Overview
- Infectious diseases (ID) are a major cause of morbidity and mortality in immunocompromised hosts (ICH). IDs may also trigger underlying conditions, graft-versus-host disease (GVHD), or organ rejection.
- To mitigate these risks, ID management in ICH requires comprehensive care from day one, including:
- Reducing exposure: fewer social contacts, cocooning (vaccinating close contacts), and adhering to a “low-pathogen” diet.
- Avoiding environmental risks such as dust and contaminated surroundings.
- Detecting pre-existing risks, including latent infections and reviewing vaccination history.
- Anticipating “expected infections” based on the type and severity of immunosuppression.
- Inactivated vaccines generally have similar reactogenicity and safety profiles in ICH and healthy individuals; however, reduced immunogenicity may lead to lower efficacy.
- Live vaccines are typically contraindicated for severely immunocompromised patients because they pose a risk of causing disease. They may only be considered after careful individual risk–benefit assessment, depending on the patient’s residual immune function.
- In certain cases, post-exposure prophylaxis with immunoglobulins (“passive immunization”) is effective—particularly against measles and varicella-zoster virus. For varicella-zoster, antiviral therapy can also be used as an alternative.
