Silva-Pinto André, Abreu Isabel, Martins António, Bastos Juliana, Araújo Joana, Pinto Ricardo
Infectious Diseases Department, São João Hospital, 4200-319 Porto, Portugal.
Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal.
Vaccines (Basel). 2024 Dec 23;12(12):1449. doi: 10.3390/vaccines12121449.
Haematopoietic stem cell transplantation (HCT) induces profound immunosuppression, significantly increasing susceptibility to severe infections. This review examines vaccinations' necessity, timing, and efficacy post-HCT to reduce infection-related morbidity and mortality. It aims to provide a structured protocol aligned with international and national recommendations. A systematic review of current guidelines and studies was conducted to assess vaccination strategies in HCT recipients. The analysis included the timing of vaccine administration, factors influencing efficacy, and contraindications. Recommendations for pre- and post-transplant vaccination schedules were synthesised, specifically for graft-versus-host disease (GVHD), immunosuppressive therapy, and hypogammaglobulinemia. Vaccination is essential as specific immunity is often lost after HCT. Inactivated vaccines are recommended to commence three months post-transplant, including influenza, COVID-19, and pneumococcal vaccines. Live attenuated vaccines remain contraindicated for at least two years post-transplant and in patients with ongoing GVHD or immunosuppressive therapy. Factors such as GVHD and immunosuppressive treatments significantly impact vaccine timing and efficacy. The review also underscores the importance of pre-transplant vaccinations and ensuring that patients' close contacts are adequately immunised to reduce transmission risks. Implementing a structured vaccination protocol post-HCT is critical to improving patient outcomes. Timely and effective vaccination strategies can mitigate infection risks while addressing individual patient factors such as GVHD and immunosuppression. This review highlights the need for tailored vaccination approaches to optimize immune reconstitution in HCT recipients.
造血干细胞移植（HCT）会引发严重的免疫抑制，显著增加患者对严重感染的易感性。本综述探讨了HCT后疫苗接种的必要性、时机和效果，以降低感染相关的发病率和死亡率。其目的是提供一个符合国际和国家建议的结构化方案。我们对当前的指南和研究进行了系统综述，以评估HCT受者的疫苗接种策略。分析内容包括疫苗接种的时机、影响效果的因素以及禁忌证。综合了移植前和移植后疫苗接种计划的建议，特别是针对移植物抗宿主病（GVHD）、免疫抑制治疗和低丙种球蛋白血症的情况。疫苗接种至关重要，因为HCT后特异性免疫通常会丧失。建议在移植后三个月开始接种灭活疫苗，包括流感疫苗、新冠疫苗和肺炎球菌疫苗。减毒活疫苗在移植后至少两年内以及患有持续性GVHD或接受免疫抑制治疗的患者中仍属禁忌。GVHD和免疫抑制治疗等因素会显著影响疫苗接种的时机和效果。该综述还强调了移植前疫苗接种的重要性，并确保患者的密切接触者得到充分免疫，以降低传播风险。实施HCT后的结构化疫苗接种方案对于改善患者预后至关重要。及时有效的疫苗接种策略可以降低感染风险，同时考虑到个体患者因素，如GVHD和免疫抑制。本综述强调需要采用量身定制的疫苗接种方法，以优化HCT受者的免疫重建。
