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Year : 2016  |  Volume : 26  |  Issue : 7  |  Page : 19-25

Guidelines for vaccination in kidney transplant recipients

Date of Web Publication27-Apr-2016

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How to cite this article:
. Guidelines for vaccination in kidney transplant recipients. Indian J Nephrol 2016;26, Suppl S1:19-25

How to cite this URL:
. Guidelines for vaccination in kidney transplant recipients. Indian J Nephrol [serial online] 2016 [cited 2022 Dec 5];26, Suppl S1:19-25. Available from:

Kidney transplant recipients are at increased risk of developing infections, including vaccine-preventable diseases. [1] However, some of these vaccines may not be beneficial whereas others could even be harmful to kidney transplant recipients. [2] Under immunosuppression not only could live vaccine strains proliferate unchecked causing vaccine-induced diseases but also the immune response of recipients to the vaccines could be suboptimal, rendering vaccination ineffective, or even futile in certain situations.

The Kidney Disease Improving Global Outcomes (KDIGO) in 2009 brought out comprehensive, evidence-based guidelines for care of kidney transplant recipients including vaccination. [3] This chapter would attempt to endorse those guidelines with comments on the same or modify them if required, based on current literature to suit Indian scenario, with supporting rationale and evidence where available. For most of the supporting evidence for those guidelines adopted from the KDIGO guidelines, the readers are requested to refer to the original document.

  1. Kidney transplant recipients should receive age-appropriate inactivated vaccinations as recommended for general population

    1. Hepatitis B Vaccination should be guided by anti-HBS titers, (measured at least 3 months after completion of vaccination and annually thereafter).
  2. Kidney transplant recipients should not receive live vaccines. If a patient has received a live vaccine, the transplant should be delayed by at least 4 weeks since the time of administration
  3. In general, it is best to wait until the first 3-6 months after kidney transplantation, the period of intense immunosuppression, before attempting vaccination. However, inactivated influenza vaccination can be administered as early as 1 month after kidney transplant to time it before onset of the flu season
  4. Kidney transplant patients should receive ancillary inactivated vaccines based on the risk factors for the respective disease and the propensity to develop these rare infections, especially for vaccines that are neither routinely recommended for general population nor specifically in transplant recipients.

  Rationale and Supporting Evidence Top

Response to vaccination has been shown to be suboptimal in transplant recipients. [1] The pretransplant vaccination history and the seroprotective status would affect the posttransplant vaccination strategies. Hence, detailed vaccination history should be obtained in all kidney transplant recipients at the first visit after kidney transplantation to plan the vaccination schedule if it is not already available.

Timing of vaccination after kidney transplant

Immune responses are suboptimal during the period of intense immunosuppression. The greater the degree of immunosuppression, the poorer is the response to vaccination. In this context, the degree of immunosuppression is best considered from the net state of immunosuppression rather than by the immunosuppressive drug doses and concentrations alone. Considering that the initial 3-6 months are a period of intense immunosuppression after kidney transplantation, it is preferable to avoid vaccinations during this time. [2] After 3-6 months, once maintenance immunosuppressive levels are reached, immunization could be undertaken.

If needed, some vaccines can be given after 2 months of kidney transplantation although the immune response is likely to be muted. [3],[4]

Type of vaccine

Live attenuated vaccines pose considerable risk of unchecked vaccine strain proliferation and vaccine induced diseases in transplant recipients. Live virus vaccines should be administered as early in the course of chronic kidney disease (CKD) as possible. After administration of a live attenuated vaccine, a mandatory minimum waiting period of 4 weeks is necessary before using immunosuppression. [2]

Monitoring immune response to vaccination

Wherever possible, seroconversion should be documented after 4 weeks of completing the course of immunization to ascertain adequacy of protection, and determine need or additional boosters. While on ongoing immunosuppression, it may be prudent to monitor protective antibody levels to time booster doses appropriately.

Monitoring cellular immunity for protection against infections is under research.

Vaccination of health care workers and household contacts

Prevention of infections in kidney transplant should also involve a strategy to vaccinate household contacts and pets with vaccines for preventable diseases. Vaccine-preventable diseases such as Hepatitis B, pneumococcal disease, and especially influenza vaccine should be offered to household contacts of transplant recipients. In general, inactivated vaccines are preferred for vaccination of household contacts.

