Re-immunization schedule

After a Stem Cell Transplant the patient is likely to lose some or all of the natural, or man-made disease immunities they used to have. Quite simply this is because the high dose chemotherapy killed off many or all of the antibody producing, and memory cells responsible for conferring immunity upon us.

Although getting new immunizations is not required it is well advised since many of the childhood diseases we thought were behind us could rear their ugly head again. You can have your blood titres done to find our which ones are really required and which are not.

Webmasters note: 18 months after my SCT in 2002 I had all my titres done (see results below) As you can see by my titres many of of my vaccinations were not required. I had them done anyway just to be sure.

The following recommendations are adapted by Sunnybrook Regional Cancer Centre in Toronto from the Fred Hutchinson Cancer Centre, and the American Society for Blood and Marrow Transplantation, and they apply to both Autologous and allogeneic transplant patients. Other cancer centres could very well have a different schedule.

Patients can be tested beforehand to find out which vaccines are needed and which ones are not required due to adequate antibody levels in the blood. The tests for these is a simple blood test known as a titre. The following vaccines only need to be given if the titres show a lowered or absent level of protective antibodies for the disease mentioned.

12 MONTHS AFTER TRANSPLANT

• Inactivated poliovirus (IPV) 1st dose
• Hepatitis B vaccine 1st dose
• Tetanus / diphtheria (TD) 1st dose
• Pertussis (< 7 yr. old children) 1st dose
• Haemophilus Influenza Type B 1st dose
• Pneumococal vaccine (Pneumovax) 1st dose
• Influenza (standard flu) vaccine every fall

14 MONTHS AFTER TRANSPLANT

• Inactivated poliovirus (IPV) 2nd dose
• Hepatitis B vaccine 2nd dose
•  Tetanus / diphtheria (TD) 2nd dose
• Pertussis (< 7 yr. old children) 2nd dose
• Haemophilus Influenza Type B 2nd dose
• Pneumococal vaccine (Pneumovax) 2nd dose
• Influenza vaccine 2nd dose

16 MONTHS AFTER TRANSPLANT

• Inactivated poliovirus (IPV) 3rd dose
• Hepatitis B vaccine 3rd dose
• Tetanus / diphtheria (TD) 3rd dose
• Pertussis (< 7 yr. old children) 3rd dose
• Haemophilus Influenza Type B 3rd dose

2 YEARS AFTER TRANSPLANT

• Measles, Mumps and Rubella (MMR) IF the patient is off all immunosuppressive therapy. Do not give if patient has active GVHD or is pregnant.

ADDITIONAL NOTES

1. Antibody titres normal: For patients with normal prevaccination antibody levels to tetanus, diphtheria, strep, pneumonia, haemophilus, one vaccine (booster) is give for each vaccine. If preimmunization level to Hepatitis B surface antibody is positive, no additional Hepatitis B vaccine is given.

2. Immunization of household contacts: The household members and the immunocompromised individual in particular must be carefully counselled to avoid exposure to fecal-oral contamination, essentially by practising good personal hygiene. If polio vaccine needs to be given to household members within the patients first year after transplantation we strongly recommend the inactivated vaccine be used. If the oral vaccine is given, close contact between the household member and transplant recipient should be avoided for approximately 2 months after vaccination. If a household member receives the varicella vaccine and then develops lesions, the transplant recipient needs to be isolated while the lesions are still present.

3. Live virus vaccination: Live virus vaccines (oral polio vaccine - OPV, measles, mumps rubella, BCG, yellow fever, and smallpox) carry risk in immunocompromised hosts and should be avoided. Measles, mumps and rubella should not be given within the first two years post-transplant nor any time the patient continues on immunosuppressive therapy, or has active graft versus host disease (GVHD). At the present time we do not recommend routine use of varicella vaccine in this population until other information is available.