{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:17:00Z","timestamp":1776273420235,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background\/Objectives: Haematopoietic stem cell transplantation (HCT) induces profound immunosuppression, significantly increasing susceptibility to severe infections. This review examines vaccinations\u2019 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. Methods: 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. Results: 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\u2019 close contacts are adequately immunised to reduce transmission risks. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/vaccines12121449","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T05:58:27Z","timestamp":1734933507000},"page":"1449","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Vaccination After Haematopoietic Stem Cell Transplant: A Review of the Literature and Proposed Vaccination Protocol"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2077-3356","authenticated-orcid":false,"given":"Andr\u00e9","family":"Silva-Pinto","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, S\u00e3o Jo\u00e3o Hospital, 4200-319 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"}]},{"given":"Isabel","family":"Abreu","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, S\u00e3o Jo\u00e3o Hospital, 4200-319 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"}]},{"given":"Ant\u00f3nio","family":"Martins","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, S\u00e3o Jo\u00e3o Hospital, 4200-319 Porto, Portugal"},{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"}]},{"given":"Juliana","family":"Bastos","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"},{"name":"Haematology Department, S\u00e3o Jo\u00e3o Hospital, 4200-319 Porto, Portugal"}]},{"given":"Joana","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"},{"name":"Haematology Department, S\u00e3o Jo\u00e3o Hospital, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6234-4827","authenticated-orcid":false,"given":"Ricardo","family":"Pinto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal"},{"name":"Haematology Department, S\u00e3o Jo\u00e3o Hospital, 4200-319 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"ref_1","unstructured":"Khaddour, K., Hana, C.K., and Mewawalla, P. (2024, December 18). Hematopoietic Stem Cell Transplantation, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK536951\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/164_2021_544","article-title":"Immune Suppression in Allogeneic Hematopoietic Stem Cell Transplantation","volume":"272","author":"Michniacki","year":"2022","journal-title":"Handb. Exp. Pharmacol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e200","DOI":"10.1016\/S1473-3099(18)30600-5","article-title":"Vaccination of haemopoietic stem cell transplant recipients: Guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)","volume":"19","author":"Cordonnier","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jtct.2023.11.009","article-title":"Facilitators and Barriers to Successful Revaccination After Hematopoietic Stem Cell Transplantation Among Adult Survivors: A Scoping Review","volume":"30","author":"Wickline","year":"2024","journal-title":"Transpl. Cell Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1016\/j.vaccine.2011.02.018","article-title":"Vaccination of allogeneic haematopoietic stem cell transplant recipients: Report from the international consensus conference on clinical practice in chronic GVHD","volume":"29","author":"Hilgendorf","year":"2011","journal-title":"Vaccine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1182\/blood-2015-12-550475","article-title":"How I vaccinate blood and marrow transplant recipients","volume":"127","author":"Carpenter","year":"2016","journal-title":"Blood"},{"key":"ref_7","unstructured":"(2024, May 14). Alberta Immunization Policy|Special Situations for Immunization|Immunization for Adult Hematopoietic Stem Cell Transplant (HSCT) Recipients. Available online: https:\/\/open.alberta.ca\/dataset\/aip\/resource\/c74197ab-4f13-4052-9dce-73ab84c3314f\/download\/AIP-Adult-HSCT.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"110320","DOI":"10.1016\/j.clim.2024.110320","article-title":"Limitations in the clinical utility of vaccine challenge responses in the evaluation of primary antibody deficiency including Common Variable Immunodeficiency Disorders","volume":"266","author":"Ameratunga","year":"2024","journal-title":"Clin. Immunol."},{"key":"ref_9","unstructured":"Freitas, G., Marques, J.G., Santos, L.A., Vaz, L.R., Cal\u00e9, M.E., and Fernandes, T. (2024, December 18). Programa Nacional de Vacina\u00e7\u00e3o 2020, Available online: https:\/\/www.sns24.gov.pt\/tema\/vacinas\/programa-nacional-de-vacinacao\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/cid\/civ287","article-title":"Immunogenicity, safety, and tolerability of 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine in recipients of allogeneic hematopoietic stem cell transplant aged \u22652 years: An open-label study","volume":"61","author":"Cordonnier","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jinf.2022.11.005","article-title":"Joint consensus statement on the vaccination of adult and paediatric haematopoietic stem cell transplant recipients: Prepared on behalf of the British society of blood and marrow transplantation and cellular therapy (BSBMTCT), the Children\u2019s cancer and Leukaemia Group (CCLG), and British Infection Association (BIA)","volume":"86","author":"Miller","year":"2023","journal-title":"J. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1182\/bloodadvances.2021004629","article-title":"Vaccine response following anti-CD20 therapy: A systematic review and meta-analysis of 905 patients","volume":"5","author":"Vijenthira","year":"2021","journal-title":"Blood Adv."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pochon, C., and Voigt, S. (2018). Respiratory Virus Infections in Hematopoietic Cell Transplant Recipients. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.03294"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.bbmt.2015.11.015","article-title":"Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index","volume":"22","author":"Kmeid","year":"2016","journal-title":"Biol. Blood Marrow Transpl."