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Laue T, Junge N, Leiskau C, Mutschler F, Ohlendorf J, Baumann U. Diminished measles immunity after paediatric liver transplantation-A retrospective, single-centre, cross-sectional analysis. PLoS One 2024; 19:e0296653. [PMID: 38315673 PMCID: PMC10843477 DOI: 10.1371/journal.pone.0296653] [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: 08/16/2023] [Accepted: 12/16/2023] [Indexed: 02/07/2024] Open
Abstract
Liver transplantation in childhood has an excellent long-term outcome, but is associated with a long-term risk of infection. Measles is a vaccine-preventable infection, with case series describing severe courses with graft rejection, mechanical ventilation and even death in liver transplant recipients. Since about 30% of liver transplanted children receive liver transplants in their first year of life, not all have reached the recommended age for live vaccinations. On the contrary, live vaccines are contraindicated after transplantation. In addition, vaccination response is poorer in individuals with liver disease compared to healthy children. This retrospective, single-centre, cross-sectional study examines measles immunity in paediatric liver transplant recipients before and after transplantation. Vaccination records of 239 patients, followed up at Hannover Medical School between January 2021 and December 2022 were analysed. Twenty eight children were excluded due to stem cell transplantation, regular immunoglobulin substitution or measles vaccination after transplantation. More than 55% of all 211 children analysed and 75% of all those vaccinated at least once are measles seropositive after transplantation-48% after one and 84% after two vaccinations-which is less than in healthy individuals. Interestingly, 26% of unvaccinated children also showed measles antibodies and about 5-15% of vaccinated patients who were seronegative at the time of transplantation were seropositive afterwards, both possibly through infection. In multivariable Cox proportional hazards regression, the number of vaccinations (HR 4.30 [95% CI 2.09-8.83], p<0.001), seropositivity before transplantation (HR 2.38 [95% CI 1.07-5.30], p = 0.034) and higher age at time of first vaccination (HR 11.5 [95% CI 6.92-19.1], p<0.001) are independently associated with measles immunity after transplantation. In contrast, older age at testing is inversely associated (HR 0.09 [95% CI 0.06-0.15], p<0.001), indicating a loss of immunity. Vaccination in the first year of life does not pose a risk of non-immunity. The underlying liver disease influences the level of measles titres of twice-vaccinated patients; those with acute liver failure being the lowest compared to children with metabolic disease. In summary, vaccine response is poorer in children with liver disease. Liver transplant candidates should be vaccinated before transplantation even if this is earlier in the first year of life. Checking measles IgG and re-vaccinating seronegative patients may help to achieve immunity after transplantation.
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Affiliation(s)
- Tobias Laue
- Division for Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Norman Junge
- Division for Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Christoph Leiskau
- Paediatric Gastroenterology, Department of Paediatrics and Adolescent Medicine, University Medical Centre Goettingen, Georg August University Goettingen, Goettingen, Germany
| | - Frauke Mutschler
- Division for Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Johanna Ohlendorf
- Division for Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ulrich Baumann
- Division for Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Sohal A, Kohli I, Chaudhry H, Singh I, Arora K, Kalra S, Dukovic D, Roytman M. Vaccine-Preventable Illness Leads to Adverse Outcomes in Liver Transplant Recipients. Dig Dis Sci 2024; 69:588-595. [PMID: 38030833 DOI: 10.1007/s10620-023-08202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Liver transplant recipients (LTR) and patients with chronic liver disease (CLD) are at an increased risk of infections. AIMS The objective of our study was to assess the incidence, and impact of vaccine preventable illness (VPI) on outcomes in LTR. METHODS National Inpatient Sample (NIS) 2016-2020 was used to identify adults (age > 18) hospitalized LTR using ICD-10 codes. Data were collected on patient demographics, hospital characteristics, etiology of liver disease, hepatic decompensations and outcomes. Patients were stratified into two groups based on the presence or absence of VPI. Multivariate logistic regression analysis was performed to identify the association between VPI and outcomes. RESULTS Out of 170,650 hospitalized LTR, 13.5% of the patients had VPI. The most common VPI was noted to be influenza (10.7%), followed by pneumococcal infection (2.7%). Incidence of mortality (6.9% vs. 1.6%, p < 0.001), ICU admissions (14.3% vs. 3.4%, p < 0.001), and acute kidney injury (AKI) (43.7% vs 37.35%, p < 0.001) was higher in the VPI group. CONCLUSION More than 13% of the LT hospitalizations had concomitant VPI. VPI in LTR was associated with worse outcomes. Our data suggests the need to identify factors associated with reduced vaccination rates and identify strategies to improve vaccination rates and responses in these patients.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, 3216 NE 45Th Pl, Suite 212, Seattle, WA, 98105, USA.
| | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA
| | | | - Kirti Arora
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Shivam Kalra
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Dino Dukovic
- Ross University of Medical Sciences, Miramar, FL, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA
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Condran B, Kervin M, Burton C, Blydt-Hansen TD, Morris SK, Sadarangani M, Otley A, Yong E, Mitchell H, Bettinger JA, Top KA. Parent and healthcare provider views of live varicella vaccination of pediatric solid organ transplant recipients. Pediatr Transplant 2023; 27:e14609. [PMID: 37746885 DOI: 10.1111/petr.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Live attenuated varicella vaccine (LAVV) has historically been contraindicated in children who are immunocompromised due to solid organ transplant (SOT) because of safety concerns. Recently, clinical guidelines were developed that support post-transplant varicella vaccination in selected SOT recipients based on emerging evidence of LAVV safety. This qualitative study sought to explore barriers and facilitators to implementing the new guidelines, as well as acceptability of LAVV among healthcare providers (HCPs) and parents. METHODS HCPs and parents of transplant recipients were recruited from four sites using purposive sampling. Data from semi-structured interviews were analyzed using an Interpretive Description approach that incorporated data from the interviews, academic knowledge and clinical experience, and drew from Grounded Theory and Thematic Analysis. The theoretical framework used was Adaptive Leadership. RESULTS Thirty-four participants (16 HCPs and 18 parents) were included in the analysis. Parents developed skills in adaptive leadership that included strategies to protect their child against infectious diseases. Foundational information that live vaccines were absolutely contraindicated post-transplant "stuck" with parents and led them to develop strategies other than vaccination to keep their child safe. Some parents struggled to understand that information previously presented as a certainty (contraindication of LAVV) could change. Their approach to adaptive leadership informed their appraisal of the new vaccination guidelines and willingness to accept vaccination. CONCLUSIONS HCPs should adopt a family-centered approach to communicating changing guidelines that considers parents' approach to adaptive leadership and discusses the changing nature of medical evidence. Trust between HCPs and parents can facilitate these conversations.
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Affiliation(s)
- Brian Condran
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Melissa Kervin
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Catherine Burton
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun K Morris
- Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases and Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Anthony Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hana Mitchell
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Donà D, Bravo-Gallego LY, Remacha EF, Cananzi M, Gastaldi A, Canizalez JT, Stephenne X, Lacaille F, Lindemans C, Calore E, Galea N, Benetti E, Nachbaur E, Sandes AR, Teixeira A, Ferreira S, Klaudel-Dreszler M, Ackermann O, Boyer O, Espinosa L, Guereta LG, Sciveres M, Fischler B, Schwerk N, Neland M, Nicastro E, Dello Strologo L, Toporski J, Vainumae I, Rascon J, Urbonas V, Del Rosal T, López-Granados E, Perilongo G, Baker A, Vega PJ. Vaccination practices in pediatric transplantation: A survey among member centers of the European reference network TransplantChild. Pediatr Transplant 2023; 27:e14589. [PMID: 37543721 DOI: 10.1111/petr.14589] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/24/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND There is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN-TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence-based protocols. METHODS A cross-sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN-TransplantChild. RESULTS A total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on-site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%-100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between the centers, with 2 weeks for inactivated vaccines and variable time (2-4 weeks) for live-attenuated vaccines (LAVs). Almost all sites recommended immunization in the post-transplant period, with a time window of 4-8 months for the inactivated vaccines and 16-24 months for MMR and Varicella vaccines. Only five sites administer LAVs after transplantation, with seroconversion evaluated in 80% of cases. CONCLUSIONS The immunization coverage of European pediatric transplant recipients is still inconsistent and far from adequate. This survey is a starting point for developing shared evidence-based immunization protocols for safe vaccination among pediatric transplant centers and generating new research studies.
