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Keywords:

  • Immunizations;
  • influenza;
  • live virus vaccines;
  • prevention;
  • vaccines
Abbreviations
HCW

healthcare worker

HPV

human papilloma virus

LAIV

live-attenuated influenza vaccine

MMR

measles, mumps rubella vaccine

TST

tuberculin skin test

VZV

varicella zoster virus

General Principles

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Transplant candidates and recipients are at increased risk of infectious complications of vaccine-preventable diseases. Every effort should be made to ensure that transplant candidates, their household members and healthcare workers have completed the full complement of recommended vaccinations prior to transplantation. Since the response to many vaccines is diminished in organ failure, transplant candidates should be immunized early in the course of their disease.

It is recommended that vaccination status ideally be documented at the pretransplant clinic visit and the patient referred for the appropriate vaccines at the time of listing. Many transplant centers will do routine pretransplant serology for vaccine-preventable diseases such as Hepatitis B, Varicella, measles, mumps and rubella to guide individual vaccine recommendations (Tables 1 and 2).

While every effort should be made to vaccinate prior to transplantation, inactivated vaccines are generally safe after solid organ transplantation. For inactivated vaccines where data are lacking specifically for transplant candidates or recipients, recommendations made by national immunization advisory committees (e.g. the Advisory Committee on Immunization Practices [ACIP] in the United States) for the general population should be followed. There is no evidence to link clinical rejection episodes to vaccination (II-2). This topic is discussed in detail for influenza vaccine, in the specific vaccination section on Influenza [1].

In general live vaccines are not administered after transplantation. Therefore, when possible it is recommended to administer live vaccines such as measles, mumps, rubella (MMR), Varicella vaccine and Zoster vaccine prior to transplantation. For patients who are incompletely or unvaccinated prior to transplant, consultation with an infectious diseases specialist is recommended. If possible, this should be done at the time of pretransplant assessment to allow for sufficient time for vaccine administration.

While the optimal time to give vaccines after transplantation is not known, most centers restart vaccinations at approximately 3–6 months after transplantation when baseline immunosuppression levels are attained. The ability to mount an immune response will be impacted by the type and amount of immunosuppression after organ transplantation. It is unknown whether the type-of-transplant impacts response as this is closely linked with degree of immunosuppression. Accordingly, seroconversion should be documented by serologic assays for those specific vaccines where serologic assays are available and protective titers are known. A minimum of 4 weeks should elapse between vaccine administration and evaluation for seroconversion based on protective titers established in the literature. However, given that serology may not be an accurate measure of immunity in the posttransplant period, developing assays for cellular immunity is an area of research that needs further study in this population (III).

Healthcare Workers, Close Contacts Including Pets

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Healthcare workers and close contacts, such as family members, of transplant recipients should be immunized fully, and in particular should receive influenza vaccine yearly. In general, if inactivated vaccine options are available for household members they are preferred. Influenza vaccination is especially important. It is preferable that HCW and close contacts receive inactivated influenza vaccine; however, if live-attenuated influenza vaccine (LAIV) is the only option, then it can be given with good use of infection prevention precautions such as frequent handwashing for a 2-week period after vaccination. Viral shedding has been reported to be rare more than 11 days after LAIV administration [2]. With the exception of small pox and oral polio vaccines there is little to no risk from the family members or close contacts receiving live vaccines. In fact, it is preferred that household and close contacts be vaccinated against measles, mumps, rubella and varicella to prevent the transplanted patient from having contact with wild type viruses (III). Rotavirus vaccines also pose a theoretical risk of transmission and viral antigen can be detected in stool in 50–90% of infants up to 2 weeks after the first dose [3]. Therefore, good handwashing practices should be used after diaper changes. Pets should also be fully immunized. There is little or no risk of transmission following immunization of pets with live vaccines (e.g. Canine Bordetella bronchiseptica intranasal vaccine; Table 3).

Table 1. Recommendations for immunization of pediatric patients
 Inactivated/ liveRecommendedRecommendedMonitor vaccineQuality
Vaccineattentuated (I/LA)before transplant1after transplanttitersevidence
  1. 1Whenever possible, the complete complement of vaccines should be administered before transplantation. Vaccines noted to be safe for administration after transplantation may not be sufficiently immunogenic after transplantation.

  2. 2Routine vaccine schedule recommended prior to transplant and as early in the course of disease as possible; vaccine poorly immunogenic after transplantation, and accelerated schedules may be less immunogenic. Serial hepatitis B surface antibody titers should be assessed both before and every 6–12 months after transplantation to assess ongoing immunity [28].

