Vaccination after hematopoietic stem cell transplantation: Difference between revisions
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+ | *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 |
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− | * Most live vaccines can be given after 24 months, including univalent varicella, MMR, and yellow fever faccines |
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+ | **Recipients recipients respond poorly to polysaccharide vaccines |
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− | ** MMRV, rotavirus, smallpox, oral poliovirus are all contraindicated |
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+ | **Titres can be checked to confirm immune response and direct further revaccination |
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− | ** Must not be experiencing [[graft-versus-host disease]] or undergoing significant immunosuppression |
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+ | *Most inactivated vaccines are started around 6 months after vaccination |
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− | *** No corticosteroids or other immunosuppressnats for at least 3 months |
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+ | *Most live vaccines can be given after 24 months, including univalent varicella, MMR, and yellow fever faccines |
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− | ** Must also be assessed by their primary team as having normal immunity |
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− | * |
+ | *Close contacts should also ensure vaccinations are up to date |
+ | == Inactivated Vaccines == |
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+ | |||
+ | * Recommended post-transplant |
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+ | ** 3-9 months: conjugate pneumococcal vaccine, 3 doses 1 month apart |
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+ | ** 4-6 months: annual inactivated influenza vaccine |
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+ | ** 6 months: quadrivalent meningococcal vaccine, 1 dose (or a second dose after 8 weeks if first is given before 6 months) |
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+ | ** 6 to 12 months: |
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+ | *** Polysaccharide pneumococcal vaccine: 1 dose at least 6 to 12 months after conjugate vaccine, with a booster 12 months later |
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+ | **** Delay if ongoing GVHD, and given a fourth dose of Pneu-C-13 instead |
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+ | *** [[Diphtheria]]: 3 doses 1 month apart, with booster at 18 months |
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+ | *** [[Pertussis]]: 1 dose (if given alone), with booster at 18 months |
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+ | *** Inactivated [[polio]]: 3 doses 1 month apart, with booster at 18 months |
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+ | *** [[Tetanus]]: 3 doses 1 month apart, with booster at 18 months |
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+ | *** [[Hepatitis B]]: 3 doses (at 0, 1, and 6 months) followed by HBsAb titres and a booster if titre less than 10 IU/L |
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+ | *** [[Haemophilus influenzae]]: 3 doses at least 4 weeks apart |
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+ | ** Inactivated herpes zoster vaccine is not routinely indicated, but can be considered in those age 50 years and older |
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+ | * Not routinely given, but no contraindications: [[hepatitis A]], inactivated oral [[cholera]], [[Japanese encephalititis]], [[rabies]], inactivated intramuscular [[typhoid]], [[tick-borne encephalitis]], and [[HPV]] |
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+ | |||
+ | == Live Vaccines == |
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+ | |||
+ | * Contraindicated vaccines include: BCG, live influenza vaccine, rotavirus, smallpox, oral typhoid, oral polio, live herpes zoster (Zostavax) |
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+ | * 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: |
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+ | ** At least 24 months post-transplant |
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+ | ** No ongoing [[graft-versus-host disease]] |
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+ | ** No corticosteroids or other immunosuppressants for at least 3 months |
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+ | ** No immunoglobulin in the past 8 to 11 months (except for yellow fever vaccine) |
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+ | **Assessed by primary team and considered immunocompetent |
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+ | *Following immunization, check titres for varicella and MMR |
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+ | |||
+ | == Sample Schedule == |
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+ | {| class="wikitable" |
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+ | |+Sample immunization schedule |
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+ | ! rowspan="2" | |
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+ | ! rowspan="2" |Vaccine |
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+ | ! colspan="9" |Months Post-Transplant |
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+ | ! rowspan="2" |Notes |
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+ | |- |
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+ | !6 |
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+ | !7 |
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+ | !8 |
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+ | !10 |
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+ | !12 |
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+ | !14 |
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+ | !18 |
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+ | !24 |
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+ | !26 |
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+ | |- |
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+ | | rowspan="9" |Inactivated |
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+ | |DTaP-Hib-IPV |
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+ | |x |
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+ | |x |
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+ | |x |
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+ | | |
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+ | | |
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+ | | |
||
+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |Hepatitis B |
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+ | |x |
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+ | |x |
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+ | | |
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+ | | |
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+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |booster if titre less than 10 IU/L |
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+ | |- |
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+ | |Pneu-C-13 |
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+ | |x |
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+ | |x |
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+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
||
+ | | |
||
+ | | |
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+ | | |
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+ | |- |
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+ | |Pneu-P-23 |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
||
+ | | |
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+ | |x |
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+ | | |
||
+ | | |
||
+ | |x |
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+ | | |
||
+ | |- |
||
+ | |Men-C-ACYW135 |
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+ | |x |
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+ | | |
||
+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |Influenza |
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+ | | colspan="9" |annually |
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+ | | |
||
+ | |- |
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+ | |Hepatitis A |
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+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |if travel or other risk present |
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+ | |- |
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+ | |HPV |
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+ | |x |
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+ | | |
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+ | |x |
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+ | | |
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+ | |x |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |if recommended by age and sex |
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+ | |- |
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+ | |Herpes zoster |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |if age ≥50 years |
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+ | |- |
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+ | | rowspan="2" |Live |
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+ | |Varicella |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |x |
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+ | | |
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+ | | rowspan="2" |booster at 3 months if no seroconversion |
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+ | |- |
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+ | |MMR |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |x |
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+ | | |
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+ | |} |
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[[Category:Vaccination]] |
[[Category:Vaccination]] |
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[[Category:Immunocompromised hosts]] |
[[Category:Immunocompromised hosts]] |
Latest revision as of 11:26, 20 September 2020
- 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 |