so could lead to
severe consequences, including mortality. The use of non-live vaccines—subunit,
conjugate, and whole killed vaccines—offers a safe alternative for
immunocompromised individuals.

It is crucial for patients to inquire about the
type of vaccine being administered to avoid the risks associated with live
vaccines inadvertently. Such knowledge empowers patients to engage proactively
with their healthcare providers, informing them of their immune status and any
ongoing treatments, thus facilitating informed decision-making regarding
appropriate vaccination strategies.

The complexity of the immunocompromised state
varies widely across individuals, influenced by various conditions and
treatments. For example, the eligibility for vaccination among patients
receiving HIV treatment may hinge on their CD4 cell count. To narrate an example, if their CD4 cell count is more than 200 then we can give live vaccine
to protect against varicella (chickenpox) whereas if their CD4 count is below
200 then we will not able to give the same vaccine.

This emphasises the need
for tailored vaccination approaches. The timing of vaccination is also
critical, especially for patients undergoing treatments such as cancer
chemotherapy or preparing for elective splenectomy. Vaccines should ideally be
administered during periods when the immune system is at its most responsive to
achieve maximum efficacy.

Furthermore, ongoing research and development
efforts are needed to improve vaccination strategies for immunocompromised
patients. This includes investigating alternative vaccine formulations, such as
novel adjuvants or delivery systems, that can enhance immune responses in this
population.

Additionally, studies focusing on immune monitoring techniques can
help tailor vaccination schedules and boosters to optimize protection while
minimizing risks. Education also plays a crucial role in empowering both healthcare
providers and patients.

By raising awareness about the importance of
vaccination in immunocompromised individuals and providing clear guidelines for
vaccination practices, we can improve vaccination rates and ultimately reduce
the burden of vaccine-preventable diseases in this vulnerable population.

In conclusion, both physicians and patients
must recognize the complexities involved in vaccinating immunocompromised
individuals. This understanding is increasingly important in today’s medical
landscape, characterized by the advent of biological therapies, chemotherapy,
and organ transplantation.

By customizing vaccination strategies to meet the
unique needs of this vulnerable group, healthcare providers can offer the best
possible protection against infectious diseases, reflecting the nuanced and evolving
nature of medical care for the immunocompromised.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.

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Union Home Minister inaugurates Swaminarayan Institute of Medical Science in Gujarat

Union Home Minister and Minister of Cooperation, Shri Amit Shah inaugurated ‘Swaminarayan Institute of Medical Science and Research’ of Shri Swaminarayan Vishwamangal Gurukul at Kalol in Gandhinagar, Gujarat. On this occasion, Chief Minister of Gujarat Shri Bhupendra Patel and many dignitaries were present.

Addressing the inaugural programme, Shri Amit Shah lauded the Swaminarayan sect and said that Lord Swaminarayan made Gujarat Karmabhoomi, established nine temples and a great tradition. He said that the Swaminarayan sect freed crores of people from addiction, promoted the values ​​of devotion in every home, and taught them how to live a smooth life. Shri Shah said the Swaminarayan sect started setting up Gurukuls across Gujarat since the 1960s.

For more information click on the link below:

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Post-traumatic stress disorder trajectories in sepsis survivors

Recently published study identified and predict trajectories of post-traumatic stress symptoms in sepsis survivors up to two years after discharge from the ICU. It addressed the limited research on long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. The study included data on post-traumatic stress symptoms collected from sepsis survivors at one, six, 12, and 24 months after ICU discharge. The results identified three distinct trajectories of post-traumatic stress symptoms: stable low symptoms (59% of patients), increasing symptoms (26%), and recovering from symptoms (15%). Patients with initially high post-traumatic symptoms were more likely to show a decrease. Females and patients reporting early traumatic memories of the ICU were at higher risk for increasing post-traumatic stress symptoms.

Implications of Findings

The findings suggest that post-traumatic stress is a relevant long-term burden for sepsis patients after ICU stay and highlight the importance of regular screening for post-traumatic stress, especially in patients with few initial symptoms. The study suggests the need for timely screening for early traumatic memories after ICU discharge and regular monitoring of post-traumatic stress symptoms in the long term. Additionally, it indicates that women may be at a higher risk of increasing symptom severity and emphasizes the importance of screening and monitoring, particularly in general practice settings.

Limitations and Recommendations

The study provides valuable insights into the long-term trajectories of post-traumatic stress symptoms in sepsis survivors and identifies potential risk factors for adverse mental health outcomes. However, it also acknowledges certain limitations, such as the exploratory nature of the analysis and the need for replication in larger prospective cohorts with more measurement points. Overall, the study contributes to the understanding of post-traumatic stress in ICU survivors and emphasizes the need for ongoing monitoring and support for sepsis survivors.

Reference –

Schmidt, K.F.R., Gensichen, J.S., Schroevers, M. et al. Trajectories of post-traumatic stress in sepsis survivors two years after ICU discharge: a secondary analysis of a randomized controlled trial. Crit Care 28, 35 (2024). https://doi.org/10.1186/s13054-024-04815-4.

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Prostate cancer test may lead to harmful overdiagnosis in Black men

A new study from experts at the University of Exeter has found that a widely used test for prostate cancer may leave Black men at increased risk of overdiagnosis.

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Cause of clogged hypodermic needles discovered

In very rare cases, the needles of prefilled syringes may become blocked. This can have potentially detrimental consequences for patients if their medication does not enter the body or the dosage is too low.