  3. 3For children, routine recommendation for all transplant candidates and recipients. In adults, routinely recommended for liver transplant candidates and recipients. Other adults pre-or posttransplant should receive if high risk of exposure (e.g. travel or residence in high-risk areas, occupational or lifestyle risk of exposure). Monitoring indicated only if ongoing risk for exposure, for example with planned travel to high-risk areas.

  4. 4Serologic assessment recommended if available. Haemophilus influenzae type B titer greater than 0.15 mg/L is considered protective in the general population.

  5. 5Serologic assessment recommended if available, see text for additional information.

  6. 6All patients 11–18 years of age, and adults or patients as young as 9 months of age who meet the following criteria: members of the military, travelers to high risk areas, properdin deficient, terminal complement component deficient (including acquired complement deficiency such as prior to starting eculizumab), those with functional or anatomic asplenia, college freshman living on campus. There are no immunogenicity studies in posttransplant patients. For infants and young children, newer vaccination recommendations may become available. Please check local and national recommendations for most up-to-date information.

  7. 7HPV vaccine, see text.

  8. 8Not routinely administered. Recommended for exposures or potential exposures due to vocation.

  9. 9MMR pretransplant, see text. Varicella vaccine should be administered after 12 months of age, and the second vaccine may be given as early as 3 months later. Although not routinely recommended after transplant, live-virus vaccines (MMR and Varivax) have been administered to selected organ transplant recipients on minimal immunosuppression [48]. Vaccination is at the discretion of the individual transplant center with the understanding of the potential risks for live-virus vaccination in this population. In adults, there are reports of disseminated vaccine-strain disease occurring with inadvertent varicella vaccination [49]; also see text.

  10. 10The indications for BCG administration in the United States are limited to instances in which exposure to tuberculosis is unavoidable and where measures to prevent its spread have failed or are not possible.

  11. 11Transplant recipients who are face-to-face contacts of a patient with smallpox should be vaccinated; Vaccinia immune globulin may be administered concurrently if available. Those who have less intimate contact should not be vaccinated.

Influenza [17-21]IYesYesNoII-1
 LASee textNoNoIII
Hepatitis B2[22-28]IYesYesYesII-1
Hepatitis A3 [29, 30]IYesYesYes (see footnote)II-1
PertussisIYesYesNoIII
Diphtheria [31-34]IYesYesNoII
Tetanus [31-34]IYesYesYesII-1
Inactivated Polio vaccine [31]IYesYesNoII-2
H.influenzae4 [35]IYesYesYesII-1
S. pneumoniae5 (conjugate vaccine) [1, 13-15, 36, 37]IYesYesYesII-1
S. pneumoniae5 (polysaccharide vaccine) [1, 13-15, 36, 37]IYesYesYesII-1
N. meningitidis6 [1, 38](MCV4)IYesYesNoIII
Human papillomavirus (HPV)7,IYesYesNoIII
Rabies8IYesYesYes (see footnote)III
Varicella (live-attenuated)9 [39-42]LAYesNoYesII-1
RotavirusLAYesNoNoIII
Measles9 [43-46]LAYesNoYesII-1
Mumps9 [43, 46]LAYesNoYesII-1
Rubella9 [32, 43, 46]LAYesNoYesII-1
BCG10LAYesNoNoIII
Smallpox11 [47]LANoNoNoIII
AnthraxINoNoNoIII
Table 2. Recommendations for immunization of adult patients
 Inactivated/ liveRecommendedRecommendedMonitorQuality
Vaccineattentuated (I/LA)before transplant1after transplantvaccine titersof evidence
  1. 1Whenever possible, the complete complement of vaccines should be administered before transplantation. Vaccines noted to be safe for administration after transplantation may not be sufficiently immunogenic after transplantation.

  2. 2Influenza, see text.

  3. 3Routine vaccine schedule recommended prior to transplant and as early in the course of disease as possible; vaccine poorly immunogenic after transplantation, and accelerated schedules may be less immunogenic. Serial hepatitis B surface antibody titers should be assessed both before and every 6–12 months after transplantation to assess ongoing immunity [28].

  4. 4For children, routine recommendation for all transplant candidates and recipients. In adults, routinely recommended for liver transplant candidates and recipients. Other adults pre-or posttransplant should receive if high risk of exposure (e.g. travel or residence in high-risk areas, occupational or lifestyle risk of exposure). Monitoring indicated only if ongoing risk for exposure, for example with planned travel to high-risk areas.

  5. 5If no tetanus booster in the past 10 years, Tdap should be administered. At least one dose of acellular pertussis should be given in adulthood, with particular attention to women of child-bearing age and individuals with in contact with infants.

