22
Special Populations
95. SOT candidates 6-11 months of age can receive MMR if they are
not receiving immunosuppression and transplantation is not
anticipated within 4 weeks (WR-VL). If transplantation is delayed
(and the child is not receiving immunosuppression), MMR should be
repeated at 12 months of age (SR-M).
96. VAR should be administered to SOT candidates without evidence
of varicella immunity (as defined in recommendation 16) if they
are not receiving immunosuppression and transplantation is not
anticipated within 4 weeks (SR-M). VAR can be administered to
varicella-naive SOT candidates 6-11 months of age who are not
immunosuppressed provided the timing is ≥4 weeks prior to
transplant (WR-VL).* Optimally, 2 doses should be administered
≥3 months apart (SR-L).
97. SOT candidates age ≥60 years (SR-M) and varicella-positive (as
defined in recommendation 22) candidates ages 50-59 years
(WR-L)* who are not severely immunocompromised should receive
ZOS if transplantation is not anticipated within 4 weeks.
SOT Recipients
98. Vaccination should be withheld from SOT recipients during
intensified immunosuppression including the first 2-month
post-transplant period because of the likelihood of inadequate
response (SR-L), except that IIV can be administered ≥1 month after
transplant during a community influenza outbreak (WR-VL).
99. Standard age-appropriate inactivated vaccine series should be
administered 2-6 months after SOT based on the CDC annual
schedule (SR-L to M), including IIV (SR-M) (Table 5).
100. PCV13 should be administered starting 2-6 months after SOT if
not administered before SOT, with timing based on the degree
of immunosuppression of the individual patient, as described in
recommendations 27a-c (Table 5) (SR-VL to M).
101. For SOT patients ≥2 years of age, 1 dose of PPSV23 should be
administered starting 2-6 months after SOT with timing based on the
degree of immunosuppression of the individual patient, and
≥8 weeks after indicated doses of PCV13, if not given within 5 years and
if patient has received no more than 1 previous lifetime dose (SR-M).
102. HepB should be considered for chronic hepatitis B-infected recipients
starting 2-6 months after liver transplant in an attempt to eliminate
the lifelong requirement for hepatitis B immune globulin (WR-L).*
103. MMR and VAR should generally not be administered to SOT
recipients because of insufficient safety and effectiveness data
(SR-L), except for VAR in children without evidence of immunity (as
defined in recommendation 15) who are renal or liver transplant
recipients and are receiving minimal or no immunosuppression and
have no recent graft rejection (WR-M).*
104. Vaccination should not be withheld because of concern about
transplant organ rejection (SR-M).
