Vaccinations in kidney transplant recipients: Clearing the muddy waters

Table 1 Recommendations for various vaccines in kidney transplant recipients

Vaccine	Prior to transplant	After transplant	Prior to travel to endemic areas after transplant	Endemic areas	Antibody titers?
Hepatitis A	Yes	Yes	Yes		> 33 mIU/mL is protective
Hepatitis B	Yes	Yes	Yes		> 10 mIU/mL is protective
Pneumococcal	Yes	Yes	No
Meningococcal	Yes	Yes	Yes	Sub-Saharan Africa, India, Philippines, Saudi Arabia
Tdap	Yes	Yes	No
Td	Yes	Yes	No
MMR	Yes	No	No
Varicella zoster	Yes	Only Shingrix may be given post-transplant	No
Influenza	Yes	Yes - avoid live virus	No
Rabies1 only upon exposure	No	No	No
Diphtheria	No	No	Yes1	SE Asia, Hajj travelers to Saudi Arabia
Tick-borne encephalitis	No	No	No (live)		Can follow antibody titers
Japanese encephalitis	No	No	Yes, day 0 and 28	South, South East, and East Asia and part of Western Pacific
Cholera	No	No	Yes, oral killed vaccine	South and South East Asia
Yellow fever	No	No	No,	Sub-Saharan Africa, South America
Typhoid	No	No	Yes, 2 wk prior to travel	South and South East Asia, Africa, Caribbean, Central and South America

¹Re-vaccination required if last vaccination was 10-15 years prior. MMR: Measles, mumps, rubella; TdaP: Tetanus toxoid, reduced diphtheria toxoid, acellular pertussis, Td: Tetanus diphtheria.