Immunization in Hematopoietic Cell Transplantation

Abstract

Our manuscript discusses recommendations about immunization in patients with hematopoietic cell transplantation (HCT). Each of the commonly administered vaccines is reviewed, current knowledge summarized, and areas for additional studies are presented. Some general concepts emerge. Live vaccines represent special risks, and the risks and benefits for each vaccine must be carefully assessed. Live poliovirus vaccine is contraindicated in all immunocompromising conditions, but an acceptable, alternative inactivated vaccine is widely available. Live measles and varicella vaccines have specific indications in HCT recipients, but caution should be exercised in their use. Inactivated vaccines can be generally regarded as safe in immunocompromised individuals, but immunogenicity and potential for protection vary by condition and severity of disease. Immunization appears to succeed best when vaccines can be administered before anticipated immunocompromise or after immunosuppression has ended. Booster doses of vaccine may be indicated in some circumstances where failure of response occurs. Priming of the donor with vaccine prior to harvest also may be an effective method to enhance the immune response in HCT recipients. We should also remember that household exposure to vaccine-preventable diseases poses a risk. Strategies that encourage immunization of susceptible household contacts may partially compensate for poor response to vaccines in the immunodeficient patient.

Key Words:

• immunization
• vaccines