Table. Recommendations for vaccination before and after solid organ transplant

These recommendations are based on the principle that, where possible, children and adults should complete an age-appropriate routine vaccination schedule before transplant. An accelerated schedule or catch-up schedule may also be considered before transplant when needed. Immunogenicity is likely to be improved when candidates receive the vaccine before transplant. If this has not occurred, the person should receive additional vaccine doses after transplant.

Vaccine category	Vaccine	Before solid organ transplant: if never previously vaccinated OR partly vaccinated	After solid organ transplant: if never vaccinated OR partly vaccinated before transplant	After solid organ transplant: if fully vaccinated before transplant	Comments
Non-live vaccines	COVID-19	Use if indicated following age-appropriate primary schedule (see comments)	Complete 2-dose primary schedule and can consider a 3rd dose	Aged <5 years: further doses not indicated Aged ≥5 years: 1 additional dose or ongoing doses every 6–12 months, based on individual risk benefit assessment (see comments)	Number of primary and additional doses are based on the person’s age and presence of other risk factors for severe illness from COVID-19.
	Diphtheria-tetanus-pertussis-containing vaccine^a,b	Complete routine primary schedule or catch-up for missed doses	Aged <10 years: at least 3 primary doses of DTPa, and then follow the routine schedule for their age Aged ≥10 years: complete a 3-dose schedule of dTpa-containing vaccine if unvaccinated, or catch-up for missed doses	1 additional dose of dTpa if previous doses were >10 years ago	–
	Haemophilus influenzae type b^b	Complete routine primary schedule or catch-up for missed doses	Aged <18 years: 1 additional dose (in addition to routine schedule) Aged ≥18 years: complete routine schedule or catch-up for missed doses	Further doses not indicated	–
	Hepatitis A^b,c	Recommended for seronegative people who have: chronic liver disease chronic infection with either hepatitis B or hepatitis C	2 doses are recommended for people who have: had a liver transplant chronic liver disease chronic infection with either hepatitis B or hepatitis C	Further doses not indicated if seropositive	Confirm immunity by serological testing before vaccination. If the person is also at risk of acquiring hepatitis B, they can receive a combination hepatitis A-hepatitis B vaccine. See also Vaccination for international travellers.
	Hepatitis B^b,c	Recommended for all seronegative people, and an accelerated schedule may be followed (Table. Accelerated hepatitis B vaccination schedules for people with imminent risk of exposure)	3 doses are recommended for all seronegative people	Further doses not indicated if seropositive	Confirm immunity by serological testing before and after vaccination. The combination hepatitis A-hepatitis B vaccine may be appropriate for people who are about to receive a liver transplant if they are not immune to either disease (see Table. Combination hepatitis A-hepatitis B vaccines).
	Human papillomavirus	Aged ≥9 years if immunocompromised before transplant: a 3-dose schedule	Aged ≥9 years: complete a 3-dose primary schedule (at 0, 2 and 6 months) if unvaccinated, or catch up for missed doses	Further doses not indicated	Gardasil 9 is registered for people aged 9–45 years. For people >25 years of age, conduct a risk assessment to determine their need for vaccination.
	Influenza (non-live)	Aged 6 months to 9 years if immunocompromised and never received influenza vaccine: a 2-dose schedule	Aged ≥6 months: 2 doses in the 1st year after transplant, then 1 dose every year	2 doses in the 1st year after transplant, then 1 dose every year	Use age-appropriate vaccine option.
	Japanese encephalitis (inactivated)	Use if indicated	Use if indicated	Follow booster recommendation if indicated	See also Vaccination for international travellers.
	Meningococcal (MenACWY and MenB)^c	Complete age-appropriate routine primary schedule	Complete age-appropriate routine primary schedule or catch-up for missed doses	Follow booster recommendation for certain conditions that increase the risk of meningococcal disease	The number of doses needed depends on the vaccine brand used and the person’s age when they start the vaccine course. See Table. Recommendations for MenACWY vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease and Table. Recommendations for MenB vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease.
	Mpox (live, non-replicating)	Use if indicated	Use if indicated	A 10-yearly booster is recommended if there is an ongoing occupational exposure	Seek specialist advice on individual risks and benefits of vaccination.