Administration of live vaccines to household contacts can result in viral shedding, which can potentially result in vaccine-induced infectious disease in the transplant recipient. Hence, care should be taken to avoid live vaccines for household contacts of transplant recipients. Of importance to India is the administration of oral polio vaccine to children in the recipient's household, which can result in virus shedding and potentially result in virus-induced disease in the kidney transplant recipient. However, so far, there have been no documented reports of vaccine-induced poliomyelitis among transplant recipients, possibly due to preexisting immunity against polio among the recipients.

In case only a live attenuated vaccine is available, viral shedding should be considered and preferably the household contacts who have received them should exercise precaution as well as infection prevention measures such as frequent hand-washing and limit contact with the transplant recipient for the first 2 weeks, when viral shedding is likely to be at its peak.

Vaccines of special interest in transplantation

A summary of the various vaccines used in kidney transplant recipients is given in [Table 14].

Table 14: Vaccines in kidney transplantation

Click here to view

Hepatitis B Vaccination

The ideal time to administer Hepatitis B vaccine is before the onset of End stage renal disease. However, many patients do not receive the complete course of vaccination before kidney transplantation.

Kidney transplant recipients who lack protective antibody titers (>10 IU/ml) should receive hepatitis B vaccination. [5],[6],[7],[8] It is preferable that the vaccination be administered at a time of less intense immunosuppression, which is after the first 3 months of kidney transplantation. Protective response to hepatitis B vaccination post solid organ transplant varies widely from 17 to 89%. [9],[10] In view of low immunogenic response, there has been interest in accelerated vaccination schedules [11],[12] although they have not been studied in kidney transplant recipients.

Protective antibody titres against Hepatitis B (Anti HBS) show a rapid decline post kidney transplantation. Hence, Anti HBS titres should be checked every 6-12 months and booster doses should be administered either when the titres fall below 10IU/ml or when it is expected to fall below that level in the next 3-6 months. In addition, it is important to note that the response to booster doses in transplant recipients will be less intense than with general population.

Pneumococcal vaccination

Vaccination with both 23 valent polysaccharide vaccine (PPSV23) and 13 valent conjugate vaccine (PCV13) are safe in kidney transplant recipients. [13],[14],[15] The schedule of immunization with the vaccines is as per the recommended schedule for general adults. The ACIP guidelines suggest the following comprehensive approach for optimal vaccine efficacy among immunocompromised adults: [16]

  • If a patient receives the first dose of PCV13, it should be followed by PPSV23 at about 8 weeks later
  • If patient had received PPSV23 in the past, a PCV13 dose should be administered after at least a year only
  • If a patient who has received PPSV23 requires further doses of PPSV23, it should be administered at least 5 years after the last dose of PPSV23.
For immunocompromised children: [17]

  • Between 2 and 5 years age: Two doses of PCV13 administered 8 weeks apart, followed by the additional dose of PPSV23 should be administered at least 8 weeks after the last dose of PCV13
  • 6-18 years age:

    1. The first dose of PCV13 should be followed by 8 weeks later a dose of PPSV23
    2. If patient had been administered PPSV23, PCV13 should be administered after 8 weeks later.
In the year 2014, ACIP recommended routine use of PCV13 among adults aged ≥65 years. [18] As per this recommendation, both PCV13 and PPV23 should be routinely administered in series to all adults aged ≥65 years. ACIP recommendations for use of PCV13 (high risk) in adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants remain unchanged. The ACIP recommendation was amended in 2015 to simplify the spacing between PCV13 and PPSV23 in adults >65 years. [19] The new recommendation states that the recommended interval for adults receiving PCV13 and PPV23 to be at least 1 year apart, regardless of sequence.

