Immunisation

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Vaccines for transplant recipients

Transplant recipients can receive inactivated vaccines to shield them from infectious diseases. For example, during the flu season, a recipient can get the flu vaccine; Also they are encouraged to vaccinate against Hepatitis A and B.

Recipients cannot receive live vaccines as they can will activate the disease instead of shielding them from it. For example the the chicken pox vaccine is risky for you after your transplant, but don’t worry if you have had it pre-transplant.

Include below as extra info with visuals – infographics or speech bubbles or something 

You can receive live vaccines before your transplant while your body is free from the effects of immunosuppressants. (visual 1)

Children (0-18 years) can be given Haemophilus influenzae type B (Hib Vaccine) after transplantation if they have not been given it before the transplant. It is recommended to take this if possible before transplantation. (visual 2)

Both live and inactivated polio vaccines are available internationally. You must be careful to use only the inactivated vaccine after your transplant. (Visual 3)

Quick checklist on what you should and should not receive:

SAFE to use vaccines

  • Pneumococcal vaccine
  • Diphtheria, tetanus, pertussis (DPT)
  • Influenza
  • Inactivated polio vaccine (IPV). Note that
  • Hepatitis A & hepatitis B
  • Meningococcal vaccine
  • Human papillomavirus vaccine (HPV)

Click on the downloadable resource for detailed information on vaccines you can receive.

UNSAFE vaccines (which contain live organisms)

  • BCG (Bacillus Calmette-Guérin)
  • Yellow fever
  • MMR (mumps, measles and rubella) 
  • Varicella-zoster virus (also known as chicken pox)
  • Small pox
  • Oral polio (live) Sabin 

Vaccination schedule for recipients

Vaccination schedule for family members

Travel related vaccines

Note: If you have been exposed to people who have chicken pox or other viruses, notify your transplant team immediately.

Vaccination Schedules for solid organ transplant recipients

Vaccine Vaccines recommended before transplantation Child

(0 -18 years)

Vaccines recommended before transplantation Adult

(Over 18 years)

Vaccines recommended after transplantation, if not given before

Child

(0 -18 years)

Vaccines recommended after transplantation, if not given before

Adult

(over 18 years)

