Measles outbreak risk assessment for transplant candidates and recipients

Abstract

Solid organ transplant (SOT) candidates and recipients are at risk of significant morbidity and mortality from infection due to receipt of immunosuppressive medications necessary to mitigate risk of allograft rejection after transplant. 1-4 Infection prevention measures are routinely incorporated into patient care before and after transplantation and include antibiotic prophylaxis, immunizations, and patient education. Transplant professionals must remain aware of regional infectious disease outbreaks and the associated potential risk for patients awaiting transplantation and for patients who have successfully undergone transplantation. The measles (rubeola) virus is the most contagious human pathogen and an important vaccine-preventable cause of morbidity and mortality around the world. 5 No specific treatment exists for measles infection. Complications and long-term sequelae of infection include pneumonia, vision loss. and subacute sclerosing panencephalitis.

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

“…For both diseases, passive immunization with specific or non‐specific immunoglobulins (Igs) is possible. Therefore, MMR vaccination after SOT is offered by some transplant centers in areas with high incidence or in outbreak situations, as it has been shown to prevent primary infection with these pathogens 12,24 …”

“…Therefore, MMR vaccination after SOT is offered by some transplant centers in areas with high incidence or in outbreak situations, as it has been shown to prevent primary infection with these pathogens. 12,24 There are still major differences between immunization practices in SOT centers, as shown by the lack of standardized protocols in 25% of the European Reference Network (ERN) Transplant Child centers. 25 Only five of 27 sites administer LAVVs after transplantation, with seroconversion evaluated in 80% of cases.…”

Spotting a potential threat: Measles among pediatric solid organ transplantation recipients

“…Risk assessment of SOT recipients is also needed in the setting of ongoing measles outbreaks to inform management 106 . Though not rigorously studied, given accumulating safety and immunogenicity data, MMR vaccination within 72 h of measles exposure may be an option in certain SOT recipients receiving low‐level immunosuppression 101,107 .…”

“…105 Risk assessment of SOT recipients is also needed in the setting of ongoing measles outbreaks to inform management. 106 Though not rigorously studied, given accumulating safety and immunogenicity data, MMR vaccination within 72 h of measles exposure may be an option in certain SOT recipients receiving low-level immunosuppression. 101,107 Susceptible SOT candidates and recipients are considered exposed if they shared the same space with an individual known to have measles, from 4 days before to 4 days after the onset of the measles rash or if they were in a room that had been occupied in the previous 2 h by the individual with measles.…”

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

“…[8][9][10][11] From 2018 to 2019, a measles outbreak, including 649 cases, occurred in the New York City area. 12 Kreiger-Benson et al 12 described developing a systematic 3-part approach risk assessment, the highest was nonimmune adults living in the area, in their SOT patients and 117 waitlisted or previously transplanted patients who lived in outbreak areas were given timely patient education and screening for measles immunity with serologic testing. During a large measles outbreak in the United States in 2015, transplant recipients without measles immunoglobulin G were suggested to receive immune globulin to mitigate the risks and complications after transplantation.…”