A national survey of immunization practices following allogeneic bone marrow transplantation
K. J. Henning, M. H. White, K. A. Sepkowitz and D. Armstrong
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
OBJECTIVES: To describe the frequency and patterns of use of routine
childhood and hepatitis B, pneumococcal, influenza, and meningococcal
vaccines following allogeneic bone marrow transplantation (BMT). DESIGN,
SETTING, AND PARTICIPANTS: Survey of all US transplantation centers
participating in the National Marrow Donor Program (NMDP) during 1994. MAIN
OUTCOME MEASURES: Use, timing, and total doses of selected vaccines given
to patients younger than 7 years and patients aged 7 years or older
following allogeneic BMT. RESULTS: Of 66 centers associated with the NMDP,
45 (68%) responded. A total of 97% of centers performing transplants on
patients younger than 7 years and 88% of centers performing transplants on
patients aged 7 years or older gave either the diphtheria-tetanus vaccine
or the diphtheria-tetanus-pertussis vaccine compared with 77% and 58%
usage, respectively, of Haemophilus influenza type b conjugate vaccine
(P=.03 and .003, respectively). Centers were more likely to administer
inactivated poliovirus and measles-mumps-rubella vaccines to patients
younger than 7 years than to the older age group (94% vs 73% for
poliovirus, P=.02; and 94% vs 70% for measles-mumps-rubella, P=.01). About
one half of centers routinely administer hepatitis B vaccine and
approximately three quarters immunize with pneumococcal and influenza
vaccines. Few programs, regardless of age of bone marrow recipient, use
multiple vaccine (> or =2) doses. The number of schedules reported for
specific vaccines varied widely (3-11 schedules per vaccine). CONCLUSIONS:
Despite convincing evidence that patients lose protective antibodies to
vaccine-preventable diseases following allogeneic BMT and accumulating data
showing the safety and efficacy of many vaccines after BMT, vaccines are
underutilized and schedules vary widely at US transplant centers. National
guidelines for optimal doses and timing of vaccines after BMT are
warranted.
