[Management of vaccination in children receiving an allogeneic marrow transplant]

Over the last decades, significant advances in the diagnosis and therapeutics have considerably improved success rate from bone marrow transplant in patients suffering from otherwise life-threatening diseases, allowing now for prolonged survival and better quality of life after an allograft. However, infectious diseases remain one of the most serious complication in this population, hence associated with a high morbidity and mortality. Prevention, in particular through vaccination, constitutes a cornerstone of the management of immunocompromised hosts, since this procedure aims to protect them once back to life in community after long periods of hospitalization. If the necessity of vaccinating immunocompromised patients as well as their family is unequivocally recognized among health care workers, some questions remain source of debate. Several famous societies edited guidelines, but those differ from each other and cannot be transposed from a country to another without considering their local epidemiology and implemented vaccination schedule. Moreover, development and availability of new vaccines render recommendations constantly susceptible to adaptations. After exhaustive literature review, this article aims to offer pragmatic answers to the main questions raised by healthcare workers when vaccinating children after a bone marrow transplant. We here review all vaccines available and discuss their modalities of administration considering the timing after transplant, the immunological residual status and the medical history of the child. We also offer clues to optimize vaccination of patients' siblings. In addition to highlight some interrogations about future vaccines formulations, we propose here a vaccination schedule tailored for pediatric bone marrow transplant recipients in Belgium in 2017.