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Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13529. [PMID: 30859623 DOI: 10.1111/ctr.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection. Patients should be advised on vaccine-preventable illnesses as well as any need for prophylaxis (ie, malaria) based on their individual travel itineraries. Information with regards to specific recommendations for vaccines and prophylactic medications, along with drug-drug interactions, is summarized. Counseling should be provided for modifiable risks and exposures (ie, food and water safety, and insect bite prevention) as well as non-infectious travel topics. These guidelines also briefly address risks associated with transplant tourism and specific infections to consider if patients seek care for transplants done in foreign countries.
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Affiliation(s)
- C Arianne Buchan
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Pneumococcal vaccination in adult solid organ transplant recipients: A review of current evidence. Vaccine 2018; 36:6253-6261. [PMID: 30217523 DOI: 10.1016/j.vaccine.2018.08.069] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022]
Abstract
This narrative review summarizes the current literature relating to pneumococcal vaccination in adult solid organ transplant (SOT) recipients, who are at risk of invasive pneumococcal disease (IPD) with its attendant high morbidity and mortality. The effect of the pneumococcal polysaccharide vaccine has been examined in several small cohort studies in SOT recipients, most of which were kidney transplant recipients. The outcomes for these studies have been laboratory seroresponses or functional antibody titers. Overall, in most of these studies the transplant recipients were capable of generating measurable serological responses to pneumococcal vaccination but these responses were less than those of healthy controls. A mathematical model estimated the effectiveness of polysaccharide vaccination in SOT recipients to be one third less than those of patients with HIV. The evidence for the efficacy of the pneumococcal conjugate vaccine in SOT is based on a small number of randomized controlled trials in liver and kidney transplant recipients. These trials demonstrated that SOT recipients mounted a serological response following vaccination however there was no benefit to the use of prime boosting (conjugate vaccine followed by polysaccharide vaccine). Currently there are no randomized studies investigating the clinical protection rate against IPD after pneumococcal vaccination by either vaccine type or linked to vaccine titers or other responses against pneumococcus. Concerns that vaccination may increase the risk of adverse alloresponses such as rejection and generation of donor specific antibodies are not supported by studies examining this aspect of vaccine safety. Pneumococcal vaccination is a potentially important strategy to reduce IPD in SOT recipients and is associated with excellent safety. Current international recommendations are based on expert opinion from conflicting data, hence there is a clear need for further high-quality studies in this high-risk population examining optimal vaccination regimens. Such studies should focus on strategies to optimize functional immune responses.
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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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Aung AK, Trubiano JA, Spelman DW. Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review. Travel Med Infect Dis 2014; 13:31-47. [PMID: 25593039 DOI: 10.1016/j.tmaid.2014.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/19/2022]
Abstract
International travellers with immunocompromising conditions such as human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT) and haematopoietic stem cell transplantation (HSCT) are at a significant risk of travel-related illnesses from both communicable and non-communicable diseases, depending on the intensity of underlying immune dysfunction, travel destinations and activities. In addition, the choice of travel vaccinations, timing and protective antibody responses are also highly dependent on the underlying conditions and thus pose significant challenges to the health-care providers who are involved in pre-travel risk assessment. This review article provides a framework of understanding and approach to aforementioned groups of immunocompromised travellers regarding pre-travel risk assessment and management; in particular travel vaccinations, infectious and non-infectious disease risks and provision of condition-specific advice; to reduce travel-related mortality and morbidity.
