Vaccination of Hematopoietic Stem Cell Transplant (HSCT) Recipients
Extracted from the January 2011 ACIP General Recs
Vaccinating Recipients of Hematopoietic Cell Transplants
A hematopoietic cell transplant (HCT) results in immunosuppression because of the hematopoietic ablative therapy administered before the transplant, drugs used to prevent or treat graft-versus-host disease, and, in some cases, from the underlying disease process necessitating transplantation.
HCT involves ablation of the bone marrow followed by reimplantation of the person's own stem cells or stem cells from a donor. Antibody titers to vaccine-preventable diseases (e.g., tetanus, poliovirus, measles, mumps, rubella, and encapsulated bacteria) decrease 1-4 years after autologous or allogeneic HCT if the recipient is not revaccinated. HCT recipients of all ages are at increased risk for certain vaccine-preventable diseases, including diseases caused by encapsulated bacteria (i.e., pneumococcal, meningococcal, and Hib infections). As a result, HCT recipients should be revaccinated routinely after HCT, regardless of the source of the transplanted stem cells. Most inactivated vaccines should be initiated 6 months after the HCT.
- Inactivated influenza vaccine should be administered beginning at least 6 months after HCT and annually thereafter for the life of the patient. A dose of inactivated influenza vaccine can be given as early as 4 months after HCT, but a second dose should be considered in this situation. A second dose is recommended routinely for all children receiving influenza vaccine for the first time.
- Sequential administration of 3 doses of pneumococcal conjugate vaccine is recommended, beginning 3-6 months after the transplant, followed by a dose of PPSV.
- A 3-dose regimen of Hib vaccine should be administered beginning 6 months after transplant; at least 1 month should separate the doses.
- MMR vaccine should be administered 24 months after transplant if the HCT recipient is immunocompetent.
- Because of insufficient experience using varicella vaccine among HCT recipients, physicians should assess the immune status of each recipient on a case-by-case basis and determine the risk for infection before using the vaccine. If a decision is made to vaccinate with varicella vaccine, the vaccine should be administered a minimum of 24 months after transplantation if the HCT recipient is presumed to be immunocompetent.
For more specific information, see Tomblyn M, Chiller T, Einsele H, et al. Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective [1.9MB, 96 pages]. Biol Blood Marrow Transplant 15:1143-1238;2009.
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