Background
Solid organ transplant (SOT) can be a treatment option for an individual whose own organ/s are not functioning adequately. ‘Solid’ refers to transplants of organs such as liver, lung, heart or kidney, as opposed to stem cell or other tissue. Between 2009 and 2024, 19,469 people in Australia received a donated organ. Rejection of a donated organ is a significant and ongoing concern for transplant recipients. Rejection occurs when the recipient’s immune system identifies the transplanted organ as foreign, so tries to destroy it. To avoid rejection, transplant recipients remain on lifelong immunosuppressive medication, leaving them immunocompromised.
Vaccination is particularly important for those who are immunocompromised, due to the increased risk of developing severe disease (which can lead to hospitalisation, intensive care admission or death) if exposed to vaccine-preventable diseases. In people who are immunocompromised, protection gained from a vaccine can be suboptimal as the body is not as easily able to mount a response. There can also be a loss of protection gained from past vaccines or infections. Conversely, some vaccines (live-attenuated vaccines) may be contraindicated due to the potential risk of vaccine-related disease.
Recommendations
Serology and screening
With the exception of hepatitis B, MVEC does not routinely recommend serological testing for vaccine-preventable diseases as a measure of seroconversion. Instead, children < 18 years of age requiring a SOT are recommended additional doses of vaccines to ensure adequate protection.
As part of transplant work-up, tuberculosis screening is recommended for children identified as at-risk for infection (latent or active). Children aged < 5 years should undergo tuberculin skin testing (TST), children ≥ 5 years of age should have Interferon Gamma Release Assay (IGRA) performed. The identified risk factors include:
- previous overseas travel to countries with high prevalence of TB
- known contact with tuberculosis
- being born in, or having a close family member/household contact born in, a TB-endemic country
- children living in remote Aboriginal or Torres Strait Islander communities.
Vaccination timing and schedule
To overcome the challenges with mounting an effective immune response, it is recommended that SOT recipients receive National Immunisation Program (NIP) vaccines and additional vaccines well before transplant. Planning for this should occur at diagnosis and/or consideration of transplant. Where a child is overdue routine vaccines, they should be caught up as soon as possible. Any live-attenuated vaccines must be administered a minimum of 4 weeks prior to transplant (these will be contraindicated once immune-suppressed post-transplant).
The following paediatric guidance has been prepared by vaccine experts, immunologists, paediatricians, infections disease physicians and nurse immunisation specialists from MVEC, the Royal Children’s Hospital and Monash Health.
Table 1: Pre-solid organ transplant recipient (SOTR) paediatric immunisation guideline (September 2025)
| Age | Routine immunisation schedule | Additional vaccines or monoclonal antibodies | Comments and resources |
| Birth | Engerix-B (paediatric) OR H-B-Vax II (paediatric) | Beyfortus (nirsevimab) | - A single dose of hepatitis B vaccine should be administered within 7 days of birth; no need for catch up if dose missed. - Beyfortus (nirsevimab) can be administered from birth, protection lasts up to 6 months; further doses for protection in subsequent RSV seasons may be recommended. |
| 6 weeks | Infranrix hexa OR Vaxelis Prevenar 20 Rotarixβ | Nimenrix Bexsero*^ | - Nimenrix and Bexsero courses can commence from 6 weeks of age, or at diagnosis/consideration of transplant. The total number of recommended doses for Bexsero and Nimenrix varies depending on the age at which the course is commenced. |
| 4 months | Infranrix hexa OR Vaxelis Prevenar 20 Rotarixβ | Nimenrix Bexsero*^ | |
| 6 months | Infranrix hexa OR Vaxelis# | InfluenzaΩ (variable brands) Prevenar 20 | - Additional Prevenar 20 (to make a total of 4 doses) to be given at 6 months or diagnosis/consideration of transplant (minimum of 8 weeks following previous dose of Prevenar 20). - In the first year of receiving an influenza vaccine, children < 9 years of age should receive 2 doses, 4 weeks apart. - COVID-19 vaccination recommended from 6 months of age; the number of recommended doses varies depending on age commencing course and other at-risk factors. |