  6. 6Serologic assessment recommended if available, see text for additional information.

  7. 7All patients 11–18 years of age, and adults or patients as young as 9 months of age who meet the following criteria: members of the military, travelers to high risk areas, properdin deficient, terminal complement component deficient (including acquired complement deficiency such as prior to starting eculizumab), those with functional or anatomic asplenia, college freshman living on campus. There are no immunogenicity studies in posttransplant patients. For infants and young children, newer vaccination recommendations may become available. Please check local and national recommendations for most up-to-date information.

  8. 8Not routinely administered. Recommended for exposures or potential exposures due to vocation.

  9. 9HPV vaccine, see text.

  10. 10MMR pretransplant, see text. Varicella vaccine should be administered after 12 months of age, and the second vaccine may be given as early as 3 months later. Although not routinely recommended after transplant, live-virus vaccines (MMR and Varivax) have been administered to selected organ transplant recipients on minimal immunosuppression [48]. Vaccination is at the discretion of the individual transplant center with the understanding of the potential risks for live-virus vaccination in this population. In adults, there are reports of disseminated vaccine-strain disease occurring with inadvertent varicella vaccination [49]; also see text.

  11. 11Zoster, see text.

  12. 12The indications for BCG administration in the United States are limited to instances in which exposure to tuberculosis is unavoidable and where measures to prevent its spread have failed or are not possible.

  13. 13Transplant recipients who are face-to-face contacts of a patient with smallpox should be vaccinated; Vaccinia immune globulin may be administered concurrently if available. Those who have less intimate contact should not be vaccinated.

Influenza2 [17-21]IYesYesNoII-2
 LASee textNoNoIII
Hepatitis B3 [22, 23, 26-28]IYesYesYes (see footnote)II-2
Hepatitis A4 [29, 30]IYesYesYesII-1
Tetanus [31-34]IYesYesNoII-2
Pertussis (Tdap)5IYesYesNoIII
Inactivated Polio vaccineIYesYesNoIII
S. pneumoniae6 [13-15, 36]IYesYesYesI
N. meningitidis7 (MCV4)IYesYesNoIII
Rabies8IYesYesYes (see footnote)III
Human papilloma virus (HPV)9IYesYesNoIII
MMR9LAYesNoNoII-2
Varicella (live-attenuated; Varivax)10LAYesNoYesII-2
Varicella (live-attenuated; Zostavax)11LAYesNoNoIII
BCG12LAYesNoNoIII
Smallpox13 [47]LANoNoNoIII
AnthraxINoNoNoIII
Table 3. Immunizations for health care workers and other close contacts/household members of transplant candidates/recipients
 Inactivated/ live Quality
Vaccineattentuated (I/LA)Recommendedof evidence
  1. 1If no tetanus booster in the past 10 years, Tdap should be administered. At least one dose of acellular pertussis should be given in adulthood, with particular attention to women of child-bearing age and individuals with in contact with infants.

InfluenzaIYesII-2
 [17-21]LAYes (see text)III
Hepatitis B [22-28]IYesII-2
Hepatitis A [29, 30]IYesII-1
H. influenzae [35]IYesII-2
Pertussis1 (Tdap)IYesII-2
Varicella [39-42]LAYesII-2
Measles [43-46]LAYesII-2
Mumps [43, 45, 46]LAYesII-2
Rubella [43, 45, 46]LAYesII-2

Specific Vaccines

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

MMR

Outbreaks of measles continue to occur and disease may be acquired during a local outbreak or while travelling. Since MMR vaccine contains live attenuated virus, it is contraindicated posttransplant. Therefore, when possible, MMR serology should be checked prior to transplant and the transplant candidate immunized. In very young infants, the presence of maternal antibody interferes with response to live vaccines. Therefore, MMR is most effective after 1 year of age when maternal antibody has waned. MMR can be administered as early as 6 months of age for pediatric patients who may require transplantation. If transplantation has still not occurred by the time the infant is a year of age and transplant is not anticipated within 4 weeks, MMR should be repeated. The second dose of MMR can be administered as soon as 4 weeks after the first MMR. All children should complete a two-dose MMR series with at least 4 weeks between doses [4]. Seronegative adults should receive one dose of MMR with serologic testing postvaccination. If seroconversion does not occur, the dose can be repeated once if time permits. Of note, blood products such as intravenous immune globulin can interfere with the response to live vaccines. Ideally, MMR (and varicella) vaccine should be delayed for 3 months after the receipt of blood products. In addition, two live vaccines (e.g. MMR and Varicella) can be administered on the same day; however, if not done on the same day, the second live vaccine should be administered ≥28 days later. Since tuberculin skin test (TST) is also part of the pretransplant workup, it should be noted that live vaccines can interfere with the TST response. The TST can be done on the same day as the live vaccine injection; however, if not done on the same day, it should be done 4–6 weeks later.