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Affiliation(s)
- A K Aung
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - J A Trubiano
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D W Spelman
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
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Evaluation of specific humoral and cellular immune responses against the major capsid L1 protein of cutaneous wart-associated alpha-Papillomaviruses in solid organ transplant recipients. J Dermatol Sci 2014; 77:37-45. [PMID: 25439730 DOI: 10.1016/j.jdermsci.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/07/2014] [Accepted: 11/02/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infection with different species of cutaneous human papillomaviruses (cHPV) of genus alpha (cαHPVs) and associated skin disease are highly prevalent in solid organ transplant recipients (OTR), documenting the importance of the immunological control of HPV infection. OBJECTIVES To investigate the natural course of cαHPV-specific cellular and humoral immune responses during systemic long-term immunosuppression. METHODS Integrating bead-based multiplex serology and flow cytometry we analyzed natural cαHPV-specific antibodies and T(H) cell responses against the major capsid protein L1 of HPV types 2, 27, 57 (species 4) and 3, 10 and 77 (species 2) in sera and blood of OTR before and after initiation of iatrogenic immunosuppression and in comparison to immunocompetent individuals (IC). RESULTS Among OTR we observed an overall 42% decrease in humoral L1-specific immune responses during the course of iatrogenic immunosuppression, comparing median values 30 d before and 30 d after initiation of immunosuppressive therapy (p < 0.05). This difference disappeared after long-term (>1 year) immunosuppression. The predominant cellular L1-specific immune response was of type T(H)1 (CD4(+)CD40L(+)IL-2(+)IFN-γ(+)). Consistent with the detected L1-specific antibody titers, L1-specific T(H)1 responses were unchanged in long-term immunosuppressed OTR compared to IC. Notably, cαHPV-L1-specific IL-2(+)/CD40L(+)CD4(+) or IFN-γ(+)/CD40L(+) CD4(+) T(H) cell responses against any of the cαHPV-L1 types were significantly higher in OTR with clinically apparent common warts. CONCLUSION The systemic humoral immune response against cαHPV may reflect the individual degree of iatrogenic immunosuppression indicating a higher susceptibility for cαHPV infection among OTR during the early phase after organ transplantation. Humoral cαHPV-specific immune responses may show a reconstitution to pre-transplantation levels despite continuous potent immunosuppression.
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Abstract
Many transplant recipients are not protected against vaccine-preventable illnesses, primarily because vaccination is still an underutilized tool both before and after transplantation. This missed opportunity for protection can result in substantial morbidity, graft loss and mortality. Immunization strategies should be formulated early in the course of renal disease to maximize the likelihood of vaccine-induced immunity, particularly as booster or secondary antibody responses are less affected by immune compromise than are primary or de novo antibody responses in naive vaccine recipients. However, live vaccines should be avoided in immunocompromised hosts. Although some concern has been raised regarding increased HLA sensitization after vaccination, no clinical data to suggest harm currently exists; overall, non-live vaccines seem to be immunogenic, protective and safe. In organ transplant recipients, some vaccines are indicated based on specific risk factors and certain vaccines, such as hepatitis B, can protect against donor-derived infection. Vaccines given to close contacts of renal transplant recipients can provide an additional layer of protection against infectious diseases. In this article, optimal vaccination of adult transplant recipients, including safety, efficacy, indication and timing, is reviewed.
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Fagiuoli S, Colli A, Bruno R, Craxì A, Gaeta GB, Grossi P, Mondelli MU, Puoti M, Sagnelli E, Stefani S, Toniutto P, Burra P. Management of infections pre- and post-liver transplantation: report of an AISF consensus conference. J Hepatol 2014; 60:1075-89. [PMID: 24384327 DOI: 10.1016/j.jhep.2013.12.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 02/06/2023]
Abstract
The burden of infectious diseases both before and after liver transplantation is clearly attributable to the dysfunction of defensive mechanisms of the host, both as a result of cirrhosis, as well as the use of immunosuppressive agents. The present document represents the recommendations of an expert panel commended by the Italian Association for the Study of the Liver (AISF), on the prevention and management of infectious complications excluding hepatitis B, D, C, and HIV in the setting of liver transplantation. Due to a decreased response to vaccinations in cirrhosis as well as within the first six months after transplantation, the best timing for immunization is likely before transplant and early in the course of disease. Before transplantation, a vaccination panel including inactivated as well as live attenuated vaccines is recommended, while oral polio vaccine, Calmette-Guerin's bacillus, and Smallpox are contraindicated, whereas after transplantation, live attenuated vaccines are contraindicated. Before transplant, screening protocols should be divided into different levels according to the likelihood of infection, in order to reduce costs for the National Health Service. Recommended preoperative and postoperative prophylaxis varies according to the pathologic agent to which it is directed (bacterial vs. viral vs. fungal). Timing after transplantation greatly determines the most likely agent involved in post-transplant infections, and specific high-risk categories of patients have been identified that warrant closer surveillance. Clearly, specifically targeted treatment protocols are needed upon diagnosis of infections in both the pre- as well as the post-transplant scenarios, not without considering local microbiology and resistance patterns.
