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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 vaccinea,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 bb 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 Ab,c

Recommended for seronegative people who have:

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
Hepatitis Bb,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 
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
  • Aged 6 months to 9 years if first time receiving influenza vaccine: a 2-dose schedule
  • Aged 6 months to 9 years (2nd vaccination season), or >9 years (1st vaccination season): 1 dose every year
  • Aged 6 months to 9 years if first time receiving influenza vaccine: a 2-dose schedule, then 1 dose every year
  • Aged >9 years: 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

All solid organ transplant recipients are recommended to complete the routine schedule and receive:

  • 1 additional dose of PCV
  • 1 dose of PPV 2–12 months after PCV, and
  • a 2nd dose of PPV 5 years later

All solid organ transplant recipients are recommended to receive:

  • 1 additional dose of PCV
  • 1 dose of PPV 2–12 months after PCV, and
  • a 2nd dose of PPV 5 years later
  If a person receives a dose of 21vPCV as their PCV dose, subsequent doses of 23vPPV are not required.
Poliob 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
Japanese encephalitis (live) Contraindicated Choose non-live vaccine option if indicated Follow booster recommendation if indicated See also Travellers who are immunocompromised
Measles-mumps-rubellad 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: 

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
 
Related diseases
COVID-19
Diphtheria
Pertussis (whooping cough)
Haemophilus influenzae type b (Hib)
Hepatitis A
Hepatitis B
Human papillomavirus (HPV)
Japanese encephalitis
Meningococcal disease
Mpox (previously known as monkeypox)
Pneumococcal disease
Poliomyelitis
Rabies and other lyssaviruses
Respiratory syncytial virus (RSV)
Zoster (herpes zoster)
Related chapters
Secondary (acquired) immunodeficiency due to medical conditions

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