Table 1.
Paediatric SOT candidate and recipient immunization recommendations: indications and schedules.
| Type of Vaccine | Minimum Age at First Dose | Standard Schedule |
Accelerated Schedule | Recommended after Transplant |
|---|---|---|---|---|
| Inactivated Vaccines | ||||
| Diphtheria/Tetanus/Pertussis | 6 weeks |
WHO schedule: - The primary series includes 3 doses (with interval between doses: 4–8 weeks) 3 booster doses are administered as follows: - At 12–23 months DTP-containing vaccine; - At 4–7 years only Td-containing vaccine; - At 9–15 yrs only Td-containing vaccine. CDC schedule: 5-dose series are administered at ages 2, 4, 6, 15–18 months, 4–6 years. |
The minimum interval between 1st and 2nd dose: 4 weeks; between 2nd and 3rd dose: 4 weeks; between 3rd and 4th dose: 6 months and after age of 12 months; between 4th and 5th dose: 6 months and after age of 4 yo. |
Yes |
| Inactivated Polio (IPV, applied to countries in polio-free regions with a very low risk of importation and sustained high routine immunization coverage) | 6 weeks |
WHO schedule: The primary series includes 3 doses (with interval between doses: 4–8 weeks); an IPV booster (6 months after 3rd dose) is needed when 1st dose is given at <8 weeks. CDC schedule: 4-dose series are administered at age 2 months, 4 months, 6 through 18 months, 4 through 6 years. |
Minimum interval between 1st and 2nd dose: 4 weeks; between 2nd and 3rd dose: 4 weeks and after age of 6 months; between 3rd and 4th dose: 6 months and after age of 4 yo. |
Yes |
| Haemophilus Influenzae B (HiB) | 6 weeks |
WHO schedule includes 3 options: 3 primary doses without a booster OR 2 primary doses plus a booster OR 3 primary doses with a booster Interval between doses: 4 weeks in case where 3 primary doses are given; 8 weeks in case where 2 primary doses are given. Booster doses: at least six months after completion of the primary series. Single dose if >12 months of age. Not recommended for children > 5 yrs. CDC schedule: 4-dose series, including 3-dose primary series at age 2, 4 and 6 months, followed by a booster dose at age 12–15 months OR 3-dose series, including 2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12–15 months. |
Minimum interval between 1st and 2nd dose: 4 weeks; between 2nd and 3rd dose: 4 weeks; between 3rd and 4th dose: 8 weeks and after age of 12 months. |
Yes |
| HBV | At birth |
WHO schedule includes 2 options: 3-doses schedule, with first dose given at birth and second and third doses given at the same time as the first and third doses of DTP-containing vaccine; OR 4-doses schedule, where a monovalent birth dose is followed by 3 doses, usually given with other routine infant vaccines. The interval between doses should be at least 4 weeks. CDC schedule: 3-dose series at age 0, 1–2, 6–18 months. Infants who did not receive a birth dose should begin the series as soon as possible; in this case: dose interval 1st–2nd dose: 4 weeks; dose interval 2nd–3rd dose: 8 weeks and at least 16 weeks after first dose. Minimum age for the final dose: 24 weeks. |
Minimum interval between 1st and 2nd dose: 4 weeks; between 2nd and 3rd dose: 8 weeks and after 24 weeks of age. |
Yes |
| HAV | ≥12 months |
WHO schedule: 1 or 2 doses; interval between 1st and 2nd dose: 6–18 months (max around 4–5 years) CDC schedule: 2-dose series at age 12–23 months (minimum interval: 6 months) |
Minimum interval between 1st and 2nd dose: 4 weeks. | Yes |
| HPV | 9 years |
WHO schedule: 1–2 doses in girls at 9–14 yo; Interval between doses: 6–12 months. CDC schedule: 2- or 3-dose series, depending on the age at first vaccination: Age 9–14 years: 2-dose series at 0, 6–12 months (minimum interval: 5 months). Age 15 years or older: 3-dose series at 0, 1–2 months, 6 months. |
Minimum interval between 1st and 2nd dose: 4 weeks; between 2nd and 3rd dose: 12 weeks. |
Yes |
| MENACVY | 2-9-23 months (according to different vaccine formulations) |