Influenza vaccination

Among the various flu vaccines, the injectable inactivated vaccine is safe in kidney transplant recipients whereas the nasal live attenuated vaccine is contraindicated in the immunocompromised. [20] If an ESRD patient received a live attenuated influenza vaccine, he/she should not be immunosuppressed preferably for the next 4-6 weeks, and at least for not <2 weeks. [20]

After kidney transplantation, routine annual inactivated influenza vaccine administration is recommended in all transplant recipients. [20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30] Immunogenicity of the influenza vaccine in kidney transplant recipients varies widely. [31],[32] This variation could be attributed to the vaccine strain, the time after transplantation, the immunosuppressive regimen, as well as the net state of immunosuppression of the recipient. [1],[31],[33] For example, patients on MMF have a lower seroprotective rate. [31],[32]

Concerns about influenza vaccine triggering an immune response and increase the risk of acute rejections [34],[35] were not substantiated in large scale studies that demonstrated no increase in acute rejection episodes when influenza vaccine was used. [36],[37] In large registry data, influenza vaccine use in transplant recipients was associated with lower rates of allograft loss and death. [27] However, use of adjuvanted Influenza vaccines has been shown to cause a rise in anti-HLA antibodies but not acute rejection episodes. [38],[39] It is, therefore, advisable not to use adjuvanted influenza vaccines in kidney transplant recipients. [20]

Varicella vaccines

Being a live vaccine, this vaccine is contraindicated in kidney transplant recipients. It should be administered at least 4-6 weeks before kidney transplantation. [40] If transplant is emergently indicated in a patient who has received a varicella vaccine recently, he/she should receive peri-transplant prophylaxis with intravenous acyclovir or oral valacyclovir. [2] The Zoster vaccine, composed of a stronger dose of the live attenuated strain, is also contraindicated in kidney transplant recipients. [41]

Human papillomavirus vaccination

HPV vaccination should be completed prior to kidney transplantation. If the vaccination has been initiated pretransplant and could not be completed, additional doses could be administered after 3 months of kidney transplantation when the intensity of immunosuppression is less. [42] Serconversion after kidney transplant is around 50-70%. Unvaccinated kidney transplant recipients who satisfy the following criteria must receive HPV vaccination [43],[44],[45]

  • 9-13 years age girls should be primary target of vaccination. Similar age boys could also be vaccinated
  • Catch-up vaccination can be administered to those men and women between 11-26 years of age who have not been vaccinated previously.
The role of HPV vaccination among male and female kidney transplant recipients may expand in future. [46]

Hepatitis A vaccination

Hepatitis A vaccine is an inactivated subunit vaccine that can be administered in high-risk individuals or a potential to contract the viral infection from food, water, and body fluids of infected individuals. One study has shown reasonable seroprotective rates with the two-dose regimen among solid organ transplant recipient including kidney transplant recipients. [47]

Haemophilus influenzae vaccine

Pediatric transplant recipients are significantly susceptible to haemophilus influenza pneumonia. A study of the Haemophilus influenzae b (HiB) vaccine in adult kidney transplant recipients demonstrated 71% immunogenicity. [48]

Considering that splenectomized individuals and sickle cell disease (SCD) are at high risk of this infection, [45] it is reasonable to consider immunizing CKD patients with SCD and in those undergoing desensitization protocol or ABO incompatible transplantation.

In contrast, children should receive the vaccine as per routine schedule and the immunogenicity can be assessed by a follow up HiB antibody titer after 4 weeks of the vaccination. [2]

Meningococcal vaccine

Kidney transplant recipients at risk of developing meningococcal infection and those who undergo a desensitization protocol transplantation or ABO incompatible transplantation may be reasonably administered the vaccine. [2]

Tetanus vaccine

Among adults, immunization against tetanus with the inactivated tetanus toxoid vaccine should be kept updated. Following the general principles of immunization, adult kidney transplant recipients should undergo a similar updating of their vaccination status based on routine indications and recommendations as for adults. [2] The immunogenicity of tetanus vaccine and its safety in kidney transplant recipients have been supported by several studies. [39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51] Pediatric kidney transplant recipients should be vaccinated according to the regular pediatric schedule of immunization. [2]

Rabies vaccine

Rabies cell culture vaccines are safe in immunocompromised individuals, and kidney transplant recipients should receive rabies vaccine as per recommendations for general population. [2] Although kidney recipients can potentially acquire rabies from the organ donor through donation, [52],[53] currently there is no evidence to recommend vaccination for all potential deceased donor kidney transplant wait-listed patients. While kidney transplant patients who have been bitten by a rabid dog must receive vaccination according to international guidelines, the protective effect may be inadequate [54] and it is prudent to monitor protective immunoglobulin levels and administer additional vaccine doses when indicated. [55],[56]

