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Important: Protocol superseded July 2009 - see new version here at www.edren.co.uk.
That website is in development - you can ignore the 'This website is not ready' signs ONLY for the Transplant protocols. Others are not updated or fully transferred. |
If previously unimmunised, adults should receive Polio, Tetanus and Diphtheria vaccines.
Administration of Pneumococcal, Menningococcal and Haemophilus Influenza type B vaccinations are desirable. Live Varicella vaccine may also be considered it is available on a named patient basis from pharmacy. Vaccinations should be documented in admission clerk in.
Live vaccines should not be given to immunosuppressed patients. Influenza vaccine is inactivated and therefore safe.
The following are live vaccines:
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Oral Polio vaccine (OPV, Sabin) |
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Oral Typhoid vaccine (Vivotif) |
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Measles, Mumps, Rubella - MMR vaccine (MMR II, Priorix ) |
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Rubella vaccine (Erverax) |
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BCG vaccine |
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Varicella vaccine - not in UK |
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Yellow fever (Arilvax) |
There are inactive alternatives for the oral polio and typhoid vaccines. Household contacts of immunosuppressed patients should also receive the inactive polio vaccine as they will excrete live polio for up to 6 weeks post-vaccination if they receive the live polio vaccine.
Inactivated vaccine is available on a named patient basis via the pharmacy.
There is no risk of infection from vaccinees. Immunosuppressed patients who have come into contact with measles should receive HNIG (Human Normal Immunoglobulin) as soon as possible after exposure. HNIG may be given to pregnant women with proven Rubella infection where termination is unacceptable.
Varicella Zoster Immunoglobulin (VZIG) is indicated in patients who have had significant exposure to Chickenpox or Herpes Zoster and who have no antibodies to the VZ Virus. If required VZIG should be administered within 7 days of the initial contact.
For patients intending to travel to countries where a Yellow Fever certificate is required they should obtain a letter of exemption from a medical practitioner. Yellow Fever occurs in tropical Africa and South America. Up-to-date information is available from a pharmacy or WHO publications.
Up to date information on Malaria prophylaxis for a given destination is available from pharmacy.
The following table gives an indication of interactions:
| Tacrolimus | Ciclosporin | |
| Choloroquine | ? increased tacrolimus (cP450 3A4) | increased CyA (CP450 3A4) |
| Proguanil | No interactions likely | No interactions likely |
| Mefloquine | ? increased tacrolimus (displacement from plasma protein) | No interactions likely |
| Doxycycline | ? increased tacrolimus (CP450 3A4) | increased CyA (CP450 3A4) |
Transplant protocols developed on the Edinburgh Transplant Unit. This page first published March 2002 by Amit Adlakha, updated December 2006 and last modified
NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.