Immunisations

Renal Transplantation Protocol: Immunisations

A. Killed Vaccines Pre-Transplant Post-Transplant
Tetanus / diphtheria / inactive polio1 Yes
Hepatitis B Yes Yes
Influenza Yes Yes
Typhoid (inactive polysaccharide vaccine) Yes Yes
Pneumococcal / Meningococcal / Hib Yes
Combined Hepatitis A / B (TWINRIX) Yes Yes
B. Live Vaccines Pre-Transplant Post-Transplant
MMR2 Yes Contraindicated
Varicella Yes Not recommended
BCG Yes Contraindicated
Yellow Fever Vaccine Yes Contraindicated

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:

  Tacrolimus Ciclosporin
Choloroquine ↑tacrolimus (CP450 3A4) levels ↑CyA (CP450 3A4)
Proguanil No interactions likely No interaction likely
Mefloquine ↑tacrolimus levels (displacement from plasma protein) No interaction likely
Doxycycline ↑tacrolimus (CP450 3A4) ↑CyA (CP450 3A4)