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

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 >25 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) 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.
PCV (pneumococcal conjugate vaccine) - 13vPCV, 15vPCV or 20vPCV Yes Yes Yes Not needed See Pneumococcal disease.
23vPPV (23-valent pneumococcal polysaccharide vaccine) No No No Yes (2-12 months after a dose of PCV [13vPCV, 15vPCV or 20vPCV])
  • 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.
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.
Recombinant zoster vaccine (Shingrix) Yes Yes Not needed Not needed

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.
COVID-19 vaccine Yes (≥3-6 months after HSCT; 3 doses separated by a minimum interval of 8 weeks; see comments)       A 2 dose course is recommended, with consideration of a 3rd dose. Additional doses may be required based on age, degree of ongoing immunosuppression and presence of other risk factors for severe illness.
Respiratory syncytial virus (RSV) vaccine Yes Not needed Not needed Not needed A single dose of RSV vaccine is recommended in adults aged ≥60 years who are at increased risk of severe RSV disease including HSCT recipients.

Sources: Tomblyn et al,30 Ljungman et al,31 Kumar et al,32 Cordonnier et al,33 Meisel et al,34 Centers for Disease Control and Prevention,35 Ljungman et al36

Related chapters
Vaccination for special risk groups

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