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.ccm.2022.11.012","article-title":"Coronavirus Disease-2019 in the Immunocompromised Host","volume":"44","author":"Bertini","year":"2023","journal-title":"Clin. Chest Med."},{"key":"ref_16","first-page":"e45602","article-title":"The Safety and Effectiveness of mRNA Vaccines Against SARS-CoV-2","volume":"15","author":"Jamous","year":"2023","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s13045-022-01300-9","article-title":"Immune response to vaccination against SARS-CoV-2 in hematopoietic stem cell transplantation and CAR T-cell therapy recipients","volume":"15","author":"Wu","year":"2022","journal-title":"J. Hematol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"9687","DOI":"10.1007\/s00520-022-07376-w","article-title":"mRNA-1273 SARS-CoV-2 vaccine safety and COVID-19 risk perception in recently transplanted allogeneic hematopoietic stem cell transplant recipients","volume":"30","author":"Albiol","year":"2022","journal-title":"Support. Care Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.vaccine.2018.11.053","article-title":"Long-term pneumococcal vaccine immunogenicity following allogeneic hematopoietic stem cell transplantation","volume":"37","author":"Langedijk","year":"2019","journal-title":"Vaccine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1086\/598324","article-title":"Randomized study of early versus late immunization with pneumococcal conjugate vaccine after allogeneic stem cell transplantation","volume":"48","author":"Cordonnier","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7203a1","article-title":"Pneumococcal Vaccine for Adults Aged \u2265 19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023","volume":"72","author":"Kobayashi","year":"2023","journal-title":"MMWR. Recomm. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yahiaoui, R.Y., Bootsma, H.J., Heijer, C.D.J.D., Pluister, G.N., Paget, W.J., Spreeuwenberg, P., Trzcinski, K., and Stobberingh, E.E. (2018). Distribution of serotypes and patterns of antimicrobial resistance among commensal Streptococcus pneumoniae in nine European countries. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3341-0"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"793","DOI":"10.15585\/mmwr.mm7336a2","article-title":"Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices\u2014United States, 2024","volume":"73","author":"Kobayashi","year":"2024","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_24","unstructured":"ECDC (2024, May 14). Invasive Meningococcal Disease\u2014Annual Epidemiological Report for 2021. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/MEN%20AER%202021.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1038\/sj.bmt.1700768","article-title":"A randomized comparison between early and late vaccination with tetanus toxoid vaccine after allogeneic BMT","volume":"19","author":"Parkkali","year":"1997","journal-title":"Bone Marrow Transpl."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.bbmt.2007.05.009","article-title":"Allografted recipients immunized against hepatitis B virus are at high risk of gradual surface antibody (HbsAb) disappearance post transplant, regardless of adoptive immunity transfer","volume":"13","author":"Kaloyannidis","year":"2007","journal-title":"Biol. Blood Marrow Transpl."},{"key":"ref_27","first-page":"1700857","article-title":"Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016","volume":"24","author":"Curran","year":"2019","journal-title":"Eurosurveillance"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"698","DOI":"10.15585\/mmwr.mm6832a3","article-title":"Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices","volume":"68","author":"Meites","year":"2019","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Munoz-Quiles, C., Lopez-Lacort, M., Diez-Domingo, J., and Orrico-Sanchez, A. (2020). Herpes zoster risk and burden of disease in immunocompromised populations: A population-based study using health system integrated databases, 2009-2014. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05648-6"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1001\/jama.2019.9053","article-title":"Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell Transplantation: A Randomized Clinical Trial","volume":"322","author":"Bastidas","year":"2019","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/QCO.0000000000000845","article-title":"Adjuvanted recombinant zoster vaccine in solid organ transplant and hematopoietic stem-cell transplant recipients","volume":"35","author":"Eberhardt","year":"2022","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e14109","DOI":"10.1111\/tid.14109","article-title":"Vaccine schedule recommendations and updates for patients with hematologic malignancy post-hematopoietic cell transplant or CAR T-cell therapy","volume":"25","author":"Reynolds","year":"2023","journal-title":"Transpl. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e321","DOI":"10.1016\/j.bbmt.2019.07.034","article-title":"Preventing Measles in Immunosuppressed Cancer and Hematopoietic Cell Transplantation Patients: A Position Statement by the American Society for Transplantation and Cellular Therapy","volume":"25","author":"Pergam","year":"2019","journal-title":"Biol. Blood Marrow Transpl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1007\/s00277-016-2711-1","article-title":"Infectious diseases in allogeneic haematopoietic stem cell transplantation: Prevention and prophylaxis strategy guidelines 2016","volume":"95","author":"Ullmann","year":"2016","journal-title":"Ann. Hematol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1056\/NEJMoa2209604","article-title":"Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults","volume":"388","author":"Papi","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1056\/NEJMoa2213836","article-title":"Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults","volume":"388","author":"Walsh","year":"2023","journal-title":"N. Engl. J. Med."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/12\/1449\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:58:20Z","timestamp":1760115500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/12\/12\/1449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["vaccines12121449"],"URL":"https:\/\/doi.org\/10.3390\/vaccines12121449","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]}}}