Table 6.

Vaccinations recommended for both autologous and allogeneic HCT recipients

Vaccine	Recommended for use after HCT	Time post-HCT to initiate vaccine	Number of dosesa	Improved by donor vaccination (practicable only in related-donor setting)
Pneumococcal Conjugate (PCV)	Yes (BI)	3–6 mo	3–4b	Yes; may be considered when the recipient is at high risk for chronic GVHD
Tetanus, diphtheria, acellular pertussisc	Yes Tetanus-diphtheria: (BII) Pertussis (CIII)	6–12 mo	3d	Tetanus: likely Diphtheria: likely Pertussis: unknown
Haemophilus influenzae conjugate	Yes (BII)	6–12 mo	3	Yes
Meningococcal conjugate	Follow country recommendations for general population (BII)	6–12 mo	1	Unknown
Inactivated Polio	Yes (BII)	6–12 mo	3	Unknown
Recombinant Hepatitis B	Follow country recommendations for general population (BII)	6–12 mo	3	Likelye
Inactivated Influenza	Yearly (AII)	4–6 mo	1 –2f	Unknown
Measles-Mumps-Rubellag (live)	Measles: All children and seronegative adults Measles:BII Mumps:CIII Rubella:BIII EIII (<24 mo post HCT, active GVHD, on immune suppression)	24 mo	1 –2h	Unknown

Notes:

^aA uniform specific interval between doses cannot be recommended as various intervals have been used in studies. As a general guideline, a minimum of 1 month between doses may be reasonable.

^bFollowing the primary series of 3 PCV doses, a dose of the 23-valent polysaccharide pneumococcal vaccine (PPSV23) to broaden the immune response might be given (BII). For patients with chronic GVHD who are likely to respond poorly to PPSV23, a fourth dose of the PCV should be considered instead of PPSV23 (CIII).

^cDTaP is preferred, however, if only Tdap is available (eg, because TDaP is not licensed for adults), administer Tdap. Acellular pertussis vaccine is preferred, but the whole-cell pertussis vaccine should be used if it is the only pertussis vaccine available. (See text for more information)

^dSee text for consideration of an additional dose(s) of tetanus toxoid–reduced diphtheria toxoid–reduced acellular pertussis vaccine (Tdap) for older children and adults

^eSignificant improvement of recipient response to hepatitis B vaccine posttransplant can be expected only if the donor receives more than 1 hepatitis vaccine dose prior to donation.

^fFor children < 9 years of age, 2 doses are recommended yearly between transplant and 9 years of age. [306].

^gMeasles, mumps, and rubella vaccines are usually given together as a combination vaccine. In females with pregnancy potential, vaccination with rubella vaccine either as a single or a combination vaccine is indicated.

^hIn children, 2 doses are favored.