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Keutler A, Lainka E, Posovszky C. Live-attenuated vaccination for measles, mumps, and rubella in pediatric liver transplantation. Pediatr Transplant 2024; 28:e14687. [PMID: 38317348 DOI: 10.1111/petr.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Infections are a serious short- and long-term problem after pediatric organ transplantation. In immunocompromised patients, they can lead to transplant rejection or a severe course with a sometimes fatal outcome. Vaccination is an appropriate means of reducing morbidity and mortality caused by vaccine-preventable diseases. Unfortunately, due to the disease or its course, it is not always possible to establish adequate vaccine protection against live-attenuated viral vaccines (LAVVs) prior to transplantation. LAVVs such as measles, mumps, and rubella (MMR) are still contraindicated in solid organ transplant recipients receiving immunosuppressive therapy (IST), thus creating a dilemma. AIM This review discusses whether, when, and how live-attenuated MMR vaccines can be administered effectively and safely to pediatric liver transplant recipients based on the available data. MATERIAL AND METHODS We searched PubMed for literature on live-attenuated MMR vaccination in pediatric liver transplantation (LT). RESULTS Nine prospective observational studies and three retrospective case series were identified in which at least 833 doses of measles vaccine were administered to 716 liver transplant children receiving IST. In these selected patients, MMR vaccination was well tolerated and no serious adverse reactions to the vaccine were observed. In addition, an immune response to the vaccine was demonstrated in patients receiving IST. CONCLUSION Due to inadequate vaccine protection in this high-risk group, maximum efforts must be made to ensure full immunization. MMR vaccination could also be considered for unprotected patients after LT receiving IST following an individual risk assessment, as severe harm from live vaccines after liver transplantation has been reported only very rarely. To this end, it is important to establish standardized and simple criteria for the selection of suitable patients and the administration of the MMR vaccine to ensure safe use.
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Affiliation(s)
- Anne Keutler
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Elke Lainka
- University Children's Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
- Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
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Mirambo MM, Michael F, Nyawale H, Mbugano F, Walwa MB, Mahamba D, Msanga DR, Okamo B, Damiano P, Mshana SE. The High Seropositivity of Mumps Virus IgG Antibodies among School-Aged Children in Rural Areas of the Mbarali District in the Mbeya Region, Tanzania: It Is High Time for Consideration in the National Immunization Program. CHILDREN (BASEL, SWITZERLAND) 2024; 11:73. [PMID: 38255386 PMCID: PMC10814223 DOI: 10.3390/children11010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Mumps is an acute contagious viral disease caused by paramyxovirus characterized by complications that include orchitis, oophoritis, aseptic meningitis, and spontaneous abortion among many others. This study reports high mumps IgG seropositivity among school-aged children in rural areas of the Mbeya region, information that might be useful in understanding the epidemiology of mumps and instituting appropriate control measures including vaccination. Between May and July 2023, a cross-sectional study involving 196 enrolled children aged 5-13 years was conducted. Sociodemographic information and other relevant information were collected using a structured data collection tool. Blood samples were collected and used to detect mumps immunoglobulin G antibodies using indirect enzyme-linked immunosorbent assay (ELISA). A descriptive analysis was performed using STATA version 15. The median age of the enrolled children was 13 (interquartile range (IQR): 8-13) years. The seropositivity of mumps IgG antibodies was 88.8% (174/196, 95% CI: 83.5-92.5). By multivariable logistic regression analysis, history of fever (OR: 5.36, 95% CI: 1.02-28.22, p = 0.047) and sharing utensils (OR: 8.05, 95% CI: 1.99-32.65, p = 0.003) independently predicted mumps IgG seropositivity. More than three-quarters of school-aged children in rural areas of the Mbeya region are mumps IgG-seropositive, which is significantly associated with the sharing of utensils and history of fever. This suggests that the virus is endemic in this region, which calls for further studies across the country so as to institute evidence-based, appropriate control measures including a vaccination program.
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Affiliation(s)
- Mariam M. Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (F.M.); (M.B.W.); (P.D.); (S.E.M.)
| | - Fausta Michael
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania;
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (F.M.); (M.B.W.); (P.D.); (S.E.M.)
| | - Frank Mbugano
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (F.M.); (M.B.W.); (P.D.); (S.E.M.)
| | - Maneja B. Walwa
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (F.M.); (M.B.W.); (P.D.); (S.E.M.)
| | - Dina Mahamba
- Department of Pediatrics and Child Health, College of Health Sciences, University of Dodoma, Dodoma P.O. Box 395, Tanzania;
| | - Delfina R. Msanga
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Bernard Okamo
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Prisca Damiano
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (F.M.); (M.B.W.); (P.D.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (F.M.); (M.B.W.); (P.D.); (S.E.M.)
