Immunizations

Immunizations are one of the most useful preventive measures available to infants, children, and adults. This benefit should be extended to all individuals regardless of other chronic conditions, unless there is a specific disease-related or personal (e.g., allergy) contraindication. For people with SCD, there are no disease-related contraindications.

Summary of the Evidence
The Advisory Committee on Immunization Practices (ACIP) reviews the evidence for each immunization it recommends. The expert panel determined that the methodology used for those reviews was compatible with its own methodology. Therefore, evidence reviews for this topic were not performed by the methodology team.
The expert panel based its recommendations on those made by the ACIP (see exhibit 6).22

Evidence reviews on this topic were not performed by the methodology team. Therefore, the expert panel based its
recommendations on those developed by the ACIP (see exhibit 6).
1. All individuals with SCD should receive immunizations according to the ACIP harmonized immunization schedule unless they have a personal contraindication as noted in the ACIP schedule.
(Consensus—Adapted)
2. Because of their increased susceptibility to invasive pneumococcal disease, all infants with SCD should receive the complete series of the 13-vaIent conjugate pneumococcal vaccine series beginning shortly after birth and the
23-vaIent pneumococcal polysaccharide vaccine at age 2 years, with a second dose at age 5 years.‘
(Consensus—Panel Expertise}

All individuals should be immunized as recommended by the ACIP. The most up-to-date schedule should be followed, as changes can be made up to four times per year. Consult the immunization schedule at: http://www.cdc.qov/vaccines/schedules. The following immunizations are of special importance or unique to people with SCD as recommended by the ACIP. These recommendations may also change periodically, and the above ACIP recommendations should be consulted for confirmation.

• Pneumococcal (PCV13) vaccine—Children
Children aged 6 to 18 years with functional or anatomic asplenia should receive one dose of PCV13.
• Pneumococcal vaccine•naive Adults
Adults aged >’19 years with functional or anatomic asplenia who have not previously received PCV13 or PPSV23 should receive
• One dose of PCV13 first, followed by a dose of PPSV23 at least8 weeks later.
• Subsequent doses of PPSV23 should follow current PPSV23 recommendations for adults at high risk.
A second PPSV23 dose is recommended 5 years after the first PPSV23 dose for persons aged 19-64 years with functional or anatomic asplenia.
Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years, or later if at least 5 years have elapsed since their previous PPSV23 dose.
• Previous vaccination with PPSV2 adults
Adults aged >’19 years with functional or anatomic asplenia who previously have received >’1 dose of PPSV23 should
• Be given a PCV13 dose >’1 year after the last PPSV23 dose was received.
— For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks ager PCV13 and at least 5 years ager the most recent dose of PPSV23.
• Hib
One dose of Hib vaccine for people aged >5 years who have SCD if they have not previously received Hib vaccine
• Meningococcal vaccine
Vaccinate infants at high risk (including those with SCD) at 2, 4, and 6 months of age, and again at 12 through 15 months with this vaccine, which is generically known as HibMenCY.
Persons aged 9 months through 55 years at increased risk for meningococcal disease (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies) should receive MenACWY.
Children aged 2 months to 6 years should receive an additional dose of MenACWY 3 years after primary immunization; boosters should be repeated every 5 years thereafter.
Children >’7 years of age should receive an additional dose of MenACWY 5 years after primary immunization; boosters should be repeated every 5 years thereafter.