A NATIONAL SURVEY OF IMMUNIZATION PRACTICES FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANTATION

Objectives.-To describe the frequency and patterns of use of routine c hildhood and hepatitis B, pneumococcal, influenza, and meningococcal v accines 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 vacci nes given to patients younger than 7 years and patients aged 7 years o r older following allogeneic BMT. Results.-Of 66 centers associated wi th the NMDP, 45 (68%) responded. A total of 97% of centers performing transplants on patients younger than 7 years and 88% of centers perfor ming transplants on patients aged 7 years or older gave either the dip htheria-tetanus vaccine or the diphtheria-tetanus-pertussis vaccine co mpared 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-rub ella vaccines to patients younger than 7 years than to the older age g roup (94% vs 73% for poliovirus, P=.02; and 94% vs 70% for measles-mum ps-rubella, P=.01). About one half of centers routinely administer hep atitis B vaccine and approximately three quarters immunize with pneumo coccal and influenza vaccines. Few programs, regardless of age of bone marrow recipient, use multiple vaccine (greater than or equal to 2) d oses. The number of schedules reported for specific vaccines varied wi dely (3-11 schedules per vaccine). Conclusions.-Despite convincing evi dence that patients lose protective antibodies to vaccine-preventable diseases following allogeneic BMT and accumulating data showing the sa fety and efficacy of many vaccines after BMT, vaccines are underutiliz ed and schedules vary widely at US transplant centers. National guidel ines for optimal doses and timing of vaccines after BMT are warranted.