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Javaid H, Prasad P, De Golovine A, Hasbun R, Jyothula S, Machicao V, Bynon JS, Ostrosky L, Nigo M. Seroprevalence of Measles, Mumps, Rubella, and Varicella-Zoster Virus and Seroresponse to the Vaccinations in Adult Solid Organ Transplant Candidates. Transplantation 2023; 107:2279-2284. [PMID: 37309028 DOI: 10.1097/tp.0000000000004681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Updating live vaccines such as measles, mumps, rubella, and varicella (MMRV) is an important step in preparing patients for solid organ transplant (SOT) to prevent morbidity from these preventable diseases. However, data for this approach are scarce. Thus, we aimed to describe the seroprevalence of MMRV and the efficacy of the vaccines in our transplant center. METHODS Pre-SOT candidates >18 y of age were retrospectively retrieved from SOT database in Memorial Hermann Hospital Texas Medical Center. MMRV serologies are routinely screened at the time of pretransplant evaluation. We divided patients into 2 groups: MMRV-positive group versus MMRV-negative group, patients with positive all MMRV serologies and with negative immunity to at least 1 dose of MMRV, respectively. RESULTS A total of 1213 patients were identified. Three hundred ninety-four patients (32.4%) did not have immunity to at least 1 dose of MMRV. Multivariate analysis was conducted. Older age (odds ratio [OR]: 1.04) and liver transplant candidates (OR: 1.71) were associated with seropositivity. Previous history of SOT (OR: 0.54) and pancreas/kidney transplant candidates (OR: 0.24) were associated with seronegativity. Among 394 MMRV seronegative patients, 60 patients received 1 dose of MMR vaccine and 14 patients received 1 dose of varicella-zoster virus vaccine without severe adverse events. A total of 35% (13/37) of patients who had follow-up serologies did not have a serological response. CONCLUSIONS A significant number of pre-SOT candidates were not immune to at least 1 dose of MMRV. This highlights the importance of MMRV screening and vaccinations pre-SOT. Postvaccination serological confirmation should be performed to evaluate the necessity for a second dose.
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Affiliation(s)
- Hana Javaid
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Pooja Prasad
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Aleksandra De Golovine
- Division of Renal Disease, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Soma Jyothula
- Division of Critical Care, Pulmonary, Sleep and Lung Transplant Medicine, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Victor Machicao
- Division of Transplant Hepatology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - John S Bynon
- Division of Immunology and Organ Transplantation, Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Luis Ostrosky
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Masayuki Nigo
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
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Rezahosseini O, Sørensen SS, Perch M, Ekenberg C, Møller DL, Knudsen AD, Kirkby N, Lundgren J, Lodding IP, Wareham NE, Gustafsson F, Rasmussen A, Nielsen SD. Measles, mumps, rubella, and varicella-zoster virus serology and infections in solid organ transplant recipients during the first year post-transplantation. Clin Infect Dis 2020; 73:e3733-e3739. [PMID: 32564061 DOI: 10.1093/cid/ciaa824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mumps, measles, rubella, and varicella-zoster viruses (MMRV) may cause severe infections in seronegative adult solid organ transplant (SOT) recipients but can be prevented by vaccination. We aimed to determine MMRV serostatus in adult SOT recipients before and one-year post-transplantation as well as evidence of MMRV infections in a large, prospective cohort of SOT recipients. METHODS A prospective study of 1182 adult SOT recipients included in the Management of Posttransplant Infections in Collaborating Hospitals (MATCH) cohort from 2011 to 2017 with a one-year follow-up. Systematic monitoring of MMRV serology was performed prior to transplantation and one-year post-transplantation. PCR was used to confirm viral replication in SOT-recipients presenting with clinical evidence of infection. RESULTS Among 1182 adult SOT recipients, 28 (2.4%), 77 (6.5%), 65 (5.5%), and 22 (1.9%) were seronegative for measles, mumps, rubella, and VZV, respectively, and 165 (14%) were seronegative for at least one of the MMRV viruses. One-year post-transplantation, 29/823 (3.5%) of seropositive SOT recipients had seroreverted, and 63/111 (57%) of seronegative SOT recipients seroconverted for at least one MMRV virus. No evidence of MMR infections was found, but 8 (0.7%) SOT recipients developed symptoms and had a positive VZV PCR. CONCLUSIONS A large proportion of SOT recipients were seronegative for at least one of the MMRV viruses. MMRV infections in SOT recipients may disseminate and become fatal, and although only few cases of VZV infection were detected, results from this study suggest increase attention towards vaccination of patients waiting for SOT.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Perch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Ekenberg
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Kirkby
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Isabelle P Lodding
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Neval Ete Wareham
