Vaccination after hematopoietic stem cell transplantation: Difference between revisions

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* Following [[hematopoietic stem cell transplantation]], the new, naive immune system requires essentially all (allogeneic) or most (autologous) routine immunizations
 +
*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
−
* Most live vaccines can be given after 24 months, including univalent varicella, MMR, and yellow fever faccines
  
  +
**Recipients recipients respond poorly to polysaccharide vaccines
−
** MMRV, rotavirus, smallpox, oral poliovirus are all contraindicated
  
  +
**Titres can be checked to confirm immune response and direct further revaccination
−
** Must not be experiencing [[graft-versus-host disease]] or undergoing significant immunosuppression
  
  +
*Most inactivated vaccines are started around 6 months after vaccination
−
*** No corticosteroids or other immunosuppressnats for at least 3 months
  
  +
*Most live vaccines can be given after 24 months, including univalent varicella, MMR, and yellow fever faccines
−
** Must also be assessed by their primary team as having normal immunity
  
−
* Close contacts should also ensure vaccinations are up to date
 +
*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
  +
** 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 ==
  +
{| class="wikitable"
  +
|+Sample immunization schedule
  +
! rowspan="2" |
  +
! rowspan="2" |Vaccine
  +
! colspan="9" |Months Post-Transplant
  +
! rowspan="2" |Notes
  +
|-
  +
!6
  +
!7
  +
!8
  +
!10
  +
!12
  +
!14
  +
!18
  +
!24
  +
!26
  +
|-
  +
| rowspan="9" |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
  +
| colspan="9" |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
  +
|-
  +
| rowspan="2" |Live
  +
|Varicella
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|x
  +
|
  +
| rowspan="2" |booster at 3 months if no seroconversion
  +
|-
  +
|MMR
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|x
  +
|
  +
|}
 
[[Category:Vaccination]]
  
[[Category:Vaccination]]
 
[[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
    • 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

Sample immunization 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
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