Polio vaccine

Oral polio vaccine is contraindicated in kidney transplant recipients. [2] Pediatric transplant recipients below the age of 5 years should not participate in the pulse polio campaign to avoid oral polio vaccine strain induced poliomyelitis due to their immunocompromised state. Vaccine strain transmission has been documented from household contacts of immunocompromised individuals; therefore, household contacts of transplant recipients should also not receive oral polio vaccine. [57],[58] Injectable inactive polio vaccine is safe and effective and pediatric kidney transplant recipients should be vaccinated according to the regular schedule of immunization for polio. [57]

Typhoid vaccine

Live oral typhoid vaccine Ty21a is contraindicated in transplant recipients and their household contacts. [4],[59] Instead, killed Vi polysaccharide vaccine can be administered when indicated. [33] Typhoid vaccine is recommended as per routine indications in the country.

Cholera vaccine

Oral live cholera vaccine is contraindicated in kidney transplant recipients. [4],[58] The new indigenous vaccine from India (VA 1.4) developed by the National Institute of Cholera and Enteric Diseases in Kolkata is a live oral vaccine that should not be used in transplant recipients. [60],[61] The killed and subunit vaccine is considered safe in immunocompromised patients although its immunogenicity of the vaccine in transplant recipients in unclear. [62]

Yellow fever vaccine

The live attenuated Yellow fever vaccine is contraindicated in kidney transplant recipients. [2],[4] Although a case series has suggested that there was no important side effects in that cohort of solid organ transplanted patients. [63] Travel to endemic regions is best avoided. If unavoidable, travelers should take precautionary measures and carry a letter from physician stating the contraindication to vaccination with the stamp of an approved yellow fever immunization center. [64] However, some countries may deny entry without immunization.[85]