- Centre of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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Vaccinations in pediatric kidney transplant recipients. Pediatr Nephrol 2019; 34:579-591. [PMID: 29671067 DOI: 10.1007/s00467-018-3953-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
Pediatric kidney transplant (KT) candidates should be fully immunized according to routine childhood schedules using age-appropriate guidelines. Unfortunately, vaccination rates in KT candidates remain suboptimal. With the exception of influenza vaccine, vaccination after transplantation should be delayed 3-6 months to maximize immunogenicity. While most vaccinations in the KT recipient are administered by primary care physicians, there are specific schedule alterations in the cases of influenza, hepatitis B, pneumococcal, and meningococcal vaccinations; consequently, these vaccines are usually administered by transplant physicians. This article will focus on those deviations from the normal vaccine schedule important in the care of pediatric KT recipients. The article will also review human papillomavirus vaccine due to its special importance in cancer prevention. Live vaccines are generally contraindicated in KT recipients. However, we present a brief review of live vaccines in organ transplant recipients, as there is evidence that certain live virus vaccines may be safe and effective in select groups. Lastly, we review vaccination of pediatric KT recipients prior to international travel.
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Safdar A. Rare and Emerging Viral Infections in the Transplant Population. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7119999 DOI: 10.1007/978-1-4939-9034-4_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Viral infections account for a large proportion of emerging infectious diseases, and the agents included in this group consist of recently identified viruses as well as previously identified viruses with an apparent increase in disease incidence. In transplant recipients, this group can include viruses with no recognized pathogenicity in immunocompetent patients and those that result in atypical or more severe disease presentations in the immunocompromised host. In this chapter, we begin by discussing viral diagnostics and techniques used for viral discovery, specifically as they apply to emerging and rare infections in this patient population. Focus then shifts to specific emerging and re-emerging viruses in the transplant population, including human T-cell leukemia virus 1, rabies, lymphocytic choriomeningitis virus, human bocavirus, parvovirus 4, measles, mumps, orf, and dengue. We have also included a brief discussion on emerging viruses and virus families with few or no reported cases in transplant recipients: monkeypox, nipah and hendra, chikungunya and other alphaviruses, hantavirus and the Bunyaviridae, and filoviruses. Finally, concerns regarding infectious disease complications in xenotransplantation and the reporting of rare viral infections are addressed. With the marked increase in the number of solid organ and hematopoietic stem cell transplants performed worldwide, we expect a corresponding rise in the reports of emerging viral infections in transplant hosts, both from known viruses and those yet to be identified.
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Affiliation(s)
- Amar Safdar
- Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX USA
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Höcker B, Aguilar M, Schnitzler P, Pape L, Dello Strologo L, Webb NJA, Bald M, Genc G, Billing H, König J, Büscher A, Kemper MJ, Marks SD, Pohl M, Wigger M, Topaloglu R, Rieger S, Krupka K, Bruckner T, Fichtner A, Tönshoff B. Incomplete vaccination coverage in European children with end-stage kidney disease prior to renal transplantation. Pediatr Nephrol 2018; 33:341-350. [PMID: 28983694 DOI: 10.1007/s00467-017-3776-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Because infections constitute a major cause of morbidity and mortality in paediatric renal allograft recipients, avoidance of preventable systemic infections by vaccination before transplantation is of utmost importance. However, data on the completeness of vaccinations and factors associated with incomplete vaccination coverage are scarce. METHODS Within the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multi-centre, multi-national, retrospective study investigating the vaccination coverage before transplantation of 254 European children with end-stage renal disease (mean age 10.0 ± 5.6 years). RESULTS Only 22 out of 254 patients (8.7%) presented complete vaccination coverage. In particular, the respective vaccination coverage against human papillomavirus (27.3%), pneumococci (42.0%), and meningococci (47.9%) was low. Patients with complete pneumococcal vaccination coverage had numerically less lower respiratory tract infections during the first 3 years post-transplant than children without vaccination or with an incomplete status (16.4% vs 27.7%, p = 0.081). Vaccine-preventable diseases post-transplant were 4.0 times more frequently in unvaccinated than in vaccinated patients. Factors associated with an incomplete vaccination coverage were non-Caucasian ethnicity (OR 9.21, p = 0.004), chronic dialysis treatment before transplantation (OR 6.18, p = 0.001), and older age at transplantation (OR 1.33, p < 0.001). CONCLUSIONS The vaccination coverage in paediatric kidney transplant candidates is incomplete. Paediatric nephrologists, together with primary-care staff and patients' families, should therefore make every effort to improve vaccination rates before kidney transplantation.
