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

• 2 primary doses, can consider a 3rd dose
• Additional doses every 6–12 months based on individual risk assessment (see comment)

• HSCT recipients aged <10 years: 3-dose schedule of DTPa-containing vaccine (eg DTPa-HepB-IPV-Hib)
• HSCT recipients aged ≥10 years: 3-dose schedule of dTpa-containing vaccine (eg dTpa-IPV)

• 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 dose. If titres are <10IU/mL, repeat the vaccination course.

• 2 doses 1st year after HSCT
• 1 seasonal dose should be given in each subsequent year

• A full primary schedule of MenACWY vaccine, with ongoing booster doses depending on the person’s age
• A full primary schedule of MenB vaccine, with a single booster dose

• 8 weeks between the primary doses of MenACWY.
• 6 weeks between the primary doses of MenB if aged 6–23 months, and 4 weeks if aged ≥ 2 years.

• The number of doses depends on the person’s age and vaccine brand. See Meningococcal disease
• 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

• A 3-dose schedule of PCV followed by 1 dose of 23vPPV, and a booster dose of 23vPPV at least 5 years later
• The 1st dose of 23vPPV should be administered ≥2 months after the last dose of PCV

• 5-dose schedule administered intramuscularly, and possibly HRIG
• Not routinely recommended, but may be given to HSCT recipients based on increased risk of exposure or severe outcomes from disease

• Adults ≥60 years: 1 dose of RSV vaccine
• At-risk neonates and infants aged <24 months: 1 dose of RSV-specific monoclonal antibody

• Use non-live vaccine option if indicated
• See also Vaccination for international travellers

• Use non-live vaccine option if indicated
• See also Vaccination for international travellers

• Pre-vaccination serological testing for measles and rubella can be considered in adult patients at 24 months after HSCT to confirm their need for revaccination.
• If MMR immunity has not been confirmed before vaccination, check serology after the 2nd dose to confirm seroconversion, or seek specialist advice.

• Use non-live vaccine option if indicated
• See also Vaccination for international travellers

Acronyms used: 

• – = none
• BCG = bacille Calmette–Guérin 
• GVHD = graft-versus-host disease
• DTPa/dTpa = diphtheria-tetanus-pertussis
• HepB = hepatitis B
• Hib = Haemophilus influenzae type b
• HPV = human papillomavirus
• HSCT = haematopoietic stem cell transplant
• IPV = inactivated poliovirus
• MenACWY = meningococcal ACWY
• MenB = meningococcal B
• MMR = measles-mumps-rubella
• PCV = pneumococcal conjugate vaccine
• PPV = pneumococcal polysaccharide vaccine
• RSV = respiratory syncytial virus

Footnotes:
^a DTPa for children <10 years of age; dTpa for those ≥10 years of age 
^b Young children should complete the recommended age-based vaccination schedule after completing the primary post-HSCT vaccination doses in this table.
^c May be given as combined vaccines
^d Recommended but not funded under the National Immunisation Program
^e Measles-mumps-rubella-varicella combination vaccines are not recommended.  

Sources: Tomblyn et al,²⁰ Ljungman et al,¹⁵ Kumar et al,¹³ Cordonnier et al,¹⁴ Meisel et al,¹⁶ Centers for Disease Control and Prevention⁴⁰