	Pneumococcal (conjugate and polysaccharide vaccines)	Complete routine or catch-up for missed doses	Aged <18 years: 1 dose of 20vPCV at least 2 months after any previous dose of PCV Aged ≥18 years: 1 additional dose of PCV 1 dose of PPV 2–12 months after PCV, and a 2nd dose of PPV 5 years later	Aged <18 years: 1 dose of 20vPCV at least 2 months after any previous dose of PCV Aged ≥18 years: 1 additional dose of PCV 1 dose of PPV 2–12 months after PCV, and a 2nd dose of PPV 5 years later	Children who have received either a routine course of 3 doses of any PCV, or 4 doses of 13vPCV or 15vPCV, or 4 doses of any PCV plus 1 dose of PPV, are recommended to receive 1 dose of 20vPCV at least 8 weeks after any previous doses of PCV. Children who received either a routine course of 4 doses of 20vPCV or 4 doses of any PCV plus 2 doses of PPV (i.e. Aboriginal and Torres Strait Islander children) have already received the recommended number of doses of pneumococcal vaccine and do not require any additional doses. For children who have not received a full routine infant course of pneumococcal vaccination, see Table. Catch-up schedule for 20vPCV for children aged <5 years who are either Aboriginal and Torres Strait Islander (including those living in ACT, NSW, Tas or Vic born on or after 1 March 2025), or have a risk condition(s) for pneumococcal disease
	Polio^b	Complete routine or catch-up for missed doses	Aged <10 years: complete routine or catch-up schedule Aged ≥10 years: complete a 3-dose schedule if unvaccinated, or catch-up for missed doses	Aged ≥18 years: a 10-yearly booster is recommended if there is an ongoing risk of polio exposure	See also Travellers who are immunocompromised
	Rabies	Use if indicated	Use if indicated	Use if indicated	Give 5-dose schedule intramuscularly if immunocompromised. See also Travellers who are immunocompromised
	Immunisation against respiratory syncytial virus (RSV)^c	Aged ≥60 years: 1 primary dose of RSV vaccine At-risk neonates and infants aged <24 months: 1 primary dose of RSV-specific monoclonal antibody	Aged ≥60 years: 1 primary dose of RSV vaccine if unvaccinated At-risk neonates and infants aged <24 months if unvaccinated: 1 primary dose of RSV-specific monoclonal antibody	Further doses not indicated	–
	Zoster (herpes zoster, recombinant)	Aged ≥18 years if immunocompromised: a 2-dose schedule	Aged ≥18 years: a 2-dose schedule (1–2 months apart) if unvaccinated, or catch up for missed doses after antiviral prophylaxis has been completed.	Further doses not indicated	Shingrix is registered for people aged ≥18 years.
Live vaccines	BCG	Only use if benefit outweighs risk. Give ≥4 weeks before transplant.	Contraindicated when immunocompromised. Consult a specialist for timing of vaccination if indicated	Further doses not indicated	See also Travellers who are immunocompromised
	Cholera (live)	Contraindicated	Choose non-live vaccine option if indicated	Further doses not indicated	See also Travellers who are immunocompromised
	Influenza (live)	Give ≥4 weeks before transplant if not contraindicated	Choose non-live vaccine option if indicated	Choose non-live vaccine option if indicated	-
	Japanese encephalitis (live)	Contraindicated	Choose non-live vaccine option if indicated	Follow booster recommendation if indicated	See also Travellers who are immunocompromised
	Measles-mumps-rubella^d	Complete a 2-dose schedule ≥4 weeks before transplant if seronegative	Complete a 2-dose schedule at least 12 months after transplant if seronegative following an assessment of degree of immunocompromise	Further doses not indicated if seropositive	Confirm immunity by serological testing before vaccination.
	Q fever	Use if indicated	Contraindicated	Further doses not indicated if seropositive	Serological and skin tests are needed before vaccination.
	Rotavirus	Complete routine schedule (≥4 weeks before transplant, if possible)	Contraindicated when immunocompromised	Further doses not indicated	Only indicated in infants within age limit (1st dose <15 weeks of age, 2nd dose <25 weeks of age)
	Typhoid (live)	Contraindicated	Choose non-live vaccine option if indicated	Further doses not indicated	See also Travellers who are immunocompromised
	Varicella (monovalent)^d	Complete a 2-dose schedule ≥4 weeks before transplant if seronegative	Complete a 2-dose schedule at least 12 months after transplant if seronegative following an assessment on degree of immunocompromise	Further doses not indicated if seropositive	Confirm immunity by serological testing before vaccination
	Yellow fever	If benefit outweighs risk, give ≥4 weeks before transplant	Contraindicated when immunocompromised. Consult a specialist for timing of vaccination if indicated	Further doses not indicated	See also Travellers who are immunocompromise
Acronyms used: – = none BCG = bacille Calmette–Guérin DTPa/dTpa = diphtheria-tetanus-pertussis MenACWY = meningococcal ACWY MenB = meningococcal B PCV = pneumococcal conjugate vaccine PPV = pneumococcal polysaccharide vaccine Footnotes: ^a DTPa for children <10 years of age; dTpa for those ≥10 years of age ^b May be given as combined vaccines ^c Recommended but not funded under the National Immunisation Program ^d Measles-mumps-rubella-varicella combination vaccines are not recommended. Source: Danziger-Isakov et al,⁷ Centers for Disease Control and Prevention et al.¹⁰