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Affiliation(s)
- Britta Höcker
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Martin Aguilar
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Lars Pape
- Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - Luca Dello Strologo
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Nicholas J A Webb
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9WL, Manchester, UK
| | - Martin Bald
- Clinic of Stuttgart, Olga Children's Hospital, Kriegsbergstrasse 62, 70174, Stuttgart, Germany
| | - Gurkan Genc
- Paediatric Nephrology Department, Ondokuz Mayis University Faculty of Medicine, Children's Hospital, Kurupelit, 55139, Samsun, Turkey
| | - Heiko Billing
- University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076, Tübingen, Germany
| | - Jens König
- Department of General Paediatrics, Paediatric Nephrology, University Children's Hospital, Waldeyerstrasse 22, 48149, Münster, Germany
| | - Anja Büscher
- University Children's Hospital, Hufelandstrasse 55, 45122, Essen, Germany
| | - Markus J Kemper
- University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, WC1N 3JH, London, UK
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Marianne Wigger
- Paediatric Nephrology, University Children's Hospital, Ernst-Heydemann-Strasse 8, 18057, Rostock, Germany
| | - Rezan Topaloglu
- Department of Paediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Susanne Rieger
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Kai Krupka
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Alexander Fichtner
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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9
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James SH. Measles, Mumps and Rubella Viruses. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Immunization practices in solid organ transplant recipients. Vaccine 2016; 34:1958-64. [DOI: 10.1016/j.vaccine.2016.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/25/2015] [Accepted: 01/14/2016] [Indexed: 01/26/2023]
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Abstract
Solid organ and hematopoietic stem cell transplant recipients may be exposed to diseases which may be prevented through live attenuated virus vaccines (LAVV). Because of their immunosuppression, these diseases can lead to severe complications in transplant recipients. Despite increasing evidence regarding the safety and effectiveness of certain LAVV, these vaccines are still contraindicated for immunocompromised patients, such as transplant recipients. We review the available studies on LAVV, such as varicella zoster, measles-mumps-rubella, influenza, yellow fever, polio, and Japanese encephalitis vaccines in transplant patients. We discuss the current recommendations and the potential risks, as well as the expected benefits of LAVV immunization in this population.
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Affiliation(s)
- Charlotte M Verolet
- Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva & University of Geneva Medical School, Geneva, Switzerland,
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Ramamurthy M, Kannangai R, Abraham AM, Sridharan G. Viral Infections in Immunocompromised Hosts. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s40011-011-0008-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abuali MM, Arnon R, Posada R. An update on immunizations before and after transplantation in the pediatric solid organ transplant recipient. Pediatr Transplant 2011; 15:770-7. [PMID: 22111996 DOI: 10.1111/j.1399-3046.2011.01593.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vaccination offers a unique opportunity to decrease the burden of infectious complications following solid organ transplantation. In this paper we review the current guidelines for routine immunizations before and after solid organ transplantation, including the recent updates and changes to recommendations for certain vaccines. We also address the issue of waning immunity in solid organ transplant recipients and discuss the current data on vaccinating this patient population with live vaccines after transplantation.
