Recommended vaccines prior to TPIAT
1. Tdap
Suggested when indicated per routine immunization schedule/not required
2. Seasonal influenza vaccine
September-April typical period for patients to receive the influenza vaccine
ID can provide updates to the PCC based on influenza activity in the early spring as needed
3. Pneumococcal conjugate vaccine (PCV 13 or Prevnar 13®) if not previously received
Teens vaccinated before 2010 who received PCV 7 will need a single dose of PCV 13
Complete Prevnar 13 at least 8 weeks prior to Meningoccoccal (Menactra®) as Prevnar 13® decreases the immunogenicity of Menactra
4. Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax®)
At least 8 weeks after Prevnar 13®
Can be given with meningococcal (Menactra®) without any interactions
Pneumovax/PPSV23® boosters as suggested every 5 years
5. Meningococcal conjugate vaccines (Menactra®, Menveo®, and MenHibrix®) MCV
Guidelines for patients 24 months and older, for patients <24 months – refer to CDC immunization schedule
Everyone should receive 2 doses spaced 8-12 weeks apart
Boosters as suggested every 5 years
Can be given with Pneumovax®
Can be given with Meningococcal B series
6. Meningococcal B series (MenB) (Trumemba® or Bexsero®)
The CDC/ACIP currently recommends MenB for patients 10 years of age and older with anatomic or functional asplenia
ID recommends MenB vaccination to individuals that will likely undergo surgery within 12 months of the TPIAT evaluation (due to the durability of the vaccine)
Trumemba (3 vaccine series) or Bexsero (2 vaccine series). Bexsero and Trumemba vaccines are not interchangeable, therefore it is preferable for most patients to receive the vaccine from the same provider/location
Trumemba 3-dose series administered at 0, 1-2, and 6 months
Bexsero 2-dose series administered at 0 and ≥ 1 month later
Can be given with Meningococcal/Menactra®
7. HPV (Gardasil®)
Suggested when indicated per routine immunization schedule/not required
If <15 when started, the HPV9 is a 2-dose series at 0 and 6-12 months
If >15 when started, the 3-dose series is recommended at 0, 1-2 months, and 6 months
General ID recommendations re: TPIAT patients
Vaccinations prior to TPIAT should not be administered within two weeks of OR date
There is not a specified number of doses for each vaccine required prior to TPIAT. As many as possible is suggested and depends on the clinical urgency for TPIAT
All pre-TPIAT patients are seen by ID prior to TPIAT for evaluation; this includes a review of vaccine history and recommendations for needed vaccines
For vaccines that were not completed prior to TPIAT, post-TPIAT can:
Resume vaccines at approximately 4 weeks post op
If fully recovered earlier than 4 weeks, vaccines can be resumed at 2 weeks
All post-TPIAT patients are to remain on PCN until they are 1 year post-TPIAT AND at least >5 years of age, AND fully immunized
All post-TPIAT patients should have a pre-prescribed antibiotic in hand if, in the case of fever or concern for infection, the patient cannot be evaluated within 2 hours (due to living in a remote location, camping, travelling, etc). Amoxicillin is recommended as first-line, with levofloxacin as second-line or for those with a penicillin allergy
If TPIAT evaluation recommended vaccines are not completed at the 1 year post op interval, the patient will remain on PCN. Once all TPIAT evaluation recommended vaccines are completed, PCN may be discontinued 4 weeks post last received vaccine.
All post-TPIAT patients are seen for ID follow up at:
3 month post-TPIAT to review immunizations, discuss prophylaxis PCN, when to call for fevers (>100.4), and overall risks. If ID is unavailable to see a patient at the 3 month interval, ID follow up will be scheduled at 6 month interval
1 year post-TPIAT and yearly thereafter to review immunizations, discuss prophylaxis PCN, when to call for fevers (>100.4), and overall risks