1
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Sweiss H, Lyons JM, Hitchman KMK, Kincaide EL, Hall R, Ranch D, Crowther B. Impact of catch-up vaccinations on anti-HLA antibody response in pediatric kidney transplant candidates. Pediatr Transplant 2022; 26:e14304. [PMID: 35531710 DOI: 10.1111/petr.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Efforts have been concentrated on improving vaccination administration during the pretransplant evaluation period. However, concern for human leukocyte antigen (HLA) sensitization subsequent to vaccination exists. METHODS A retrospective review of pediatric kidney transplant candidates (PKTCs) ≤18 years old who had received vaccinations between February 1, 2017 and November 30, 2019 was conducted. Emergence of de novo anti-HLA antibody (HLA-Ab) 3-4 weeks postvaccinations detected by the Luminex single antigen bead assay (SAB) was evaluated. Outcomes assessed included change in the HLA-Ab mean fluorescence intensity (MFI) ≥25% from baseline, and change in preexisting HLA-Ab MFI strength, categorized as weak: 1000-2999; moderate: 3000-9999; and strong: ≥10 000. RESULTS Sixty vaccinations were administered to 14 patients. Forty-one potential de novo HLA-Ab were detected in five patients. After additional antibody panel testing, 5/41 potential de novo HLA-Ab were determined to be HLA specific; the remaining 36 were deemed nonspecific. The 5 de novo HLA-Ab were observed in three patients and were deemed weak antibody (Ab). Median MFI showed a significant increase for nonspecific Ab, but not de novo HLA-Ab. Median MFI values were deemed transient at 7-10 week follow-up. No HLA-donor-specific Ab developed posttransplant in the patients who developed de novo HLA-Ab. CONCLUSION Vaccination resulted in a transient increase in non-HLA-specific Ab. The majority of responses were non-HLA specific, hypothesized to be related to denatured antigens on single antigen beads. These data suggest limited clinical impact of vaccinations on the emergence of de novo HLA-Ab.
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Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, Texas, USA.,University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA
| | - John Michael Lyons
- Department of Pharmacy, Loyola University Medical Center, Chicago, IL, USA
| | - Kelley M K Hitchman
- University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Histocompatibility and Immunogenetics Laboratory, University Health System, San Antonio, Texas, USA.,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Elisabeth Lapp Kincaide
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, Texas, USA.,University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA
| | - Reed Hall
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, Texas, USA.,University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA
| | - Daniel Ranch
- University Health Transplant Institute, University Health System, San Antonio, Texas, USA.,Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Barrett Crowther
- Ambulatory Care Pharmacy Services, University of Colorado Health, Aurora, Colorado, USA.,University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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2
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Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates. Pediatr Nephrol 2022; 37:2559-2569. [PMID: 35333972 PMCID: PMC8949834 DOI: 10.1007/s00467-022-05511-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022]
Abstract
The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.
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3
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MacDonald SE, Palichuk A, Slater L, Tripp H, Reifferscheid L, Burton C. Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review. Hum Vaccin Immunother 2021; 18:1-16. [PMID: 34270376 PMCID: PMC8920240 DOI: 10.1080/21645515.2021.1935169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.
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Affiliation(s)
| | | | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Hailey Tripp
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Catherine Burton
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
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4
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Feldman AG, Marsh R, Kempe A, Morris MA. Barriers to Pretransplant Immunization: A Qualitative Interview Study of Pediatric Solid Organ Transplant Stakeholders. J Pediatr 2020; 227:60-68. [PMID: 32681988 PMCID: PMC7686014 DOI: 10.1016/j.jpeds.2020.07.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To describe the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pretransplant immunization rates. STUDY DESIGN Semistructured interviews were conducted with transplant team members (hepatologists, cardiologists, nephrologists, transplant nurse coordinators, and transplant infectious diseases physicians), primary care physicians, and parents of heart, liver, and kidney transplant recipients at 3 geographically diverse large pediatric transplant centers in the US. Interviews were conducted between July 2017 and February 2020 until thematic saturation was reached within each stakeholder subgroup. Content analysis methodology was used to identify themes. RESULTS Stakeholders participated in 30- to 60-minute interviews (16 transplant subspecialists, 3 transplant infectious diseases physicians, 11 transplant nurse coordinators, 12 primary care physicians, and 40 parents). Five central themes emerged: (1) gaps in knowledge about timing and safety of pretransplant immunizations, (2) lack of communication, coordination, and follow-up between team members regarding immunizations, (3) lack of centralized immunization records, (4) subspecialty clinic functioning as the medical home for transplant candidates but unable to provide all needed immunizations, and (5) differences between organ type in prioritization and completion of pretransplant immunization. CONCLUSIONS There are multiple factors that contribute to low immunization rates among pediatric transplant candidates. New tools are needed to overcome these barriers and increase immunization rates in transplant candidates.