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Affiliation(s)
- Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | | | - Raffaele Bruno
- Department of Infectious Diseases, IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Italy
| | - Giovanni Battista Gaeta
- Infectious Diseases, Department of Internal and Experimental Medicine, Second University of Naples, Italy
| | - Paolo Grossi
- Infectious & Tropical Diseases Unit, Department of Surgical & Morphological Sciences, Insubria University, Varese, Italy
| | - Mario U Mondelli
- Research Laboratories, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy
| | - Massimo Puoti
- Infectious Diseases Department, Niguarda Cà Granda Hospital, Milano, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Preventive Medicine, Second University of Naples, Italy
| | - Stefania Stefani
- Department of Bio-Medical Sciences, Section of Microbiology, University of Catania, Italy
| | - Pierluigi Toniutto
- Department of Medical Sciences, Experimental and Clinical, Medical Liver Transplant Section, Internal Medicine, University of Udine, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Kotton CN. Vaccination and immunization against travel-related diseases in immunocompromised hosts. Expert Rev Vaccines 2014; 7:663-72. [DOI: 10.1586/14760584.7.5.663] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2013; 58:e44-100. [PMID: 24311479 DOI: 10.1093/cid/cit684] [Citation(s) in RCA: 543] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
An international panel of experts prepared an evidenced-based guideline for vaccination of immunocompromised adults and children. These guidelines are intended for use by primary care and subspecialty providers who care for immunocompromised patients. Evidence was often limited. Areas that warrant future investigation are highlighted.
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Affiliation(s)
- Lorry G Rubin
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York of the North Shore-LIJ Health System, New Hyde Park
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Kotton CN, Hibberd PL. Travel medicine and transplant tourism in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:337-47. [PMID: 23465026 DOI: 10.1111/ajt.12125] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C N Kotton
- Transplant Infectious Disease and Compromised Host Program; Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
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Randomized, single blind, controlled trial to evaluate the prime-boost strategy for pneumococcal vaccination in renal transplant recipients. PLoS One 2012; 7:e46133. [PMID: 23029408 PMCID: PMC3460962 DOI: 10.1371/journal.pone.0046133] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/28/2012] [Indexed: 12/17/2022] Open
Abstract
Renal transplant recipients are at increased risk of developing invasive pneumococcal diseases but may have poor response to the 23-valent pneumococcal polysaccharide vaccine (PPV). It may be possible to enhance immunogenicity by priming with 7-valent pneumococcal conjugate vaccine (7vPnC) and boosting with PPV 1 year later. In a randomized single-blind, controlled study, adult recipients of renal transplants received either 7nPVC or PPV followed by PPV 1 year later. The vaccine response was defined as 2-fold increase in antibody concentration from baseline and an absolute post-vaccination values ≥1 µg/ml. The primary endpoint was vaccine response of the primed group (7vPnC/PPV) compared with single PPV vaccination. Antibody concentrations for 10 serotypes were measured at baseline, 8 weeks after first vaccination, before second vaccination, and 8 weeks after second vaccination. Of 320 screened patients, 80 patients were randomized and 62 completed the study. Revaccination with PPV achieved no significant increase of immune response in the 7vPnC/PPV group compared with the single PPV recipients A response to at least 1 serotype was seen in 77.1% of patients who received 7vPnC and 93.1% of patients who received PPV (P = 0.046). After second vaccination response to at least 1 serotype was seen in 87.5% patients of 7vPnC/PPV group and 87.1% patients of PPV group (non significant p). The median number of serotypes eliciting a response was 3.5 (95% CI 2.5–4.5) in the 7vPnC/PPV group versus 5 (95% CI 3.9–6.1) in the PPV group (non-significant p). Immunogenicity of pneumococcal vaccination was not enhanced by the prime–boost strategy compared with vaccination with PPV alone. Administration of a single dose of PPV should continue to be the standard of care for adult recipients of renal transplants. Trial Registration EudraCT 2007-004590-25.
