Revised vaccination guidelines issued for solid organ transplant candidates, recipients

  • Danziger-Isakov L & al.
  • Clin Transplant
  • 19 Apr 2019

  • International Clinical Digest
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  • Updated vaccination recommendations for solid organ transplant (SOT) candidates and recipients reinforce the need to prevent infection-related morbidity, mortality in this population.

Why this matters

  • Ensure current vaccination status in all transplant candidates, recipients.
  • Administer inactivated vaccines ≥2 weeks pretransplant for adequate immune response.
  • Administer live attenuated vaccines ≥4 weeks pretransplant to ensure resolution of vaccine-related viral replication.
  • Influenza vaccine can be given 1-month posttransplant.
  • Vaccinate household, close contacts against measles, mumps, rubella (MMR), varicella to prevent SOT recipient from wild-type virus exposure.

Key recommendations

  • Influenza: strongly recommended; in posttransplant high dose, booster dosing in same season confers greatest immunogenicity, preferred over standard dosing.
  • Administer inactivated vaccine in health care workers, close contacts unless live attenuated vaccine is the only option.
  • Hepatitis B: offer pretransplant via accelerated schedules (0, 1, 2 months or 0, 7, 21 days); use high dose (40 µg) in posttransplant setting.
  • Monitor titers for revaccination.
  • Both pneumococcal vaccines 23-valent polysaccharide (PPSV23), 13-valent protein-conjugated (PCV13) are recommended.
  • Vaccine-naive: administer PCV13 followed by PPSV23 ≥8 weeks after.
  • Meningococcal: provide routine quadrivalent vaccine to children; vaccinate at-risk adults pre- or post-SOT.
  • MMR, varicella: generally contraindicated.
  • HPV: administer pre-, posttransplant to at-risk patients meeting age criteria.
  • Herpes zoster (subunit) vaccination highly recommended in SOT patients aged ≥50 years.