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immumisation guidelines 2016

 

Additional Notes

During transplant work up (predialysis or dialysis)

Awaiting transplant  (live donor or on deceased donor list)

Post Renal Transplant on immunosuppression

 

Vaccinate Annually:

Influenza

(eg Influvac, Flurix)

 

One dose annually

One dose annually

Wait 3 months post transplant

 

Check immunization history (including electronic record) and omit if clear evidence of vaccination. If in doubt, vaccinate.

Human Papilloma Virus HPV 4 (Female)

Gardasil)

Give up to 45 years of age

Recommended

                                               

Recommended

 

Recommended

 

Human Papilloma Virus HPV 4 (Male)

Gardasil)

Give up to 45 years of age

Recommended

 

Recommended

 

Recommended

Tdap

(Boostrix)

 

Every 10 years

Every 10 years

Every 10 years

Pneumococcal

PCV 13

(Prevenar13)

If PPV23 has been given wait one year.

Single dose can be given  at any stage

Recommended

                                

Recommended

 

Recommended

 

Pneumococcal polysaccharide

PPV23

At least 8 weeks after PCV13

Recommended

 

Recommended

 

Recommended

 

Meningococcal MCV4-D

(eg Menactra)

2 doses initially then 5 yearly booster

Recommended

Recommended

 

Recommended

Zoster

(eg Zostervax)

Over 50 years only

Recommended >50yrs

Not funded

Contraindicated from 4 weeks prior to transplant

Contraindicated

Haemophilus influenzae type b – Hib

 

Single dose can be given at any stage

Recommended

Recommended

Recommended

 

Check serology:

·         Prior to vaccination - if immune, vaccination not required

·         After vaccination (>4 weeks) – if non-immune,  seek advice

Varicella

 

 

 

Recommended if non immune

 

2 doses 6 weeks apart

Contraindicated from  4 wks prior to transplant

Contraindicated

 

Measles/Mumps/Rubella

 

(MMR)

 

Recommended if non immune to any component

2 doses

Contraindicated from 4 weeks prior to transplant

Contraindicated

 

Hepatitis A

(Havrix)

 

Recommended

Recommended

 

Recommended

 

Hepatitis B

 

Not required if HbsAg +ve or Anti-HBs/HBc +ve

Recommended

 

recommended

recommended

Key

 

Recommended and funded

 

Can be given safely but not funded

 

LIVE VACCINE -  CONTRAINDICATED – DO NOT GIVE,

Re

Notes

GENERAL

·         The term Transplant patient in the Funded vaccines for Special groups in the Immunisation Handbook refers to patients in all stages of the transplant process ie those post transplant, those listed for transplantation, undergoing transplant work up or with deteriorating renal function making this likely in the near future

·          Immunisations should be undertaken prior to transplantation if possible as response may be better and some vaccinations are contraindicated following transplantation.

·         Live vaccines should not be given in the 4 weeks prior to transplant. If a patient is active on the deceased donor list and requires a live vaccine suspend from list for 4 weeks post vaccination.

·         Please refer to the Starship clinical guidelines for recommendations for under 18 years of age at www.starship.org.nz.

·         Reimmunisation is not required  pre transplant if serology is positive (patient is immune).  

·         Specific advice re dosing and route is available in the NZ Immunisation Handbook. This can be found on line at http://www.immune.org.nz/resources.Patients who have received immunoglobulin or other blood products may require time for passive antibodies to decrease prior to immunization. This is only relevant for live vaccines. Suggested time intervals are in the Immunisation Handbook table 1.3

VACCINES

·         Influenza –transplanted patients can receive this from 4 weeks post transplant if at high risk of infection eg during influenza epidemic. Two doses should be given in the first year, separated by 4 weeks. Influenza vaccine for household contacts is strongly recommended but not funded

·         Varicella vaccine is funded for house hold contacts of immunocompromised seronegative adults (including transplant recipients) who cannot receive a live vaccine- refer to the NZ Immunisation Handbook 2014 – Funded vaccines for special groups.

·         PPV 23 should be given at least 8 weeks after PCV 13 with a further dose after 5 years, and a 3rd dose at 65 years old. Consider for patients at increased risk of pneumococcal disease.

·         If PCV 13 is needed then  Menactra can only be given a minimum of 4 weeks later.

·          MMR and Varicella vaccine should either be given at same time, or minimum 4 weeks apart

·         PCV 13 and  Hib are funded for a single dose either pre or post transplant.

·         Dialysis patients who are not being worked up for transplant are eligible for Hepatitis B, Tdap, PCV 13, PPV 23 , Hib, influenza and , meningococcal vaccines if have received or are going to receive  immunosuppression lasting > 28 days.  

 

Name:

Initial Serology

Immunization history

Date(s)  Given

Recheck Serology post immunisation –date and result

Recheck serology 12 months post transplant

Notes

Influenza

 

 

Annual

 

 

 

Tdap

 

 

 

 

 

 

PCV13

 

 

 

 

 

 

PPV23

 

 

 

 

 

 

Varicella

 

 

 

 

 

 

MMR

 

 

 

 

 

 

Zoster

 

 

 

 

 

 

HPV

 

 

 

 

 

 

Menactra

 

 

 

 

 

 

Hepatitis A

 

 

 

 

 

 

Hepatitis B

 

 

 

 

 

 

Hib