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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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POTSANGBAM GULIVER, YADAV ASHOK, CHANDEL NIRUPAMA, RATHI MANISH, SHARMA ASHISH, KOHLI HARBIRS, GUPTA KRISHANL, MINZ MUKUT, SAKHUJA VINAY, JHA VIVEKANAND. Challenges in containing the burden of hepatitis B infection in dialysis and transplant patients in India. Nephrology (Carlton) 2011; 16:383-8. [DOI: 10.1111/j.1440-1797.2010.01429.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gattringer R, Winkler H, Roedler S, Jaksch P, Herkner H, Burgmann H. Immunogenicity of a combined schedule of 7-valent pneumococcal conjugate vaccine followed by a 23-valent polysaccharide vaccine in adult recipients of heart or lung transplants. Transpl Infect Dis 2011; 13:540-4. [PMID: 21489090 DOI: 10.1111/j.1399-3062.2011.00628.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A combined schedule of 7-valent pneumococcal conjugate vaccine (PCV7) followed by 23-valent pneumococcal polysaccharide vaccine (PPV23) was evaluated retrospectively in 26 adult recipients of heart or lung transplants. PCV7 was immunogenic in these patients but there appeared to be no benefit from the additional PPV23 dose.
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Affiliation(s)
- R Gattringer
- Department of Medicine I, Division of Infectious Diseases, Medical University of Vienna, Vienna, Austria
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Chesi C, Günther M, Huzly D, Neuhaus R, Reinke P, Engelmann H, Mockenhaupt F, Bienzle U. Immunization of liver and renal transplant recipients: a seroepidemiological and sociodemographic survey. Transpl Infect Dis 2009; 11:507-12. [DOI: 10.1111/j.1399-3062.2009.00436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kotton CN, Hibberd PL. Travel medicine and the solid organ transplant recipient. Am J Transplant 2009; 9 Suppl 4:S273-81. [PMID: 20070691 DOI: 10.1111/j.1600-6143.2009.02920.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C N Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
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Fiorante S, López-Medrano F, Ruiz-Contreras J, Aguado JM. [Vaccination against Streptococcus pneumoniae in solid organ transplant recipients]. Enferm Infecc Microbiol Clin 2009; 27:589-92. [PMID: 19361892 DOI: 10.1016/j.eimc.2007.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 10/31/2007] [Indexed: 01/06/2023]
Abstract
The risk of developing invasive pneumococcal disease in transplant patients is estimated at 28 to 36 per 1000 patients/year according to the type of organ transplanted. This rate is much higher than the estimated incidence in the general population. This study reviews the current experience regarding the different types of vaccinations against Streptococcus pneumoniae in transplant patients, the immunogenic response to pneumococcal vaccine in these patients, the clinical experience to date with the use of pneumococcal vaccines, and the utility of a sequential vaccination regime including the heptavalent vaccine and vaccine for the 23 serogroups. The immunogenicity produced by pneumococcal vaccines in transplant patients is lower and not as long-lasting as in immunocompetent individuals, and the revaccination regimen inducing the most favorable immunological response is unknown. Nonetheless, pneumococcal vaccination provides clear benefits to transplant recipients and should be given before transplantation whenever possible.