WHO schedule: One single dose to individuals ≥2 years. It is also approved for children 9–23 months of age and given as a 2-dose series, 3 months apart, beginning at the age of 9 months. CDC schedule: 2-dose series at age 11–12 years and 16 years. Only in particular conditions (functional asplenia, HIV infection, persistent complement component deficiency), different schedules, starting from 2 months of age. |
First dose at 9 months; interval between 1st and 2nd dose: 12 weeks. | Yes |
| MENB | 3 months |
WHO schedule: This vaccine is not included. CDC schedule: Adolescents 16–18 yo: 2-dose series, at least 1–6 months (according to different vaccine formulations) In some European Countries: 2-dose series at 3–5 months of age, followed by a booster dose at 15 months of age. Minimum interval between 1st and 2nd dose: 2 months. Minimum interval between 2nd dose and booster: 6 months. |
/ | Yes |
| Pneumococcal disease | 6 weeks |
WHO schedule: PCV 13 vaccine, including 2 options: - 2 primary doses at an interval of ≥8 week, followed by a booster dose at 9–18 months of age. - 3 doses, each 4 weeks apart. CDC schedule: 4-dose series at 2, 4, 6, 12–15 months (PCV13 or PCV 15) For PPV23 indications: see text. |
Minimum interval between 1st and 2nd dose: 4 weeks; between 2nd and 3rd dose: 4 weeks; between 3rd and 4th: 8 weeks. If between 12 and 24 months and unvaccinated: give 3 doses, 8 weeks apart; If between 24 months and 5 yo and unvaccinated, give 1 dose. |
Yes (see text for details) |
| SARS-CoV-2 | 6 months |
WHO schedule: Not included (different approach in different countries, according to vaccine availability) CDC schedule: Age 6 months–4/5 years: 2-dose series at 0, 4–8 weeks (bivalent Moderna, 0.25 mL/0.25 ug) OR 3-dose series at 0, 3–8 weeks, 8 weeks (2 months) after dose 2 (bivalent Pfizer-BioNTech, 0.2 mL/0.3 ug); Age > 5 years: 1 dose bivalent Moderna (6–11 yo dose 0.25 mL/25 ug; ≥12 yo dose 0.5 mL/50 ug) OR 1 dose bivalent Pfizer-BioNTech (age 5–11 yo dose 0.2 mL/10 ug; age ≥ 12 yo dose 0.3 mL/30 ug) In adolescents ≥12: Novavax 2-dose primary series (separated by at least 3–8 weeks) |
/ |
CDC schedule for immunocompromised persons (such as transplant recipients): Age 6 months–4 years: 3-dose series at 0, 4, 8 weeks (Moderna) OR 3-dose series at 0, 3, 11 weeks (Pfizer-BioNTech); Age 5–11 years: 3-dose series at 0, 4, 8 weeks (Moderna) OR 3-dose series at 0, 3, 7 weeks (Pfizer-BioNTech) Age 12–18 years: 3-dose series at 0, 4, 8 weeks (Moderna) OR 2-dose series at 0, 3 weeks (Novavax) OR 3-dose series at 0, 3, 7 weeks (Pfizer-BioNTech) Booster dose: 1 more dose at least 2 months following the last recommended dose. |
| Influenza inactivated vaccine (inactivated tri- and quadrivalent) |
6 months |
WHO and CDC schedule: 6 mo–8 yo: 2 doses, 4 weeks interval between doses. ≥9 years: 1 dose. Revaccinate annually: 1 dose only. |
Interval between 1st and 2nd dose: 4 weeks. |
Yes |
| LIVE vaccines | ||||
| MMR (Measles/Mumps/Rubella) | 9–12 months (WHO) 12 months (CDC) |
WHO schedule: 2 doses, interval between doses: 4 weeks (min) CDC schedule: 2-dose series at age 12–15 months, 4–6 years |
Anticipate 1st dose at 6 months; interval between 1st and 2nd dose: 4 weeks. |
Only in selected cases (see text) |
| VZV | 12–18 months |
WHO schedule: 1–2 doses; interval between 1st and 2nd dose from 4 weeks to 3 months, according to manufacturer recommendations CDC schedule: 2-dose series at age 12–15 months, 4–6 years. Dose 2 may be administered as early as 3 months after dose 1. |
Anticipate 1st dose at 6 months; interval between 1st and 2nd dose: 4 weeks. |
Only in selected cases (see text) |
| Rotavirus | 6 weeks |
WHO schedule: 2–3-dose series (depending on product); interval between doses: 4 weeks (min) Vaccination of children >24 months of age is not recommended. CDC schedule: 2-dose series at age 2 and 4 months OR 3-dose series at age 2, 4 and 6 months (depending on product). maximum age for the final dose: 8 months |
Minimum age: 6 weeks. Interval between 1st and 2nd dose: 4 weeks. Interval between 2nd and 3rd dose: 4 weeks. |
No |