Long‐term study showed that vaccination protected paediatric renal transplant recipients from life‐threatening varicella zoster virus

Abstract

AimRenal transplant patients are particularly susceptible to highly contagious diseases due to their reduced immunity. We studied transplant recipients to gauge their varicella zoster virus (VZV) serology status over time and the outcome of any VZV infections.MethodThis retrospective study comprised 85 children who underwent renal transplants in Gothenburg, Sweden, from 1986 to 2014, at a mean age of eight (1–18) years. The children's medical records were reviewed and 47 had the VZV infection pre‐transplant and 38 had been vaccinated pre‐transplant. Clinical outcomes were available for 85 children and serology results for 72.ResultsAt transplantation, the VZV seropositivity rate was 50% in the vaccination group and 94% in the infection group and the antibody titres were significantly lower in the vaccination group (p = 0.031). During the median follow‐up period of five years post‐transplant, 28% of the vaccinated children and 97% of the infection group remained seropositive and the varicella infection affected eight children: one in the infection group and seven in the vaccination group. The herpes zoster was observed in two children in the infection group.ConclusionThis study demonstrated that VZV vaccination protected from symptomatic infections to a lesser extent than natural infection, but provided effective protection from life‐threatening disease.

Management and prevention of varicella and measles infections in pediatric solid organ transplant candidates and recipients: An IPTA survey of current practice

“…However, both varicella and measles vaccination can be administered as early as six months of age without harm and potential benefit 8 . Studies show that a high number of patients immunized before SOT continue to be seroprotected after SOT and do not require further vaccination 11,14,19,24 . Recently, a study reported 50% of patients (5/10) immunized with MMR before 9 months of age had sustained seroprotection against measles up to 15 years after liver transplantation 19 .…”

“…8 Studies show that a high number of patients immunized before SOT continue to be seroprotected after SOT and do not require further vaccination. 11,14,19,24 Recently, a study reported Briefly, the consensus considered both LAV to be safe in patients who are more than one year after liver or kidney transplantation and more than two months after an acute rejection episode, clinically well, and meet specific criteria of "low-level" immunosuppression.…”

Highlights in this issue

“…Lindahl et al. studied 85 renal transplant patients to see whether they developed varicella zoster virus (VZV) immunity over time. They found that the varicella vaccination provided transplant patients with less protection from symptomatic VZV diseases than natural infections, but it did provide effective protection from life‐threatening diseases.…”

What benefits do immunocompromised children get from the varicella zoster virus vaccination?

“…Therefore, the study by Lindahl et al. in this issue of Acta Paediatrica is an interesting contribution to the field, as it provides data on VZV serology over time in children undergoing renal transplants. The authors also evaluated the outcome of any VZV infections post‐transplant.…”

“…The incidence of the VZV disease after transplant was also evaluated by Lindahl et al. Clinical VZV infections occurred in eight patients during follow‐up, and seven were in the vaccine group. Of these eight children, five were already seronegative at transplantation and the other three became seronegative after surgery, before they developed the VZV.…”