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Affiliation(s)
- Silvana Fiorante
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España
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Harris K, Baggs J, Davis RL, Black S, Jackson LA, Mullooly JP, Chapman LE. Influenza vaccination coverage among adult solid organ transplant recipients at three health maintenance organizations, 1995-2005. Vaccine 2009; 27:2335-41. [PMID: 19428848 DOI: 10.1016/j.vaccine.2009.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 02/05/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
Abstract
Annual immunization against influenza is recommended for solid organ transplant (SOT) recipients. We used Vaccine Safety Datalink data from 1995 to 2005 to assess influenza vaccination during the first full vaccination season (September-February) following transplant among 1800 kidney, liver, and heart transplant recipients at three health maintenance organizations. Overall, 52% of recipients were vaccinated. Older age at transplant (age 50-64 years, OR 1.81, 95% CI 1.43-2.30; age > or =65 years, OR 1.94, 95% CI 1.39-2.69), receiving vaccination in the full season pre-transplant (OR 4.54, 95% CI 3.67-5.60), and year of transplantation were significant predictors of post-transplant vaccination. Although vaccine coverage increased during study years, SOT recipients are under-immunized against influenza. Efforts to understand barriers to vaccination and increase education of physicians managing patients while awaiting and after receipt of transplant are needed.
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Affiliation(s)
- Kalynne Harris
- Immunization Safety Office, Office of the Chief Science Officer, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333, USA
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Kumar D, Chen M, Wong G, Cobos I, Welsh B, Siegal D, Humar A. A Randomized, Double‐Blind, Placebo‐Controlled Trial to Evaluate the Prime‐Boost Strategy for Pneumococcal Vaccination in Adult Liver Transplant Recipients. Clin Infect Dis 2008; 47:885-92. [DOI: 10.1086/591537] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant 2008; 8:9-14. [PMID: 18093271 DOI: 10.1111/j.1600-6143.2007.02051.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Vaccine-preventable diseases remain a major source of morbidity and mortality in transplant recipients. Since the publication of the American Society of Transplantation's guidelines for vaccination of solid organ transplant recipients in 2004 (1), several new vaccines have been licensed. Transplant clinicians have been inundated by questions from patients and colleagues regarding the utility and safety of these vaccines in transplant candidates and recipients. In addition, new data has appeared regarding utility of some established vaccines, lack of rejection after vaccination and newer adjuvant strategies. Literature published between 2004 and 2007 was reviewed in a Medline search. Guidelines from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices are reviewed and summarized, with particular attention to vaccines for human papillomavirus, varicella and varicella-zoster, tetanus-reduced diphtheria-acellular pertussis (Tdap) and hepatitis B, as well as conjugated meningococcal and conjugated pneumococcal vaccines. Although randomized controlled trials in transplant recipients have not been performed for most new licensed vaccines, preliminary recommendations can be formulated based on current data and guidelines. Further studies will be important to determine the indications and optimal timing of newer immunizations and immunization strategies.
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Affiliation(s)
- R K Avery
- Section head, Transplant Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
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Minden K, Niewerth M, Borte M, Singendonk W, Haas JP. [Immunization in children and adolescents with rheumatic diseases]. Z Rheumatol 2007; 66:111-2, 114-8, 120. [PMID: 17364157 DOI: 10.1007/s00393-007-0150-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vaccinations represent a special problem in children and adolescents with inflammatory rheumatic diseases. There are very limited data on the safety and efficacy of vaccines in these patients, and guidelines for immunization are missing. The immunosuppressive therapy often necessary for these patients gives rise to additional uncertainty. In addition, many colleagues consider vaccination to increase the risk of relapse of the rheumatic illness. As a consequence, there are substantial variations in practicing vaccination in these patients, resulting in insufficient vaccination coverage rates. For example, every third patient with juvenile idiopathic arthritis is incompletely vaccinated; this even includes toxoid vaccines for tetanus and diphtheria. The benefit of vaccinations, which far outweighs their potential risks, is well recognized even in patients with autoimmune diseases. These patients in particular require a special protection from infections due to their immunosuppressive therapies. Therefore, children and adolescents with rheumatic diseases should be immunized according to the Standing Immunization Commission of the Robert Koch Institute recommendations whenever possible. However, the time of vaccination must be carefully selected, taking disease activity and treatment into account.