  References Top

Gangappa S, Kokko KE, Carlson LM, Gourley T, Newell KA, Pearson TC, et al. Immune responsiveness and protective immunity after transplantation. Transpl Int 2008;21:293-303.  Back to cited text no. 1
Danziger-Isakov L, Kumar D; AST Infectious Diseases Community of Practice. Vaccination in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:311-7.  Back to cited text no. 2
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009;9 Suppl 3:S1-155.  Back to cited text no. 3
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:e44-100.  Back to cited text no. 4
Jacobson IM, Jaffers G, Dienstag JL, Tolkoff-Rubin NE, Cosimi AB, Delmonico F, et al. Immunogenicity of hepatitis B vaccine in renal transplant recipients. Transplantation 1985;39:393-5.  Back to cited text no. 5
Krishnamurthy G, Kher V, Naik S. Immunogenicity and efficacy of hepatitis B vaccination in Indian chronic renal failure patients on hemodialysis and after renal transplantation. Nephron 1996;74:424-5.  Back to cited text no. 6
Krishnamurthy K, John GT, Abraham P, Jacob CK. Granulocyte macrophage colony stimulating factor augmented hepatitis B vaccine protocol for rapid seroprotection in voluntary kidney donors. Indian J Med Res 2004;119:162-4.  Back to cited text no. 7
Lefebure AF, Verpooten GA, Couttenye MM, De Broe ME. Immunogenicity of a recombinant DNA hepatitis B vaccine in renal transplant patients. Vaccine 1993;11:397-9.  Back to cited text no. 8
Grob PJ, Binswanger U, Zaruba K, Joller-Jemelka HI, Schmid M, Häcki W, et al. Immunogenicity of a hepatitis B subunit vaccine in hemodialysis and in renal transplant recipients. Antiviral Res 1983;3:43-52.  Back to cited text no. 9
Serrano B, Bayas JM, Bruni L, Díez C. Solid organ transplantation and response to vaccination. Vaccine 2007;25:7331-8.  Back to cited text no. 10
Domínguez M, Bárcena R, García M, López-Sanroman A, Nuño J. Vaccination against hepatitis B virus in cirrhotic patients on liver transplant waiting list. Liver Transpl 2000;6:440-2.  Back to cited text no. 11
Villeneuve E, Vincelette J, Villeneuve JP. Ineffectiveness of hepatitis B vaccination in cirrhotic patients waiting for liver transplantation. Can J Gastroenterol 2000;14 Suppl B: 59B-62B.  Back to cited text no. 12
Kumar D, Rotstein C, Miyata G, Arlen D, Humar A. Randomized, double-blind, controlled trial of pneumococcal vaccination in renal transplant recipients. J Infect Dis 2003;187:1639-45.  Back to cited text no. 13
Kumar D, Chen MH, Wong G, Cobos I, Welsh B, Siegal D, et al. A randomized, double-blind, placebo-controlled trial to evaluate the prime-boost strategy for pneumococcal vaccination in adult liver transplant recipients. Clin Infect Dis 2008;47:885-92.  Back to cited text no. 14
Kumar D, Welsh B, Siegal D, Chen MH, Humar A. Immunogenicity of pneumococcal vaccine in renal transplant recipients - Three year follow-up of a randomized trial. Am J Transplant 2007;7:633-8.  Back to cited text no. 15
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2012;61:816-9.  Back to cited text no. 16
Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6-18 years with immunocompromising conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2013;62:521-4.  Back to cited text no. 17
Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged >65 years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014;63:822-5.  Back to cited text no. 18
Available from: [Last accessed on 2016 Jan 25 at 1300 hrs].  Back to cited text no. 19
Kumar D, Blumberg EA, Danziger-Isakov L, Kotton CN, Halasa NB, Ison MG, et al. Influenza vaccination in the organ transplant recipient: Review and summary recommendations. Am J Transplant 2011;11:2020-30.  Back to cited text no. 20
Azevedo LS, Gerhard J, Miraglia JL, Precioso AR, Tavares Timenetsky MD, Agena F, et al. Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors. Transpl Infect Dis 2013;15:612-8.  Back to cited text no. 21
Birdwell KA, Ikizler MR, Sannella EC, Wang L, Byrne DW, Ikizler TA, et al. Decreased antibody response to influenza vaccination in kidney transplant recipients: A prospective cohort study. Am J Kidney Dis 2009;54:112-21.  Back to cited text no. 22
Cowan M, Chon WJ, Desai A, Andrews S, Bai Y, Veguilla V, et al. Impact of immunosuppression on recall immune responses to influenza vaccination in stable renal transplant recipients. Transplantation 2014;97:846-53.  Back to cited text no. 23
