Immunization in Children and Adults who have Thalassemia

General Recommendations
Children who have thalassemia trait should be treated and immunized in a manner identical to all other children. The United States Center for Disease Control (CDC) has recently published an immunization schedule for 1998. This schedule represents the latest recommendations of this United States Government body. Their recommendations cover Hepatitis B vaccination, to be completed in the first year of life. Diphtheria, tetanus, and pertussis vaccination initially completed in the first 18 months of life with booster vaccination between 4 and 6 years and an adult tetanus booster between 14 and 16 years. Haemophilus influenzae conjugate vaccination completed by 15 months. Polio vaccination completed by 4 to 6 years, the first two vaccine doses optionally being the Salk IPV killed vaccine followed by the Sabin live oral vaccine. Measles, mumps and rubella vaccination completed by the age of 4 to 6 years. Varicella vaccine is recommended before the age of 18 months.

Hepatitis A VaccineChildren who have thalassemia intermedia or thalassemia major receive the above vaccines. In addition transfused children who test negative for Hepatitis A should be immunized against this virus whether or not they have been infected with Hepatitis C. Infection with Hepatitis A after infection Hepatitis C can lead to fulminant disease. It is not know whether late infection with this virus can cause worse hepatitis in individuals co-infected with other hepatitis viruses or with severe hemosiderosis.

Pneumococcal Vaccination
All children are immunized against Streptococcus pneumoniae with the 23-valent pneumococcal polysaccharide vaccine prior to splenectomy and boosters given every five years if their pneumococcal immunoglobin titers are negative. The conjugate pneumococcal vaccine is now available and should be considered for infants who have the possibility of early splenectomy; children who have Hemoglobin H Constant Spring might fall into this category. Children who have sickle thalassemia syndromes such as Sickle Beta Zero Thalassemia and Sickle Beta Plus Thalassemia should also receive either the conjugate vaccine as infants or the polysaccharide vaccine if they are over two years old. All children should receive boosters if they have negative titers to Streptococcus pneumoniae.

Influenza Vaccine
All children who have thalassemia intermedia or major should receive the influenza vaccine beginning at the age of six months (split vaccine with a booster the first season). Children who have other risk factors should also receive this vaccine.
HIV Infected Children
Children who are immune suppressed with HIV viral infection should not receive live virus vaccines: Measles, Mumps, Rubella; Oral Polio Vaccine; Varicella Vaccine. Nor should their siblings receive these vaccines without medical management to prevent infection of the immunosuppressed child.

Recommendations for children infected with the human immunodeficiency virus (HIV):
• All routine inactivated vaccines (IPV, Hib, Hepatitis B, and DTaP) are recommended for all children.
• Children who are six months or older receive the influenza vaccine (split dose with booster during the first season).
• Children who are two years old or older receive pneumococcal vaccine.
• The MMR vaccine is recommended only for children infected with HIV who are not severely immune compromised.
• Live virus vaccines are contraindicated in all children who are infected with HIV with the above exception.

Children Receiving Intravenous Gamma Globulin
Children who are receiving intravenous gamma globulin (IVIG) have the possibility that live virus vaccines will be inactivated or that they will not develop immunity.
Children After Bone Marrow Transplantation
Centers performing bone marrow transplantation each have their own preferred schedule for reimmunization of their patients. These schedules should be followed. After immunocompentence is documented and all other immunizations are complete these children should receive the influenza vaccination annually.

Other VaccinesNew vaccines are being developed and will be available periodically. The Rotavirus Vaccine has recently been released and is not specifically indicated for children who have thalassemia.
The meningococcal vaccine is available, but is not generally recommended in most references. It would be indicated for splenectomized children and adults. This vaccine is not thought to be optimal and is not routinely administered at this center.