Post‐hematopoietic stem cell transplant immunization practices in the Pediatric Blood and Marrow Transplant Consortium

Abstract

Despite the 2000 CDC guidelines, wide variation in post-HSCT immunization practices still exists. Updated guidelines have been needed, particularly to address the use of the pneumococcal conjugate vaccine. In conjunction with multiple other groups, the CDC recently released new immunization guidelines in October 2009. Additional data are still needed to adequately address the utility of incorporating immunologic parameters with the timing of vaccination after HSCT.

A survey of infectious diseases and vaccination uptake in long‐term hematopoietic stem cell transplant survivors in Australia

“…In this study, the largest ever of Australian long‐term allogeneic HSCT survivors, we found a high incidence of self‐reported VPDs (42%) together with low complete revaccination rates (31%) for recommended inactivated vaccines. While our revaccination rates are poor, they are consistent with international literature and with Australian single centre studies; complete revaccination rates of HSCT survivors range from 20% to 33% . Live attenuated vaccinations were analyzed separately in this study as the recommendation for their use is limited by levels of post‐transplant immunosuppression, and incomplete immune reconstitution in the post‐transplant period which is expected to take at least 24 months.…”

“…While our revaccination rates are poor, they are consistent with international literature and with Australian single centre studies; complete revaccination rates of HSCT survivors range from 20% to 33%. 19,[35][36][37] Live attenuated vaccinations were analyzed separately in this study as the recommendation for their use is limited by levels of post-transplant immunosuppression, and incomplete immune reconstitution in the post-transplant period which is expected to take at least 24 months. Pneumococcal disease occurs more commonly post HSCT compared to the general population.…”

Analysis of factors affecting immune recovery and initial response to tetanus after DTaP vaccination in pediatric allogeneic HSCT patients

“…For individual vaccines, compliance with the CDC guidelines ranged from 22 to 93%. Less than 20% of the centers reported schedules consistent with the 2000 CDC recommendations for both allogeneic and autologous HSCT recipients .…”

Immunization Strategies to Span the Spectrum of Immunocompromised Adults

“…118 Despite attempts to simplify vaccination protocols for post-HSCT patients, studies have shown gaps in implementation of these schedules with many patients not completing recommended vaccine doses post-HSCT. [119][120][121] Before stem cell donation, donors should receive vaccines that are recommended for them based on their age, risk factors, and exposure history. At this time, vaccinations that would be strictly for the benefit of the recipient are not recommended.…”

“…1,5,117 In the future, with increased data on post-HSCT vaccine responses specific to transplant type, chemotherapy, other patient-specific factors, and with input from in-depth immunologic studies, more tailored guidelines are likely. For now, based on past studies showing poor vaccine series completion rates with simplified schedules, [119][120][121] providers should focus on ensuring completion of current schedules. Implementation science studies are needed to address barriers to vaccine series completion.…”