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Affiliation(s)
- K Minden
- Deutsches Rheuma-Forschungszentrum Berlin und Universitätskinderklinik Charité, Campus Virchow-Klinikum, Otto-Heubner-Centrum, SPZ, Augustenburger Platz 1, 13353 Berlin.
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Luthy KE, Tiedeman ME, Beckstrand RL, Mills DA. Safety of live-virus vaccines for children with immune deficiency. ACTA ACUST UNITED AC 2006; 18:494-503. [PMID: 16999715 DOI: 10.1111/j.1745-7599.2006.00163.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Conduct an integrative literature review to evaluate the safety and effectiveness of live-virus vaccines, namely, the measles, mumps, rubella, and varicella vaccines, in children who are immune compromised by exogenous medication either posttransplant or while undergoing maintenance chemotherapy for leukemia. DATA SOURCES Medline, MedlinePlus, EBSCO, PubMed, MD Consult, CINAHL, Clinical Pharmacology, ERIC, Biomedical Reference Collection-Basic, Health Source-Consumer Edition, Health Source-Nursing/Academic Edition, Ovid, CANCERLIT, and the Cochrane Library Online. CONCLUSIONS Because measles infection has a low incidence rate in the United States, it may be advisable not to vaccinate children who are immunocompromised and risk side effects of the vaccine. In contrast to measles infection, varicella has a higher incidence rate and poses a more imminent threat to those who are immunocompromised. Children who are immunosuppressed can receive the varicella vaccination; however, they should have regular titers drawn to confirm adequate protection against the disease and should receive boosters as deemed appropriate. IMPLICATIONS FOR PRACTICE The number of solid organ transplant recipients is steadily increasing with more than 600,000 solid organ transplantations worldwide since the first renal transplant in 1954. The steadily increasing numbers of pediatric patients surviving transplantation, coupled with increased life expectancy, accelerate the need for nurse practitioners to understand the management of these delicate patients following release from the transplant unit.
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Affiliation(s)
- Karlen E Luthy
- College of Nursing, Brigham Young University, Provo, Utah 84602-5432, USA.
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25
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Abstract
Solid-organ transplant recipients are at risk from various infectious diseases, many of which can be prevented by immunizations that could reduce morbidity and mortality. However, it is not uncommon for children requiring transplantation to have received inadequate or no immunizations pre-transplant. Every effort should be made to immunize transplant candidates early in the course of their disease according to recommended schedules prior to transplantation. It is also important to immunize their household contacts and healthcare workers. In this review, we summarize the major immunization issues for children undergoing transplantation, the data currently available on immunization safety and efficacy, and suggest immunization practices to reduce vaccine-preventable disease. There is a real need for a standardized approach to the administration and evaluation of immunizations in this group of patients.
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Affiliation(s)
- Anita Verma
- Health Protection Agency, London, Region Laboratory, Department of Medical Microbiology, King's College Hospital, London, UK.
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Parasuraman R, Yee J, Karthikeyan V, del Busto R. Infectious complications in renal transplant recipients. Adv Chronic Kidney Dis 2006; 13:280-94. [PMID: 16815233 DOI: 10.1053/j.ackd.2006.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Post-kidney transplant infection is the most common life-threatening complication of long-term immunosuppressive therapy. Optimal immunosuppression, in which a balance is maintained between prevention of rejection and avoidance of infection, is the most challenging aspect of posttransplantation care. The study of infectious complications in immunologically compromised recipients is changing rapidly, particularly in the fields of prophylactic and preemptive strategies, molecular diagnostic methods, and antimicrobial agents. In addition, emerging pathogens such as BK polyomavirus and West Nile flavivirus infections and the introduction of newer immunosuppressive agents that constantly change the risk profiles for opportunistic infections has added layers of complexity to this burgeoning field. Although remarkable progress has been made in these disciplines, comprehensive understanding of the clinical manifestations of infections remains limited, and the standardization of prophylaxis, diagnosis, and treatment of most infections is yet inadequately defined. The long-term goal for optimal care of transplant recipients, with respect to infection, is the prevention and/or early recognition and treatment of infections while avoiding drug-related toxicities.
