| Vaccine | Pre-HCT | Post-HCT |
| Recommendation | Recommendation; earliest time post-transplant; number of doses | |
| Haemophilus influenzae b conjugate | U | R; six months; three doses |
| Hepatitis A | U | R; six months; two doses |
| Hepatitis B | U | R; six months; three doses |
| DTaP, DT, Td, Tdap | U | R: age <7 years: DTaP; six months; three doses |
| R: age ≥7 years: DTaP*; six months; three doses OR one dose Tdap, then two doses DT* or Td; six months | ||
| Human papillomavirus | U: age 11 to 26 years | U; six months; three doses |
| Influenza-inactivated (inactivated influenza vaccine) | U | R; four months |
| Influenza-live attenuated (live attenuated influenza vaccine) | X | X |
| Measles, mumps, and rubella-live | U¶ | XΔ |
| Measles, mumps, and rubella-varicella-live | U¶ | XΔ◊ |
| Meningococcal conjugate | U | R: age 11 to 18 years; six months; two doses |
| Pneumococcal conjugate | R§ | R; three months; three doses |
| Pneumococcal polysaccharide (PPSV23) | R§ | R; ≥12 months post-transplant if no GVHD¥ |
| Polio-inactivated (inactivated poliovirus vaccine) | U | R; three months; three doses |
| Rotavirus-live | X | X |
| Varicella-live | U¶ | X◊ |
| Zoster-live (ZVL)‡ | U¶†: age ≥50 years* | X |
| X | ||
| Recombinant zoster vaccine (RZV)[1] | U: age ≥18 years | R** |
| COVID-19 (SARS-CoV-2) vaccine[2] | R¶¶ | R¶¶ |
HCT: hematopoietic cell transplant; U: usual – administer if patient not current with recommendations for dose(s) of vaccine for immunocompetent persons in risk and age categories; R: recommended – administer if not previously administered or current; such patients may be at increased risk for this vaccine-preventable infection; DT: diphtheria toxoid, tetanus toxoid; DTaP: diphtheria toxoid, tetanus toxoid, acellular pertussis; Td: tetanus toxoid, reduced diphtheria toxoid; Tdap: tetanus toxoid, reduced diphtheria toxoid, and reduced acellular pertussis; X: contraindicated; GVHD: graft-versus-host disease; COVID-19: coronavirus disease 2019; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
* Indicates recommendation for a course of action that deviates from recommendations of the Advisory Committee on Immunization Practices (ACIP) and United States Centers for Disease Control and Prevention (CDC).
¶ These live vaccines should not be administered unless the vaccine is otherwise indicated based on the annually updated CDC recommendations AND the patient is not immunosuppressed AND there will be an interval of ≥4 weeks prior to transplant.
Δ Administer to adolescents and adults (strong, low) and to children (strong, moderate) if measles seronegative, the timing is ≥24 months after transplant, no GVHD is present, and the patient is not receiving immunosuppressive medication. Two doses should be administered.
◊ Administer if varicella seronegative, the timing is ≥24 months after transplant, no GVHD is present, the patient is not receiving immunosuppressive medication, and at least 8 months have elapsed since the last dose of intravenous immunoglobulin (IVIG). Two doses should be administered (strong, low).
§ If not previously administered.
¥ PPSV23 administration is indicated for recipients of the 10-valent pneumococcal conjugate vaccine (PCV10), the 13-valent pneumococcal conjugate vaccine (PCV13), or the 15-valent pneumococcal conjugate vaccine (PCV15). For recipients of the 20-valent pneumococcal conjugate vaccine (PCV20), PPSV23 is no longer recommended.
‡ Live-attenuated zoster vaccine is no longer available in the United States. ZVL should only be used if RZV is not available.
† Consider if the patient is not severely immunosuppressed 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[3] AND there will be an interval of ≥4 weeks prior to transplant.
** Refer to UpToDate content on zoster vaccination for details on vaccine timing and dosing.
¶¶ Refer to UpToDate content on COVID-19 vaccination for details on vaccine selection, timing, and dosing.Modified 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/.
