Table. Recommendations for revaccination after haematopoietic stem cell transplant in children and adults

• For recipients <10 years of age, give all 3 primary doses as DTPa-containing vaccine.
• For recipients ≥10 years of age, give the 1st dose as dTpa, followed by 2 doses of dT. If dT is unavailable, complete vaccination course with dTpa.
• Young children should complete the recommended age-based vaccination schedule after receiving the 3 primary post-HSCT vaccination doses.

• A high-dose formulation (H-B-Vax II dialysis formulation) is preferred.
• If a high-dose formulation is not available, give single-strength hepatitis B vaccine in each arm at each dosing interval or give the standard vaccination course, then check hepatitis B surface antibody titres 4–8 weeks after the last vaccine dose. If titres are <10 mIU/mL, repeat the vaccination course.

• A 3-dose schedule (0,  2,  6 months) of 9vHPV is recommended.
• Specific immunogenicity data for HSCT recipients are not available. Better immune responses are obtained at >12 months after transplant, when the person’s immune system is better reconstituted.
• For people >25 years of age, conduct a risk assessment to determine their need for vaccination (see Human papillomavirus).

• 2  doses should be given 4  weeks apart in 1st  year after transplant.
• 1  dose should be given every year after that.

• People who have finished immunosuppressive therapy, have no chronic graft-versus-host-disease and have reconstituted cell-mediated immunity can receive MMR vaccine.
• Check serology 4–6 weeks after 1st vaccine dose. If there is no seroconversion, repeat the dose.
• Alternatively, 2 doses can be given. This approach is preferable for young children. If possible, check serology 4–6 weeks after 2nd dose to confirm seroconversion. Seek specialist advice if no seroconversion after 2nd dose.

• The number of doses depends on the person’s age. See Table. Recommendations for MenB vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease in Meningococcal disease.
• If the person is ≥10 years of age and Trumenba vaccine is used, a 3-dose schedule plus a single booster dose 5 years after completion of the primary course, is recommended for patients who remain immunocompromised after HSCT.

• 1 dose of 23vPPV given 12 months after the 3rd dose of 13vPCV (2–12 months is acceptable) or at 4 years of age, whichever is later
• a 2nd dose of 23vPPV at least 5 years later

See also Pneumococcal disease.

Seronegative people should receive 2 doses of varicella vaccine if they:

• are not taking immunosuppressive therapy
• have no chronic graft-versus-host disease
• have reconstituted cell-mediated immunity

It is not recommended to check serology after vaccination.

Shingrix is recommended for those aged ≥18 years who are immunocompromised.

Consideration can be given to delaying the timing of each dose of Shingrix (e.g. dose 1 at 7 months and dose 2 at 9 months post HSCT), taking into account an individual patients transplant type, ongoing treatment and preference for receipt of multiple vaccines at one visit.