| 9 months (additional timepoint) | - If transplant is imminent, commencing early administration of measles -mumps-rubella (MMR) (3 doses in total) and varicella vaccines (2 doses in total) can be considered. - The combination MMRV vaccine (Priorix-Tetra) must not be given as the first dose of measles-containing vaccine in children under 4 years of age but can be used for subsequent doses. | ||
| 12 months | Priorix β§ OR M-M-R IIβ§ Nimenrix Prevenar 20 | Vaqta (paediatric)∞ Varilrixβ§ Bexsero*^ | - A course of hepatitis A using Vaqta (paediatric) can be commenced from 12-months of age (total of 2 doses, given 6 months apart are required). - A total of 3 doses of a measles containing vaccines, and a total of 2 doses of a varicella-containing vaccine are recommended prior to SOT. - Only if a child has previously received a dose of MMR (see additional timepoint at 9 months), use Priorix-Tetra (MMRV) instead of Priorix/M-M-R II and Varilrix to reduce the number of injections. |
| 18 months | Priorix-Tetraβ§ Infanrix OR Tripacel ActHIB | Vaqta (paediatric) | - Vaqta (paediatric) dose 2 can be administered (ensuring ≥ 6 months has lapsed since the 1st dose). - A total of 3 doses of a measles containing vaccines, and a total of 2 doses of a varicella-containing vaccine are recommended prior to SOT. |
| 19 months (additional timepoint) | Priorix ⧠OR M-M-R II⧠OR Priorix-Tetra⧠| - A total of 3 doses of a measles-containing vaccine, and a total of 2 doses of a varicella-containing vaccine are recommended prior to SOT. | |
| 4 years | Infanrix IPV OR Quadracel | Prevenar 20 | - Due to changes to the National Immunisation Program as at 1 September 2025, children who have previously completed their pneumococcal course of vaccination with Prevenar 13 and would have been offered Pneumovax 23 at 4 years of age are instead recommended to receive a single dose of Prevenar 20. Children who have already received 4 doses of Prevenar 20 do not require a further dose at 4 years of age. |
| 12–13 years (Year 7 equivalent) | Gardasil 9 Boostrix OR Adacel | - Can consider giving Boostrix early prior to transplant. | |
| 15–16 years (Year 10 equivalent) | MenQuadfi |
* Where a course of Bexsero begins between 6 weeks to ≤ 12 months old, 3 doses are required (minimum 8 weeks between 1st and 2nd doses; 3rd dose at ≥ 12 months/more than 8 weeks after the 2nd dose, whichever is later); When a course of Bexsero commences from 12 months old, 2 doses (minimum 8 weeks apart) are required.
^ Prophylactic paracetamol is recommended to those < 4 years old due to the increased likelihood of the child experiencing fever following vaccination.
# Before having 6-month vaccines, patient must be ≥ 24 weeks of age, and it must be ≥ 8 weeks post 4-month immunisations.
Ω Influenza vaccination is recommended annually from 6 months of age.
β Indicates live-attenuated vaccine. Injected live-attenuated vaccines such as varicella and measles-mumps-rubella (MMR) must be given on the same day (co-administered) or a minimum of 4 weeks apart. They are contraindicated post-transplant.
§ The combination MMRV vaccine (Priorix-Tetra) must not be given as the first dose of measles-containing vaccine in children under 4 years of age due to the risk of febrile seizures, but can be used for the subsequent doses.
∞ Alternate brands may be used if commencing a course of hepatitis A vaccines in children aged ≥ 2 years.
Considerations
Household contacts
Family members and other household contacts should ensure they are up to date with all recommended vaccines, including influenza, pertussis, COVID-19 and live-attenuated vaccines (MMR and varicella).
Vaccine access
Some of the recommendations in this reference are outside the scope of the NIP. Different jurisdictions and individual hospitals have varying approaches to non-NIP vaccines, which should be clarified with the local health service.
Authors: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)
Reviewed by: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute), Sharon Choo (Paediatric Allergist, Immunologist & Immunopathologist, Royal Children’s Hospital) and Rachael McGuire (MVEC Education Nurse Coordinator)
Date: September 2025
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.