Table. Immunosuppressive potential of certain medical conditions

Condition	Diagnosis	Immunosuppressive potential	Susceptibility to infectious diseases (including those that are vaccine-preventable)
Inborn errors of immunity (primary immunodeficiencies)	Less severe antibody (B-cell) immunodeficiencies: selective IgA deficiency specific polysaccharide antibody deficiency IgG subclass deficiency	Moderate	Susceptible to bacterial infections
	Severe antibody (B-cell) deficiencies: X-linked agammaglobulinemia common variable immunodeficiency	Severe	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses
	T-cell or combined T- and B-cell immunodeficiencies: incomplete DiGeorge syndrome Wiskott–Aldrich syndrome ataxia telangiectasia hyper IgM syndrome hyper IgE syndrome X-linked lymphoproliferative disease	Moderate	Susceptible to bacterial and viral infections
	Severe combined immunodeficiency: X-linked severe combined immunodeficiency Complete DiGeorge syndrome	Severe	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses
	Phagocytic and neutrophil disorders: congenital neutropenia cyclic neutropenia chronic granulomatous disease leukocyte adhesion and migration defects myeloperoxidase deficiency Chediak–Higashi syndrome	Moderate	Susceptible to bacterial and fungal infections of the skin,lungs and bones
	Defects of innate immunity: interferon-gamma/interleukin 12 axis defects toll-like receptor signalling pathway defects	Moderate	Susceptible to bacterial and mycobacterial infections
	Complement deficiencies: complement properdin deficiency factor D or B deficiency mannan-binding lectin deficiency	Mild	Susceptible to infections with Neisseria meningitidis and other encapsulated bacteria (such as Streptococcus pneumoniaeand Haemophilus influenzae)
Autoimmune, inflammatory or rheumatic diseases	Ankylosing spondylitis Rheumatoid arthritis Psoriatic arthritis Juvenile idiopathic arthritis Multiple sclerosis Systematic lupus erythematosus	Mild (when no immunosuppressive medications to optimise disease control are prescribed)	Increased susceptibility to vaccine-preventable infections including influenza, herpes zoster, human papillomavirus and pneumococcal infections
Autoimmune, inflammatory or rheumatic diseases	Severe atopic dermatitis Psoriasis	Mild (when no immunosuppressive medications to optimise disease control are prescribed)	Susceptible to viral and bacterial skin infections
Inflammatory bowel diseases	Crohn’s disease Ulcerative colitis	Mild (when no immunosuppressive medications to optimise disease control are prescribed)	Increased susceptibility to vaccine-preventable diseases such as influenza, hepatitis B and cholera
Oncological disorders	Haematological malignancies: leukemia (eg chronic lymphocytic leukemia, acute myeloid leukemia, chronic myeloid leukemia, acute lymphocytic leukemia) myeloma	Severe	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses
Oncological disorders	Non-haematological malignancies (eg solid organ tumours)	Moderate to severe	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses
Cellular therapies	Haematopoietic stem cell transplant (autologous and allogenic)	Severe (for at least 6 months after transplant)	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses, and severe complications after these infections
Cellular therapies	Chimeric antigen receptor modified T-cell (CAR-T) therapy	Severe (for at least 6 months after transplant)	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses, and severe complications after these infections
Organ transplant	Before solid organ transplant	Moderate	May be susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses, due to organ failure
Organ transplant	After solid organ transplant	Severe	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses during post-transplant immunocompromise, particularly for the first 6 months
Asplenia or hyposplenia	Anatomical or functional asplenia or hyposplenia (eg congenital asplenia, sickle cell anaemia, splenectomy)	Moderate	Susceptible to infections with N. meningitidis alongside other encapsulated bacteria (such as S. pneumoniae and H. influenzae type b)
HIV infection	Infants (<12 months): CD4⁺ ≥1500/μL Children (1–5 years): CD4⁺ ≥1000/μL Children (>6 years) and adults: CD4⁺ ≥500/μL	Mild	Lower risk of severe infection with vaccine-preventable diseases, but remain vulnerable to disease complications and should receive optimised vaccine coverage
	Infants (<12 months): CD4⁺ 750–1499/μL Children (1–5 years): CD4⁺ 500–999 /μL Children (>6 years) and adults: CD4⁺ 200–499/μL	Moderate	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses
	Infants (<12 months): CD4⁺ <750/μL Children (1–5 years): CD4⁺ <500/μL Children (>6 years) and adults: CD4⁺<200/μL	Severe	Susceptible to many infectious pathogens including bacteria, fungi, protozoa and viruses. Particularly susceptible to opportunistic infections
Chronic medical conditions	Chronic respiratory diseases: suppurative lung disease bronchiectasis cystic fibrosis chronic obstructive pulmonary disease chronic emphysema severe asthma (requiring frequent medical consultations or the use of multiple medicines) chronic obstructive pulmonary disease chronic lung disease in preterm infants interstitial and fibrotic lung disease	Mild	Increased risk of respiratory viral, bacterial and fungal diseases due to organ dysfunction (rather than inherent immunocompromise)
	Chronic liver diseases: cirrhosis autoimmune hepatitis non-alcohol fatty liver disease alcoholic liver disease biliary atresia	Mild	Increased risk of hepatitis A, hepatitis B and pneumococcal disease due to liver dysfunction
	Chronic kidney diseases: relapsing or persistent nephrotic syndrome chronic renal impairment – eGFR <30 mL/min (stage 4 disease)	Mild	Susceptible to hepatitis viruses and infections with encapsulated bacteria
	Severe cardiac diseases: ischaemic heart disease valvular heart disease congestive cardiac failure cardiomyopathy poorly controlled hypertension pulmonary hypertension complex congenital heart disease	Mild	Increased risk of viral and bacterial infections due to organ dysfunction rather than immunosuppression. However, the immunocompromise risk is higher if person has recently received extracorporeal membrane oxygenation
	CNS anatomical barrier defects: cerebrospinal fluid leak inner ear dysplasia cochlear implants intracranial shunts	Mild	Increased risk of bacterial CNS infections due to structural defects (rather than immunocompromise)
	Chronic neurological conditions: hereditary and degenerative CNS diseases seizure disorders spinal cord injuries neuromuscular disorders	Mild	Increased risk of more severe viral and bacterial infections due to underlying comorbidity
	Chronic metabolic disorders: type 1 or 2 diabetes amino acid disorders carbohydrate disorders cholesterol biosynthesis disorders fatty acid oxidation defects, lactic acidosis mitochondrial disorders organic acid disorders urea cycle disorders vitamin/cofactor disorders porphyrias obesity	Mild	Although these are not inherently immunocompromising conditions, there may be an increased risk of more severe viral or bacterial infections due to organ dysfunction or comorbidities.
Acronyms used: eGFR = estimated glomerular filtration rate CNS = central nerves system Note: This list does not consider the additional potential of immunosuppressive medication to alter this categorisation. For patients receiving immunosuppressive medication, please also consider: Table. Immunosuppressive potential of cancer and organ rejection therapies Table. Immunosuppressive potential of conventional (non-biological) immunosuppressive therapies Table. Immunosuppressive potential of small molecule targeted therapies Table. Immunosuppressive potential of biological therapies Table. Immunosuppressive potential of corticosteroids.

