Tetanus vaccines Immunosuppressants

In organ transplant recipients taking immunosuppressants, tetanus vaccines and inactivated polio vaccines produced protective antibody titres. The response to diphtheria vaccine was lower than in healthy controls and the antibody titre had fallen below the protective level by 12 months in 38% of patients in one study, and 24% in another. Note that live polio vaccines are not recommended in immunosuppressed patients (see Live vaccines, below). 

Response to nonliving antigens (tetanus, typhoid, poliomyelitis) is diminished and giving one or two extra doses may be wise. Living vaccines are contraindicated in patients who are immunosuppressed by drug therapy or indeed by disease (AIDS, leukaemia, reticulosis) as there is a risk of serious generalised infection. 

Appropriate immunizations should be a primary consideration in the prevention of infections in HSCT recipients. Immunizations against common bacterial and viral pathogens are timed to avoid periods of severe immunosuppression following HSCT when the protective response to vaccination potentially would be decreased. Current recommendations for immunization of HSCT patients include three doses each of diphtheria-pertussis-tetanus or diphtheria-tetanus, inactivated polio, conjugated H. influenzae type b, and hepatitis B vaccines at 12, 14, and 24 months after transplantation. The 23-valent pneumococcal vaccine should be administered at 12 and 24 months after HSCT, and the influenza vaccine should be administered prior to HSCT, resumed at least 6 months after transplantation, and con-... 

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