What vaccinations are contraindicated in patients undergoing Hematopoietic Stem Cell Transplant (HSCT)?

From the Guidelines

Stem cell transplant patients should avoid live vaccines due to their compromised immune systems, and specifically contraindicated vaccines include measles-mumps-rubella (MMR), varicella (chickenpox), zoster (shingles), oral polio, yellow fever, smallpox, BCG, oral typhoid, and intranasal influenza vaccines, as stated in the most recent study 1. These live vaccines contain weakened but viable pathogens that could potentially cause serious or fatal infections in immunocompromised transplant recipients. The contraindication is strongest in the immediate post-transplant period and while patients remain on immunosuppressive medications. Inactivated vaccines are generally safe but may produce suboptimal immune responses. Vaccination timing is critical - most centers recommend waiting at least 6-12 months post-transplant before administering any vaccines, with live vaccines typically delayed for 24 months or longer and only given if the patient is no longer immunosuppressed and shows evidence of immune reconstitution, as recommended in 1. Some key points to consider include:

• Live vaccines are contraindicated in HSCT patients with active GVHD or ongoing immunosuppression, as stated in 1 and 1.
• Inactivated vaccines, such as the influenza vaccine, can be administered 6 months after HSCT, as recommended in 1 and 1.
• Family members and close contacts of transplant patients should also avoid live virus vaccines that shed, particularly oral polio and intranasal influenza, to prevent transmission to the vulnerable patient, as stated in 1 and 1. It is essential to follow the guidelines and recommendations from reputable sources, such as the IDSA and ECIL, to ensure the best possible outcomes for stem cell transplant patients, as mentioned in 1, 1, and 1.

From the Research

Vaccinations Contraindicated in Stem Cell Transplant Patients

• Live attenuated vaccines are generally contraindicated in stem cell transplant patients due to their immunosuppressed state 2, 3
• Specific live attenuated vaccines that are contraindicated include:
  • Varicella zoster vaccine (live attenuated) 2, 3
  • Measles, mumps, and rubella vaccine (live attenuated) in adult stem cell transplant recipients or those with a recent history of allograft rejection 2, 4
• However, there is emerging evidence to support the use of specific live attenuated vaccines, such as measles, mumps, and rubella, in pediatric liver or kidney transplant recipients who are on low-level maintenance immunosuppression and without recent history of allograft rejection 2
• Inactivated subunit varicella zoster virus vaccine may be a safer alternative for immunocompromised individuals, including transplant recipients, and is currently awaiting US Food and Drug Administration approval 2

Special Considerations

• Vaccination timing and administration should be carefully considered in stem cell transplant patients, taking into account their underlying disease, therapy received, time since transplant, and complications such as graft-versus-host disease 5
• Household contacts of stem cell transplant recipients should be vaccinated per the Advisory Committee on Immunization Practices schedule and recommendations to prevent transmission of vaccine-preventable diseases 2