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Affiliation(s)
- Amy G. Feldman
- Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health Institute, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine & Children’s Hospital Colorado
| | - Rebekah Marsh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado
| | - Allison Kempe
- Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine & Children’s Hospital Colorado
| | - Megan A. Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado & Children’s Hospital Colorado
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5
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Cortina G, Ojinaga V, Zlamy M, Giner T, Riedl M, Rauchenzauner M, Entenmann A, Müller T. Vaccination Status in Pediatric Solid-Organ Transplant Recipients and Their Household Members. EXP CLIN TRANSPLANT 2019; 17:429-434. [DOI: 10.6002/ect.2018.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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6
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Camargo LF, Lother AM, Mazzali M, Stucchi RSB. Immunization in end stage renal disease: The perception of waiting list patients. Transpl Infect Dis 2018; 20:e12831. [PMID: 29337400 DOI: 10.1111/tid.12831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/08/2017] [Accepted: 12/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The number of patients with chronic kidney disease is increasing worldwide, as well as the number of patients in kidney transplant waiting lists. In order to prevent infections related to immunosuppressive therapy, immunization guidelines for CKD patients before transplantation have been proposed. The aim of the present study was to evaluate adherence to immunization in a cohort of CKD patients in transplant waiting list and their renal replacement therapy clinics. METHODS CKD patients older than 18 years old, receiving renal replacement therapy longer than 12 months and included in kidney transplant waiting list at University of Campinas (Unicamp) were enrolled. RESULTS From February 2014 to December 2015, 105 patients fulfilled the inclusion criteria. Complete hepatitis B vaccination was observed in 73% and influenza vaccine in 67%. None of the other vaccine protocols reached 50% of coverage. Patients receiving immunization at primary health units presented higher coverage for diphtheria, tetanus (dT), measles, mumps, rubella (MMR), and hepatitis B vaccines, while patients immunized at renal replacement therapy clinics showed higher prevalence of pneumococcus (pneumo23). CONCLUSION The low rates of immunization could reflect the RRT's clinics knowledge about the vaccines guidelines and its application on daily care. We suggest an integration between transplant center and RRT clinics, through lectures, periodic checking of vaccination cards, and easy to follow guidelines in order to provide a better vaccine coverage and to obtain higher immunization rates.
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Affiliation(s)
- Leonardo Figueiredo Camargo
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil
| | | | - Marilda Mazzali
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil
| | - Raquel S B Stucchi
- Division of Infectious Diseases, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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7
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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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8
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Carthon CE, Hall RC, Maxwell PR, Crowther BR. Impact of a pharmacist-led vaccine recommendation program for pediatric kidney transplant candidates. Pediatr Transplant 2017; 21. [PMID: 28677269 DOI: 10.1111/petr.12989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/28/2022]
Abstract
Pediatric transplant recipients commonly have deficient vaccination status at the time of transplantation. Utilizing transplant pharmacists to improve vaccination rates has not previously been described. This single-center, retrospective study evaluated the impact of transplant pharmacist interventions on the completion rate of vaccination schedules at time of kidney transplant. Patients who received pharmacist-led vaccination recommendations prior to transplant were compared to patients without pharmacist recommendations. Forty-seven pediatric patients were included: 24 intervention patients and 23 control patients. The median percentage of up-to-date vaccinations at time of transplant was significantly higher in intervention group (91%; IQR 86%-100%) vs. control group (80%; IQR 71%-80%) (P<.0001). The median change in up-to-date vaccinations from time of evaluation to time of transplant was also significantly higher in the intervention group (7.5%) compared to the control group (0%) (P<.0001). There was no difference in live vaccination rates. No patients in either group were readmitted for a vaccine-preventable disease within 6 months post-transplant. With pharmacist intervention, significantly more patients were up to date with vaccination schedules at the time of transplant. These results suggest that a transplant pharmacist may serve as a valuable resource to increase vaccination schedule compliance between time of evaluation and transplantation.
