Vaccination practices in End Stage Renal Failure and Renal Transplantation; Review of current guidelines and recommendations

Table 1 Vaccination in end stage renal disease and pre-transplant

Vaccine	Live/inactivated	Comments
Hepatitis B	Inactivated	Higher concentration in 3-4 divided doses Check seroconversion after 6-12 wk Repeat dosing if HBsAb titre < 10 IU/L
Pneumococcal	Inactivated	(1) Adults (≥ 19 yr), previously unvaccinated; PCV-13 followed 8 wk later by PPSV-23 (2) Previously vaccinated; Single dose of PCV-13, one year after the last PPSV-23
HPV	Inactivated	All patients aged 9-26 yr
Influenza	Live (LAV)	Contra-indicated
	Inactivated (TIV)	Recommended annually
MMR Rubella	Live	Mandatory for all paediatric patients; 2 doses given 4 wk apart Single dose booster for all sero-negative adult patients For all seronegative female patients of child-bearing age
Varicella	Live attenuated	For all paediatric and adolescent patients, completed 6 wk before transplant
HZV	Live	Recommended for all elderly (> 60 yr) patients Optional for those 50-60 yr with a history of varicella or zoster No evidence of benefit in those < 50 yr
DTP Td/ Tdap	Inactivated Inactivated	For all paediatric patients Td; Formerly (before 2005) recommended to all adult patients as a booster Tdap to all as a one-time dose followed by Td booster every 10 yr
BCG	Live	Routine neonatal vaccination done in Asia, Eastern Europe, Middle East, Africa and South America Elsewhere, recommended children < 5 yr deemed to be at high risk (see text)

HPV: Human papilloma virus; MMR: Mumps and rubella; DTP: Diptheria, tetanus and pertussis; BCG: Bacille Calmette-Guérin; LAV: Live attenuated vaccine; TIV: Trivalent inactivated vaccine.

Table 2 Common vaccinations contra-indicated post-transplant

Vaccine	Remarks
Influenza-Live attenuated	Inactivated is recommended annually
MMR	Recommended pre-transplant to all paediatric patients and sero-negative adult patients
Varicella	Recommended pre-transplant to all paediatric and adolescent recipients
HZV	Recommended pre-transplant to all those > 60 yr and those with a history of varicella or zoster infection (50-60 yr)
BCG	Trials under way for inactivated vaccine-currently not in routine clinical use post-RT
Oral polio vaccine	Inactivated injectable vaccine recommended when indicated
Typhoid	Travel vaccine, not routinely recommended Inactivated variant available for emergency travel

MMR: Mumps and rubella; BCG: Bacille Calmette-Guérin.