Schedule/Recommendations
Pneumococcal Vaccine (13vPCV) Yes (if aged more than 6 weeks) Yes Yes (if aged more than 6 weeks) Yes Recommendations depend on age. Check with your doctor if your child is under 2 years
Pneumococcal Vaccine (23PPV) Yes (8 weeks after 13vPCV) Yes (8 weeks after 13vPCV) Yes (8 weeks after 13vPCV) Yes (8 weeks after 13vPCV) Recommendations depend on age. Check with your doctor if your child is under 2 years
Haemophilus Influenzae type B (Hib Vaccine) Yes Not indicated Yes Not indicated If possible, complete vaccination before transplantation
Diphtheria, Tetanus, Pertussis vaccine Yes Yes (if no diptheria, tetanus and pertussis vaccination has been given in the last 10 years) Yes (if not previously vaccinated) Yes (if no diptheria, tetanus and pertussis vaccination has been given in the last 10 years) To be taken every 10 years. Different formulations are used for children under 10 years. Consult your doctor for more details.
Influenza Yes (if over 6 months of age) Yes Yes (if over 6 months of age) Yes (if not received within 12 months before transplant) Recommended annually. Two doses of the vaccine at least 4 weeks apart are recommended for all recipients receiving the influenza vaccine for the first-time post-transplant irrespective of age and annually thereafter.
Inactivated Polio Vaccine Yes Yes Yes Yes If you are an adult and have received a routine course of polio vaccination in childhood you are recommended to receive a booster every 10 years if you are at risk of exposure to polio e.g. through travel or laboratory work
Hepatitis B vaccine Yes Yes (see recommendations) Yes Yes (see recommendations) Check with your doctor for your virus exposure status. Recommended for all transplant candidates who have never been exposed to the hepatitis B virus.
Hepatitis A vaccine Yes (if never been exposed to the virus) Yes (if never been exposed to the virus) Yes (if never been exposed to the virus) Yes (if never been exposed to the virus) Check with your doctor for your virus exposure status. Recommended for all liver patients or if you have long term liver disease, or have long term infections with either hepatitis B or hepatitis C.
Meningococcal C conjugate Vaccine (MenCCV or Hib-MenCCV) Yes Not indicated Yes Not indicated A single dose of meningococcal C conjugate vaccine is recommended at 12 months of age. The Hib MenCCV vaccine is a meningococcal Conjugate vaccine in a combination formulation with the Haemophilus influenzae type b (Hib) vaccine
Quadrivalent meningococcal conjugate vaccine (4vMenCV) & Meningococcal B vaccine (MenBV) Yes, if at risk due to age or other defined risk factors Yes, if at risk due to age or other defined risk factors Yes, if at risk due to age or other defined risk factors Yes, if at risk due to age or other defined risk factors You may have certain conditions or undergoing treatment that will require you to take 4vMenCV/MenBV. Check with your doctor to see if you fall in that category.
Human papillomavirus vaccine (HPV) Yes Yes Yes, if no history of prior immunisation Yes, if no history of prior immunisation 3 dose schedule of 4vHPV is recommended for those aged over 9 years. The 2nd and 3rd dose is to be taken 2 months and 6 months after you take the first dose. Recommended for both males and females
Measles, mumps and rubella vaccine (MMR) Yes Yes (unless 2 previous documented doses) No – Contraindicated after transplant No – Contraindicated after transplant You must complete, this schedule before your transplant provided you don’t already have a suppressed immune system e.g. due to immunosuppressive therapy
Varicella (chicken pox) Vaccine Yes, if non- immune (refer to comments) Yes, if non- immune (refer to comments) No – contraindicated after transplant No – contraindicated after transplant You may be immune from varicella (chickenpox) if you have already had the disease previously. You should give a detailed history to the doctor of your symptoms and the doctor may carry out further tests to confirm previous exposure to the virus. If you have not had the disease previously, you should only complete the vaccination schedule before you have the transplant provided you do not have a suppressed immune system, e.g. due to immunosuppressive therapy.

Information sourced from THE AUSTRALIAN IMMUNISATION HANDBOOK 10TH EDITION; table 3.3.2 and Table 3.3.3

Travel and vaccinations (solid organ transplant recipients)

The vaccinations you receive for travel safety depend on your destination and the time lapsed after your transplantation. Be sure to plan in advance as you may have to receive the vaccinations several months before your trip.

Your transplant doctor may need time to review and reduce the amount of immunosuppression if possible. This is in addition to routine vaccination (non-travel related) schedule recommended for transplant recipients.

See below recommendations for travel related vaccines.

travelling vaccines

Vaccine Recommended before transplant Recommended after transplant Comments
Salmonella typhi (intra muscular) Yes Yes This is an inactivated vaccine. You must maintain food and water hygiene during your travels despite receiving this vaccine. First dose recommended in children over 6 years of age
Salmonella typhi (Vivotif, oral) Yes No This is a live vaccine and must not be taken after your transplant.
Yellow fever vaccine Yes No This is a live vaccine and you must not receive it after your transplant. If you do not receive this vaccination, you are advised to carry a vaccine waiver letter. A yellow fever vaccine waiver letter stating the contraindication to vaccine is acceptable to most governments. The letter must bear the stamp of an official, approved yellow fever immunisation centre.
Rabies See comments See comments Recommended before travelling only if you have a very high risk of exposure and are far away from medical facilities. If there is a potential risk of rabies exposure, you should seek treatment immediately after exposure. You must receive multiple doses of the intramuscular vaccine along with the rabies immunoglobulin.

Children can receive it at any age.

Japanese encephalitis Yes Yes Please be aware that some Japanese encephalitis vaccines in Asia contain live virus. You must not receive this after your transplant.

Some vaccines are not approved for paediatric use. Check with your transplant unit for the appropriate vaccine for your transplanted child

Cholera vaccine Yes Yes For children between 2-6 years, three doses are required, given a minimum of 1 week and up to 6 weeks apart. If an interval of more than 6 weeks occurs between any of the doses, re-start the vaccination course 5

Information in this table has been adapted from Cotton4   and the Australian Immunisation Handbook 10th edition5

If you are travelling with a child that has been transplanted, ensure that all vaccination schedules/routine immunisations are up to date.

