Table 8.

Vaccinations for Family, Close Contacts, and Healthcare Workers (HCWs) of HCT Recipients

Vaccine	Recommendations for Use	Rating
Hepatitis A [829]	Routine vaccination is recommended for: • Children ≥12 months of age; and • Other persons at increased risk for hepatitis A or its adverse consequences	BIII
Inactivated Influenza∗, † 307, 308 NOTE: Use of intranasal influenza vaccine is contraindicated (EIII)	Family and close contacts Vaccination with trivalent inactivated vaccine (TIV) is strongly recommended annually for all during each influenza season, beginning in the season before the transplant and continuing as long as there is contact with an immunocompromised HCT recipient HCWs Annual vaccination with TIV is strongly recommended during each influenza season.
		AII
		AI
Polio‡	Not routinely recommended for adults but inactivated§ polio vaccine should be administered when polio vaccination is indicated	AII
Rotavirus	Vaccination not contraindicated in contacts of HCT transplant patients. Follow recommendations for general population in each country	CIII
Measles-mumps-rubella (MMR) (live)	Vaccination is recommended for all persons who are ≥ 12 months old and are not pregnant or immunocompromised. No evidence exists that live-attenuated vaccine-strain viruses in MMR vaccine are transmitted from person to person	AIII
Pertussis	Vaccination with DTaP is recommended for children < 7 years and with Tdap for adolescents and adults.	BIII
Varicella¶ (live)	Vaccination should be administered to all persons ≥12 months old and who are not pregnant or immunocompromised and who have a negative or uncertain history of varicella disease with a negative serologic screen. Note: Two doses should be given separated by at least 28 days⊥	AIII

HCT indicates hematopoietic cell transplant.

^∗Children aged 6 months to <9 years receiving influenza vaccination for the first time require 2 doses and those who only receive 1 dose in the first year should receive 2 doses the following year 304, 307.

^†If HCWs, family members, or other close contacts of HCT recipients receive influenza vaccination during an influenza outbreak, they should also receive chemoprophylaxis, based on strain susceptibility (BI), while the vaccinee develops an immunologic response to the vaccine. However, if a nosocomial outbreak occurs with an influenza strain that is not contained in the available influenza vaccine, HCWs, family members, and other close contacts of HCT recipients and candidates should be administered influenza chemoprophylaxis based on strain susceptibility, until the end of the outbreak (BIII) 307, 830, 831.

^‡Vaccine-strain polio virus in oral polio vaccine can be transmitted person to person; therefore, oral polio vaccine administration is contraindicated among household contacts of immunocompromised persons. If oral polio vaccine is inadvertently administered to a household contact of an HCT recipient, ACIP's and the American Academy of Pediatrics' recommendations should be followed to minimize close contact with the immunocompromised person for 4-6 weeks after vaccination 304, 832, 833.

^§Although vaccine-associated paralytic poliomyelitis has not been reported among HCT recipients after exposure to household contacts inadvertently vaccinated with oral polio vaccine, inactivated polio vaccine should be used among family members, close contacts, and HCWs to avoid person-to-person transmission of vaccine-strain polio virus [832].

^¶HCWs, family members, close contacts, and visitors who do not have a documented history of varicella-zoster infection or who are seronegative should receive varicella vaccine before being allowed to visit or have direct contact with an HCT recipient (AIII). Ideally, varicella-zoster- susceptible HCWs, family members, household contacts, and potential visitors of immunocompromised HCT recipients should be vaccinated as soon as the decision to perform an HCT is made. The vaccination dose or doses should be completed >4 weeks before the conditioning regimen begins or >6 weeks (42 days) before contact with the HCT recipient is planned (BIII). If a varicella vaccinee develops a postvaccination rash within 42 days of vaccination, the vaccinee should avoid contact with HCT recipients until all rash lesions are crusted or the rash has resolved 282, 304

^⊥Children 12 months to 12 years should receive two doses 3 months apart; adolescents ≥13 years and adults should receive 2 doses 4 weeks apart.