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Affiliation(s)
- Ravi Parasuraman
- Division of Nephrology and Hypertension, Henry Ford Health Systems, Detroit, MI 48202, USA
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Warmington L, Lee BE, Robinson JL. Loss of antibodies to measles and varicella following solid organ transplantation in children. Pediatr Transplant 2005; 9:311-4. [PMID: 15910386 DOI: 10.1111/j.1399-3046.2005.00313.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to determine if loss of antibodies to measles and to varicella occurs in pediatric solid organ transplant recipients. Antibodies were measured in eight hepatic, four cardiac, and six renal transplant patients who had antibodies to measles prior to transplantation, and in six hepatic, five cardiac, and seven renal transplant patients who had antibodies to varicella prior to transplantation. Within 6 months of the transplant, loss of antibodies occurred in four of 18 patients who were seropositive for measles prior to transplantation (22.2%) and in two of 18 patients who were seropositive for varicella prior to transplantation (11.1%). In conclusion, serology for measles and varicella should be considered annually following solid organ transplantation so that appropriate advice can be given to patients who have seroreverted.
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Affiliation(s)
- Lise Warmington
- Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
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28
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Kotton CN, Ryan ET, Fishman JA. Prevention of infection in adult travelers after solid organ transplantation. Am J Transplant 2005; 5:8-14. [PMID: 15636606 DOI: 10.1111/j.1600-6143.2004.00708.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Increasing numbers of solid organ transplant recipients are traveling to the developing world. Many of these individuals either do not seek or do not receive optimal medical care prior to travel. This review considers risks of international travel to adult solid organ transplant recipients and the use of vaccines and prophylactic agents in this population.
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Affiliation(s)
- Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
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29
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Abstract
PURPOSE OF REVIEW The purpose of this review is to update and summarize information concerning the epidemiology of infections due to Streptococcus pneumoniae and the early results of effectiveness studies of the heptavalent pneumococcal conjugate vaccine. This vaccine was licensed in the US in 2000, and has been used increasingly since that time. RECENT FINDINGS Several studies have documented a dramatic decline in the rate of invasive infections due to S. pneumoniae in children under 5 years of age. There has been a simultaneous decrease in serious infections in persons over 20 years of age, presumably because of a decrease in transmission of S. pneumoniae to unvaccinated individuals. Three different studies have shown a modest reduction in the overall number of cases of acute otitis media in children who have received the vaccine. Although the overall number of cases has decreased there has been an increase in the number of cases of acute otitis media caused by serotypes of S. pneumoniae not contained in the vaccine. Worldwide, many studies have appeared that examine the prevalence of different pneumococcal serotypes/serogroups as a cause of invasive and respiratory disease, to assess the likelihood that the vaccine will be effective in particular geographic areas. SUMMARY Use of the heptavalent pneumococcal conjugate vaccine has led to a major decline in the prevalence of invasive pneumococcal disease (bacteremia, meningitis) and a more modest decrease in respiratory tract infections (acute otitis media, pneumonia). Continued surveillance is essential to document future trends in the occurrence of pneumococcal infections and the enduring protectiveness of the heptavalent pneumococcal conjugate vaccine.
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Affiliation(s)
- Klara M Posfay-Barbe
- Children's Hospital of Pittsburgh, Division of Allergy, Immunology and Infectious Diseases, Pittsburgh, Pennsylvania 15213, USA
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30
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Actualización en la vacunación del adulto. Enferm Infecc Microbiol Clin 2004. [DOI: 10.1016/s0213-005x(04)73107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Advances in medicine, science, and technology have led to increasing numbers of people in the general population with altered host defenses. The risk for clinical infection in an immunocompromised host, such as a person who has received a solid organ transplant, is determined largely by the interaction between two factors: the epidemiologic exposures the person encounters and the person's net state of immunosuppresson. Vaccination represents a crucial approach for preventing infection in the general public and immunocompromised persons. This article reviews the benefits of and risks for immunization in immunocompromised persons and provides recommendations for the use of specific vaccines.