Vaccinations for family members of transplant recipients

When you have a suppressed immune system, it is important to protect yourself from infections from everyone including your family members. It is recommended that your family members and your close contacts receive vaccines to minimise risks of spreading infections to you. Listed below are the vaccines those in your circle should and should not receive.

Vaccine Recommended for your close contacts before your transplant Recommended for your close contacts after your transplant
Influenza (Inactivated) Yes Yes
Influenza (Live attenuated) Yes No
Hepatitis B Yes Yes
Hepatitis A Yes Yes
Haemophilus influenza Yes Yes
Pertussis Yes Yes
Varicella Yes Yes
Measles Yes Yes
Mumps Yes Yes
Rubella Yes Yes

Danzinger-Isakov L2 

Key table

Vaccine Details
13vPCV This protects against 13 types of pneumococcal strains
23 PPV This protects against 23 types of pneumococcal strains
MenCCV This protects against the C meningococcal strain
Hib-Men CCV This is a combination vaccine that protects against Haemophilus influenzae and meningococcal strains
4vMenCV This protects against A,C,W135 and Y meningococcoal strains
MenBV This protects against group B meningococcal strains

Danzinger-Isakov L2

 

 

References

  1. Information sourced from THE AUSTRALIAN IMMUNISATION HANDBOOK 10TH EDITION; table 3.3.2 Recommendations for vaccinations for solid organ transplant (SOT) recipients and Table 3.3.3 and viewed on 23/05/2016 at http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part3~handbook10-3-3
  2. Danzinger-Isakov L, Kumar D, AST Infectious Diseases Community of Practice. Guidelines for vaccination of Solid Organ Transplant Candidates and Recipients. American Journal of travel Medicine 2009; Volume 9, Issue Supplement s4, Version of Record online: 16 DEC 2009. Viewed on 1 November 2016. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2009.02917.x/pdf
  3. Kidney Health Australia. Transplant and Travel. Last reviewed on May 2016. http://kidney.org.au/cms_uploads/docs/kidney-health-australia-transplant-and-travel-information.pdf . Link viewed on November 7, 2016.
  4. Cotton C, Hibberd P, the AST Infectious Disease Community of Practice. Travel Medicine and Transplant Tourism in Solid Organ Transplantation. American Journal of Transplantation – Wiley Online library. First published 6 March 2013. http://onlinelibrary.wiley.com/doi/10.1111/ajt.12125/full Link viewed on November 11, 2016
  5. The Australian Immunisation Handbook 10th Cholera. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/content/Handbook10-home~handbook10part4~handbook10-4-1#4-1 Link viewed on November 7, 2016 
  6. Information Manual for Liver Transplant Recipients and their families – Jan 2009. Australian Liver Transplantation Unit
  7. Allogenic Bone Marrow Transplant – A patient’s Guide. Blood and Bone Marrow Transplant Network, NSW, 2006
  8. Information Manual for Heart, Heart-Lung and Lung Transplant Recipients. Heart and lung Transplant Unit. St. Vincents Health Network. Sydney. March 2014
  9. K. Averya, M. G. Michaels,∗ and the AST Infectious Diseases Community of Practice “Strategies for Safe Living After Solid Organ Transplantation”; American Journal of Transplantation. Volume 13 Issue S4. Viewed on 13/05/2016 in http://onlinelibrary.wiley.com/doi/10.1111/ajt.12121/pdf

Videos Used with kind permission from Astellas Pharma. Transplant Australia acknowledges that each patient experience is different and in no way provides this information as a substitute for medical advice. Please contact your transplant unit if you have any questions or concerns regarding your medication. Transplant Australia gratefully acknowledges the valuable contribution of Elaine Chan for reviewing this article.

Acknowledgements

Transplant Australia acknowledges that each patient experience is different and in no way provides this information as a substitute for medical advice. Please contact your transplant unit if you have any questions or concerns regarding your medication.

Transplant Australia gratefully acknowledges the valuable contribution of Elaine Chan for reviewing this article.