Hematopoietic Stem Cell Transplant (Table 4)
Donors and Patients Before Transplantation
74. The HSCT donor should be current with routinely recommended
vaccines based on age, vaccination history, and exposure history
according to the CDC annual schedule (SR-H), but MMR, MMRV,
VAR, and ZOS administration should be avoided within 4 weeks of
stem cell harvest (WR-VL). Vaccination of the donor for the benefit
of the recipient is NOT recommended (WR-M).
75. Prior to HSCT, candidates should receive vaccines indicated for
immunocompetent persons based on age, vaccination history, and
exposure history according to the CDC annual schedule if they
are not already immunosuppressed (SR-VL to M) and when the
interval to the start of the conditioning regimen is ≥4 weeks for live
vaccines (SR-L) and ≥2 weeks for inactivated vaccines (SR-M).
76. Nonimmune HSCT candidates ≥12 months of age should receive
VAR (as a 2-dose regimen if there is sufficient time) if they are
not immunosuppressed and when the interval to the start of the
conditioning regimen is ≥4 weeks (SR-L).
HSCT Patients Post-transplantation
77. Administer 1 dose of IIV annually (SR-M) to persons ≥6 months of
age starting 6 months after HSCT (SR-M) and starting at 4 months
if there is a community outbreak of influenza as defined by the local
health department (SR-VL). For children 6 months through 8 years
of age who are receiving influenza vaccine for the first time,
2 doses should be administered (SR-L).
78. Administer 3 doses of PCV13 to adults and children starting 3-6
months after HSCT (SR-L). At 12 months after HSCT a dose of
PPSV23 should be given provided the patient does not have chronic
GVHD (SR-L). For patients with chronic GVHD a fourth dose of
PCV13 can be given at 12 months after HSCT (WR-VL).*
79. Administer 3 doses of Hib starting at 6-12 months after HSCT (SR-M).
80. Administer 2 doses of MCV4 starting 6-12 months after HSCT to
persons 11-18 years of age with a booster dose at age 16-18 years
for those receiving the initial post-HSCT dose of vaccine at 11-15
years of age (SR-L).
81. Administer 3 doses of tetanus/diphtheria-containing vaccine
starting 6 months after HSCT (SR-L). For children <7 years of age,
administer 3 doses of DTaP (SR-L). For patients 7 years and older,
administration of 3 doses of DTaP should be considered (WR-VL).*
Alternatively, administer a dose of Tdap followed by either 2 doses of
diphtheria-tetanus vaccine (DT) (WR-M)* or 2 doses of Td (WR-L).
17