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Affiliation(s)
- David J Weber
- Adult Infectious Disease Division, University of North Carolina School of Medicine, CB #7030, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7030, USA.
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Iglesias Berengue J, López Espinosa J, Campins Martí M, Ortega López J, Moraga Llop F. [Vaccinations and solid-organ transplantation: review and recommendations]. An Pediatr (Barc) 2003; 58:364-75. [PMID: 12681186 DOI: 10.1016/s1695-4033(03)78071-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Pediatric solid-organ transplant recipients are at high risk for various infectious diseases. Many children are not fully vaccinated before transplantation. To reduce the risk of morbidity and mortality from vaccine-preventable disease, physicians treating pediatric solid-organ transplant recipients should monitor the immunization status of these patients. Consensus on the most appropriate immunization schedule for solid-organ transplant recipients is lacking. Therefore, we provide a review of the currently available data on immunization safety and efficacy and describe strategies to avoid vaccine-preventable diseases in pediatric solid-organ transplant recipients.
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Affiliation(s)
- J Iglesias Berengue
- Equipo de Trasplante Hepático Pediátrico. Hospital Universitario Vall d'Hebron. Barcelona. España.
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Dropulic LK, Rubin RH, Bartlett JG. Smallpox vaccination and the patient with an organ transplant. Clin Infect Dis 2003; 36:786-8. [PMID: 12627364 DOI: 10.1086/374716] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2003] [Accepted: 01/30/2003] [Indexed: 11/04/2022] Open
Abstract
Organ transplant recipients are vulnerable to a variety of infections because of the immunosuppressed state required to prevent organ rejection. We review the recommendations of the Centers for Disease Control and Prevention (Atlanta, Georgia) for smallpox vaccination and the possible complications of vaccination in the population with organ transplants. The risk of these complications is presumably dependent on the extent of deficient cell-mediated immunity.
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Affiliation(s)
- Lesia K Dropulic
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Sullivan KM, Dykewicz CA, Longworth DL, Boeckh M, Baden LR, Rubin RH, Sepkowitz KA. Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2001; 2001:392-421. [PMID: 11722995 DOI: 10.1182/asheducation-2001.1.392] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This review presents evidence-based guidelines for the prevention of infection after blood and marrow transplantation. Recommendations apply to all myeloablative transplants regardless of recipient (adult or child), type (allogeneic or autologous) or source (peripheral blood, marrow or cord blood) of transplant. In Section I, Dr. Dykewicz describes the methods used to rate the strength and quality of published evidence supporting these recommendations and details the two dozen scholarly societies and federal agencies involved in the genesis and review of the guidelines. In Section II, Dr. Longworth presents recommendations for hospital infection control. Hand hygiene, room ventilation, health care worker and visitor policies are detailed along with guidelines for control of specific nosocomial and community-acquired pathogens. In Section III, Dr. Boeckh details effective practices to prevent viral diseases. Leukocyte-depleted blood is recommended for cytomegalovirus (CMV) seronegative allografts, while ganciclovir given as prophylaxis or preemptive therapy based on pp65 antigenemia or DNA assays is advised for individuals at risk for CMV. Guidelines for preventing varicella-zoster virus (VZV), herpes simplex virus (HSV) and community respiratory virus infections are also presented. In Section IV, Drs. Baden and Rubin review means to prevent invasive fungal infections. Hospital design and policy can reduce exposure to air contaminated with fungal spores and fluconazole prophylaxis at 400 mg/day reduces invasive yeast infection. In Section V, Dr. Sepkowitz details effective clinical practices to reduce or prevent bacterial or protozoal disease after transplantation. In Section VI, Dr. Sullivan reviews vaccine-preventable infections and guidelines for active and passive immunizations for stem cell transplant recipients, family members and health care workers.
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Affiliation(s)
- K M Sullivan
- Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA
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