Vaccination of Cancer and Transplant PTS Receiving Chemotherapya
| Use in Indicated Pts | |||
|---|---|---|---|
| Vaccine | Intensive Chemotherapy | Hodgkin's Disease | Hematopoietic Stem Cell Transplantation |
| Diphtheria-tetanusb | Primary series and boosters as necessary | No special recommendation | Three doses given 6-12 months after transplantation |
| Poliomyelitisc | Complete primary series and boosters | No special recommendation | Three doses given 6-12 months after transplantation |
| Haemophilus influenzae type b conjugate | Primary series and booster for children | Single dose for adults | Three doses given 6-12 months after transplantation (separated by 1 month) |
| HPV | Quadrivalent HPV vaccine is approved for males and females 9-26 years of age. Check CDC website (www.cdc.gov/vaccines) for updated recommendations. | Quadrivalent HPV vaccine is approved for males and females 9-26 years of age. Check CDC website (www.cdc.gov/vaccines) for updated recommendations. | Quadrivalent HPV vaccine is approved for males and females 9-26 years of age. Check CDC website (www.cdc.gov/vaccines) for updated recommendations. |
| Hepatitis A | As indicated for normal hosts on the basis of occupation and lifestyle | As indicated for normal hosts on the basis of occupation and lifestyle | As indicated for normal hosts on the basis of occupation and lifestyle |
| Hepatitis B | Same as for normal hosts | As indicated for normal hosts on the basis of occupation and lifestyle | Three doses given 6-12 months after transplantation |
PCV13 PPSV23d | Finish series prior to chemotherapy if possible | Pts with splenectomy should receive PPSV23. | Three doses of PCV13, beginning 3-6 months after transplantation, are followed by a dose of PPSV23 at least 8 weeks later. A second PPSV23 dose can be given 5 years later. |
| Quadrivalent meningococcal vaccinee | Should be administered to splenectomized pts and to pts living in endemic areas, including college students in dormitories | Should be administered to splenectomized pts and to pts living in endemic areas, including college students in dormitories. An additional dose can be given after 5 years. | Should be administered to splenectomized pts and to pts living in endemic areas, including college students in dormitories. An additional dose can be given after 5 years. |
| Influenza | Seasonal immunization | Seasonal immunization | Seasonal immunization (A seasonal dose is recommended and can be given as early as 4 months after transplantation; if given <6 months after transplantation, an additional dose is recommended.) |
| Measles/mumps/rubella | Contraindicated | Contraindicated during chemotherapy | After 24 months in pts without graft-versus-host disease |
| Varicella-zoster virusf | Contraindicatedg | Contraindicated | Contraindicated (CDC recommends use on a case-by-case basis following reevaluation.) |
aThe latest recommendations by the Advisory Committee on Immunization Practices and the CDC guidelines can be found at http://www.cdc.gov/vaccines.
bA single dose of tetanus-diphtheria-acellular pertussis (TDaP), followed by a booster dose of tetanus-diphtheria (Td) every 10 years, is recommended for adults.
cLive-virus vaccine is contraindicated; inactivated vaccine should be used.
dTwo types of vaccine are used to prevent pneumococcal disease. A conjugate vaccine active against 13 serotypes (13-valent pneumococcal conjugate vaccine, or PCV13) is currently administered in three separate doses to all children. A polysaccharide vaccine active against 23 serotypes (23-valent pneumococcal polysaccharide vaccine, or PPSV23) elicits titers of antibody lower than those achieved with the conjugate vaccine, and immunity may wane more rapidly. Because the ablative chemotherapy given to recipients of hematopoietic stem cell transplants eradicates immunologic memory, revaccination is recommended for all such pts. Vaccination is much more effective once immunologic reconstitution has occurred; however, because of the need to prevent serious disease, pneumococcal vaccine should be administered 6-12 months after transplantation in most cases. Because PPSV23 includes serotypes not present in PCV13, recipients of stem cell transplants should receive a dose of PPSV23 at least 8 weeks after the last dose of PCV13. Although antibody titers from PPSV23 clearly decay, experience with multiple doses of PPSV23 is limited, as are data on the safety, toxicity, or efficacy of such a regimen. For this reason, the CDC currently recommends the administration of one additional dose of PPSV23 at least 5 years after the last dose to immunocompromised pts, including transplant recipients, as well as pts with Hodgkin's disease, multiple myeloma, lymphoma, or generalized malignancies. Beyond this single additional dose, further doses are not recommended at this time.
eMeningococcal conjugate vaccine MenACWY is recommended for adults ≤55 years old, and meningococcal polysaccharide vaccine (MPSV4) is recommended for those ≥56 years old.
fIncludes both varicella vaccine for children and zoster vaccine for adults.
gContact the manufacturer for more information on use in children with acute lymphocytic leukemia.
Abbreviations: CDC, Centers for Disease Control and Prevention; HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV, pneumococcal polysaccharide vaccine.