Immunization For Adults Solid Organ Transplant

Adult SOTImmunization for Adult Solid Organ Transplant Candidates and RecipientsRevision Date: September 24, 2021Note: This guide is meant to supplement existing recommendations for routine immunization as outlined in thecurrent Alberta Immunization Policy. See Principles of Immunization in Hematopoietic Stem Cell TransplantRecipients and Solid Organ Transplant Recipients.Inactivated vaccines should be given at least 2 weeks before transplantation and live attenuated vaccines shouldbe given at least 4 weeks prior to transplantation. Consult with an attending physician before providing livevaccines.11. Routine Immunizations – Before TransplantVaccineSeriesCommentsCOVID-192 dosesConsult with primary health care provider or medical specialist prior toimmunization, including timing of when vaccine should be given.Dose 2: 21 to 28 days afterdose 1Dose 3at least 8 weeks after dose2mRNA vaccine is preferentially recommended except in the event of acontraindication.COVID-19 vaccines may be given simultaneously with other inactivatedvaccines.It is recommended a third dose of the COVID-19 vaccine be offered toprovide stronger protection for those who have a suboptimal or waningimmune response to vaccines (Dose 3: at least 8 weeks after the seconddose).dTap or Td3 dosesDose 2: Four weeks afterdose 1Dose 3: Six months afterdose 2dTap booster every 10years.PolioIPV3 dosesDose 2: Four weeksafter dose 1Dose 3: Six monthsafter dose 2.If an adult requires completion of a primary series of Td/dTap, dTapvaccine should be administered. Adults who have not previously receiveda dose of acellular pertussis in adulthood should receive a dose of dTap,followed by dTap boosters every 10 years.Note: If both dTap and polio are indicated, dTap-IPV may be used.Primary immunization with inactivated polio vaccine is recommended forall previously unimmunized SOT candidates and recipients.1Notes: Booster doses of IPV are not necessary for adults living in Canadaexcept for adults at high risk of exposure. Those at higher risk (e.g.,health care workers and laboratory workers) may receive a single lifetimebooster dose.1Immunity screening after immunization is not recommended.Immunization for Adult SOTAlberta Immunization Policy Special Situations for Immunization 2021 Government of Alberta Revision Date: September 24, 2021 Published October 2021 Page 1 of 6

VaccineSeriesCommentsPneumococcalPneu-C13 andPneumo-PPneu-C13 followedby Pneumo-P at leasteight weeks later.There should be at least eight weeks between Pneu-C13 and PneumoP1,2Adults who have already received Pneumo-P should receive Pneu-C13.Pneu-C13 should be administered at least one year after any previouslyadministered dose of Pneumo-P.2,31 re-immunization ofPneumo-PHib5 years after the initialdose of Pneumo-P.1Immunity screening after immunization is not recommended.1 doseOne dose is recommended for candidates/ recipients of SOT five years ofage and older regardless of previous Hib immunization (at least one yearafter any previous dose) 1Immunity screening after immunization is not recommended.MenC-ACYW(18 years to 24years of ageinclusive andthose 25 years ofage and older athigher risk)18 – 24 years ofage*: One dose(unless received as anadolescent at 12 years ofage or older.)1*Booster doses are notindicated.Increased risk: 18years of age andolder.**(Under lying medicalcondition)Two doses eightweeks apartRecommended for individuals: 18 – 24 years of age inclusive Increased risk - 18 years of age and older as listed1: Anatomical or functional asplenia including sickle cell disease HIV infection Congenital complement, properdin, factor D or primary antibodydeficiencies. Acquired complement deficiency e.g. those receiving eculizumab(Soliris ). Laboratory workers routinely exposed to Neisseria meningitides.Note: Provincially funded vaccine is not provided for internationaltravellers. Refer individuals to local travel clinics.Immunity screening after immunization is not recommended.**Booster dose every fiveyears if risk continues.1Increased risk ofexposure(laboratoryworkers):One doseHepatitis BHBVD1Follow the dosageand schedule forhypo-responsiveindividuals forHepatitis B Vaccine.Repeat series ifresponse is less than10 IU/mL after seriescompletion.1Hepatitis AHAVTwo doses:Follow the dosage and schedule for hypo-responsive individuals forHepatitis B Vaccine.Laboratory RecommendationsScreen for anti-HBs within 1 – 6 months after the series is completed. Ifantibody levels are less than 10 IU/L, repeat the series once and retestfor anti-Hbs within 1 – 6 months after the repeat series.1Periodic screening as recommended by the transplant physician takinginto account the severity of the immunocompromised state and whetheror not the risk of hepatitis B is still present.1 Ordering serology and interpretation of the results is theresponsibility of the transplant physician.Only for those considered at high risk: Lifestyle risks of infection, including people engaging in illicit drug use(injectable and non-injectable) and men having sex with men Chronic liver disease and liver transplantationImmunization for Adult SOTAlberta Immunization Policy Special Situations for Immunization 2021 Government of Alberta Revision Date: September 24, 2021 Published October 2021 Page 2 of 6

