These recommendations are regardless of previous vaccination history. Young children may need extra doses of certain vaccines in addition to those in this table. Young children should complete the recommended age-based vaccination schedule after completing the primary post-HSCT vaccination doses in this table. See the relevant disease-specific chapters in this Handbook for details.

Vaccine

6 months after HSCT

8 months after HSCT

12 months after HSCT

24 months after HSCT

Comments

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)

MenACWY (quadrivalent meningococcal conjugate) vaccine

Yes

Yes

Not needed (see comments)

Not needed (see comment)

13vPCV (13-valent pneumococcal conjugate vaccine)

Yes

Yes

Yes

Not needed

23vPPV (23-valent pneumococcal polysaccharide vaccine)

No

No

No

Yes (after 13vPCV)

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.

Sources: Tomblyn et al,22 Ljungman et al,23 Kumar et al,30 Cordonnier et al,31 Meisel et al,32 Centers for Disease Control and Prevention,33 Ljungman et al34

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Table. Recommendations for pneumococcal vaccination using 23vPPV for Aboriginal and Torres Strait Islander adults who do not have a condition(s) associated with an increased risk of invasive pneumococcal disease

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Table. Recommendations for use of zoster vaccine in people on immunosuppressive therapy

Last updated: 
5 June 2018
Last reviewed: 
5 June 2018

Definitions

HSCT
haematopoietic stem cell transplant
DTPa
diphtheria-tetanus-acellular pertussis vaccine
dTpa
diphtheria-tetanus-acellular pertussis vaccine, reduced antigen content formulation
dT
diphtheria-tetanus vaccine for use in adults
IPV
inactivated poliomyelitis vaccine
MMR
measles-mumps-rubella
13vPCV
13-valent pneumococcal conjugate vaccine
23vPPV
23-valent pneumococcal polysaccharide vaccine