Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation

Abstract

Vaccine‐preventable viral infections are associated with increased risk of morbidity and mortality in post‐transplant patients on immunosuppression regimens. Therefore, we studied rates of immunity against vaccine‐preventable viruses in lung transplantation (LTx) candidates and their associations with underlying lung disease and clinical characteristics. We retrospectively studied 1025 consecutive adult patients who underwent first‐time evaluation for LTx at a single center between January 2016 and October 2018. Viruses studied included varicella zoster (VZV), measles, and mumps. Young age (17–48 years old) was negatively associated with immunity for VZV (OR 4.54, p < .001), measles (OR 15.45, p < .001) and mumps (OR 3.1, p < .001), as compared to those 65+. Many LTx candidates with cystic fibrosis (CF) had undetectable virus‐specific antibody titers including: 13.5% for VZV, 19.1% for measles, and 15.7% for mumps with significant odds of undetectable titers for VZV (OR 4.54, p < .001) and measles (OR 2.32, p = .010) as compared to those without CF. Therefore, a substantial number of patients undergoing LTx evaluation had undetectable virus‐specific antibody titers. Our results emphasize the importance of screening for immunity to vaccine‐preventable infections in this population and the need for revaccination in selected patients to boost their humoral immunity prior to transplantation.

Coxsackievirus B infections are common in Cystic Fibrosis and experimental evidence supports protection by vaccination

“…CF is associated with altered immune functions ( Giacalone et al., 2020 ; Lara-Reyna et al., 2020 ) and reports exist describing weakened vaccine responses in individuals with CF ( Browning et al., 2014 ; Hostetler et al., 2021 ; Launay et al., 2014 ; Lucidi et al., 1996 ). A weak response to the CVB vaccine could limit the efficacy of future vaccine efforts in this group.…”

“…Alterations in immune system functions (reviewed in Giacalone et al., 2020 ; Lara-Reyna et al., 2020 ) and impaired vaccine responses ( Browning et al., 2014 ; Hostetler et al., 2021 ; Launay et al., 2014 ; Lucidi et al., 1996 ) have been described in CF. Measuring nAB titers against polioviruses provides a reasonable surrogate to determine whether individuals with CF have an impaired immune response to enterovirus vaccines.…”

“…Notably, it was observed that children >8 years old had weaker nAB responses to poliovirus 2, although titers always reached protective levels ( Lucidi et al., 1996 ). Furthermore, another recent study described low or undetectable immunity to measles, mumps, and varicella zoster in a subgroup of individuals with CF ( Hostetler et al., 2021 ). As CVB infections are common in childhood, immunizations with CVB vaccines would likely follow the same vaccination schedule as IPV (i.e.…”

“…We have also reported that mice harboring the F508del mutation have an impaired immune response to CVB3 infection, with defective viral clearance linked to a delay in virus-neutralizing antibody (nAB) production ( Svedin et al., 2017 ). Despite these observations, few studies have been conducted assessing vaccine responses and virus nAB durability in CF ( Browning et al., 2014 ; Hostetler et al., 2021 ; Launay et al., 2014 ; Lucidi et al., 1996 ).…”

Seroprevalence of Measles, Mumps, Rubella, and Varicella-Zoster Virus and Seroresponse to the Vaccinations in Adult Solid Organ Transplant Candidates

“…22 Several studies have evaluated the seroprevalence of MMRV in SOT candidates. Hostetler et al 23 reported seroprevalence against measles, mumps, and varicella in 1025 lung transplant candidates. They found a positive seroprevalence against those pathogens (89.5%, 86.4%, and 95.7% for measles, mumps, and VZV, respectively) which, interestingly, was higher compared to ours.…”