What should you do if your patient was given vaccines during immunosuppression?
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1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.
Counselling Conundrum: "My immunologist said I should restart several vaccine series that I got while I was taking my Cellcept for my skin disorder, but the nurse at my family doctor's office said I don't. What should I do?"
Concise Conclusion: This is certainly a complex situation. Doses given while your immune system is weakened may need to be repeated when you are no longer taking your Cellcept (and stopping may or may not be possible depending on your condition). For some illnesses, we can test to see if you're immune (e.g., Hepatitis B), or use a modified dosing series (e.g. double the dose for 3-4 doses, 3-dose schedule for HPV). In this case, I would follow the recommendation of your immunologist.
Quick Wrap-up: This example is regarding immunosuppressive therapy, but with CAR T cell therapy or HSCT patients, they are considered "never immunized", as their bone marrow has been affected, which means restarting all previous immunization series. There are many nuances, but the Canada Immunization Guide gives you everything you need to answer these questions (linked below).
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