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Affiliation(s)
- Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luz Yadira Bravo-Gallego
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Esteban Frauca Remacha
- Pediatric Hepatology Department, La Paz University Hospital, Molecular Hepatology Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | - Mara Cananzi
- Unit of Paediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Andrea Gastaldi
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Department of Pediatrics, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Juan Torres Canizalez
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Xavier Stephenne
- Laboratoire d'Hépatologie Pédiatrique et Thérapie Cellulaire, Unité PEDI, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Florence Lacaille
- Service de Gastroentérologie-Hépatologie-Nutrition Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - Caroline Lindemans
- Princess Maxima Center for Pediatric Oncology, Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elisabetta Calore
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Nathalie Galea
- Paediatric Department of Mater Dei Hospital, Msida, Malta
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Azienda Ospedaliera di Padova, Padua, Italy
| | - Edith Nachbaur
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ana Rita Sandes
- Unidade de Nefrologia e Transplantação Renal, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria, Centro Académico de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Teixeira
- Department of Pediatric Nephrology, Pediatric Service, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Sandra Ferreira
- Hepatology and Pediatric Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maja Klaudel-Dreszler
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Oanez Ackermann
- Hepatologie et Transplantation Hepatique Pediatriques, Centre de reference de l'atresie des voies biliaires et des cholestases genetiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, AP-HP, Centre de Référence de maladies rénales rares de l'enfant et de l'adulte (MARHEA), Hôpital Necker-Enfants Malades, Paris, France
- Institut Imagine, Laboratoire des maladies rénales héréditaires, INSERM UMR 1163, Université de Paris, Paris, France
| | - Laura Espinosa
- Pediatric Nephrology Department, La Paz University Hospital, Diagnosis and Treatment of Diseases Associated with Abnormalities of the Complement System Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | | | - Marco Sciveres
- Pediatric Hepatology and Liver Transplantation, ISMETT-University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Björn Fischler
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Nicolaus Schwerk
- Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Mette Neland
- Department of Paediatrics and Adolescence Medicine, Odense University Hospital, Odense, Denmark
| | - Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Dello Strologo
- Nephrology Unit, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Jacek Toporski
- Department of Pediatrics, Section of Pediatric Oncology, Hematology, Immunology and Nephrology, Skåne University Hospital, Lund, Sweden
- Center of Allogenic Stem Cell Transplantation and Cellular Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Inga Vainumae
- Department of Pediatrics, Tartu University Hospital, Tartu, Estonia
| | - Jelena Rascon
- Centre for Paediatric Oncology and Haematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vaidotas Urbonas
- Department of Paediatric Gastroenterology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Teresa Del Rosal
- Paediatric Infectious and Tropical Diseases Department, La Paz University Hospital, Translational Research Network in Paediatric Infectious Diseases (RITIP), La Paz Institute of Biomedical Research (IdiPAZ), and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Eduardo López-Granados
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
- Clinical Immunology Department, La Paz University Hospital, Madrid, Spain
| | - Giorgio Perilongo
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Alastair Baker
- Paediatric Liver, Gastrointestinal and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK
| | - Paloma Jara Vega
- Pediatric Hepatology Department, La Paz University Hospital, Molecular Hepatology Group, La Paz Institute of Biomedical Research (IdiPAZ), ERN TransplantChild Coordinator, Madrid, Spain
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Herrero-Diez MT, Catalá-López F. [Vaccination coverage, beliefs, and attitudes in transplanted children and adolescents: a mixed-methods systematic review.]. Rev Esp Salud Publica 2023; 97:e202303025. [PMID: 36999242 PMCID: PMC10558112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/07/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Vaccine-preventable infectious diseases are a cause of morbidity and mortality in transplanted children. The main objective of this study was to synthesize the available evidence of vaccination coverage in children and adolescents who are candidates or transplant recipients and to analyze beliefs, attitudes, and experiences about vaccination. METHODS A mixed-methods systematic review was performed (Open Science Framework registration: https://osf.io/auqn3/). Searches were conducted in PubMed/MEDLINE, EMBASE, IBECS and LILACS (from January 2000 to August 2021) and in gray literature. Quantitative and qualitative studies reported information on coverage, beliefs, attitudes and/or experiences about recommended vaccines in children who are candidates or recipients of solid organ or hematopoietic progenitor transplantation. Quality assessment was undertaken using Mixed Methods Appraisal Tool (MMAT). A narrative synthesis of the studies was carried out. RESULTS A total of thirty-two studies in thirty-five publications were included. The most studied interventions were vaccines against measles (n=21; 66%) and hepatitis B (n=20; 62%). Vaccination rates showed a high variability for the most represented vaccines (specifically, 2%-100% for measles, 0.4%-100% for hepatitis B, diphtheria-tetanus-pertussis and rubella), with coverages lower than 90% in at least 70% of the studies. The lowest rates were reported in post-transplantation and hematopoietic stem cell transplantation. Only one qualitative study was identified reporting information on beliefs and/or attitudes, although nine quantitative studies explored cognitive aspects. CONCLUSIONS This review shows a high variability in vaccination coverage in children and adolescents who are transplant candidates or recipients, with rates lower than those recommended. Further studies would be needed to identify beliefs and attitudes about immunization in this context.
