A national survey of immunization practices following allogeneic bone marrow transplantation.
OBJECTIVE
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).


METHODS
Survey of all US transplantation centers participating in the National Marrow Donor Program (NMDP) during 1994.


METHODS
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.
Henning
K J
KJ
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
White
M H
MH
Sepkowitz
K A
KA
Armstrong
D
D
D000293:Adolescent; D001426:Bacterial Proteins; D001428:Bacterial Vaccines; D018586:Bone Banks; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D019538:Health Care Surveys; D017325:Hepatitis B Vaccines; D006801:Humans; D007252:Influenza Vaccines; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D022401:Meningococcal Vaccines; D009108:Mumps Vaccine; D022242:Pneumococcal Vaccines; D011054:Poliovirus Vaccine, Inactivated; D011159:Population Surveillance; D012411:Rubella Vaccine; D014184:Transplantation, Homologous; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D017778:Vaccines, Combined
D001426:Bacterial Proteins; D001428:Bacterial Vaccines; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; D007252:Influenza Vaccines; D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D022401:Meningococcal Vaccines; D009108:Mumps Vaccine; D022242:Pneumococcal Vaccines; D011054:Poliovirus Vaccine, Inactivated; D012411:Rubella Vaccine; D017778:Vaccines, Combined; C061963:HibTITER protein, Haemophilus influenzae