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Casias M, Page RL, Campbell T. Postexposure prophylaxis after receipt of MMR vaccine prior to emergent heart transplant. Transpl Infect Dis 2024:e14365. [PMID: 39185759 DOI: 10.1111/tid.14365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Michael Casias
- Department of Pharmacy, UCHealth-University of Colorado Hospital, Aurora, Colorado, USA
| | - Robert L Page
- Department of Pharmacy, UCHealth-University of Colorado Hospital, Aurora, Colorado, USA
- Department of Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Thomas Campbell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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2
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Kushner LE, Kamens J, Bertaina A, Shyr D, Gans HA. Vaccine Associated Measles Complicated by Suspected Measles Inclusion Body Encephalitis in a Pediatric Leukemia Patient and Stem Cell Transplant Recipient: A Focus on Clinical Evolution and Management. Pediatr Infect Dis J 2024; 43:582-586. [PMID: 38380931 DOI: 10.1097/inf.0000000000004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Immunocompromised individuals are at increased risk for severe disease and complications from viral infections, highlighting the importance of vaccination. However, in extremely rare situations, vaccine associated viral infections can be associated with disseminated disease and complications in immunocompromised hosts. CASE Herein, we present a case of a 1-year-old child diagnosed with acute myeloid leukemia less than 2 weeks after receiving live viral vaccines who developed acute vaccine-strain measles virus disease, later complicated by central nervous system involvement following hematopoietic stem cell transplantation. A brain biopsy specimen was positive for vaccine-strain measles virus detected by reverse transcriptase polymerase chain reaction. MANAGEMENT AND OUTCOME She was treated with intravenous ribavirin, inosine pranobex, intrathecal interferon-alpha and donor lymphocyte infusion following measles-mumps-rubella vaccine boost. Despite these measures, the patient suffered neurologic decline and dysautonomia, expiring after compassionate extubation. Management and ideal risk mitigation strategies are discussed within the context of existing literature for this rare complication.
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Affiliation(s)
| | - Jennifer Kamens
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Alice Bertaina
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - David Shyr
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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3
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Beer E, Chowdhury H, Carroll B, Luintel A, van Tulleken C, Longley N. Advising the immunocompromised traveller: a review of immunocompromise at The London Hospital for Tropical Diseases Travel Clinic between 1st April 2019 and 30th April 2020. Trop Dis Travel Med Vaccines 2024; 10:8. [PMID: 38616263 PMCID: PMC11017494 DOI: 10.1186/s40794-024-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/09/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Immunocompromised travellers (ICTs) face greater infectious and non-infectious travel-associated risks than their immunocompetent counterparts. Increasing travel and emergence of novel immunosuppressants poses great challenges for travel medicine practitioners to confidently provide up-to-date evidence-based risk management advice and pre-travel care for ICTs. METHODS We reviewed the records of ICTs attending the London Hospital for Tropical Diseases (HTD) Travel Clinic between 1st April 2019 and 30th April 2020 with the aim to describe demographic and travel characteristics, type, and severity of immunocompromise, the degree of risk associated with intended travel and evaluate travel advice. RESULTS Of the 193 ICTs identified, immunocompromise was due to physiological reasons (42%), chronic infection (17.1%) and immunosuppressive therapy (16.6%). Median age was 38 (range 9 months to 84 years) and male to female ratio 0.75 (83:110). Travel was intended to 80 countries for a median of 16 days (range 2 to 3167), predominantly for leisure (53%), non-medical work (17%) and visiting friends and relatives (12%). Live vaccine safety dominated discussion in the pre-travel consultation. Existing guidelines arguably fell short in dealing with travel risks associated with hyper-specific conditions, targeted immunosuppressants and non-vaccine preventable infections. CONCLUSIONS Our cohort represents a wide spectrum of immunocompromise, for whom we arguably need more measurable ways to approach travel-associated risks. We propose prospective qualitative participatory research to inform our unit of the priorities of ICTs in the pre-travel consultation. We further recommend the formation of a repository of specialists and formulary of complex cases to direct subsequent informative systematic review and prospective risk studies.
