Version October 2024
| Vaccine type | Vaccine target | Indications |
| Nonlive (inactivated, killed, subunit, or recombinant) | Pneumococcal vaccines | All SOT candidates and recipients not previously vaccinated or who need booster doses. Vaccine formulation of choice depends on age, national guidelines, and availability.* |
| RSV¶ | Offer to all SOT candidates and recipients ≥60 years old and share the decision-making process with the patient. | |
| Seasonal influenza virus | Annually for all patients ≥6 months old.Δ | |
| HBV | All SOT candidates and recipients who are nonimmune based on serologic testing (eg, HBsAb-negative patients). NOTE: High-dose HBV vaccine or Heplisav-B are preferred to maximize immunogenicity. | |
| HAV | If not previously vaccinated or immune:
NOTE: In the setting of recent outbreaks, reasonable to vaccinate all non-immune SOT candidates and recipients. | |
| Meningococcus (serotypes A, B, C, W, and Y) | At-risk patients who have not been previously vaccinated, including those treated with eculizumab and those with impaired splenic function. NOTE: Pentavalent MenABCWY vaccine formulation is preferred, when available, to provide the widest coverage against meningococcus. | |
| Haemophilus influenzae | At-risk patients ≥5 years old who have not been previously vaccinated, including those with impaired splenic function. Children <5 years old should be vaccinated according to the routine schedule. | |
| HPV | All SOT candidates and recipients not previously vaccinated who meet age-based indications for vaccination. | |
| DTaP, Tdap, or Td | All SOT candidates and recipients per guidelines for healthy persons (eg, per routine for children). | |
| RZV | SOT candidates and recipients aged ≥19 years old. | |
| COVID-19 vaccines◊ | All SOT candidates and recipients. Choice of vaccine depends on age, national guidelines, and availability. | |
| Live, attenuated§ | ZVL | SOT candidates aged >50 years old. NOTE: RZV is preferred, when available, over ZVL. (ZVL contraindicated post-transplantation). |
| Varicella vaccine | Nonimmune SOT candidates prior to transplantation; can be given as early as 6 months of age in children. Contraindicated post-transplantation and/or for immunosuppressed patients.¥ | |
| MMR | SOT candidates who have not been previously vaccinated and/or lack evidence of measles, mumps, or rubella immunity (ie, IgG seronegative); can be given as early as 6 months of age in children. Contraindicated post-transplantation and/or for immunosuppressed patients.¥ | |
| Rotavirus | Per usual guidelines for infants prior to transplantation; not indicated for older children and adults. Contraindicated post-transplantation and/or for immunosuppressed patients. |
As part of the pretransplant evaluation, we review each patient's vaccination history and ensure that the above vaccinations have been received when appropriate. For maximal protection, vaccinations should be given pretransplantation and prior to the start of immunosuppressive therapy. This increases the likelihood of developing a protective immune response and allows for administration of any needed live vaccines, which should be given at least 4 weeks prior to transplantation and are generally contraindicated once immunosuppressive therapy has started.
For complete information on timing of vaccine administration and vaccine schedules, refer to the UpToDate topic on vaccinations in solid organ transplantation. For more detailed description of at-risk populations, refer to the UpToDate topics regarding each vaccine.ACIP: Advisory Committee on Immunization Practices; BCG: Bacillus Calmette-Guérin; COPD: chronic obstructive pulmonary disease; COVID-19: coronavirus disease 2019; DTaP: diphtheria, tetanus, and acellular pertussis vaccine; HAV: hepatitis A virus; HBsAb: hepatitis B virus surface antibody; HBV: hepatitis B virus; HPV: human papillomavirus; IgG: immunoglobulin G; MMR: measles, mumps, rubella; RSV: respiratory syncytial virus; RZV: recombinant zoster vaccine; Td: tetanus, diphtheria; Tdap: tetanus, diphtheria, and acellular pertussis vaccine; ZVL: zoster vaccine, live.
* In the United States, children <2 years old should receive the pneumococcal conjugate vaccine (PCV) series, children ≥2 years old should receive the PCV series and in some circumstances the 23-valent pneumococcal polysaccharide vaccine (PPSV23), and adults should receive either 20-valent PCV (PCV20) alone or 15-valent PCV (PCV15) followed by PPSV23 at least 8 weeks later. Dosing intervals and schedule may vary if either one of these vaccines has been given previously. Other national guideline recommendations may vary regarding vaccine selection. Refer to UpToDate topics on pneumococcal vaccination for more information on vaccine selection and timing of booster doses.
¶ In accordance with the ACIP, we discuss the benefits and potential risks and use shared clinical decision-making to help decide whether the RSV vaccine is the right choice for SOT candidates and recipients who are ≥60 years old. Although the vaccine has not been studied in SOT candidates and recipients, given the high burden of disease, we believe the benefits outweigh the potential risks, especially in patients at higher risk, such as lung transplant recipients, those with underlying lung conditions (eg, COPD), and those who have frequent exposure to young children or are in group living situations.
Δ For adults, we prefer the high-dose influenza vaccine, when available, as it augments immune response and does not appear to increase the risk of rejection. High-dose influenza vaccine outside of the usual indications may not be covered by insurance and may not be available in commercial pharmacies and other similar locations. Using the standard dose is also acceptable and preferred for children.
◊ Refer to the UpToDate content on COVID-19 vaccines in SOT patients for additional information.
§ Other live attenuated vaccines include the influenza nasal spray, oral typhoid, cholera, chikungunya, ebola, BCG, yellow fever, smallpox/mpox (ACAM2000), and some formulations of the Japanese encephalitis vaccine. These are typically not indicated apart from in selected circumstances (eg, travel) and/or alternative nonlive formulations are available (eg, influenza vaccines and typhoid vaccines).
¥ Possible exceptions are measles- and varicella-nonimmune pediatric transplant recipients who are receiving minimal or no immunosuppression and who have had no recent allograft rejection; such individuals may receive the varicella vaccine or measles vaccines with appropriate education and close follow-up.Do you want to add Medilib to your home screen?
