2014 - Transplant Infectious Disease Conference

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Drugs and Devices

5.3 - Vaccine recommendations for the transplant recipient (pre and post transplant). IDSA just published new guidelines

Presenter: Odile, Launay, Paris, France
Authors: Odile Launay

Solid organ transplant (SOT) recipients are at risk of severe infections and prevention of vaccine preventable infections is a challenging question in immunocompromised populations. Despite evidence that inactivated or sub-unit vaccines are safe and effective among immunocompromised hosts, vaccine coverage remains low in these patients. The goal of the IDSA clinical practice guidelines recently published is to provide primary care and specialty clinicians with evidence-based guidelines for active immunization of immunocompromised patients and their household contacts in order to decrease morbidity and mortality from vaccine preventable infections in immunocompromised patients. The presentation will summarize IDSA recommendations for vaccination of SOT candidates and living donors, SOT recipients, and household contacts.
Living donors should be vaccinated according to the CDC annual schedule but live attenuated vaccine administration should be avoided within 4 weeks of organ donation. Vaccination of living donors solely for the recipient’s benefit is not recommended.

Because response to vaccinations is decreased in patients with end-stage organ disease and in the first 2 to 6 months after transplantation, the vaccines should be given before transplantation, as early as possible during the course of disease and avoided during the 2 to 6 months after transplantation. However, inactivated influenza vaccine can be administered from 1 month after transplantation. Vaccination should not be withheld because of concern about transplant organ rejection.

Live attenuated vaccines should be avoided in solid-organ transplantation recipients. If necessary, they have to be administered at least 4 weeks before transplantation excepted in patients receiving immunosuppression.
Vaccination strategy should include vaccination of household contacts and health care workers at transplant centers.

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