This patient should receive a booster immunization with the tetanus-diphtheria-acellular pertussis (Tdap) vaccine because he has not received it as an adult. The childhood version of this vaccine, DTaP, is highly effective, but immunity against pertussis may wane into the adult years, increasing the risk for infection in this population. Because of this, the Advisory Committee on Immunization Practices recommends that all adults receive a single booster administration with Tdap, regardless of the timing of a previous diphtheria-tetanus booster. This recommendation does not differ for patients who have undergone transplantation; because the Tdap is not a live vaccine, administration to immunocompromised patients carries no contraindication.

This patient was immunized for Streptococcus pneumoniae, including receiving the pneumococcal conjugate and polysaccharide vaccines, before transplantation as appropriate for immunocompromised patients. Therefore, he does not require a booster of the pneumococcal conjugate vaccine and should receive instead a one-time booster of the pneumococcal polysaccharide vaccine, but not until 5 years after the first administration.

The varicella vaccine is a live-attenuated vaccine. As such, its administration is contraindicated after transplantation. Ideally, it should be given before transplantation, if needed. The zoster vaccine, indicated later in life, is also a live-attenuated vaccine and is contraindicated in immunosuppressed patients.