Table 1.
Summary of vaccines recommended for transplant recipients
| Vaccine | SOT* | HSCT** | Comments |
|---|---|---|---|
| Inactivated Vaccines | |||
| Pneumococcal | 1 dose PCV-1 dose PPV23 | 3 doses PCV-1 dose PPV23 | For HSCT, can start at 3 months post-transplant |
| Influenza (inactivated) | Annually | Annually | Poor immunogenicity < 3 months post-transplant |
| Hepatitis B | 3 doses | 3 doses | Post-transplant, use high dose vaccine, check anti-HBs regularly |
| H. influenzae type b | 1 dose | 3 doses | Can use combination vaccines |
| Tetanus-diphtheria | 1 dose | 3 doses | |
| IPV | 1 dose | 3 doses | |
| Meningococcal (MCV4) | 2 doses – 8 weeks apart for all children and adults with risks | 2 doses – 8 weeks apart | Risks: Travel to endemic area, hyposplenism, eculizumab use |
| Hepatitis A | 2 doses | 2 doses | |
| HPV | 3 doses | 3 doses | Routine schedule |
| Live Vaccines | |||
| Varicella | Pre-transplant:-children >9mo: 2 doses –adults: 1 dose Post-transplant: consider in long term transplant patients on minimal immunosuppression | Pre-transplant:-children >9mo: 2 doses –adults: 1 dose Post-transplant: 2 doses starting 2 years post-transplant if no immunosuppression or GvHD | If VZV IgG positive, no need for vaccination |
| Herpes Zoster | 1 dose pre-transplant | 1 dose pre-transplant. No data post-transplant; if VZV IgG negative, give Varicella vaccine | |
| MMR | 2 doses pre-transplant or documentation of immunity | 2 doses starting 2 years post-transplant if no immunosuppression or GvHD | If IgG positive, no need for vaccination |
| LAIV | Annually for children 2-17 years | Contraindicated | |
| Rotavirus | Contraindicated | Contraindicated |
SOT: Solid organ transplantation. HSCT: Haematopoietic stem cell transplantation; PCV: Pneumococcal conjugate vaccine; PPV: Pneumococcal polysaccharidic vaccine; IPV: Inactivated polio vaccine; MCV: Meningococcal conjugate vaccine; HPV: Human papilloma virus; MMR: Measles-mumps-rubella; GvHD: Graft versus host disease; VZV: Varicella Zoster virus.
For SOT, vaccines should be administered pre-transplant if possible. Otherwise, start vaccination at 6 months post-transplant. For influenza, vaccination can be started at 3 months.
For HSCT, start vaccines at 6 months post-transplant. For influenza and pneumococcal, start at 3 months post-transplant.
Pneumococcal conjugate vaccine may be available as 10-valent (PCV10) or 13-valent (PCV13).