Vaccinations prior to or after solid organ transplant

Vaccine	Pretransplant		Starting 2 to 6 months posttransplant
Vaccine	Recommendation	Strength, evidence quality	Recommendation	Strength, evidence quality
Haemophilus influenzae b conjugate	U	Strong, moderate	U	Strong, moderate
Hepatitis A	U: age 12 to 23 months R: age ≥2 years	Strong, moderate Strong, moderate	R, if not completed pretransplant	Strong, moderate
Hepatitis B	U: age 1 to 18 years R: age ≥18 years	Strong, moderate Strong, moderate	R, if not completed pretransplant*	Strong, moderate
Diphtheria toxoid, tetanus toxoid, acellular pertussis; tetanus toxoid, reduced diphtheria toxoid; tetanus toxoid, reduced diphtheria toxoid, and reduced acellular pertussis	U	Strong, moderate	U, if not completed pretransplant	Strong, moderate
Human papillomavirus	U: females 11 to 26 years U: males 11 to 26 years	Strong, moderate Strong, low	U: females 11 to 26 years U: males 11 to 26 years	Strong, moderate Strong, low
Influenza-inactivated (inactivated influenza vaccine)	U	Strong, moderate	U^¶	Strong, moderate
Influenza-live attenuated (live attenuated influenza vaccine)	X	Weak, low	X	Weak, low
Measles, mumps, and rubella-live	R^Δ: age 6 to 11 months U^◊: age ≥12 months	Weak, very low Strong, moderate	X	Strong, low
Measles, mumps, and rubella-varicella-live	U^◊	Strong, moderate	X	Strong, low
Meningococcal conjugate	U	Strong, moderate	U	Strong, moderate
Pneumococcal conjugate (PCV13)	U: age ≤5 years R: age ≥6 years^§	Strong, moderate Strong, very low	U: age 2 to 5 years R: age ≥6 years if not administered pretransplant^§	Strong, moderate Strong, very low
Pneumococcal polysaccharide (PPSV23)	R: age ≥2 years	Strong, moderate	R: age ≥2 years, if not administered pretransplant	Strong, moderate
Polio-inactivated (inactivated poliovirus vaccine)	U	Strong, moderate	U	Strong, moderate
Rotavirus-live	U^Δ	Strong, moderate	X	Strong, low
Varicella-live	R^¥: age 6 to 11 months U^◊	Weak, very low Strong, low	X^‡	Strong, low
Zoster vaccination^†	R**: age 50 to 59 years U^¶¶: age ≥60 years	Weak, low Strong, moderate	X	Strong, low

R: recommended - administer if not previously administered or not current; such patients may be at increased risk for this vaccine-preventable infection; U: usual - administer if patient not current with annually updated United States Centers for Disease Control and Prevention (CDC) recommendations for immunocompetent persons in risk and age categories; X: contraindicated.
* Consider hepatitis B vaccine for hepatitis B-infected liver transplant patients (weak, low).
¶ Inactivated influenza vaccine may be administered to solid organ transplant recipients despite intensive immunosuppression (eg, during the immediate posttransplant period), particularly in an outbreak situation (weak, low).
Δ Administer only if patient is not immunosuppressed and the timing is ≥4 weeks prior to transplant.
◊ Administer only if patient is nonimmune, not severely immunosuppressed, and the timing is ≥4 weeks prior to transplant.
§ For patients aged ≥19 years who have received PPSV23, PCV13 should be administered after an interval of ≥1 year after the last PPSV23 dose (weak, low).
¥ Administer only if patient is not immunosuppressed and the timing is ≥4 weeks prior to transplant. This recommendation deviates from recommendations of the Advisory Committee on Immunization Practices, CDC.
‡ Selected seronegative patients with renal or liver transplant have been safely vaccinated. This recommendation deviates from recommendations of the Advisory Committee on Immunization Practices, CDC.
† Two zoster vaccine formulations are available: the recombinant varicella zoster vaccine and the live zoster vaccine. Either can be given prior to transplantation, provided the interval between vaccination and transplantation is sufficient. Neither is recommended after transplantation or for immunocompromised patients in general. Refer to the UpToDate topic on vaccination for the prevention of shingles for detail.
** Administer only if patient is not severely immunosuppressed, the timing is ≥4 weeks prior to transplant, and the patient is varicella immune as defined by documentation of age-appropriate varicella vaccination, serologic evidence of immunity, documentation of varicella or zoster infection, or birth in the United States before 1980^[1,2]. This recommendation deviates from recommendations of the Advisory Committee on Immunization Practices, CDC.
¶¶ Administer only if patient is not severely immunosuppressed and the timing is ≥4 weeks prior to transplant.

References:

Marin M, Guris D, Chaves SS, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1.
Kotton CN, Hibberd PL. Travel medicine and the solid organ transplant recipient. Am J Transplant 2009; 9 (Suppl 4):S273.

Reproduced from: Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2013; 58:e44. By permission of the Infectious Disease Society of America. Copyright © 2013 Oxford University Press. Available at: https://www.idsociety.org/practice-guideline/vaccination-of-the-immunocompromised-host/.

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Vaccinations prior to or after solid organ transplant