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Affiliation(s)
- Mayssa M Abuali
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA
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Dittrich S, Hahné S, van Lier A, Kohl R, Boot H, Koopmans M, van Binnendijk R. Assessment of serological evidence for mumps virus infection in vaccinated children. Vaccine 2011; 29:9271-5. [DOI: 10.1016/j.vaccine.2011.09.072] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/13/2011] [Accepted: 08/23/2011] [Indexed: 11/26/2022]
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Fanoy EB, Cremer J, Ferreira JA, Dittrich S, van Lier A, Hahné SJH, Boot HJ, van Binnendijk RS. Transmission of mumps virus from mumps-vaccinated individuals to close contacts. Vaccine 2011; 29:9551-6. [PMID: 21983359 DOI: 10.1016/j.vaccine.2011.09.100] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 09/15/2011] [Accepted: 09/25/2011] [Indexed: 11/19/2022]
Abstract
During a recent mumps epidemic in the Netherlands caused by a genotype D mumps virus strain, we investigated the potential of vaccinated people to spread mumps disease to close contacts. We compared mumps viral titers of oral fluid specimens obtained by quantitative PCR from vaccinated (n=60) and unvaccinated (n=111) mumps patients. We also investigated the occurrence of mumps infection among the household contacts of vaccinated mumps patients. We found that viral titers are higher for unvaccinated patients than for vaccinated patients during the 1st 3 days after onset of disease. While no symptomatic cases were reported among the household contacts (n=164) of vaccinated mumps patients (n=36), there were cases with serological evidence of asymptomatic infection among vaccinated household contacts (9 of 66 vaccinated siblings). For two of these siblings, the vaccinated index patient was the most probable source of infection. We conclude that, in this particular outbreak, the risk of a close contact becoming infected by vaccinated patients was small, but present.
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Affiliation(s)
- Ewout B Fanoy
- Municipal Health Service "Midden-Nederland", Zeist, The Netherlands
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Leen AM, Tripic T, Rooney CM. Challenges of T cell therapies for virus-associated diseases after hematopoietic stem cell transplantation. Expert Opin Biol Ther 2010; 10:337-51. [PMID: 20132056 DOI: 10.1517/14712590903456003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE OF THE FIELD Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many hematological malignancies and genetic disorders. The majority of patients do not have a human leukocyte antigen (HLA) identical sibling donor, and alternative stem cell sources include HLA-matched or mismatched unrelated donors and haploidentical related donors. However, alternative donor HSCT are associated with three major complications i) graft rejection; ii) graft-versus-host disease (GvHD); and iii) delayed immune reconstitution leading to viral infections and relapse. AREAS COVERED IN THIS REVIEW Graft rejection and the risk of GvHD can be significantly reduced by using intensive conditioning regimens, including in vivo T cell depletion as well as ex vivo T cell depletion of the graft. However, the benefits of removing alloreactive T cells from the graft are offset by the concomitant removal of T cells with anti-viral or anti-tumor activity as well as the profound delay in endogenous T cell recovery post-transplant. Thus, opportunistic infections, many of which are not amenable to conventional small-molecule therapeutics, are frequent in these patients and are associated with significant morbidity and high mortality rates. This review discusses current cell therapies to prevent or treat viral infections/reactivations post-transplant. WHAT THE READER WILL GAIN The reader will gain an understanding of the current state of cell therapy to prevent and treat viral infections post-HSCT, and will be introduced to preclinical studies designed to develop and validate new manufacturing procedures intended to improve therapeutic efficacy and reduce associated toxicities. TAKE HOME MESSAGE Reconstitution of HSCT recipients with antigen-specific T cells, produced either by allodepletion or in vitro reactivation, can offer an effective strategy to provide both immediate and long-term protection without harmful alloreactivity.
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Affiliation(s)
- Ann M Leen
- The Methodist Hospital, Texas Children's Hospital, Center for Cell and Gene Therapy, Baylor College of Medicine, 1102 Bates Street, Houston, TX 77030, USA.
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Brockhoff HJ, Mollema L, Sonder GJB, Postema CA, van Binnendijk RS, Kohl RHG, de Melker HE, Hahné SJM. Mumps outbreak in a highly vaccinated student population, The Netherlands, 2004. Vaccine 2010; 28:2932-6. [PMID: 20188683 DOI: 10.1016/j.vaccine.2010.02.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 02/02/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
In September 2004 a mumps outbreak occurred at an international hotel school in The Netherlands. We investigated this outbreak to identify risk factors for mumps. There were 105 mumps cases (overall mumps attack rate (AR) 12% (95% CI: 10-15%)). The AR for Dutch vaccinated and unvaccinated participants was 12% (95% CI: 10-15%) and 15% (95% CI: 3-42%), respectively. Independent risk factor was mumps contact. Explanations for the relatively high AR among vaccinated participants include primary vaccine failure, waning immunity and incomplete vaccine-induced immunity in the context of high mumps virus exposure in a school party and a crowded boarding school.
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Affiliation(s)
- Heinrich J Brockhoff
- Department Infectious Disease, Municipal Health Service, The Hague, The Netherlands
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