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More than one billion people in the world are now living with obesity, global analysis suggests

The total number of children, adolescents and adults worldwide living with obesity has surpassed one billion, according to a global analysis published in The Lancet. These trends, together with the declining prevalence of people who are underweight since 1990, make obesity the most common form of malnutrition in most countries.

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Loneliness found to increase the risk of health deterioration in older adults

The loneliness often experienced by older people in our society has a negative effect on their physical health, according to researchers from Amsterdam UMC and the University of Glasgow. Emiel Hoogendijk, epidemiologist at Amsterdam Public Health, analyzed research results from more than 130 studies and found that loneliness led to an increase in physical frailty, which in turn increases the risk of adverse health outcomes such as depression, falls and cognitive decline. These results are published today in The Lancet Healthy Longevity.

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UK’s General Medical Council urged to revise terminology for international medical graduates

The General Medical Council (GMC) should revise its terminology regarding international medical graduates (IMGs) in the UK, argues a new commentary published in the Journal of the Royal Society of Medicine (JRSM).

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Biocon Biologics Biocon Campus (Site 1) facility gets 4 USFDA observations

Bangalore: Biocon has recently announced that the U.S. Food and Drug Administration (USFDA) has issued Form 483s with 4 observations at the conclusion of the inspection at the Biocon Biologics Limited’s Biocon Campus (Site 1) facility.

An FDA Form 483 is issued to firm management at the conclusion of an inspection when an investigator(s) has observed any conditions that in their judgment may constitute violations of the Food Drug and Cosmetic (FD&C) Act and related Acts.

The inspection was conducted between February 20-28, 2024.


This inspection pertains exclusively to the rh-Insulin (rhI) Drug Substance (DS) supply to a customer for
veterinary use.

“The trigger for this inspection was a Pre-Approval Supplement (PAS) filed by our customer
late last year,” the Company’s Spokesperson said in a BSE filing.

“The Company will
submit a comprehensive Corrective and Preventive Action (CAPA) Plan to the U.S. FDA within the stipulated
time and is committed to addressing these observations expeditiously.
The outcome of this inspection at Site 1 does not impact the manufacturing and distribution of the
Company’s commercial products in the US market.
Biocon Biologics remains committed to global standards of Quality and Compliance.” he added.

Read also: Biocon registers consolidated revenue of Rs 4519 crore in Q3

Biocon Biologics Ltd. (BBL), a subsidiary of Biocon Ltd., is a unique, fully integrated, global biosimilars company.

BBL has acquired the global biosimilars business of its long-standing partner Viatris. Biocon Biologics has commercialized eight biosimilars in key emerging markets and advanced markets like U.S., EU, Australia, Canada, Japan. The Company has a pipeline of 20 biosimilar assets across diabetology, oncology, immunology, and other noncommunicable diseases.

Read also: Biocon Biologics, Sandoz Australia ink pact for biosimilars Trastuzumab, Bevacizumab

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Haryana hospitals grappling with shortage of medical officers: Anil Vij

Chandigarh: In response to a query by Congress MLA Jagbir Singh Malik, Haryana’s Health Minister Anil Vij disclosed that out of the 4,260 sanctioned medical officer posts in the state, a staggering 1,134 remain unfilled.

The question highlighted the concerns about a potential shortage of specialists and doctors in Haryana. Anil Vij on Tuesday said in the state assembly that at least 26% of posts of medical officers alone are vacant.

Vij further provided details, stating that 167 medical officers have been appointed through the National Health Mission (NHM). Additionally, among the 22 sanctioned civil surgeon positions, one stands vacant, and out of 374 sanctioned senior medical officer posts, a significant 144 positions remain unfilled, reports the Hindustan Times. 

Also Read: Historic day for Haryana’s Healthcare ecosystem: Foundation stone for 750-bed AIIMS Rewari laid

The health minister acknowledged that, in the past nine years, 608 medical officers have been appointed to address staffing gaps. However, the persistent vacancies pose challenges to the healthcare system. According to official data, districts like Karnal, Yamunanagar, and Kurukshetra are among those most affected by the shortage, with 61, 54, and 53 vacant doctor positions, respectively. The other districts included Kaithal with a shortage of 49, Bhiwani 48, Fatehabad 47, Hisar 38, Jind and Ambala 35 each, Panipat and Sonepat 17 each, Faridabad 6 and Gurugram 1.

To tackle this issue, Vij announced that the government plans to create a specialist cadre, pending approval from the finance department. Once approved, separate recruitment drives for the specialist and MBBS cadres will be initiated. Despite the existing challenges, an official spokesperson assured that out of the total 5,522 sanctioned doctor positions in the state, 4,016 are currently filled. 

However, the persistent 1,506 vacancies underscore the urgency of addressing the healthcare staff shortage to ensure the delivery of quality medical services to the residents of Haryana, reports The Daily.

Medical Dialogues team had earlier reported that the Haryana Civil Medical Service (HCMS) Association was demanding the recruitment of more specialist doctors in Government Service by offering them an attractive salary package. The doctors talked about the scarcity of specialist doctors in the State, where half of the posts of specialist doctors were lying vacant till last year.

Highlighting that the work environment was not conducive in Government hospitals, the doctors mentioned how Government doctors were required to attend to several other kinds of non-clinical duties. The association even went on to stage protests airing its concerns. 

Also Read:Severe Shortage of Doctors: Haryana govt Doctors threaten Complete Shutdown if Demands are not met

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