Figure 1.

Immunization schedule for SCT recipients

¹ Inactivated influenza vaccines: For children < 9 years of age, two doses of IIV one month apart. In elderly patients (≥ 65 years of age) consider the following if readily available: High dose (HD-IIV3; Fluzone) or Adjuvanted (aIIV3; Fluad). *May administer vaccine at 4months if widespread influenza in community.

²Pneumococcal conjugate vaccine: ** Give fourth dose of PCV-13 if GVHD requiring immunosuppression. For all others, PPSV-23 booster (23 valent polysaccharide vaccine) is given at one year.

³Tetanus, diphtheria, acellular pertussis vaccination: Various combinations and doses of vaccines exist, including DTaP, DT, Tdap, Td. Capital letters indicate higher toxoid or antigen amounts. GiveDTaP × 3 doses to all children ≤ 7 years; and can consider for all patients irrespective of age, though DTaP is only license in children < 7 years of age. Alternatively, can give 3 doses of Tdap, or one dose of Tdap followed by 2 doses of Td. Among Tdap vaccines, Boostrix contains higher pertussis antigen than Adacel. Boostrix is preferred in adult’s ≥ 65 years.

⁴Recombinant Hepatitis B: check serology after 3 doses, if negative anti-Hbs titer, re-vaccinate with 3 dose series; alternative, one dose booster of either high antigen dose vaccine or standard dose and re-check anti-Hbs titer; if vaccinating with combined Hepatitis A and B vaccine product, must still check anti-Hbs titer, and re-vaccinate with Hepatitis B vaccine if negative.

⁵Measles, mumps, rubella: If measles antibody negative, vaccinate with 2 doses at least one month apart.

⁶Recommended for use in VZV seronegative patients. See text for data on recombinant zoster vaccine (Shingrix) in auto transplant recipients.

⁷MCV-4: Recommended for persons aged 11–18 years, with a booster at 16–18 years. Meningococcal B vaccines should additionally be administered to SCT recipients aged 10–25 years with at risk conditions (asplenia, terminal complement deficiency, laboratory worker, travel, outbreak).

⁸HPV: Now available as 9-valent vaccine. Vaccinate in patients 9–26 years of age; FDA has recently expanded indicated age range to up to 45 years.