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.

中文翻译：

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慢性重度中性粒细胞减少症儿童的疫苗接种 审查建议和实用方法

虽然与可调节因素相关的儿童中性粒细胞减少症的治疗应适合于主要病因，但对于严重的先天性中性粒细胞减少症，免疫性中性粒细胞减少症和分类为“特发性”的病例存在误解。儿科血液学或免疫学专家规定了预防性应用抗生素或粒细胞集落刺激因子（G-CSF）的方法，而初级保健医生应进行免疫接种，但应明确建议。有人认为，严重的中性粒细胞减少症是一种免疫缺陷，与有效性下降和免疫并发症的发生率增加有关。免疫接种可能会延迟或取消，从而增加了不必要感染的风险。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可用数据和建议。虽然几乎没有针对中性粒细胞减少症疫苗接种的安全性和有效性的研究，但专家意见提供了有关“吞噬细胞缺陷”免疫策略的信息。或明确的中性粒细胞减少症。中性粒细胞减少症没有灭活疫苗的禁忌症。禁止使用活菌疫苗。虽然通常鼓励使用活病毒疫苗进行疫苗接种，但有时中性粒细胞减少症可能与适应性免疫缺陷有关，这将阻止此类疫苗的给药。尽管这应该很容易在表型上识别出来，我们建议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测试，以排除对此类患者给予活病毒疫苗之前适应性免疫的重大缺陷。这可以提高患者的依从性。监护人和医师应遵循建议的疫苗接种政策以及与该程序相关的专业和法律安全性。