Live Vaccines in Pediatric Liver Transplant Recipients: “To Give or Not to Give”

Kemme, Sarah; Kohut, Taisa; Boster, Julia M.; Diamond, Tamir; Rand, Elizabeth B.; Feldman, Amy G.

doi:10.1002/cld.1123

Cited by 7 publications

(4 citation statements)

References 44 publications

(61 reference statements)

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“…Post‐transplant LAVs offer an alternative avenue for protecting pediatric LT patients against measles and VZV 30 ; however, given the high levels of immunosuppression required to prevent organ rejection, safety and efficacy concerns have historically precluded their use in this population. At the time of this writing, the CDC's Advisory Committee on Immunization Practices lists solid organ transplantation as a contraindication to MMR and VZV vaccination until discontinuation of anti‐rejection therapies for 2 months and 1 month, respectively 31 .…”

Section: Discussionmentioning

confidence: 99%

Low post‐transplant measles and varicella titers among pediatric liver transplant recipients: A 10‐year single‐center study

Liman

Wozniak

Maurice

et al. 2022

Pediatric Transplantation

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Background: Vaccine preventable illnesses are important sources of morbidity, mortality, and increased healthcare costs in pediatric LT recipients. Our aim was to measure the seroprevalence of antibodies to measles and VZV in this population. Methods:We conducted a retrospective chart review of 44 patients who received LT before age 18 at UCLA Mattel Children's Hospital from January 2008 to December 2017.Results: Median age at transplantation was 2.5 years (IQR 1.2-7.7). Post-transplant measles antibodies were present in 17 of 37 patients (46%); risk factors for seronegativity included younger age at transplant (p = .02) and greater time from transplant to testing (p = .04). Post-transplant VZV antibodies were present in 17 of 39 patients (44%); risk factors for seronegativity included greater time from transplant to testing (p = .04). 6 of 16 patients (38%) who tested positive for pre-transplant VZV antibodies tested negative after transplantation. Fourteen of 20 patients (70%) with at least 1 documented dose of the MMR vaccine tested positive for post-transplant measles antibodies. Ten of 20 of patients (50%) with at least 1 documented dose of the VZV vaccine tested positive for post-transplant VZV antibodies. We also describe 10 patients who received post-transplant measles and VZV vaccines without documented complications. Conclusions:Our study suggests that pediatric LT patients are at greater risk of contracting measles and VZV despite vaccination status, and that prevalence of measles and VZV antibodies decreases as time from transplantation increases. This should weigh into the institutional risk-benefit assessment when deciding whether or not to administer LAVs to these patients.

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Section: Discussionmentioning

confidence: 99%

Low post‐transplant measles and varicella titers among pediatric liver transplant recipients: A 10‐year single‐center study

Liman

Wozniak

Maurice

et al. 2022

Pediatric Transplantation

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“…Pregnant women : Pregnant women with CLD should be vaccinated against hepatitis A and B, SARS-CoV-2, influenza (inactivated) and DTaP. 102 , 103 Vaccination against pneumococcus with PPSV23 is also a consideration in pregnancy although safety data are lacking. Reassuringly, no adverse events were reported in infants whose mothers were inadvertently vaccinated with PPSV23 during the pregnancy.…”

Section: Vaccination In Special Populations With Cldmentioning

confidence: 99%

Vaccination in Chronic Liver Disease: An Update

Alukal

Naqvi

Thuluvath

2022

Journal of Clinical and Experimental Hepatology

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Patients with chronic liver disease with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis and SARS-CoV-2. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. As the severity of the liver disease progresses, vaccine efficacy declines and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Despite the strong recommendations, overall vaccination coverage in CLD remains poor; however, it is encouraging to note that in recent years coverage against influenza and pneumococcus have shown some improvement. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers and vaccine misinformation are often responsible for low immunization rates. This review summarizes the impact of vaccine preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated and barriers faced by healthcare professionals in immunizing those with liver disease.

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“…21,24 Since the advent of SOT in the second half of the 20th century, the American Society of Transplantation (AST) and the Infectious Diseases Society of America and others have advised against the administration of LAVVs after LT. 26,27 These recommendations encompassed the following concerns: first, LAVVs could cause overwhelming vaccine-associated disease in an immunocompromised transplant recipient, second, a dysregulated immunological response to LAVVs while taking immunosuppressants could lead to graft rejection and, third, an immunocompromised host might not be able to develop a protective response to LAVVs. 28 Therefore, it was recommended only to administer LAVVs no later than 4 weeks before-but none after-organ transplantation. 21,26 In the updated 2019 guideline of the American Society of Transplantation Infectious Diseases Community of Practice (AST IDCOP), this precept was moderated and MMR vaccination was considered in very select high-risk patients in an outbreak setting.…”

Section: Vaccinati On Of Mmr In Ltmentioning

confidence: 99%

Live‐attenuated vaccination for measles, mumps, and rubella in pediatric liver transplantation

Keutler,

Lainka,

Posovszky

2024

Pediatric Transplantation

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BackgroundInfections are a serious short‐ and long‐term problem after pediatric organ transplantation. In immunocompromised patients, they can lead to transplant rejection or a severe course with a sometimes fatal outcome. Vaccination is an appropriate means of reducing morbidity and mortality caused by vaccine‐preventable diseases. Unfortunately, due to the disease or its course, it is not always possible to establish adequate vaccine protection against live‐attenuated viral vaccines (LAVVs) prior to transplantation. LAVVs such as measles, mumps, and rubella (MMR) are still contraindicated in solid organ transplant recipients receiving immunosuppressive therapy (IST), thus creating a dilemma.AimThis review discusses whether, when, and how live‐attenuated MMR vaccines can be administered effectively and safely to pediatric liver transplant recipients based on the available data.Material and MethodsWe searched PubMed for literature on live‐attenuated MMR vaccination in pediatric liver transplantation (LT).ResultsNine prospective observational studies and three retrospective case series were identified in which at least 833 doses of measles vaccine were administered to 716 liver transplant children receiving IST. In these selected patients, MMR vaccination was well tolerated and no serious adverse reactions to the vaccine were observed. In addition, an immune response to the vaccine was demonstrated in patients receiving IST.ConclusionDue to inadequate vaccine protection in this high‐risk group, maximum efforts must be made to ensure full immunization. MMR vaccination could also be considered for unprotected patients after LT receiving IST following an individual risk assessment, as severe harm from live vaccines after liver transplantation has been reported only very rarely. To this end, it is important to establish standardized and simple criteria for the selection of suitable patients and the administration of the MMR vaccine to ensure safe use.

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Live Vaccines in Pediatric Liver Transplant Recipients: “To Give or Not to Give”

Cited by 7 publications

References 44 publications

Low post‐transplant measles and varicella titers among pediatric liver transplant recipients: A 10‐year single‐center study

Low post‐transplant measles and varicella titers among pediatric liver transplant recipients: A 10‐year single‐center study

Vaccination in Chronic Liver Disease: An Update

Live‐attenuated vaccination for measles, mumps, and rubella in pediatric liver transplantation

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