Table 6.
Vaccinations considered optional or not recommended for both autologous and allogeneic HCT recipients
| Vaccine | Recommendations for use | Rating |
|---|---|---|
| Optional | ||
| Hepatitis A |
Follow recommendations for general population in each country •Ig should be administered to hepatitis A-susceptible HCT recipients who anticipate hepatitis A exposure (for example, during travel to endemic areas) and for post-exposure prophylaxis. |
CIII |
| Varicella (Varivax, live) | Limited data regarding safety and efficacy. |
EIII (<24 months post-HCT, active GVHD or on immunosuppression) CIII (>24 months, without active GVHD or on immunosuppression) |
| Human papillomavirus |
Follow recommendations for general population in each country No data exist regarding the time after HCT when vaccination can be expected to induce an immune response |
CIII |
| Yellow fever (live) |
Limited data regarding safety and efficacy. The risk–benefit balance may favor use of the vaccine in patients residing in or traveling to endemic areas. |
EIII (<24 months, active GVHD or on immunosuppression) CIII (>24 months, without active GVHD or on immunosuppression) |
| Rabies |
Appropriate for use in HCT recipients with potential occupational exposures to rabies827 Preexposure rabies vaccination should probably be delayed until 12–24 months after HCT. Postexposure administration of rabies vaccine with human rabies Ig can be administered any time after HCT, as indicateda827,828 |
CIII |
| Tick-borne encephalitis (TBE) |
According to local policy in endemic areas. No data exist regarding the time after HCT when vaccination can be expected to induce an immune response |
CIII |
| Japanese B encephalitis |
According to local policy when residing in or travelling to endemic areas. No data exist regarding the time after HCT when vaccination can be expected to induce an immune response |
CIII |
| Not recommended | ||
| Bacillus Calmette– Guérin (live) | Contraindicated for HCT recipients | EII |
| Oral poliovirus vaccine (live) | Should not be given to HCT recipients, as an effective, inactivated alternative exist | EIII |
| Intranasal influenza vaccine (live) |
No data regarding safety and immunogenicity. Should not be given to HCT recipients, as an effective, inactivated alternative exist |
EIII |
| Cholera | No data were found regarding safety and immunogenicity among HCT recipients | DIII |
| Typhoid, oral (live) | No data were found regarding safety and immunogenicity among HCT recipients. | EIII |
| Typhoid (i.m.) | No data were found regarding safety, immunogenicity, or efficacy among HCT recipients. | DIII |
| Rotavirus | Must be given before 12 weeks of age to be safe. | EIII |
| Zoster vaccine (Zostavax, live) | No data regarding safety among HCT recipients. | EIII |
Abbreviation: HCT=hematopoietic cell transplant.
aCurrent Advisory Committee on Immunization Practices (ACIP) and American Academy of Pediatrics guidelines for post-exposure human rabies Ig and vaccine administration should be followed, which include administering five doses of rabies vaccine administered on days 0, 3, 7, 14 and 28 post-exposure.