Crespo M, Collado S, Mir M, Cao H, Barbosa F, Serra C, et al. Efficacy of influenza A H1N1/2009 vaccine in hemodialysis and kidney transplant patients. Clin J Am Soc Nephrol 2011;6:2208-14.  Back to cited text no. 24
Fairhead T, Hendren E, Tinckam K, Rose C, Sherlock CH, Shi L, et al. Poor seroprotection but allosensitization after adjuvanted pandemic influenza H1N1 vaccine in kidney transplant recipients. Transpl Infect Dis 2012;14:575-83.  Back to cited text no. 25
Fernández-Ruiz M, Lumbreras C, Arrazola MP, López-Medrano F, Andrés A, Morales JM, et al. Impact of squalene-based adjuvanted influenza vaccination on graft outcome in kidney transplant recipients. Transpl Infect Dis 2015;17:314-21.  Back to cited text no. 26
Hurst FP, Lee JJ, Jindal RM, Agodoa LY, Abbott KC. Outcomes associated with influenza vaccination in the first year after kidney transplantation. Clin J Am Soc Nephrol 2011;6:1192-7.  Back to cited text no. 27
Nailescu C, Xu X, Zhou H, Hall H, Wilson AC, Leiser JD, et al. Influenza vaccine after pediatric kidney transplant: A Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 2011;26:459-67.  Back to cited text no. 28
Ott U, Sauerbrei A, Lange J, Schäfler A, Walther M, Wolf G, et al. Serological response to influenza A H1N1 vaccine (Pandemrix® ) and seasonal influenza vaccine 2009/2010 in renal transplant recipients and in hemodialysis patients. Med Microbiol Immunol 2012;201:297-302.  Back to cited text no. 29
Zand MS. Safety and efficacy of influenza vaccination in renal transplant recipients. Nat Clin Pract Nephrol 2008;4:358-9.  Back to cited text no. 30
Scharpé J, Evenepoel P, Maes B, Bammens B, Claes K, Osterhaus AD, et al. Influenza vaccination is efficacious and safe in renal transplant recipients. Am J Transplant 2008;8:332-7.  Back to cited text no. 31
Sanchez-Fructuoso AI, Prats D, Naranjo P, Fernández-Pérez C, González MJ, Mariano A, et al. Influenza virus immunization effectivity in kidney transplant patients subjected to two different triple-drug therapy immunosuppression protocols: Mycophenolate versus azathioprine. Transplantation 2000;69:436-9.  Back to cited text no. 32
Blumberg EA, Albano C, Pruett T, Isaacs R, Fitzpatrick J, Bergin J, et al. The immunogenicity of influenza virus vaccine in solid organ transplant recipients. Clin Infect Dis 1996;22:295-302.  Back to cited text no. 33
Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: What clinicians need to know. Am J Transplant 2008;8:9-14.  Back to cited text no. 34
Blumberg EA, Fitzpatrick J, Stutman PC, Hayden FG, Brozena SC. Safety of influenza vaccine in heart transplant recipients. J Heart Lung Transplant 1998;17:1075-80.  Back to cited text no. 35
Kimball P, Verbeke S, Flattery M, Rhodes C, Tolman D. Influenza vaccination does not promote cellular or humoral activation among heart transplant recipients. Transplantation 2000;69:2449-51.  Back to cited text no. 36
Candon S, Thervet E, Lebon P, Suberbielle C, Zuber J, Lima C, et al. Humoral and cellular immune responses after influenza vaccination in kidney transplant recipients. Am J Transplant 2009;9:2346-54.  Back to cited text no. 37
Brakemeier S, Schweiger B, Lachmann N, Glander P, Schönemann C, Diekmann F, et al. Immune response to an adjuvanted influenza A H1N1 vaccine (Pandemrix(®)) in renal transplant recipients. Nephrol Dial Transplant 2012;27:423-8.  Back to cited text no. 38
Katerinis I, Hadaya K, Duquesnoy R, Ferrari-Lacraz S, Meier S, van Delden C, et al. De novo anti-HLA antibody after pandemic H1N1 and seasonal influenza immunization in kidney transplant recipients. Am J Transplant 2011;11:1727-33.  Back to cited text no. 39
Geel A, Zuidema W, van Gelder T, van Doornum G, Weimar W. Successful vaccination against varicella zoster virus prior to kidney transplantation. Transplant Proc 2005;37:952-3.  Back to cited text no. 40
Pergam SA, Limaye AP; AST Infectious Diseases Community of Practice. Varicella zoster virus in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:138-46.  Back to cited text no. 41
Chin-Hong PV, Kwak EJ; AST Infectious Diseases Community of Practice. Human papillomavirus in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:189-200.  Back to cited text no. 42
Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, et al. Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2014;63:1-30.  Back to cited text no. 43