References

Andrews T, Sullivan KE. Infections in patients with inherited defects in phagocytic function. Clinical Microbiology Reviews 2003 Oct;16(4):597-621.
Feldman AG, Beaty BL, Curtis D, Juarez-Colunga E, Kempe A. Incidence of hospitalization for vaccine-preventable infections in children following solid organ transplant and associated morbidity, mortality and costs. JAMA Pediatrics 2019 Mar 1;173(3):260-68. Erratum in JAMA Pediatrics 2019 Mar 1;173(3):296.
McNamara LA, Topaz N, Wang X, Hariri S, Fox L, MacNeil JR. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morbidity and Mortality Weekly Report 2017;66:734-37.
Melmed GY, Ippoliti AF, Papadakis KA, et al. Patients with inflammatory bowel disease are at risk for vaccine-preventable illnesses. American Journal of Gastroenterology 2006;101(8):1834-40.
Mueller NJ. New immunosuppressive strategies and the risk of infection. Transplant Infectious Disease 2008;10:379-84.
Oliver A, Cornely MH, eds. Infection management in hematology. Springer; 2021.
Pöyhönen L, Bustamante J, Casanova JL, Jouanguy E, Zhang Q. Life-threatening infections due to live-attenuated vaccines: early manifestations of inborn errors of immunity. Journal of Clinical Immunology 2019 May;39(4):376-90. Erratum in Journal of Clinical Immunology 2019 Jun 7.
Rahier J-F, Moutschen M, Van Gompel A, et al. Vaccinations in patients with immune-mediated inflammatory diseases. Rheumatology 2010 October;49(10): 1815–27.
Sinwar, PD. Overwhelming post splenectomy infection syndrome – review study. International Journal of Surgery 2014;12(12):1314-16.

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References

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