Immunisations in adult end stage kidney disease –
Recommendations 2015
Additional Notes
During transplant work up
(pre-dialysis or dialysis)
Awaiting transplant (live
donor or on deceased
donor list)
Post Renal
Transplant on
immunosuppression
One dose annually
One dose annually
Wait 3 months
post- transplant
Vaccinate Annually:
Influenza
(eg Influvac, Flurix)
Check immunisation history (including electronic record) and omit if clear evidence of vaccination. If in doubt, vaccinate.
Human Papilloma Virus HPV 4
(Female)
(Gardasil)
Human Papilloma Virus HPV 4
(Male)
(Gardasil)
Tdap
(Boostrix)
Pneumococcal
PCV 13
(Prevenar13)
Pneumococcal polysaccharide
PPV23
Meningococcal MCV4-D
(eg Menactra)
Give up to 45 years of age
Recommended
Recommended
Recommended
Give up to 45 years of age
Recommended
Recommended
Recommended
Every 10 years
Every 10 years
Every 10 years
Recommended
Recommended
Recommended
Recommended
Not funded
Recommended
Recommended
Not funded
Recommended
Recommended
Not funded
Recommended
If PPV23 has been given
wait one year
Single dose can be given at
any stage
2 doses initially then 5
yearly booster
Reviewed by: National Renal Transplant Leadership Team Strategic Group on 27 November 2015
Next review due: November 2016
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Additional Notes
Zoster
(eg Zostervax)
Haemophilus influenzae type b
– Hib
Over 50 years only
Single dose can be given at
any stage
During transplant work up
(pre-dialysis or dialysis)
Recommended >50 years
Not funded
Recommended
Awaiting transplant (live
donor or on deceased
donor list)
Contraindicated from 4
weeks prior to transplant
Recommended
Post Renal
Transplant on
immunosuppression
Contraindicated
Contraindicated from 4
weeks prior to transplant
Contraindicated
Contraindicated from 4
weeks prior to transplant
Contraindicated
Recommended
Recommended
Recommended
Recommended
Recommended
Check serology:
1) Prior to vaccination - if immune vaccination not required
2) After vaccination (>6 weeks) – if non-immune, seek advice
Varicella
Recommended if non
immune
2 doses 6 weeks apart
Recommended if non
immune
2 doses
Recommended
Measles/Mumps/Rubella
(MMR)
Hepatitis A
(Havrix)
Hepatitis B
Not required if HbsAg +ve
or Anti-HBs/HBc +ve
Recommended
Key
Recommended and funded
Can be given safely but not funded
LIVE VACCINE - CONTRAINDICATED – DO NOT GIVE
Notes
General
1. Live vaccines should not be given in the 4 weeks prior to transplant. If a patient is active on the deceased donor list and requires a live
vaccine suspend from list for 4 weeks post vaccination.
National Renal Transplant Service | Immunisations in adult end stage kidney disease – Recommendations 2015
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2. Please refer to the Starship guideline for Paediatric recommendations.
3. Re-immunisation is not required pre-transplant if serology is positive (patient is immune).
4. Specific advice re dosing and route is available in the NZ Immunisation Handbook. This can be found online at
http://www.immune.org.nz/resources.
5. The term Transplant patient, in the Funded vaccines for Special groups chapter of the Immunisation Handbook, refers to patients in all
stages of the transplant process, i.e. those post-transplant, those listed for transplantation, undergoing transplant work up or with
deteriorating renal function making this likely in the near future.
6. Immunisations should be undertaken prior to transplantation if possible, as response may be better and some vaccinations are
contraindicated following transplantation.
7. Patients who have received immunoglobulin or other blood products may require time for passive antibodies to decrease prior to
immunisation. This is only relevant for live vaccines. Suggested time intervals are in the Immunisation Handbook table 1.3.
Vaccines
1. Influenza –transplanted patients can receive this from 4 weeks post-transplant if at high risk of infection, e.g. during influenza epidemic.
Two doses should be given in the first year, separated by 4 weeks.
2. Varicella is funded for household contacts of immunocompromised seronegative adults, including transplant recipients, who cannot receive
a live vaccine (refer to the NZ Immunisation Handbook 2014 – Funded vaccines for special groups).
3. PPV 23 should be given at least 8 weeks after PCV 13 with a further dose at 5 years, and a third dose at 65 years old. Consider for patients
at increased risk of pneumococcal disease.
4. If PCV 13 is given, Menactra can only be given a minimum of 4 weeks later to maximize immune response. MMR and VZV should either be
given at same time, or minimum 4 weeks apart
5. PCV 13 and Hib are funded for a single dose either pre or post-transplant.
6. Dialysis patients who are not being worked up for transplant are still eligible for Hepatitis B, Tdap, PCV 13, Hib, influenza and additionally
meningococcal vaccines if also on immunosuppression lasting > 28 days.
National Renal Transplant Service | Immunisations in adult end stage kidney disease – Recommendations 2015
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