Table 4.
Recommendations on specific vaccines following allogeneic hematopoietic cell transplantation in childhood.
| Vaccine | Start* | No of doses | Schedule** | Specific notes |
|---|---|---|---|---|
| Routine vaccinations | ||||
| Hexavalent diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Hepatitis B, Haemophilus influenzae type B vaccine (DTaP-IPV-HBV/Hib) | 6 | 4 | 0-1-2-12 | |
| 13-valent pneumococcal conjugate vaccine (PCV13) | 6 | 4 | 0-1-2-12 | PCV13 comprises most serotypes in invasive pneumococcal disease post-HSCT |
| Quadrivalent, inactivated influenza virus vaccine (comprehensive current seasonal strain coverage) | (4-)6 | 1-2 | 0-2 | For first vaccination post-HSCT or after substantial antigenic shift/drift two doses should be given. Yearly revaccination is recommended. Early start at 4 months post-HSCT is possible in case of pandemia or up-coming influenza season. Live influenza vaccine is contra-indicated in HSCT recipients. |
| Live, attenuated measles- mumps-rubella virus vaccine (MMR) | 24 | 2 | 0-2 | If immunocompetent (≥ 3 months without GvHD/immunosuppression) |
| Conditional vaccinations | ||||
| Human papilloma virus vaccine (HPV) | 12 | 3 | 0-2-8 | Substantial risk for HPV-related cancer post-HSCT. Vaccination of both boys and girls if age ≥ 9years |
| Hepatitis A vaccine (HAV) | 12 | 2 | 0-6 | If risk of exposure |
| Tick-borne encephalitis vaccine (TBE) | 12 | 3 | 0-2-8 | If living in endemic region |
| Optional vaccinations | ||||
| Live, attenuated varicella-zoster-virus vaccine (in combination with MMR; MMR-V) | 24 | 2 | 0−2 | If immunocompetent (≥ 3 months without GvHD or immunosuppression. VZV-reactivations frequently occur before 24 months and are thus beyond effect of the live vaccine which can only be administered from 24 months post-HSCT. |
| Quadrivalent meningococcal type A,C,W,Y-135 conjugate vaccine (Men ACWY-135) |
12 | 3 | 0-2-8 | No data on specific risk of invasive meningococcal disease post-HSCT. Few and disappointing data for tetra-valent conjugate vaccine post-HSCT. |
| Recombinant meningococcal type B vaccine (Men B) | 12 | 3 | 0-2-8 | No reported experience with MenB vaccination after HSCT. |
| 23-valent pneumococcal polysaccharide vaccine (PPSV23) | 24 | 1 | n/a | PPSV23 may broaden serotype protection. Sparse data on the immunogenicity of PPSV23 with regard to the serotypes beyond PCV13. |
*
Months from HSCT.
**
Months from start of vaccination.