Vaccine | Recommendation | Number of doses | Comments |
3 to 6 months post-transplant | |||
RZV[1] | Age 18 years or older | 2 (2 to 6 months apart) | Antiviral prophylaxis (eg, acyclovir) is also used to prevent herpes zoster early after transplant. |
COVID-19 (SARS-CoV-2) vaccine | All HCT recipients ≥6 months of age[2] | 2 or 3 (depending on vaccine formulation) | We prefer the mRNA vaccine because there is more evidence on efficacy and safety. |
Pneumococcal conjugate vaccine-20 (PCV-20)* | All HCT recipients | 3 doses (1 month apart) 4th dose at 12 months | If PCV20 is not available:
|
6 to 12 months post-transplant | |||
Influenza vaccine (inactivated) | All HCT recipients ≥6 months of age | 1 dose (annually) | Can be given as early as 4 months if community outbreak. If given early, a 2nd dose should be administered at least 4 weeks after initial dose to provide additional protection against influenza. |
Tetanus, diphtheria, and pertussis vaccine | All HCT recipients | 3 doses DTaP (1 to 3 months apart) | For patients ≥7 years of age, an alternative schedule includes 1 dose of Tdap followed by either 2 doses of DT or Td, with all doses spaced 1 to 3 months apart. |
Haemophilus influenzae b conjugate vaccine | All HCT recipients | 3 doses (1 month apart) | |
Polio-inactivated (inactivated poliovirus vaccine) | All HCT recipients | 3 doses (1 to 3 months apart) | |
Meningococcal conjugate vaccine¶ | Age 11 to 18 years or other risk factors present (eg, asplenia, residing or traveling to areas of hyperendemicity or epidemicity) | 2 doses (4 to 5 years apart) | |
MenB vaccine¶ | Age 16 to 23 or other risk factors (eg, asplenia, residing or traveling to areas of hyperendemicity or epidemicity) | 1 dose | |
Human papillomavirus vaccine | Age 9 to 26 years | 2 to 3 doses[FN3] | |
Respiratory syncytial virus | Age 60 years or older | 1 dose | In the absence of efficacy and safety data with this vaccine in HCT recipients, balancing risk of significant disease in this population, we engage in shared decision making with our patients when deciding whether to administer this vaccine. |
Hepatitis A vaccine | If risk factors present (eg, chronic liver disease, travel to endemic areas) | 2 doses (6 months apart) | |
Mpox virus vaccine (non-replicating, modified vaccinia Ankara vaccine) | If risk factors present (eg, males who have sex with males and have multiple sex partners or a diagnosis of an STI in the past 6 months) | 2 doses (1 month apart) | |
1 year post-transplant | |||
Hepatitis B vaccine | All HCT recipients | 3 doses (dosing intervals depend on the specific vaccine formulation used) | Can be administered as early as 6 months if necessary. We prefer to wait until 12 months when possible to optimize immunity from vaccine. Test serology ≥1 month following the 3rd dose to assess the response to vaccine. |
≥2 years post-transplant | |||
Measles, mumps, and rubella vaccine | HCT recipients who meet all of the following criteria:
| 2 doses (at least 4 weeks apart) | |
Varicella | HCT recipients who meet all of the following criteria:
| 2 doses (4 to 8 weeks apart) |
COVID-19: coronavirus disease 2019; DTaP: diphtheria toxoid, tetanus toxoid, acellular pertussis; DT: diphtheria toxoid, tetanus toxoid; GVHD: graft-versus-host disease; HCT: hematopoietic cell transplant; IVIG: intravenous immunoglobulin; mRNA: messenger ribonucleic acid; PPSV: pneumococcal polysaccharide vaccine; RSV: recombinant zoster vaccine; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; STI: sexually transmitted infection; Tdap: tetanus toxoid, reduced diphtheria toxoid, and reduced acellular pertussis; Td: tetanus toxoid, reduced diphtheria toxoid.
* PCV20 formulation is preferred. However, PCV15 or another pneumococcal conjugate vaccine formulation is a reasonable alternative if PCV20 is not available.
¶ A pentavalent meningococcal conjugate vaccine (MenABCWY) is also available in the United States. If immunization against all five meningococcal groups is indicated, the pentavalent meningococcal conjugate vaccine (MenABCWY) can be administered, if available.
FN3: Dosing schedule differs based on initial age of vaccination. Refer to UpToDate content on HPV vaccination for details.
Adapted from:
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