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Affiliation(s)
- Ellen Beer
- University College London Hospital, London, NW1 2BU, UK.
| | | | | | - Akish Luintel
- University College London Hospital, London, NW1 2BU, UK
| | | | - Nicky Longley
- Hospital for Tropical Diseases, University College London Hospital, London, NW1 2BU, UK
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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4
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Sharma S, Dhamne C, Bhosale S, Parambil B, Divatia J, Chinnaswamy G, Patil V, Joshi R, Epari S, Mahadevan A, Vaidya S, Kulkarni S, Kulkarni A, Patil V, Srinivasan S, Gollamudi VRM, Roy Moulik N, Prasad M, Narula G, Banavali S. Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies. JCO Glob Oncol 2024; 10:e2300399. [PMID: 38422460 PMCID: PMC10914244 DOI: 10.1200/go.23.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE To share our clinical experience with the diagnosis and management of children with hematolymphoid malignancies presenting with epilepsia partialis continua (EPC) as a sequelae of measles infection. MATERIALS AND METHODS In December 2022, a series of children in our hemato-oncology unit presented with focal status epilepticus with no conclusive evidence pointing toward any underlying etiology. One such child had a typical measles rash a few weeks before the onset of this focal status epilepticus. After a series of cases with a similar presentation, a clinical pattern suspicious for measles became evident. cerebrospinal fluid polymerase chain reaction was positive for measles virus with measles immunoglobin M detected in the serum. This led to the diagnosis of measles inclusion-body encephalitis in a series of children who presented with EPC over a period of 3 months. EPC is a rare manifestation of measles that is seen only in immunocompromised patients. RESULTS Among the 18 children reported in this series, only 10 had a history of rashes. The rash was mostly transient and elicited only on retrospective history taking. Five of the 18 children who did not lose consciousness during the prolonged seizure episode survived the disease but had residual neurologic sequelae. Among the 18 children, two were unimmunized and immunization status could not be confirmed in three other children. CONCLUSION This case series highlights the threats posed by measles infection in children with cancer who are immunosuppressed because of the underlying disease and ongoing chemotherapy. Loss of herd immunity because of declining measles immunization rates secondary to vaccine hesitancy and COVID-19 lockdown pose a greater risk of measles infection and its complications for patients with deficient immune systems.
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Affiliation(s)
- Sudivya Sharma
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shilpushp Bhosale
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Badira Parambil
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jigeeshu Divatia
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vasundhara Patil
- Department of Radiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sridhar Epari
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sunil Vaidya
- Virus Registry and Virus Repository, National Institute of Virology, Pune, India
| | - Shilpa Kulkarni
- Department of Neurology, Wadia Children's Hospital, Mumbai, India
| | - Atul Kulkarni
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijaya Patil
- Division of Critical Care Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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5
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Jeong SY, Choe YJ, Lee DH, Kim EY, Kim MN, Kim SJ, Lee GH, Kang HJ, Han MG. Measles Vaccine-Associated Rash Illness Amidst Measles Elimination: National Surveillance Data, South Korea. J Med Virol 2022; 94:4539-4541. [PMID: 35508758 DOI: 10.1002/jmv.27827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/07/2022]
Abstract
We reviewed national surveillance data to describe measles vaccine-associated rash illness (VARI) in Korea, between 2011 and 2021. A total of 110 (11.6% of total reports) VARI case-patients were notified, with median age of 12 months; mean interval between vaccination and rash, 10 days. 86.4% had fevers, 20.0% cough. The findings demonstrate the importance of genotype identification in the midst of measles elimination phase.conducted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Soo-Yeon Jeong
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | | | - Dong-Han Lee
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Eun-Young Kim
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Mi-Na Kim
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Su-Jin Kim
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Gye-Hee Lee
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Hae-Ji Kang
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Myung-Guk Han
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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Kumar RN, Stosor V. Advances in Liver Transplantation for Persons with Human Immunodeficiency Infection. Curr Infect Dis Rep 2022; 24:39-50. [PMID: 35308580 PMCID: PMC8922075 DOI: 10.1007/s11908-022-00776-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca N. Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611 USA
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