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Vaccination After Transplant

General principles

Generally, inactivated vaccines are safe and live vaccines are not. Consult your transplant pharmacist regarding any vaccination.

Use of anti-rejection medications may prevent transplant recipients from mounting an adequate response to vaccination.

Immunization of household contacts of immunosuppressed patients provides important protection; therefore vaccination opportunities for household contacts should not be missed (live vaccines or otherwise). With the exception of smallpox and oral-polio vaccines there is little to no risk to the transplant recipient if household contacts are provided live virus vaccines. Influenza vaccine should be offered to all household contacts of transplant recipient.

Vaccines to avoid (live vaccines)

  • Intranasal Influenza Vaccine (FluMist®)
  • BCG Vaccine
  • Cholera Vaccine “Mutacol®” (Oral Live)
  • Japanese Encephalitis (Chinese source)
  • Measles, Mumps, Rubella (MMR, Priorix®)
  • Oral Typhoid Vaccine (Vivotil®, Vivotif L®)
  • Varicella Vaccine (Varivax®, Varilrix®)
  • Yellow Fever Vaccine (YF-Vax®)
  • Oral Polio Virus Vaccine (OPV) – no longer marketed in Canada

Vaccine booster protocol in solid organ transplant recipients

  • Tetanus/diphtheria every 10 years for life
  • Influenza every year for life
  • Meningococcal conjugate (Menactra®) five years after last dose of polysaccharide vaccine (Menomune®)
  • Pneumococcal – five years after transplantation (once only)

Vaccines Considered Safe

  • Influenza Vaccine (including H1N1 vaccine)
    • EXCEPTION: intranasal influenza vaccine (FluMist®) is a live vaccine and must NOT be given to transplant patients
  • Cholera/ETEC Traveller’s Diarrhea Vaccine “Dukoral®”(Oral Inactive BS-WC)
    • Safe, but may not obtain the expected response
  • Diphtheria toxoid
  • Haemophilus Vaccine
  • Hepatitis A Vaccine, Hepatitis B Vaccine, Hepatitis Combined Vaccine
  • Japanese Encephalitis (Canadian Vaccine)
    • Poor response is expected in immunocompromised individual.
  • Meningococcal Vaccine (Conjugate and Polysaccharide)
  • Pertussis Vaccine
  • Pneumococcal Vaccine (Conjugate and Polysaccharide)
  • Injectable Inactivated Poliovirus Vaccine (IPV)
  • Rabies Vaccine
    • Should be followed by antibody determination to ensure adequate response.
  • Tetanus Toxoid
  • Injectable Typhoid Vaccine
  • Human Papilloma virus vaccine (Gardisil®)

SOURCE: Vaccination After Transplant ( )
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