Vaccines and Solid Organ Transplants: What You Should Know
Published on in CHOP News
Published on in CHOP News
Vaccines are necessary for three reasons:
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.
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.
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.
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.
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.
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.
Besides getting vaccinated, other ways to help keep a transplant patient safe from illness are: