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

DTPa (diphtheria-tetanus-pertussis)–containing vaccine for children <10 years of age and dTpa for those ≥10 years of age

Yes

Yes

Yes

Not needed

• 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.

Hib (Haemophilus influenzae type b) vaccine

Yes

Yes

Yes

Not needed

• None

Hepatitis B vaccine

Yes

Yes

Yes

Not needed

• 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.

9vHPV (9-valent human papillomavirus vaccine

No

Yes

Yes

(see comments)

Yes

(see comments)

• 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 >19 years of age, conduct a risk assessment to determine their need for vaccination (see Human papillomavirus).

IPV (inactivated poliovirus) vaccine

Yes

Yes

Yes

Not needed

• A 3-dose course of IPV vaccine is recommended. This can be given as DTPa-IPV or dTpa-IPV ( see ‘DTPa’ above).

Influenza vaccine

Yes (2  doses in 1st  year after transplant, then 1 dose every year after that)

Yes (if not received already)

Yes (if not received already)

Yes

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

MMR (measles-mumps-rubella) vaccine

No

No

No

Yes (1  or 2 doses with a minimum interval of 4 weeks; see comments)

• 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.

MenB (meningococcal B) vaccine

Yes

Yes

Not needed (see comments)

Not needed (see comment)

• 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 is recommended for patients who remain immunocompromised after HSCT.

MenACWY (quadrivalent meningococcal conjugate) vaccine

Yes

Yes

Not needed (see comments)

Not needed (see comment)

• The number of doses depends on the person’s age. See Table. Recommendations for MenACWY vaccine for people with a specified medical condition that increases their risk of invasive meningococcal disease in Meningococcal disease.

13vPCV (13-valent pneumococcal conjugate vaccine)

Yes

Yes

Yes

Not needed

• See Pneumococcal disease.

23vPPV (23-valent pneumococcal polysaccharide vaccine)

No

No

No

Yes (after 13vPCV)

• See Pneumococcal disease.

Varicella vaccine

No

No

No

Yes (2  doses separated by a minimum interval of 4 weeks; see comments)

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.