Janczar Szymon, Zalewska-Szewczyk Beata, BąBOL-Pokora Katarzyna, PaŚnik JarosŁaw, Zeman Krzysztof, MŁynarski Wojciech
Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Poland.
Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
Cent Eur J Immunol. 2020;45(2):202-205. doi: 10.5114/ceji.2020.97910. Epub 2020 Jul 27.
While the management of childhood neutropenia associated with a modifiable factor should be appropriate for the primary cause, there are misconceptions regarding the management of severe congenital neutropenia, immune neutropenia and cases classified as "idiopathic". Antibiotic prophylaxis or granulocyte-colony stimulating factor (G-CSF) are prescribed by specialists in pediatric hematology or immunology, whereas immunization may be conducted by primary care physicians should clear recommendations by provided. There is a belief that severe neutropenia, as an immunodeficiency, is associated with compromised effectiveness and increased rate of complications of immunization. The immunization might be delayed or omitted, increasing the risk of unnecessary infection. We discuss the available data and recommendations regarding vaccination of children with chronic severe neutropenia. While there are virtually no studies addressing the safety and effectiveness of vaccination in neutropenia, expert opinions provide information on immunization policy in "phagocytic cells defects" or explicitly neutropenia. There are no contraindications for inactivated vaccines in neutropenia. Live bacterial vaccines are contraindicated. While in general the vaccination with live viral vaccines is encouraged, occasionally neutropenia might be associated with defects of adaptive immunity, which would preclude the administration of such vaccines. Although this should be easily phenotypically identified, we propose assessing immunoglobulin levels and performing a low-cost flow cytometry test for major lymphocyte subpopulations to exclude significant defects in adaptive immunity before administration of live viral vaccines to such patients. This can improve the adherence of patients' guardians and physicians to proposed vaccination policy and the professional and legal safety associated with the procedure.
虽然与可改变因素相关的儿童中性粒细胞减少症的管理应针对主要病因，但对于严重先天性中性粒细胞减少症、免疫性中性粒细胞减少症和归类为“特发性”的病例的管理存在误解。儿科血液学或免疫学专家会开具抗生素预防或粒细胞集落刺激因子（G-CSF），而如果有明确建议，初级保健医生可进行免疫接种。有一种观点认为，严重中性粒细胞减少症作为一种免疫缺陷，与免疫接种效果受损和并发症发生率增加有关。免疫接种可能会延迟或省略，从而增加不必要感染的风险。我们讨论了有关慢性严重中性粒细胞减少症儿童疫苗接种的现有数据和建议。虽然几乎没有研究涉及中性粒细胞减少症患者疫苗接种的安全性和有效性，但专家意见提供了关于“吞噬细胞缺陷”或明确的中性粒细胞减少症免疫接种政策的信息。中性粒细胞减少症患者接种灭活疫苗没有禁忌证。活细菌疫苗禁忌使用。虽然一般鼓励接种活病毒疫苗，但偶尔中性粒细胞减少症可能与适应性免疫缺陷有关，这将排除此类疫苗的接种。虽然这应该很容易通过表型识别，但我们建议在给此类患者接种活病毒疫苗之前，评估免疫球蛋白水平并对主要淋巴细胞亚群进行低成本流式细胞术检测，以排除适应性免疫的重大缺陷。这可以提高患者监护人及医生对建议的疫苗接种政策的依从性以及与该程序相关的专业和法律安全性。
