FAQs about the management of PIDs

Here we answer patients' questions on infections and keeping them at bay by immunisation.

Immunisation

Q. Am I okay as a PID patient if someone close to me in my family has live vaccines?

A. Yes you will be fine, as long as you yourself, as a PID patient, do not have any live vaccines.

Q. Following on from advice about the flu jab do you have any information on the pneumonia jab?

A. You can find out more about vaccinations on our website here. In regards to the pneumonia jab “Pneumococcus Streptococcus Pneumoniae (pneumococcus)
there are two types of vaccines against pneumococci. Pneumovax is a vaccine prepared from a mixture of 23 bacterial polysaccharide (sugar) components which is effective in older children and adults. This is used to protect those that have sickle cell disease or have had their spleen removed, in order to prevent chest and sinus infections. This safe vaccine may be used to test for antibody production as part of the investigation of a suspected immunodeficiency.

Children under the age of two do not respond to the polysaccharide vaccines. In order to protect this group of high-risk individuals, conjugated pneumococcal vaccines were introduced universally in the UK in 2006. These vaccines are also composed of bacterial components and contain no live organisms; they are safe in immunodeficient patients and may be used to investigate suspected immunodeficiency.

You may also find this IPOPI booklet on vaccines useful.

Q. I am giving the flu jab to a group of students and one of them has XLA, does he need to be segregated from the other students during playtime, lunch etc?

A. Although vaccinated children are known to shed virus a few days after vaccination, the vaccine virus that is shed is less able to spread from person to person than the natural infection. The amount of virus shed is normally below the levels needed to pass on infection (transmit) to others and the virus does not survive for long outside of the body. This is in contrast to natural flu infection, which spreads easily during the flu season. In schools using vaccine, therefore, the overall risk of influenza transmission is massively reduced by having a large number of children vaccinated. In the US, where there has been extensive use of The nasal spray flu vaccine (live attenuated influenza vaccine; LAIV) for many years, serious illness amongst immunocompromised contacts who are inadvertently exposed to vaccine virus has never been observed. Expert doctors at Great Ormond Street Hospital, who deal with many children with very serious immune problems, do not recommend keeping such children off school purely because of vaccination.

Q. I have a PID and my child has been offered the nasal flu vaccine at their school. If they have the live vaccine am I at risk?

A. Please see the answer above.

Q. I have just started university and have a PID should I have the meningitis and septicaemia vaccines?

A. Both the meningitis and septicaemia vaccines are killed vaccines so PID patients should definitely have the vaccination. PID patients may not make the most effective response to the vaccine but it’s better to have some protection.

Q. Is there any contraindication to being on immunoglobulin therapy and having immunisations using killed vaccines?

A. In general there is no contraindication between having immunoglobulin therapy and killed vaccines, but if the two are given close together and there are high levels of antibody in the Ig to the vaccine then the efficacy is likely to be impaired. Please check with your immunology team about the appropriate timing.

Q. I was wondering if PID patients in the U.K. get a vaccine for pneumococcal pneumonia offered by their GPs/ specialists or if they have to ask for it?

A. It is very difficult to give blanket advice in the area of vaccination for people with PID.  We advise that you discuss this with your immunology team as they can provide advice specific to you and your condition.   Some patients will be given pneumococcal vaccine as part of their work up, patients on Ig would not normally be offered it since they get the protection from their immunoglobulin.

Q. There have been cases of swine flu and bird flu reported in Scotland. Please can you let me know if the annual flu vaccine covers these types of flu?

A. The seasonal flu jab 2015/16 includes cover for H1N1 (swine flu), but avian flu is not covered and there are limited vaccine supplies.

The government guidance on all cases of flu has changed recommending that individuals with signs or symptoms of influenza who are admitted to hospital should be treated with a neuraminidase inhibitor as soon as possible and these medicines are effective against both these forms of influenza.

Q. My daughter has a PID and is due to have the human papilloma virus (HPV) vaccine.  Is there any problem with her having this immunisation?

A. All girls aged 12 to 13 are offered HPV vaccination as part of the NHS childhood vaccination programme. The vaccine protects against cervical cancer. It's usually given to girls in year eight at schools in England.

The vaccines available are recombinant protein vaccines - virus like particles, with no live virus potential so they are safe for girls who have a PID.

Q: I have CVID. My husband was going to get the shingles vaccine but was told that it might be risky or possibly contagious to me.

A. The Shingles vaccine is a live vaccine. Transmission to susceptible household contacts has been reported, but is rare. The vaccine is however recommended for healthy susceptible contacts of immunocompromised patients where continuing close contact is unavoidable (e.g. siblings of a leukaemic child, or a child whose parent is undergoing chemotherapy). If in doubt check with your centre if they would be happy for you to be vaccinated, if the answer is yes, you need not worry about household contact transmission.

Q.  My child has a PID, should they have the Fluenz vaccine?

A. No Fluenz is a live nasal vaccine and should not be given to children with a PID.  Other killed; injectable flu vaccines may be recommended. You should speak to your immunology team for advice.

Q. Why should family members and contacts of a person with PIDs get a flu jab?

A. Vaccines reduce the likelihood of getting an infection and often reduce how badly a person will be affected if infection still occurs.  Some people with PID will be able to be vaccinated, but their responses may not be as good as individuals with fully functioning immune systems.  Vaccinating family members or close household contacts with the injectable killed flu vaccine is recommended to help reduce the likelihood that someone brings influenza into the house and will therefore help protect the individual indirectly.