Petrosky E, Bocchini JA Jr, Hariri S, Chesson H, Curtis CR, Saraiya M, et al. Use of 9-valent human papillomavirus (HPV) vaccine: Updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 2015;64:300-4.  Back to cited text no. 44
Centers for Disease Control. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedules for persons aged 0 through 18 years and adults aged 19 years and older - United States, 2013. Morb Mortal Wkly Rep Surveill Summ 2013;62 Suppl 1:1.  Back to cited text no. 45
Kwak EJ, Julian K; AST Infectious Diseases Community of Practice. Human papillomavirus infection in solid organ transplant recipients. Am J Transplant 2009;9 Suppl 4:S151-60.  Back to cited text no. 46
Stark K, Günther M, Neuhaus R, Reinke P, Schröder K, Linnig S, et al. Immunogenicity and safety of hepatitis A vaccine in liver and renal transplant recipients. J Infect Dis 1999;180:2014-7.  Back to cited text no. 47
Sever MS, Yildiz A, Eraksoy H, Badur S, Yüksel-Onel D, Görçin B, et al. Immune response to Haemophilus influenzae type B vaccination in renal transplant recipients with well-functioning allografts. Nephron 1999;81:55-9.  Back to cited text no. 48
Enke BU, Bökenkamp A, Offner G, Bartmann P, Brodehl J. Response to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients. Transplantation 1997;64:237-41.  Back to cited text no. 49
Girndt M, Pietsch M, Köhler H. Tetanus immunization and its association to hepatitis B vaccination in patients with chronic renal failure. Am J Kidney Dis 1995;26:454-60.  Back to cited text no. 50
Krüger S, Müller-Steinhardt M, Kirchner H, Kreft B. A 5-year follow-up on antibody response after diphtheria and tetanus vaccination in hemodialysis patients. Am J Kidney Dis 2001;38:1264-70.  Back to cited text no. 51
Bronnert J, Wilde H, Tepsumethanon V, Lumlertdacha B, Hemachudha T. Organ transplantations and rabies transmission. J Travel Med 2007;14:177-80.  Back to cited text no. 52
Srinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, Sutker WL, Ksiazek TG, et al. Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med 2005;352:1103-11.  Back to cited text no. 53
Kopel E, Oren G, Sidi Y, David D. Inadequate antibody response to rabies vaccine in immunocompromised patient. Emerg Infect Dis 2012;18:1493-5.  Back to cited text no. 54
Rodríguez-Romo R, Morales-Buenrostro LE, Lecuona L, Escalante-Santillán N, Velasco-Villa A, Kuzmin I, et al. Immune response after rabies vaccine in a kidney transplant recipient. Transpl Infect Dis 2011;13:492-5.  Back to cited text no. 55
WHO Publication. Rabies vaccines: WHO position paper - Recommendations. Vaccine 2010;28:7140-2.  Back to cited text no. 56
Burroughs M, Moscona A. Immunization of pediatric solid organ transplant candidates and recipients. Clin Infect Dis 2000;30:857-69.  Back to cited text no. 57
Duchini A, Goss JA, Karpen S, Pockros PJ. Vaccinations for adult solid-organ transplant recipients: Current recommendations and protocols. Clin Microbiol Rev 2003;16:357-64.  Back to cited text no. 58
Pirofski LA, Casadevall A. Use of licensed vaccines for active immunization of the immunocompromised host. Clin Microbiol Rev 1998;11:1-26.  Back to cited text no. 59
Kanungo S, Sen B, Ramamurthy T, Sur D, Manna B, Pazhani GP, et al. Safety and immunogenicity of a live oral recombinant cholera vaccine VA1.4: A randomized, placebo controlled trial in healthy adults in a cholera endemic area in Kolkata, India. PLoS One 2014;9:e99381.  Back to cited text no. 60
Mahalanabis D, Lopez AL, Sur D, Deen J, Manna B, Kanungo S, et al. A randomized, placebo-controlled trial of the bivalent killed, whole-cell, oral cholera vaccine in adults and children in a cholera endemic area in Kolkata, India. PLoS One 2008;3:e2323.  Back to cited text no. 61
Jelinek T, Kollaritsch H. Vaccination with Dukoral against travelers' diarrhea (ETEC) and cholera. Expert Rev Vaccines 2008;7:561-7.  Back to cited text no. 62
Azevedo LS, Lasmar EP, Contieri FL, Boin I, Percegona L, Saber LT, et al. Yellow fever vaccination in organ transplanted patients: Is it safe? A multicenter study. Transpl Infect Dis 2012;14:237-41.  Back to cited text no. 63
Gershman M, Staples J. Yellow fever. In: Centers for Disease Control and Prevention, editor. Health Information for International Travel . New York: Oxford University Press, The Yellow Book 2014.  Back to cited text no. 64