Varicella Vaccine

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Primary varicella can lead to severe complications in the posttransplant setting. Varicella vaccine is a live attenuated viral vaccine that is indicated prior to transplant in seronegative persons. Therefore, when possible, VZV serology should be checked prior to transplant and the transplant candidate immunized. Similar to MMR vaccine, maternal antibody interferes with response to varicella vaccine and the vaccine is most effective after 1 year of age when maternal antibody has waned. Varicella vaccine can be administered as early as 9 months of age for pediatric patients requiring transplantation. Two doses should be given 4 weeks apart. Seronegative adults should receive one dose of varicella vaccine with serologic testing postvaccination. If seroconversion does not occur, the dose can be repeated once if time permits. Those who do not seroconvert are candidates for postexposure prophylaxis should this occur after transplantation. As with MMR, the same exceptions regarding timing of varicella vaccine with blood products, spacing of two live vaccines, and timing of TST, applies to varicella vaccine. These should be reviewed in the MMR section above. Posttransplant administration of varicella vaccine in pediatric transplant patients has been attempted in a research setting. Accumulating evidence in pediatric transplant recipients suggests that varicella vaccine is safe and immunogenic after transplantation [5]. However, these studies are relatively small in size. In light of these studies, we recommend that at this time, vaccination should be performed only in a carefully controlled setting.

Herpes Zoster Vaccine

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Herpes zoster vaccine is a live-attenuated vaccine that is shown in large randomized trials to prevent shingles and postherpetic neuralgia. It is indicated for persons over age 50 years. It should not be given posttransplant whether or not the transplant recipient is VZV seropositive. Disseminated disease may occur due to poor cellular immunity against the virus. In the pretransplant setting, some centers recommend vaccination; however, there are no data yet to suggest that this will reduce the risk of VZV reactivation posttransplant or whether it will be effective in persons younger than 50 years of age. This is an area for further study. In addition, for patients that have had an episode of shingles, vaccine can be given after the active episode has resolved although the vaccine has been studied for prevention of 1st shingles episodes only. Vaccine effect on prevention of subsequent episodes when given after the first episode of shingles is unknown.

Influenza Vaccine

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Several formulations are now available, including standard-dose intramuscular, high-dose intramuscular, intradermal, adjuvanted and live attenuated [6]. Practitioners should review national guidelines for specific indications for each of these formulations. Not all vaccine formulations have been formally studied in the organ transplant population; most immunogenicity and safety data available are with the standard-dose intramuscular vaccine. However, a recent randomized controlled trial shows similar immunogenicity with high-dose intradermal vaccine compared to standard-dose intramuscular injection in healthy adults [7]. Data using adjuvanted vaccines (ASO3 adjuvant) are primarily derived from univalent A(H1N1)pdm09 vaccine and very limited data are available for other adjuvants (e.g. MF59). Studies using AS03 adjuvanted vaccines show minor increases in HLA alloantibody postvaccination but no increases in rejection rates [8, 9]. These studies are difficult to interpret due to lack of control groups and because they were performed during the 2009 pandemic when infection rates were also high. Live-attenuated vaccines are cold adapted and should not replicate at normal body temperature; however, due to the small theoretical risk of replication, LAIV is not recommended posttransplant [6]. The vaccine has been shown to be safe in HIV and cancer patients but no study has been conducted in organ transplant patients [10, 11]. If a live-attenuated vaccine was to be administered inadvertently to a transplant recipient, antiviral therapy and subsequent revaccination with an inactivated influenza vaccine can be considered (III). LAIV could be given to persons awaiting transplant; however, at least 2 weeks should elapse before transplant.

Since influenza vaccine is recommended annually, timing of vaccination is of particular concern. Studies have shown that vaccine given in the first 6 months posttransplant is poorly immunogenic but is unlikely to pose an increased safety risk. Not vaccinating may leave a transplant recipient vulnerable to infection potentially for an entire influenza season. In the United States, the CMS (Medicare/Medicaid) has recommended that all patients including transplant recipients be immunized prior to discharge from hospital. This may lead to some patients being immunized very early posttransplant and decreased immune response to vaccine. Revaccination 3–6 months after transplant could be considered if still within the seasonal time period for influenza.

