Vaccines and Solid Organ Transplants: What You Should Know

Why are vaccines important?

Vaccines are necessary for three reasons:

• To prevent common infections: Some diseases are so common in this country that a choice not to get a vaccine is a choice to get infected. Pertussis (whooping cough) is an example.
• To prevent infections that could easily come back: Some diseases are not common in this country but they still occur. Measles and mumps are examples. If vaccination rates in our schools or communities are low, outbreaks of these diseases will happen.
• To prevent infections that are common in other parts of the world: Some diseases have been completely eliminated (polio) or almost eliminated (diphtheria) from this country, but they are still common in other parts of the world. Therefore, outbreaks of these diseases are only a plane ride away.

Are vaccines safe?

Vaccines are held to the highest standards of safety. As a result, they are among the safest things we put into our bodies.

But, how does one define the word safe? If safe means “free from any harm,” then vaccines aren’t 100 percent safe. All vaccines can have side effects. Most side effects are mild, like fever, or tenderness and swelling where the shot is given. But some side effects from vaccines can be severe. For example, in rare cases, the pertussis vaccine may cause an infant to cry for a long period of time, develop a high fever, or have a seizure with the fever. Although these reactions do not cause permanent harm to the child, they can be very scary for parents.

If vaccines cause side effects, wouldn’t it be “safer” to avoid them? The short answer is no. Avoiding vaccines is not a risk-free choice. It is a choice to take a different and much more serious risk of getting the disease. When you consider the risk of vaccines and the risk of diseases, vaccines are the safer choice.

Why is it important to vaccinate a child who will receive a solid organ transplant?

Children who get organ transplants are at higher risk of getting sick from diseases that vaccines prevent, like influenza and chickenpox. And, when children with transplants get sick, they may get sicker than a child who has not had a transplant. This is because after the transplant, their immune system is weak from the medications. The highest risk for illness is in the period right after the transplant, but the risk continues for months to years. Vaccines can help prevent illness and decrease how sick a child becomes if infected. Vaccines may be needed before or after the transplant or both.

Which healthcare provider will help figure out what vaccines a solid organ transplant patient should get?

The transplant team and primary care providers partner to keep transplant patients healthy. Usually the transplant team will answer questions about which vaccines to get, but the primary care provider will give them. In this way, the healthcare providers most familiar with the state of the patient’s immune system can provide guidance, but the primary care providers will know which vaccines were given.

Infectious diseases experts at Children’s Hospital of Philadelphia work closely with the transplant teams and are available to help patients, primary care providers, and the transplant teams with vaccine-related questions.

When is the best time for a child who may be getting a solid organ transplant to receive vaccines?

This depends on several things, such as the age of the child, how soon the transplant needs to occur, and the type of transplant. Vaccines work best if given before a transplant for two reasons. First, the child’s immune system will be stronger before the transplant. Second, some vaccines may need to be delayed for long periods of time after a transplant while the child recovers. So, children should get as many vaccines as they can before the transplant.

Most vaccines take about two to four weeks after they are given to work best. But sometimes, the transplant cannot be delayed that long. When that happens, the medical team will try to give as many vaccines as soon as possible. This way, when the transplant happens, the vaccines will have had time to work. Sometimes, this may mean giving vaccines sooner than they are recommended for other children.

The transplant team will decide which vaccines should be given. These decisions are made with guidance from the Centers for Disease Control and Prevention (CDC), Infectious Diseases Society of America (IDSA), American Society of Transplantation, and other experts.

The transplant teams at Children’s Hospital of Philadelphia believe that all children should receive recommended vaccines to be eligible for a solid organ transplant. Exceptions are only considered if the child has an allergy to a vaccine ingredient or when there is not enough time before the transplant.

Which vaccines should be given before a solid organ transplant?

Inactivated vaccines are made using parts of viruses or bacteria, or from killed viruses. Vaccines made in these ways are safe to give before the transplant no matter when it occurs. But these vaccines work best if given at least two weeks before the transplant to allow enough time for an immune response to develop.

Live, weakened viral vaccines, like the chickenpox and MMR vaccines, are made using viruses that have been weakened in the laboratory. These weakened viruses are less able to grow in people. But, because they can still grow somewhat, the timing of these vaccines is more important. These vaccines should be given a few weeks prior to transplant, if possible.

Which vaccines should be given after a solid organ transplant?

In general, solid organ transplant recipients can safely receive all inactivated vaccines. The transplant team will determine when these vaccines should be given. The schedule is based on when the child is most at risk of getting the disease, when the vaccine will work best, and how soon the transplant may occur.

Live, weakened viral vaccines are often not given after a transplant. The immune systems of some transplant patients might not easily control the live viruses in these vaccines. The risk of this depends on the strength of a patient’s immune system. Patients should talk to their transplant team about whether they can receive this type of vaccine.

Should family members and close contacts of solid organ transplant patients get vaccines?

Yes. It is important to protect transplant patients from illness. Everyone around the patient should be fully vaccinated, especially those living in the same home. Children and adults living with a solid organ transplant patient can safely receive all routinely recommended vaccines and are strongly encouraged to do so. In general, if inactivated vaccine options are available for household members, they are preferred. But, when live, weakened viral vaccines are the only option, persons living in the home should still get vaccinated as the risk of spreading vaccine virus to the transplant patient is small. If a close contact of a transplant patient needs to get a live, weakened viral vaccine, please check with the healthcare provider to see if any special measures should be taken.

What else can close contacts do to protect solid organ transplant patients?

Besides getting vaccinated, other ways to help keep a transplant patient safe from illness are:

• Avoid contact with the patient if you are sick. If someone has a fever or symptoms like a cough, congestion, or rash, they should not have contact with the transplant patient.
• Family members and transplant patients should always wash their hands well, properly wash and cook foods, and avoid sharing toothbrushes and drinking glasses.
• Make sure all pets are fully vaccinated and receive regular veterinary care. Transplant patients should avoid contact with animal droppings, cages and litter boxes.
• Talk with the doctor about any plans to travel, especially outside of the country.
• Keep an open line of communication with the patient’s transplant team. If you have a question about the care of a transplant patient, be sure to ask.