Gomez-Lobo V, Whyte T, Kaufman S, Torres C, Moudgil A. Immunogenicity of a prophylactic quadrivalent human papillomavirus L1 virus-like particle vaccine in male and female adolescent transplant recipients. Pediatr Transplant 2014;18:310-5.  Back to cited text no. 65
Broyer M, Tete MJ, Guest G, Gagnadoux MF, Rouzioux C. Varicella and zoster in children after kidney transplantation: Long-term results of vaccination. Pediatrics 1997;99:35-9.  Back to cited text no. 66
Furth SL, Hogg RJ, Tarver J, Moulton LH, Chan C, Fivush BA; Southwest Pediatric Nephrology Study Group. Varicella vaccination in children with chronic renal failure. A report of the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 2003;18:33-8.  Back to cited text no. 67
Webb NJ, Fitzpatrick MM, Hughes DA, Brocklebank TJ, Judd BA, Lewis MA, et al. Immunisation against varicella in end stage and pre-end stage renal failure. Trans-Pennine Paediatric Nephrology Study Group. Arch Dis Child 2000;82:141-3.  Back to cited text no. 68
Chaves Tdo S, Lopes MH, de Souza VA, Dos Santos Sde S, Pereira LM, Reis AD, et al. Seroprevalence of antibodies against varicella-zoster virus and response to the varicella vaccine in pediatric renal transplant patients. Pediatr Transplant 2005;9:192-6.  Back to cited text no. 69
Zostavax in Renal Transplant Patients. Identifier NCT01137669. Available from: [Last accessed on 2015 Oct 25].  Back to cited text no. 70
Safety and Immunogenicity of Zostavax Vaccine in Patients Undergoing Living Donor Kidney Transplantation. Identifier: NCT00940940. Available from: [Last accessed on 2015 Oct 25].  Back to cited text no. 71
Günther M, Stark K, Neuhaus R, Reinke P, Schröder K, Bienzle U. Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients. Transplantation 2001;71:477-9.  Back to cited text no. 72
Balloni A, Assael BM, Ghio L, Pedrazzi C, Nebbia G, Gridelli B, et al. Immunity to poliomyelitis, diphtheria and tetanus in pediatric patients before and after renal or liver transplantation. Vaccine 1999;17:2507-11.  Back to cited text no. 73
Pedrazzi C, Ghio L, Balloni A, Panuccio A, Foti M, Edefonti A, et al. Duration of immunity to diphtheria and tetanus in young kidney transplant patients. Pediatr Transplant 1999;3:109-14.  Back to cited text no. 74
Nkowane BM, Wassilak SG, Orenstein WA, Bart KJ, Schonberger LB, Hinman AR, et al. Vaccine-associated paralytic poliomyelitis. United States: 1973 through 1984. JAMA 1987;257:1335-40.  Back to cited text no. 75
Flynn JT, Frisch K, Kershaw DB, Sedman AB, Bunchman TE. Response to early measles-mumps-rubella vaccination in infants with chronic renal failure and/or receiving peritoneal dialysis. Adv Perit Dial 1999;15:269-72.  Back to cited text no. 76
Turner A, Jeyaratnam D, Haworth F, Sinha MD, Hughes E, Cohen B, et al. Measles-associated encephalopathy in children with renal transplants. Am J Transplant 2006;6:1459-65.  Back to cited text no. 77
Grange JM. Complications of bacille Calmette-Guérin (BCG) vaccination and immunotherapy and their management. Commun Dis Public Health 1998;1:84-8.  Back to cited text no. 78
Cramer CH nd, Shieck V, Thomas SE, Kershaw DB, Magee JC, Lopez MJ. Immune response to rabies vaccination in pediatric transplant patients. Pediatr Transplant 2008;12:874-7.  Back to cited text no. 79
Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of vaccines and immune globulins for persons with altered immunocompetence. MMWR Recomm Rep 1993;42:1-18.  Back to cited text no. 80
National Center for Immunization and Respiratory Diseases. General recommendations on immunization - Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60:1-64.  Back to cited text no. 81
Engels EA, Bennish ML, Falagas ME, Lau J. Typhoid fever vaccines. Vaccine 2000;18:1433-4.  Back to cited text no. 82
Takahashi H, Pool V, Tsai TF, Chen RT Adverse events after Japanese encephalitis vaccination: Review of post-marketing surveillance data from Japan and the United States. The VAERS Working Group. Vaccine 2000;18:2963-9.  Back to cited text no. 83
Kurane I, Takasaki T. Immunogenicity and protective efficacy of the current inactivated Japanese encephalitis vaccine against different Japanese encephalitis virus strains. Vaccine 2000;18 Suppl 2:33-5.  Back to cited text no. 84
Dropulic LK, Rubin RH, Bartlett JG. Smallpox vaccination and the patient with an organ transplant. Clin Infect Dis 2003;36:786-8.  Back to cited text no. 85


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