Killing the live vaccine?
A Denver television station is reporting that some hospitals there are refusing to administer the intranasal (live) H1N1 vaccine because of concerns of transmission of the virus to immunosuppressed patients. While CDC recommends that the vaccine should not be administered to healthcare workers in contact with severely immunocompromised patients (e.g., bone marrow transplant patients), I have heard from a number of clinicians who are expressing concerns regarding whether workers in contact with other immunosuppressed patients (e.g., solid organ transplant patients) should be vaccinated.
One of the ironies is that some locations (ours included) are receiving a small shipment of the live vaccine BEFORE the inactivated.....so after umpteen meetings about how best to distribute the first small shipment(s) of H1N1 vaccine, we'll get a box of LAIV and all that risk stratification will go out the window (since pregnant women, those with certain underlying medical conditions, etc., are no longer candidates). Otherwise healthy healthcare workers under the age of 49 constitute one of the few "priority" groups that can still receive the LAIV, so the issue you raise becomes paramount.
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