Q. I have a PID and been getting the annual flu jab for the last ten years. I’m now pregnant, should I still get it?

A. All pregnant women are advised to have flu vaccine to protect them and their newborn child. If you have a PID then live vaccine should not be used.

Q. My son has a PID and last year children in his class had the live Fluenz vaccine. My son had to be off school for two weeks. Can the live vaccine be passed on and is it still the case he should miss school?

A. To date no cases of transmission have been reported. Children well enough to attend mainstream school do not need to avoid other children who have received the vaccine, but PID patients should not receive the live virus as a direct inoculation. Children undergoing or recovering from bone marrow transplant or with SCID (untreated) are advised that household contacts should have killed, not live, vaccines.

Q. My Mum has CVID and bronchiectasis. I had the BCG vaccination on Wednesday. I am currently at university and I am meant to be returning home  next weekend. However, I was wondering if I will be putting my mum at risk from the bacteria in the vaccine?

A. There is no concern of you putting your mum at risk because you had the BCG vaccine, she cannot catch TB from it. Take a look at this link for more information.

Q.  Should children of parents with a PID get live vaccines? If not, why not?

A. Live vaccines such as oral polio may excreted in faeces for many weeks, sometimes months and years and close contact with someone with impaired immunity should be avoided during that time.  Travel vaccines such as yellow fever are not known to be contagious to other individuals.  When there are outbreaks of infections such as measles in an area children with severe immune deficiency, it is advisable to ensure that household contacts are vaccinated if this was not previously the case.

Q. I am a mum to two small healthy children, both in nappies who have received the MMR vaccine. My partner has a PID and I’m concerned he might pick up particles of the live vaccine. What precautions should we take?

A. You are right live vaccines can undergo shedding.  Shedding is when the live virus that is injected via a vaccine, moves through the human body and comes back out in the faeces, droplets from the nose, or saliva from the mouth.  The recommended precautions are avoid close contact, steer clear of nappy changing and wash your hands frequently.

Q. My child has a PID and receives immunoglobulin (Ig) therapy should they have a pneumococcal immunisation and if so how much protection does it give against pneumonia?

A. Pneumococcal vaccine is not usually given whilst on Ig therapy.  This is because there is a good spread of anti-pneumococcal antibodies in Ig, and this is part of its value.  Pneumococcal vaccine can be "neutralised" by the antibodies present in the Ig.  There is a limited useful T-cell response that would help provide further protection to these organisms, so there is no great utility in vaccinating. This is unlike the killed flu vaccine, which can provide useful T-cell protection even if there is no antibody response.

Q. Should all people with a PID have the pneumococcal vaccine?

A. Many but not all patients are suitable for pneumococcal vaccine.  Patients on immunoglobulin (Ig) replacement therapy would not normally receive it, but may do if their Ig is stopped.  Other patients may have specific contraindications and this would be best discussed with your immunologist.

Q. I'm 75 years old and have a PID. Should I have the shingles vaccine?

A. The shingles vaccine has been recommended for 70-79 year olds by the Department of Health but if you have a PID you should discuss this with your doctor.  This is because some of the vaccines are suitable and others are not and this will depend on T cell function and if you are on a medicine that suppresses your immune system.

Ebola

Q. What risk is there of me catching Ebola?

A. For people living outside Africa, the Ebola virus continues to be a very low threat unless you've travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or contaminated objects.

Q. What measures are being taken to ensure the virus does not spread?

A. Effective infection control procedures have been put in place. In past outbreaks, infection control measures have been very effective in containing Ebola within the immediate area. The UK has a robust public health system with the trained staff and facilities necessary to contain cases of Ebola. Public Health England has advised frontline medical practitioners to be alert to Ebola in those returning from affected areas.  Advice has been issued to the Border Force to identify possible cases of Ebola (read FAQS on screening for Ebola at UK airports) and there are procedures in place to provide care to the patient and to minimise public health risk to others.

Q. Can I get Ebola by travelling on an airplane?

A. This event is very unlikely, and so far there have been no documented cases of people catching the disease simply by being in the same plane as an Ebola victim. Flight crew are trained to respond swiftly to any passengers who develop symptoms during a flight from Africa. They will take measures to reduce transmission on board the plane.

Q. How does the Ebola virus spread?

A. Ebola is not spread by air like with influenza etc., and to actually be at risk of getting it you have to be in very close contact (i.e. actually getting infected blood, tissue etc on you) which make transmission more difficult than may be thought. People infected with Ebola do not become infectious until they have developed symptoms, such as a fever. The disease then progresses very rapidly. This means infectious people do not walk around spreading the disease for a long period. It typically takes five to seven days for symptoms to develop after infection, so there is time to identify people who may have been exposed, put them under surveillance and, if they show symptoms, quarantine them.

Q. Is Ebola more threatening to me because I have a PID?

A. This is unknown, but it is unlikely. The chances of catching Ebola are the same as everyone else.

Q. Is there a risk I can get Ebola through my immunoglobulin therapy?

A. No. Companies do not source plasma, from which the immunoglobulin is made, from Africa. Any donor returning from Africa will be excluded from giving plasma donations and any plasma from new donors is held for 3 months prior to its use so any affected individuals would be identified before it is used.  

These FAQs were reviewed by Dr Matthew Buckland, Chairman of our Medical Advisory Panel, October 2014; June 2015; January 2016; August 2016.