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Affiliation(s)
- Clarice E Carthon
- Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Reed C Hall
- University Transplant Center, University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.,Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Pamela R Maxwell
- University Transplant Center, University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.,Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Barrett R Crowther
- University Transplant Center, University Health System, San Antonio, TX, USA.,Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.,Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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9
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Hofstetter AM, LaRussa P, Rosenthal SL. Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake. Hum Vaccin Immunother 2015; 11:2571-81. [PMID: 26212313 PMCID: PMC4685675 DOI: 10.1080/21645515.2015.1067350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/04/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022] Open
Abstract
Adolescents with chronic medical conditions (CMCs), a growing population worldwide, possess a wide array of preventive health care needs. Vaccination is strongly recommended for the vast majority of these adolescents given their increased risk of vaccine preventable infection and associated complications. Not only should they receive routine vaccines, but some also require additional vaccines. Despite these guidelines, evidence suggests that adolescents with CMCs often fail to receive needed vaccines. Many factors contribute to this under-immunization, including lack of knowledge among parents and providers and suboptimal coordination of primary and subspecialty care. This review describes current vaccination recommendations for these adolescents as well as recent data related to infection risk, vaccine efficacy and safety, vaccination coverage, and the unique multilevel factors impacting uptake in this population. It also discusses strategies for improving coverage levels and reducing missed vaccination opportunities, with a particular focus on technology-based interventions.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics; University of Washington; Seattle, WA USA
- Center for Clinical and Translational Research; Seattle Children's Research Institute; Seattle, WA USA
| | - Philip LaRussa
- Department of Pediatrics; Columbia University Medical Center; New York, NY USA
- NewYork-Presbyterian Hospital; New York, NY USA
| | - Susan L Rosenthal
- Department of Pediatrics; Columbia University Medical Center; New York, NY USA
- NewYork-Presbyterian Hospital; New York, NY USA
- Department of Psychiatry; Columbia University Medical Center; New York, NY USA
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10
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Genc G, Ozkaya O, Aygun C, Yakupoglu YK, Nalcacioglu H. Vaccination Status of Children Considered for Renal Transplant: Missed Opportunities for Vaccine Preventable Diseases. EXP CLIN TRANSPLANT 2012; 10:314-8. [PMID: 22845763 DOI: 10.6002/ect.2012.0059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Ozkaya E, Cambaz N, Kolsuz LD, Aycan N, Calis S, Samanci N. Vaccination coverage and risk factors for incomplete vaccination in children with recurrent wheeze. Allergol Immunopathol (Madr) 2011; 39:222-7. [PMID: 21208719 DOI: 10.1016/j.aller.2010.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/02/2010] [Accepted: 07/06/2010] [Indexed: 11/16/2022]
Abstract
AIM To determine the possible impact of recurrent wheeze on immunisation status in the first three years of life. METHOD A cross-sectional case control study of 288 children less than three years of age with a history of recurrent wheezing, hospitalised at a single centre for wheeze; and a control group of 190 children with no prior history of wheezing. Vaccination charts of all children were analysed according to the National Immunisation Schedule. Additionally, some associated data were collected through a questionnaire to the parents. RESULTS Children with recurrent wheezing during the first three years of life were less likely to be vaccinated against BCG (Bacillus-Calmette-Guerin), hepatitis B, Hib (Haemophilus influenza type B), and MMR (Measles, Mumps, Rubella) (p < 0.001). A significant inverse association was also found between the number of wheezy episodes and the number of vaccine doses received. The odds ratio of incomplete vaccination in children with recurrent wheeze was 10.6 (95% CI, 2.96 to 38.1). CONCLUSION Children under three years of age with recurrent wheeze run a high risk of incomplete immunisation. Efforts should be therefore made to insure that such children receive adequate vaccination.
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Affiliation(s)
- E Ozkaya
- Department of Pediatrics, Vakıf Gureba Education and Research Hospital, Istanbul, Turkey.
