Immunization after hematopoietic stem cell transplantation
From IDWiki
- After autologous or allogeneic hematopoietic stem cell transplantation, patients need essentially all vaccines repeated
Guidelines
- DTaP-HiB-IPV: 6 to 12 months after transplant
- Diphtheria: 3 doses one month apart
- Tetanus: 3 doses one month apart
- Pertussis: 1 dose
- Haemophilus influenzae type b: 3 doses 4 weeks apart
- Polio (inactivate): 3 doses one month apart
- Hepatitis B: 6 to 12 months after transplant
- Doses at 0, 1, and 6 months using high dose (40 μg)
- Monitor HBsAb titres annually
- Influenza: annually
- Pneumococcal C-13 (Prevnar): 3 to 6 months after transplant
- 3 doses 4 weeks apart
- Pneumococcal P-23 (Pneumovax): 6 to 12 months after last dose of C-13
- 1 dose with a booster after 12 months
- If GVHD, give an extra dose of C-13 and delay P-23 until GVHD resolved
- Meningococcal conjugate (quadrivalent): 6 months
- 1 dose
- If given before 6 months, will need another after 6 months and at least 2 months after the first
- Live vaccines (varicella, MMR, and yellow fever) at least 24 months after transplant, as long as no chronic GVHD, immunosuppression has been stopped for at least 3 months, and no active underlying disease
- Contraindicated:
- Live herpes zoster vaccine
- BCG
- MMRV
- Rotavirus
- Smallpox
- Live typhoid
- Live influenza (not recommended)
Sample Schedule
| Immunization | Comments | Time post-transplant (months) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 6 | 7 | 8 | 10 | 12 | 14 | 18 | 24 | ||
| DTaP Hib IPV (Pediacel) | Diptheria, tetanus, pertussis, polio, and Haemophilus influenzae type b | X | X | X | X | ||||
| Hepatitis B | High-dose vaccine; monitor HBsAb titres annually | X | X | X | |||||
| Pneumococcal C-13 (Prevnar) | X | X | X | ||||||
| Pneumococcal P-23 (Pneumovax) | X | ||||||||
| Meningococcal conjugate (Menactra) | X | X | |||||||
| Influenza (inactivated) | Annually | ||||||||
| Varicella | Only given if no titres at 24 months. Give extra dose 3 months later if no seroconversion. | X | |||||||
| MMR | Only given if no titres at 24 months. Give extra dose 3 months later if no seroconversion. | X | |||||||
| HPV | Ages 9 to 26 years, and possibly older | X | X | X | |||||
| Herpes zoster recombinant inactivated (Shingrix) | Two doses at least one month apart | ||||||||
| Hepatitis A | If risks present or travel planned | X | X | ||||||
| Cholera/traveller's diarrhea (inactivated) | If indicated | at least 6 months | |||||||
| Typhoid (inactivated) | If indicated | at least 6 months | |||||||
| Japanese encephalitis | If indicated | at least 6 months | |||||||
| Meningococcal B | If indicated by risk factors such as funtional hyposplenia | at least 6 months | |||||||
| Rabies | If indicated | at least 6 months | |||||||
