Studies have shown that the levels of antibodies to diseases that can be prevented by vaccination decrease during the first few years after a stem cell or bone marrow transplant. The immunities acquired by the patient prior to the transplant are generally lost. This can occur after both allogeneic and autologous transplantation. In addition, while some immunity may be transferred from a donor, this is generally limited and can't be relied upon to prevent infection. Chronic GVHD increases the likelihood that immunity will be lost. Transplant patients are at a higher risk of infection until their immune systems become stronger. Vaccination can protect the transplant patient from infections such as childhood diseases, influenza and pneumococcal pneumonia.
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Transplant patients should definitely NOT receive the smallpox vaccine because it is made from a live virus (vaccinia) and can cause vaccinia infection. It is also important that patients NOT receive the measles, mumps, and rubella (MMR) vaccine until two years post-transplant and at least one year after discontinuing immunosuppressive therapy. The same is true for other live-virus vaccines, such as BCG, oral (Sabine) polio, yellow fever, and typhoid. The Varicella-zoster (chickenpox/shingles) vaccine is currently not generally recommended, pending further research. If the benefits outweigh the risks, it may be given to help prevent chickenpox if the patient doesn't already have antibodies to the chickenpox virus. Also see:
We recommend that patients receive the most common vaccinations one year after their transplant. These include: diphtheria, tetanus, Haemophilus influenzae type B, Streptococcus pneumoniae, Salk poliovirus (inactive virus) and influenza (annually). Children less than 7 years of age should also receive the pertussis vaccine. Hepatitis A and B vaccines may be recommended for certain patients. If blood tests show that immunity has waned, we may recommend additional vaccination doses. Other vaccinations may be recommended on an individual basis by your healthcare provider. Please contact LTFU at 206-667-4415 if you or your healthcare provider has questions about which vaccinations are needed. Patients being treated for chronic GVHD may not develop an adequate immune response to vaccinations. However, even a small increase in immunity is considered valuable for such patients. see:
LTFU physician guidelines
It is strongly recommended that the patient's family members and close contacts be current on vaccinations to help protect the patient from exposure to infectious diseases. However, if a family member or other close contact receives a vaccine using a live virus, you may need to take precautions. For the first year after transplant, or while a patient is receiving immunosuppressive therapy they are at risk of contracting the disease from a person who received a live-virus vaccine within the previous few months. Please contact LTFU at (206) 667-4415 for information on precautions needed if you will be in contact with someone who has received a live-virus vaccine.
Please contact LTFU at (206) 667-4415 regarding specific recommendations related to international travel vaccinations well in advance of your planned travel dates.