Background.
Vaccine-preventable viral infections are associated with increased risk of morbidity and mortality in immunocompromised patients. Current guidelines recommend routine screening and vaccination of all patients before solid organ transplantation. We studied rates of immunity against vaccine-preventable viruses in liver transplantation (LT) recipients.
Methods.
We retrospectively studied consecutive adult patients who underwent first deceased donor LT at a single center between August 2008 and October 2017. Viruses studied were hepatitis A (HAV), hepatitis B (HBV), varicella zoster virus (VZV), measles, and mumps. Hepatitis B surface antibody (anti-HBs) <10 IU/mL in HBV surface antigen-negative patients and negative IgG to other viruses was regarded as absent immunity.
Results.
Five hundred and fifty-five patients underwent LT (72.4% male; median age, 55.0 y). Percentages of patients who lacked immunity to vaccine-preventable infections were HAV (31.8%), HBV (63.8%), measles (1.4%), mumps (6.6%), and VZV (3.8%). Age was positively associated with immunity (from either past exposure or vaccination) against most viruses, including HAV, measles, mumps, and VZV (P < 0.05 for all). In contrast, older age was marginally associated with anti-HBs <10 IU/mL (P = 0.046). No significant changes in immunity rates were observed during the study period.
Conclusions.
A substantial number of patients undergoing LT are not immune to vaccine-preventable viruses at the time of assessment. This presents an opportunity for pre-LT vaccination and in particular younger patients may need to be targeted.
SYNOPSIS
This is a study of the families of 50 children with coeliac disease. A number of genetic and acquired factors of possible importance in the etiology of coeliac disease were observed. 2 siblings were found to have biopsy‐proven coeliac disease and in 3 mothers a clinical diagnosis of coeliac disease had been made, i.e. in 5 (2.4%) of 210 first degree relatives a diagnosis of coeliac disease had been made.
The mean age of introduction of gluten into the diet was identical (3.2 months) for both the coeliac children and their non‐coeliac siblings.
SYNOPSISIt was found that there was a high incidence of emotional symptoms in these children, namely withdrawal, irritability and 'clingingness.' Accompanying these symptoms in the children there was a significant disturbance of the mother-child relationship, with maternal anxiety, maternal depression and maternal preoccupation. These symptoms in the mother and child disappeared or greatly improved once the child had responded to a gluten-free diet, except when the mother was already emotionally disturbed before the onset of the child's illness.The mother-child relationship was studied in 28 children with coeliac disease.
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