Vaccination after hematopoietic stem cell transplantation
From IDWiki
- Following hematopoietic stem cell transplantation, the immune system is considered to have been never immunized
- Recipients need essentially all (allogeneic) or most (autologous) routine immunizations following transplantation
- Recipients recipients respond poorly to polysaccharide vaccines
- Titres can be checked to confirm immune response and direct further revaccination
- Most inactivated vaccines are started around 6 months after vaccination
- Most live vaccines can be given after 24 months, including univalent varicella, MMR, and yellow fever faccines
- Close contacts should also ensure vaccinations are up to date
Inactivated Vaccines
- Recommended post-transplant
- 3-9 months: conjugate pneumococcal vaccine, 3 doses 1 month apart
- 4-6 months: annual inactivated influenza vaccine
- 6 months: quadrivalent meningococcal vaccine, 1 dose (or a second dose after 8 weeks if first is given before 6 months)
- 6 to 12 months:
- Polysaccharide pneumococcal vaccine: 1 dose at least 6 to 12 months after conjugate vaccine, with a booster 12 months later
- Delay if ongoing GVHD, and given a fourth dose of Pneu-C-13 instead
- Diphtheria: 3 doses 1 month apart, with booster at 18 months
- Pertussis: 1 dose (if given alone), with booster at 18 months
- Inactivated polio: 3 doses 1 month apart, with booster at 18 months
- Tetanus: 3 doses 1 month apart, with booster at 18 months
- Hepatitis B: 3 doses (at 0, 1, and 6 months) followed by HBsAb titres and a booster if titre less than 10 IU/L
- Haemophilus influenzae: 3 doses at least 4 weeks apart
- Polysaccharide pneumococcal vaccine: 1 dose at least 6 to 12 months after conjugate vaccine, with a booster 12 months later
- Inactivated herpes zoster vaccine is not routinely indicated, but can be considered in those age 50 years and older
- Not routinely given, but no contraindications: hepatitis A, inactivated oral cholera, Japanese encephalititis, rabies, inactivated intramuscular typhoid, tick-borne encephalitis, and HPV
Live Vaccines
- Contraindicated vaccines include: BCG, live influenza vaccine, rotavirus, smallpox, oral typhoid, oral polio, live herpes zoster (Zostavax)
- Other live vaccines, including univalent varicella, yellow fever, and MMR, can be given starting at 24 months provided they are considered immunocompetent
- In other to receive live vaccines:
- At least 24 months post-transplant
- No ongoing graft-versus-host disease
- No corticosteroids or other immunosuppressants for at least 3 months
- No immunoglobulin in the past 8 to 11 months (except for yellow fever vaccine)
- Assessed by primary team and considered immunocompetent
- Following immunization, check titres for varicella and MMR
Sample Schedule
| Vaccine | Months Post-Transplant | Notes | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 6 | 7 | 8 | 10 | 12 | 14 | 18 | 24 | 26 | |||
| Inactivated | DTaP-Hib-IPV | x | x | x | x | ||||||
| Hepatitis B | x | x | x | booster if titre less than 10 IU/L | |||||||
| Pneu-C-13 | x | x | x | ||||||||
| Pneu-P-23 | x | x | |||||||||
| Men-C-ACYW135 | x | x | |||||||||
| Influenza | annually | ||||||||||
| Hepatitis A | x | x | if travel or other risk present | ||||||||
| HPV | x | x | x | if recommended by age and sex | |||||||
| Herpes zoster | if age ≥50 years | ||||||||||
| Live | Varicella | x | booster at 3 months if no seroconversion | ||||||||
| MMR | x | ||||||||||
