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1. Immunization
Practical cases

2. Case 1
• Male, 45 yo, acute leukemia patient receiving
induction,
1. intramuscular inactivated Influenza vaccine because
of secondary infection including bacterial pneumonia
and respiratory insufficiency (mortality ranges from
9% to 33%).recommended to family and close
contacts.
2 weeks before or 2 weeks after chemotherapy or to
administer the vaccine between chemotherapy cycles.

3. 2. pneumococcal vaccine: high risk for invasive
pneumococcal disease
administration of PCV13 followed by the
administration of PPSV23 8 weeks later
2. Hepatitis B vaccine
3. a booster Tdap vaccination should be
considered for patients who have completed
chemotherapy.
4. Meningococcal vaccine, once patients' immune
system has recovered.
5. Hepatitis A virus (HAV)vaccine should be
offered to patients with cancer traveling to
countries endemic for this virus.

4. Case 2: HIV
1. pneumococcal vaccine: high risk for invasive
pneumococcal disease,reduces the burden of
invasive pneumococcal disease and non-
bacteremic pneumococcal pneumonia
administration of PCV13 followed by the
administration of PPSV23 8 weeks later
2. Meningoccocal: a 2-dose primary
MenACWY . (booster after 5years).

5. patients after stem cell transplant
1. Pneumococcal: administration of PCV13
followed by the administration of PPSV23 8
weeks later
2. a booster Tdap vaccination should be
considered for patients who have completed
chemotherapy.
3. Hepatitis B vaccine
4. inactivated Influenza vaccine

6. Case 3: Splenectomized Patient
after RTI
• increased risk for fulminant bacteremia and septicemia
caused by encapsulated bacteria, which is associated with
a high mortality
1. Pneumococcal vaccine (2nd dose 5 years after )
2. Meningococcal vaccine: a 2-dose primary series of
MenACWY, with doses administered at least 2 months
apart, and revaccinate every 5 years.
They should also receive a series of MenB with
either MenB-4C (2 doses administered at least 1
month apart) or MenB-FHbp (3 doses
administered at 0, 1–2, and 6 months).
3. Haemophilus influenza b vaccine
4. Influenza vaccine

8. Patient with cirrhosis due to VHC
• HBV
• Adults with chronic liver disease, including,
but not limited to, hepatitis C virus infection,
cirrhosis, fatty liver disease, alcoholic liver
disease, autoimmune hepatitis, and an alanine
aminotransferase (ALT) or aspartate
aminotransferase (AST) level greater than
twice the upper limit of normal should receive
a HepB series.

9. Microbiologist
• should receive 1 dose of MenACWY and be
revaccinated every 5 years
• if the risk for infection remains, as well as
either MenB-4C (2 doses administered at least
1 month apart) or MenB-FHbp (3 doses
administered at 0, 1–2, and 6 months).

10. pregnancy
indicated
• 1 dose Tdap each pregnancy
• Flu vaccine at any trimester
• HB Vaccine: having more
than one sex partner during
the previous 6 months,
been evaluated or treated
for an STD, recent or
current injection drug use,
or having had an HBsAg-
positive sex partner should
be vaccinated.
contraindicated
• MMR
• VARicela
• Herpes zoster
• Papilloma virus
• Influenza (LAIV)
• BCG