Immunisations in Adult End stage kidney disease update 2016

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1 Additional Notes During work up (predialysis or dialysis) Awaiting (live donor or on deceased donor list) Post Renal Transplant on immunosuppression Vaccinate Annually: Influenza (eg Influvac, Flurix) One dose annually One dose annually Wait 3 months post Check immunization history (including electronic record) and omit if clear evidence of vaccination. If in doubt, vaccinate. Human Papilloma Virus HPV 4 (Female) Gardasil) Give up to 45 years of age Human Papilloma Virus HPV 4 (Male) Gardasil) Tdap (Boostrix) Pneumococcal PCV 13 (Prevenar13) Give up to 45 years of age If PPV23 has been given wait one year. Single dose can be given at any stage Every 10 years Every 10 years Every 10 years

2 Pneumococcal polysaccharide PPV23 Meningococcal MCV4-D (eg Menactra) Zoster (eg Zostervax) Haemophilus influenzae type b Hib At least 8 weeks after PCV13 2 doses initially then 5 yearly booster Over 50 years only Single dose can be given at any stage Recommended >50yrs Not funded Contraindicated from 4 weeks prior to Contraindicated Check serology: Prior to vaccination - if immune, vaccination not required After vaccination (>4 weeks) if non-immune, seek advice Varicella Recommended if non Contraindicated from Contraindicated immune 4 wks prior to 2 doses 6 weeks apart Measles/Mumps/Rubella Recommended if non Contraindicated from Contraindicated (MMR) immune to any component 2 doses 4 weeks prior to Hepatitis A (Havrix) Hepatitis B Not required if HbsAg +ve or Anti- HBs/HBc +ve Recommended recommended recommended

3 Key Re Recommended and funded Can be given safely but not funded LIVE VACCINE - CONTRAINDICATED DO NOT GIVE, Notes GENERAL The term Transplant patient in the Funded vaccines for Special groups in the Immunisation Handbook refers to patients in all stages of the process ie those post, those listed for ation, undergoing work up or with deteriorating renal function making this likely in the near future Immunisations should be undertaken prior to ation if possible as response may be better and some vaccinations are contraindicated following ation. Live vaccines should not be given in the 4 weeks prior to. If a patient is active on the deceased donor list and requires a live vaccine suspend from list for 4 weeks post vaccination. Please refer to the Starship clinical guidelines for recommendations for under 18 years of age at Reimmunisation is not required pre if serology is positive (patient is immune). Specific advice re dosing and route is available in the NZ Immunisation Handbook. This can be found on line at who have received immunoglobulin or other blood products may require time for passive antibodies to decrease prior to immunization. This is only relevant for live vaccines. Suggested time intervals are in the Immunisation Handbook table 1.3

4 VACCINES Influenza ed patients can receive this from 4 weeks post if at high risk of infection eg during influenza epidemic. Two doses should be given in the first year, separated by 4 weeks. Influenza vaccine for household contacts is strongly recommended but not funded Varicella vaccine is funded for house hold contacts of immunocompromised seronegative adults (including recipients) who cannot receive a live vaccine- refer to the NZ Immunisation Handbook 2014 Funded vaccines for special groups. PPV 23 should be given at least 8 weeks after PCV 13 with a further dose after 5 years, and a 3 rd dose at 65 years old. Consider for patients at increased risk of pneumococcal disease. If PCV 13 is needed then Menactra can only be given a minimum of 4 weeks later. MMR and Varicella vaccine should either be given at same time, or minimum 4 weeks apart PCV 13 and Hib are funded for a single dose either pre or post. Dialysis patients who are not being worked up for are eligible for Hepatitis B, Tdap, PCV 13, PPV 23, Hib, influenza and, meningococcal vaccines if have received or are going to receive immunosuppression lasting > 28 days.

5 Name: Influenza Tdap PCV13 PPV23 Varicella MMR Zoster HPV Menactra Hepatitis A Hepatitis B Hib Initial Serology Immunization history Date(s) Given Annual Recheck Serology post immunisation date and result Recheck serology 12 months post Notes