Fever, skin rash, headache, and thrombocytopenia are considered hallmarks of dengue infection. However, these symptoms are frequently observed in infectious and non-infectious complications of hematopoietic stem cell transplant recipients and oncohematological patients. Thus, laboratory confirmation of dengue is relevant for prompt intervention and proper management of dengue in endemic and non-endemic regions. Because no prospective study of dengue has been conducted in these populations, the actual morbidity and mortality of dengue is unknown. In the present series, we describe five cases of dengue in patients living in endemic areas, emphasizing the prolonged course of the disease and the occurrence of prolonged viremia.
Hematopoietic stem cell transplant (HSCT) recipients should be routinely revaccinated
after transplantation. We evaluated the difficulties met in the revaccination program
and how a prospective and tailored follow-up could help to overcome these obstacles.
HSCT recipients (n=122) were prospectively followed up and categorized into Group 1
(n=72), recipients who had already started the revaccination program, and Group 2
(n=50), recipients starting their vaccines. Whenever a difficulty was reported,
interventions and subsequent evaluations were performed. Reported problems were
related to patient compliance, HSCT center and/or vaccination center. Problems
related to patient compliance were less frequent than those related to HSCT center
modifications of previous recommendations, or to errors made by the vaccination
center. The main gap found was vaccination delays (81.9%). Advisory intervention was
needed in 64% and 46% of Group 1 and Group 2, respectively (p=0.05), and was
partially successful in around 70% of the cases. Total resolution was achieved in
more than 35% in both groups. Improvements are needed in the Brazilian vaccination
program for HSCT recipients to assure a complete and updated revaccination schedule.
HSCT centers should assign nurses and transplant infectious disease specialist
physicians to organize the revaccination schedule and to monitor the program
development.
The choice of alternative donors for HCT for patients without an HLA-matched related donor depends on several factors. We compared major HCT outcomes in 212 consecutive children transplanted at 11 centers in Brazil for acute leukemia or MDS from an HLA-matched unrelated donor (MUD, n = 95), mismatched unrelated donor (MMUD, n = 47) or unrelated umbilical cord blood (UCB, n = 70). Most had ALL (61%), bone marrow (57%) as the graft source and 95% received a MAC regimen. The 3-year
Background
Hepatitis A virus (HAV) infection is highly prevalent in developing countries. In countries experiencing a shift from intermediate/high endemicity to low endemicity, the World Health Organization recommends the incorporation of HAV vaccine into the national vaccination calendar for children aged ≥1 year. Since HAV antibodies wane over time, most HSCT revaccination guidelines advise vaccination as optional, following the country recommendation. However, no study has evaluated the serological response to HAV vaccine in allogeneic HSCT recipients.
Methods
We conducted a prospective study in 46 HSCT recipients who received two doses of inactivated HAV vaccine. Blood samples were taken before vaccination to determine HAV prevalence rates, and before and 4‐6 weeks after the second dose. Specific anti‐HAV antibodies were detected by a competitive commercial enzyme immune assay.
Results
Patients received the first dose of vaccine at a median of 332.5 (120‐4134) days after HSCT. Median absolute lymphocyte count at vaccination was 1947 (696‐12 500)/mm3. The seroprevalence rate was 93.5% at inclusion. Although safe and well tolerated, the serological response to HAV vaccine in susceptible patients was poor (33%), and no boost effect was observed in seropositive patients.
Conclusions
In areas with intermediate/high seroprevalence of HAV, serology should be recommended prior to referral to vaccination. The mechanisms of antibody interference and how to overcome T‐cell function deficiency need to be better understood in transplant populations receiving HAV vaccine. Alternative schedules of HAV vaccination should be evaluated in prospective trials.
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