VaccineSeriesCommentsSecond dose 6 – 12months after the firstdose. Three dosesadministered at0, 2 and 6 months1Immunity screening after immunization is not er a dose of inactivated influenza vaccine annually. Influenzavaccine can be administered as early as three months post-transplant. Solid organ transplant recipients: Live attenuated influenza vaccine(LAIV) is contraindicated. Household contacts: Immunize annually with either inactivatedinfluenza vaccine or live attenuated influenza vaccine.Immunity screening after immunization is not recommended.MMR (onlysusceptibleadults* pretransplant)1One or two doses.MMR must be administered at least four weeks prior to transplant. 1Not recommended post-transplantation*Evidence of Measles Immunity:HumanPapillomavirusVaccineHPVIndividuals receiving repeated replacement of plasma-derived clottingfactors. Workers involved in hepatitis A virus research or production ofhepatitis A vaccine who may be exposed to hepatitis A virus. Zoo-keepers, veterinarians and researchers who handle non-humanprimates. Household /close contacts of children adopted from hepatitis Aendemic countries. Populations/communities at risk of hepatitis A outbreaks or in whichhepatitis A is highly endemic.Note: Provincially funded vaccine is not provided for travellers – referindividuals to local travel clinics.Immunity screening after HAV immunization is not routinelyrecommended.1(18 – 26 years ofage inclusive2)If a second dose isindicated the intervalbetween dosesshould be at leastfour weeks.1(See LaboratoryRecommendations) Individuals born in 1970 or later with a documented history of two doses of measles-containingvaccine OR history of laboratory confirmed measles disease OR laboratory evidence of measles immunity. Individuals born prior to 1970 are generally considered to beimmune. Serology may be recommended by the transplantphysician.Laboratory Recommendations Screen for measles and rubella immunity (IgG) one month after thefirst dose of vaccine. If non-immune and a second dose can be administered, provide asecond dose (after consult with the transplant physician) and repeatscreening in one month. If seroconversion for measles, or rubella has been demonstratedfollowing a dose of MMR, a second dose is not required. However, itis recommended to provide age appropriate MMR if time allows pretransplant.4 Annual screening for immunity is not recommended.Ordering serology and interpretation of the results is the responsibility ofthe transplant physician.Immunization for Adult SOTAlberta Immunization Policy Special Situations for Immunization 2021 Government of Alberta Revision Date: September 24, 2021 Published October 2021 Page 3 of 6

VaccineSeriesCommentsVaricella(chickenpox)1 or 2 doses*Evidence of Immunity: VZ (onlysusceptibleadults* pretransplant)history of two doses of varicella vaccine after 12 months of age ORlaboratory evidence of immunityVaricella must be administered at least four weeks prior totransplantation.2,4Not recommended post-transplantationLaboratory Recommendations Routine screen pre-transplant includes varicella IgG testing toconfirm disease history. Serology is recommended one month after the after one dose of VZvaccine and if seroconversion is demonstrated consider immune (asecond dose is not required). However, it is recommended to providea second dose of varicella vaccine if time allows pre-transplant. If non-immune to provide a second dose of varicella vaccine if timeallows pre-transplant.Ordering serology and interpretation of the results is the responsibility ofthe transplant physician.Herpes-Zoster(Shingles)VaccineAdults 18 years ofage and older.4Shingrix (non-live recombinant Herpes Zoster vaccine)Shingrix is recommended for adult SOT by transplant physicians forthose 18 years of age and older.1,4 This includes individuals who havereceived Zostavax prior to transplant. An interval of one year isrecommended between live attenuated Herpes Zoster vaccine(Zostavax ) and Shingrix .Vaccine should be provided at least 2 weeks prior to transplant as withother inactivated vaccines.4Post-transplant immunization may resume once the individual is onbaseline immunosuppression, usually 6 to 12 months after transplant, andas determined appropriate by the individual’s attending transplantphysician.1,4Immunity screening after immunization is not recommended.Shingrix is available through the provincially funded immunizationprogram.Adults 50 years ofage and older2Zostavax (live attenuated Herpes Zoster vaccine)If Shingrix is contraindicated, Zostavax may be considered pretransplant for individuals with no contraindications to the use of livevaccines and if the vaccine can be administered four weeks or more priorto the transplant.Individuals should discuss the vaccine with their transplant physician.Zostavax is not available through the provincially funded immunizationprogram. It is available by prescription and may be purchased andadministered at local pharmacies.Zostavax is contraindicated post-transplant.Immunity screening after immunization is not recommended.Immunization for Adult SOTAlberta Immunization Policy Special Situations for Immunization 2021 Government of Alberta Revision Date: September 24, 2021 Published October 2021 Page 4 of 6