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Affiliation(s)
- María Teresa Herrero-Diez
- Servicio de Medicina Preventiva y Salud Pública, Hospital Clínico Universitario de Valladolid. Valladolid. España
| | - Ferrán Catalá-López
- Departamento de Planificación y Economía de la Salud, Escuela Nacional de Sanidad, Instituto de Salud Carlos III. Madrid. España
- Departamento de Medicina, Universidad de Valencia/Instituto de Investigación Sanitaria INCLIVA y CIBERSAM. Valencia. España
- Clinical Epidemiology Program, Ottawa Hospital Research Institute. Ottawa. Canadá
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Laue T, Ohlendorf J, Leiskau C, Baumann U. Hepatitis A Immunity and Paediatric Liver Transplantation-A Single-Centre Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121953. [PMID: 36553396 PMCID: PMC9776770 DOI: 10.3390/children9121953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
Following paediatric solid organ liver transplantation, risk of infection is high, both in the short and long term. Even though an infection with hepatitis A virus (HAV) is often asymptomatic and self-limited in children, some case studies describe severe cases leading to death. Vaccinations offer simple, safe and cheap protection. However, data on vaccination rates against hepatitis A in children with liver disease are scarce. Moreover, the vaccine is only approved from the age of one year old. At the same time, up to 30% of children with liver disease are transplanted within the first year of life, so the window of opportunity for vaccination is limited. This retrospective, observational, single-centre study examines the HAV immunity in paediatric liver transplant recipients before and after the first year of transplantation. Vaccination records of 229 of 279 (82.1%) children transplanted between January 2003 and June 2021 were analysed. Of 139 eligible children aged ≥ 1 year old, only 58 (41.7%) were vaccinated at least with one HAV dose prior to transplantation. In addition, seven patients received the vaccine below one year of age. After one or two doses, 38.5% or 90.6% of 65 patients were anti-HAV-IgG positive, respectively. This percentage remained stable up to the first annual check-up. For children vaccinated only once, a shorter interval from vaccination to transplantation is a risk factor for lack of immunity. Thus, HAV immunisation should be started earlier in liver transplant candidates to improve immunity in this high-risk group.
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Affiliation(s)
- Tobias Laue
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
- Correspondence:
| | - Johanna Ohlendorf
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
| | - Christoph Leiskau
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
- Paediatric Gastroenterology, Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, 37073 Göttingen, Germany
| | - Ulrich Baumann
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
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Long-Term Varicella Zoster Virus Immunity in Paediatric Liver Transplant Patients Can Be Achieved by Booster Vaccinations—A Single-Centre, Retrospective, Observational Analysis. CHILDREN 2022; 9:children9020130. [PMID: 35204851 PMCID: PMC8870030 DOI: 10.3390/children9020130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
Varicella is one of the most common vaccine-preventable infections after paediatric solid organ transplantation; thus, vaccination offers simple and cheap protection. However, children with liver disease often progress to liver transplantation (LT) before they reach the recommended vaccination age. As a live vaccine, varicella zoster virus (VZV) vaccination after transplantation is controversial; however, many case series demonstrate that vaccination may be safe and effective in paediatric liver transplant recipients. Only limited data exists describing long-term vaccination response in such immunocompromised patients. We investigated retrospectively vaccination response in paediatric patients before and after transplantation and describe long-term immunity over ten years, including the influence of booster-vaccinations. In this retrospective, single-centre study, 458 LT recipients were analysed between September 2004 and June 2021. Of these, 53 were re-transplantations. Patients with no available vaccination records and with a history of post-transplant lymphoproliferative disease, after hematopoietic stem cell transplantation and clinical chickenpox were excluded from this analysis (n = 198). In total, data on 207 children with a median annual follow-up of 6.2 years was available: 95 patients (45.9%) were unvaccinated prior to LT. Compared to healthy children, the response to vaccination, measured by seroconversion, is weaker in children with liver disease: almost 70% after one vaccination and 93% after two vaccinations. One year after transplantation, the mean titres and the number of children with protective antibody levels (VZV IgG ≥ 50 IU/L) decreased from 77.5% to 41.3%. Neither diagnosis, gender, nor age were predictors of vaccination response. Booster-vaccination was recommended for children after seroreversion using annual titre measurements and led to a significant increase in mean titre and number of protected children. Response to vaccination shows no difference from monotherapy with a calcineurin inhibitor to intensified immunosuppression by adding prednisolone or mycophenolate mofetil. Children with liver disease show weaker seroconversion rates to VZV vaccination compared to healthy children. Therefore, VZV-naïve children should receive basic immunization with two vaccine doses as well as those vaccinated only once before transplantation. An average of 2–3 vaccine doses are required in order to achieve a long-term seroconversion and protective antibody levels in 95% of children.
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