| Vaccine type | Vaccine target | Indications |
| Nonlive (inactivated, killed, subunit, or recombinant) | Pneumococcal vaccines | All SOT candidates and recipients not previously vaccinated. Vaccine formulation of choice depends on age, national guidelines, and availability.* |
| Seasonal influenza virus | Annually for all patients ≥6 months old.¶ | |
| Hepatitis B virus | All SOT candidates and recipients who are nonimmune based on serologic testing (eg, HBsAb-negative patients). | |
| Hepatitis A virus | If not previously vaccinated:
| |
| Meningococcus | At-risk patients who have not been previously vaccinated, including those treated with eculizumab and those with impaired splenic function. | |
| 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. | |
| Human papillomavirus | All SOT candidates and recipients not previously vaccinated who meet age-based indications for vaccination. | |
| Tetanus, diphtheria, pertussis (DTaP, Tdap) or tetanus, diphtheria (Td) | All SOT candidates and recipients per guidelines for healthy persons (eg, per routine for children). | |
| Recombinant zoster vaccine (RZV) | SOT candidates and recipients aged ≥19 years old. | |
| COVID-19 vaccinesΔ | All SOT candidates and recipients. Choice of vaccine depends on age, national guidelines, and availability. | |
| Live, attenuated◊ | Zoster vaccine, live (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.§ | |
| Measles, mumps, rubella | 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.HBsAb: hepatitis B virus surface antibody; COVID-19: coronavirus disease 2019; IgG: immunoglobulin G.
* In the United States, children <2 years old should receive the pneumococcal conjugate vaccine (PCV) series, children ≥2 years old should receive both the PCV series and 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 in regard to vaccine selection.
¶ For adults, we prefer the high-dose influenza vaccine as it augments immune response and does not appear to increase the risk of rejection. However, using the standard dose is also acceptable and preferred for children.
Δ 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, 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.