View source for Immunization after hematopoietic stem cell transplantation

* 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
** If receiving IVIg, delay MMR and [[varicella]] vaccines until 8 to 11 months after last dose
** Check titres after second dose of MMR or [[varicella]]
* '''Contraindicated''':
** Live [[herpes zoster]] vaccine
** BCG
** MMRV
** [[Rotavirus]]
** [[Smallpox]]
** Live [[typhoid]]
** Live influenza (not recommended)

== Sample Schedule ==
{| class="wikitable"
! rowspan=2 | Immunization
! rowspan=2 | Comments
! colspan=8 | 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)
|
| colspan=8 | 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
| colspan=8 | at least 6 months
|-
| [[Typhoid]] (inactivated)
| If indicated
| colspan=8 | at least 6 months
|-
| Japanese encephalitis
| If indicated
| colspan=8 | at least 6 months
|-
| Meningococcal B
| If indicated by risk factors such as funtional hyposplenia
| colspan=8 | at least 6 months
|-
| [[Rabies]]
| If indicated
| colspan=8 | at least 6 months
|}

== Further Reading ==
* [https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-3-vaccination-specific-populations/page-8-immunization-immunocompromised-persons.html#a17 Canadian Immunization Guide: Hematopoietic stem cell transplantation (HSCT) - autologous or allogeneic]

[[Category:Immunocompromised hosts]]