Serologic screening and infectious diseases consultation in renal transplant candidates for measles, mumps, rubella and varicella

Abstract

Background: Renal transplant recipients are at increased risk for developing complications of vaccine-preventable diseases. They benefit from a comprehensive pre-transplant evaluation when they might safely receive live vaccines. The primary aim of our study was to investigate the number of renal transplant recipients who were evaluated for serologic status against measles, mumps, rubella (MMR), and varicella. Secondarily, we investigated if pre-transplant Infectious Diseases consultation (IDC) improved vaccination rates.Methods: We retrospectively analyzed 282 kidney-alone and kidney-plus adult transplant recipients who were born in or after 1957. Patients were evaluated at Mayo Clinic, Florida Transplant Center between January 2015 and December 2017. Serologic status evaluation and vaccination rates were compared in two groups created based on IDC and no ID consultation (NIDC).Results: 235 (83%) of a total 282 patients received an IDC pre-transplantation. Varicella IgG levels were screened in all 235 IDC candidates. Among the IDC patients, mumps, measles and rubella IgG serologies were performed in 7 (3%), 143 (61%) and 144 (61%), respectively. Among 44 patients seronegative for any of MMR, 24 (55%) were vaccinated. Ten (66%) of 15 varicella seronegative patients were vaccinated. Zostavax was not given to 18% of IDC patients. Zostavax and MMR were administered more frequently in the IDC group compared to NIDC (p<.001 and p=0.0016, respectively).Conclusion: Although the majority of patients had IDC, the screening rate for MMR serologies was lower than varicella. A protocol-driven serologic screening similar to the one for VZV is required for MMR. Pre-transplant IDC increases vaccination rates.

Vaccination in Kidney Transplant Candidates

“…The value of Infectious Disease consultation or structured programs for screening and catch-up immunization in improving vaccination rates among KT candidates have been demonstrated in other studies, and this was further strengthened by our study. 12,13,18-20 Vaccine acceptance rate was as high as 99% in 1 study, whereas in others, despite ID consultation or structured catch-up immunization programs, there was only a modest increase in immunization rates. 12,13,18,20 We did not have data on reasons for refusal except for a few patients.…”

“…12,13,18-20 Vaccine acceptance rate was as high as 99% in 1 study, whereas in others, despite ID consultation or structured catch-up immunization programs, there was only a modest increase in immunization rates. 12,13,18,20 We did not have data on reasons for refusal except for a few patients. It is noteworthy that hepatitis A vaccine refusal was common (refused by 15/17 patients who refused vaccination).…”

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

“…A previous study described how infectious disease consultation improved rates of MMRV serological screening and vaccination rates. 18 In our center, the transplant infectious diseases team works closely with the SOT teams to provide guidance and protocols for vaccinations. This highlights the importance of a multidisciplinary approach to improve transplant patient care.…”

“…17 However, previous studies showed that these immunity screenings were not routinely done in many transplant centers. 18 Various regimens of MMR and VZV vaccines are recommended by the CDC based on underlying patient conditions. Although the CDC does not have specific MMRV recommendations for pretransplant candidates, 2 doses of MMR vaccines are recommended in patients who do not have immunity against measles or mumps or who were born after 1957.…”

Approaches to pretransplant vaccination

“…These consultations may be most effective when linked to universal screening and vaccination protocols. Even with high rates of infectious diseases consultation, one study group identified measles, mumps and rubella serologic screening and vaccination in their transplant candidates as an opportunity for further improvement through protocolization [32 ▪ ,33 ▪ ]. Transplant pharmacist-led vaccination recommendations have also been shown to increase vaccination rates [34].…”