HPV Vaccine

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Two formulations of HPV vaccine are available: quadrivalent vaccine and an AS04-adjuvanted bivalent vaccine. Quadrivalent vaccine is recommended for use in males and females 9-26 years and bivalent vaccine in females 9-26 years; however, the quadrivalent vaccine can also be used in women up to the age of 45 years. The vaccine can be given regardless of history of sexual activity. However, since these vaccines are prophylactic and not therapeutic, there is limited or no effect on existing HPV-related lesions. Limited data are available for the immunogenicity of these vaccines in the posttransplant setting. A three-dose vaccine schedule should be given prior to transplant in those who meet the indications. However, if all doses are not completed pretransplant, the additional doses can be resumed starting 3–6 months posttransplant. A small study in adult posttransplant patients suggests suboptimal immunogenicity with quadrivalent vaccine [12]. No data in the transplant setting are available for the bivalent vaccine. This is an area for further study.

Pneumococcal Vaccine

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

Two main formulations are available: a 23-valent polysaccharide vaccine and a 13-valent protein-conjugated vaccine. Protein-conjugated vaccines may produce antibodies of higher avidity and also lead to formation of memory B cells. Therefore, conjugate vaccines are widely studied and are recommended in routine childhood immunization programs including for pediatric transplant recipients. In adults posttransplant, conjugate vaccines produce a similar immunogenicity profile to polysaccharide vaccines [13]. In addition, studies in which the conjugate vaccine is used for priming followed 8 weeks later by a polysaccharide pneumococcal vaccine did not show any additional benefit of polysaccharide vaccine (for the serotypes contained in the conjugate vaccine) and titers were similar with both strategies [14]. Pneumococcal vaccine recommendations for immunocompromised adults are under review by national advisory bodies; recently the ACIP has recommended a prime-boost strategy (conjugate followed by polysaccharide vaccine 8 weeks later). The absolute protective titer for Pneumococcus is unknown and may vary by serotype. Pneumococcal titers should be monitored yearly as they have been reported to decline posttransplant [15].

For children older than 5 years, Pneumovax should be given. Children less than 2 years of age should receive 13-valent conjugate vaccine (Prevnar-13) according to national guidelines. Those 2–5 years (24–71 months) of age should receive pneumococcal vaccine as follows:

Previous doseRecommendations [16]
Unvaccinated or any incomplete schedule (less then three doses)Two doses PCV13 First dose ≥8 weeks after most recent dose Second dose ≥8 weeks later
Any incomplete schedule of three dosesOne dose, ≥8 weeks after most recent dose
Four doses of PCV7 or other age-appropriate completeOne dose PCV13, ≥8 weeks after most recent dose

In addition, children who are transplant candidates and recipients 24–71 months should receive PPV23 at least 8 weeks after completing PCV13 dosing

Vaccines for Travel

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

For transplant recipients who intend to travel to areas of increased risk for infection, immunization status should be reviewed. Both routine vaccinations (e.g. Hepatitis B) and travel-specific vaccinations such as typhoid vaccine should be addressed (see Table 4 for travel vaccinations).

Table 4. Travel vaccine recommendations
 Inactivated/ liveRecommendedRecommendedMonitor vaccineQuality
Vaccineattentuated (I/LA)before transplant/after transplant/titersof evidence
  1. 1Yellow fever vaccination may be required for travel to some countries of Africa and South America, but should be waived if travelers are immunosuppressed. Severely immunosuppressed travelers should be strongly discouraged from travel to destinations that present true risk of yellow fever [37].

  2. 2Oral inactivated vaccine against cholera and Enterotoxigenic E. coli provides short term protection. Not available in the United States.

Yellow fever1 [50]LAYesNoNoIII
Japanese encephalitis [51, 52]IYesYesNoIII
Salmonella typhi [53] (Typhim Vi, intramuscular)IYesYesNoIII
Salmonella typhi (Vivotif, oral)LAYesNoNoIII
Traveler's diarrhea and cholera vaccine (Dukoral)2 [54]IYesYesNoIII

Acknowledgment

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

This manuscript was modified from a previous guideline written by Lara Danziger-Isakov and Deepali Kumar published in the American Journal of Transplantation 2009; 9(Suppl 4): S258–S262, and endorsed by the American Society of Transplantation/Canadian Society of Transplantation.

Disclosure

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr. Kumar receives grant support from Roche, Astellas, and Merck, and has received speaker honoraria from Pfizer.

References

  1. Top of page
  2. General Principles
  3. Healthcare Workers, Close Contacts Including Pets
  4. Specific Vaccines
  5. Varicella Vaccine
  6. Herpes Zoster Vaccine
  7. Influenza Vaccine
  8. HPV Vaccine
  9. Pneumococcal Vaccine
  10. Vaccines for Travel
  11. Acknowledgment
  12. Disclosure
  13. References