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12
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Teich N, Klugmann T, Tiedemann A, Holler B, Mössner J, Liebetrau A, Schiefke I. Vaccination coverage in immunosuppressed patients: results of a regional health services research study. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:105-11. [PMID: 21412507 DOI: 10.3238/arztebl.2011.0105] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/16/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with chronic inflammatory diseases are at elevated risk of infections that can be prevented by vaccination. This elevated risk is due not just to these patients' primary illnesses, but also to the immunosuppressive treatment that they often receive. We studied the vaccination rate in a random sample of patients with two types of inflammatory bowel disease (IBD), namely, Crohn's disease and ulcerative colitis. In particular, we asked unvaccinated patients why they had re-fused the vaccine. METHODS From April to September 2009, we gave a 38-item questionnaire to 203 consecutive patients with IBD (57% with Crohn's disease, 63% female, median age 36 years) who had not received vaccination counseling for at least one year, and inspected the patients' vaccination cards. We compared the findings to the current recommendations of the German Federal Standing Committee on Vaccination (Ständige Impfkommission). RESULTS 83% of the patients had a vaccination card. Substantial deficiencies in vaccination were found. Only 67% of the patients had been immunized against tetanus in the previous 10 years, and only 21% against pertussis. Only 28% were vaccinated against seasonal influenza in 2008, and only 9% had ever received anti-pneumococcal vaccine. A subgroup analysis in which we compared 39 patients taking TNF-blockers to 67 patients who never had any type of immunosuppressive treatment revealed no difference in vaccination rates. 80% of all patients said they were willing to receive all of the officially recommended vaccinations. 22% of all patients said they avoided vaccinations for fear of side effects, while 15% said they did so because their immune system was supposedly "not intact", and 9% because they feared vaccination would worsen their IBD. CONCLUSION In this random sample, the vaccination rate fell far behind the recommendations. In particular, there was a marked discrepancy between patients' willingness to be vaccinated and the actual provision of vaccination. These findings imply that physicians need to be more aware of the possibly inadequate vaccination state of their immunosuppressed patients.
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13
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Determinants of vaccine immunity in the cohort of human immunodeficiency virus-infected children living in Switzerland. Pediatr Infect Dis J 2009; 28:996-1001. [PMID: 19820427 DOI: 10.1097/inf.0b013e3181a78348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected children are at increased risk of infections caused by vaccine preventable pathogens, and specific immunization recommendations have been issued. METHODS A prospective national multicenter study assessed how these recommendations are followed in Switzerland and how immunization history correlates with vaccine immunity. RESULTS Among 87 HIV-infected children (mean age: 11.1 years) followed in the 5 Swiss university hospitals and 1 regional hospital, most (76%) had CD4 T cells >25%, were receiving highly active antiretroviral treatment (79%) and had undetectable viral load (60%). Immunization coverage was lower than in the general population and many lacked serum antibodies to vaccine-preventable pathogens, including measles (54%), varicella (39%), and hepatitis B (65%). The presence of vaccine antibodies correlated most significantly with having an up-to-date immunization history (P<0.05). An up-to-date immunization history was not related to age, immunologic stage, or viremia but to the referral medical center. CONCLUSIONS All pediatricians in charge of HIV-infected children are urged to identify missing immunizations in this high-risk population.
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14
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Dehghani SM, Shakiba MA, Ziaeyan M, Imanieh MH, Haghighat M, Bahador A, Nikeghbalian S, Salahi H, Alborzi A, Malek-Hosseini SA. Vaccination status in pediatric liver transplant candidates. Pediatr Transplant 2009; 13:820-2. [PMID: 19413722 DOI: 10.1111/j.1399-3046.2009.01177.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Infection is a recognized and potentially serious complication in children following solid organ transplantation. This problem is particularly important for young children undergoing any organ transplantation who often have not completed standard childhood immunizations at the time of transplantation and who are therefore at risk for vaccine-preventable infections. To evaluate the vaccination status in liver transplant candidates, vaccination charts of 100 patients who were referred to Organ Transplant Center of Nemazee Hospital were reviewed and the vaccination status considered appropriate according to the recommendation of NIP and the patients' age. Fifty-eight percent of patients were completely vaccinated for HBV, 85% for OPV, 97% for BCG, 63% for DTP, and 58% of the patients were completely vaccinated for MMR. We concluded that the vaccination charts should be periodically reviewed and updated to prevent the vaccine-preventable disease in liver transplant candidates not only before but also after transplant. Every effort should be made to assure that candidates are immunized early in the course of their disease. Also it may be indicated to recommend a special guideline for immunization of liver transplant candidates and add other vaccines such as Haemophilus influenzae and Streptococcus pneumoniae vaccine to their vaccination program.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Shiraz Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Abstract
Patients receiving immunosuppressive therapies may be at increased risk for complications of vaccine preventable diseases, including influenza, varicella, and pneumococcus. However, studies suggest that patients with chronic illness may be inadequately immunized. In part, this is because of a paucity of formal vaccine studies in immune compromised populations. This review discusses the methods one uses to assess vaccine efficacy and provides an update on currently known data on the vaccine antibody responses in immune compromised hosts. Currently published studies suggest that influenza vaccine can be safely administered to patients with IBD on immunosuppression, and is effective in the majority of patients. Further formal studies with other inactivated vaccines (e.g., pneumococcal vaccine, meningitis vaccine) should be conducted. While some studies in immune compromised hosts suggest the live attenuated varicella vaccine can be given without adverse events, administration of this vaccine in patients on immunosuppression remains controversial.
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