Immunisations

Renal Transplantation Protocol: Immunisations

A. Killed VaccinesPre-TransplantPost-Transplant
Tetanus / diphtheria / inactive polio1Yes
Hepatitis BYesYes
InfluenzaYesYes
Typhoid (inactive polysaccharide vaccine)YesYes
Pneumococcal / Meningococcal / HibYes
Combined Hepatitis A / B (TWINRIX)YesYes
B. Live VaccinesPre-TransplantPost-Transplant
MMR2YesContraindicated
VaricellaYesNot recommended
BCGYesContraindicated
Yellow Fever VaccineYesContraindicated

Notes:

  • There is no risk of infection from vaccines and susceptible contacts.
  • Measles – patients who are immunosuppressed and come into contact with measles should receive HNIG (human normal immunoglobulin) as soon as possible, but within 6 days.
  • Chickenpox – Varicella zoster immunoglobulin (VZIG) is indicated in patients who have had significant exposure to chickenpox or shingles and who have no antibodies to VZ.  VZIG should be given within 7 days of contact.
  • Yellow Fever – patients post-transplant intending to travel to countries where a Yellow Fever vaccination certificate is mandatory should obtain a letter of exemption from a medical practitioner.  (Yellow Fever occurs in tropical Africa and in South America – see WHO website for details.)

Malaria Prophylaxis – up-to-date information on Malaria prophylaxis for a given destination is available from pharmacy.  The following table gives an indication of interactions:


TacrolimusCiclosporin
Choloroquinetacrolimus (CP450 3A4)CyA (CP450 3A4)
ProguanilNo interactions likelyNo interaction
likely
Mefloquinetacrolimus (displacement from plasma
protein)
No interaction
likely
Doxycyclinetacrolimus (CP450 3A4)CyA (CP450 3A4)

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