Vaccines in immunocompromised children. Consensus of the Latin American Society of Pediatric Infectious Diseases 2025

Abstract

Immunocompromised children are more susceptible to infections, including those caused by vaccine-preventable agents. It is extremely important to avoid delays in the vaccination schedules of immunocompromised patients and update them as soon as possible, ideally 4 weeks before starting various immunosuppressive therapies. These strategies are tailored to the individual patient, including measurement of vaccine-induced antibody titers and/or additional doses, if appropriate. Inactivated vaccines can be safely administered, even if their immune response may be inadequate. The recommendation is to vaccinate and not postpone vaccination for prolonged periods, waiting for intervals without immunosuppressive therapy. In the case of live attenuated vaccines, which are usually contraindicated in these patients, there is increasing information supporting their use, which will allow for an individual risk-benefit assessment, avoiding their use in severe phases of immunosuppression. To organize the vaccination schedule, dose intervals, authorized accelerated schedules, coordination with vaccination centers, current approvals depending on the country, and contraindications must be considered. It is important to educate healthcare teams to actively report adverse effects, ensuring safe vaccination while optimizing immunogenicity results. The aim of this document is to guide clinical teams caring for pediatric patients with different types of immune system compromise to keep vaccination schedules up-to-date, with a personalized approach.