Seroprevalence of antibodies against varicella‐zoster virus and response to the varicella vaccine in pediatric renal transplant patients

Abstract

The severity of varicella-zoster virus (VZV) in immunocompromised children, especially in those receiving renal transplants, is well known. However, the use of live attenuated virus vaccine in this population is controversial. This study aimed to: (i) assess the immunization status of pediatric renal transplant recipients at our center; (ii) determine the anti-VZV antibody titers in such patients; (iii) evaluate the response to VZV vaccine in seronegative children and in those who present low antibody titers (defined as <500 mAU/mL). Vaccinated children were monitored for adverse effects for 8 wk after vaccination. Fifty patients with a mean age of 13.7 yr (range, 3-17 yr) were enrolled. In 49, blood samples were collected and antibodies were screened using ELISA. Seropositivity to VZV was found in 43 (88%), and antibody titers were >/=500 mAU/mL in 37 (75.5%). Of the 12 children who were eligible for vaccination and had antibody titers <500 mAU/mL, one developed varicella before vaccination, two did not meet the inclusion criteria, and three parents refused the vaccination. In the six vaccinated children, there were no adverse reactions to the vaccine, and four (66.6%) responded with anti-VZV titers >/=500 mAU/mL 6-8 wk after vaccination. In conclusion, after renal transplantation, varicella vaccine is safe with a 66% rate of conversion to high antibody titers.

Vaccine administration in children with chronic kidney disease

“…Similarly, in another study, none of the adolescent RT recipients who received a booster vaccination against measles, mumps, and rubella (MMR) suffered adverse events [13]. Finally, in the third study, none of the six children who had recently undergone RT and received one or two doses of varicella vaccine experienced severe adverse events following vaccination [48]. In addition, only a limited number of mild adverse events were reported among pediatric patients who received MMR vaccines 1.5-173 months after liver or small intestine transplantation, and no relevant infections were reported [48][49][50][51].…”

“…Finally, in the third study, none of the six children who had recently undergone RT and received one or two doses of varicella vaccine experienced severe adverse events following vaccination [48]. In addition, only a limited number of mild adverse events were reported among pediatric patients who received MMR vaccines 1.5-173 months after liver or small intestine transplantation, and no relevant infections were reported [48][49][50][51]. The most important mild adverse effects in these studies were fever and skin rash, both of which were spontaneously resolved in few days [47][48][49][50].…”

Immunizations for renal transplant candidates and recipients

“…56 Data from the pediatric literature suggest that vaccination in seronegative patients before transplantation results in significantly fewer and milder episodes of varicella and zoster compared with no vaccination. 53 Cases of successful immunization of children with varicella vaccine after renal transplantation have been reported, 57,58 with one small study demonstrating a 66% seroconversion rate. 58 However, at this point, the clinical data are too scarce to recommend a live vaccine for adult patients with renal allografts.…”

“…53 Cases of successful immunization of children with varicella vaccine after renal transplantation have been reported, 57,58 with one small study demonstrating a 66% seroconversion rate. 58 However, at this point, the clinical data are too scarce to recommend a live vaccine for adult patients with renal allografts. Solid organ transplant recipients are at increased risk of many cancers, including anogenital malignancies such as cervical cancer.…”

Análise da inserção de um Centro de Referência para Imunobiológicos Especiais em hospital universitário: aspectos assistenciais, de ensino e pesquisa.

“…Estes dados servem de alerta para os responsáveis por programas de transplantes, que envolvem procedimentos de alto custo e alta complexidade, mas por vezes negligenciam procedimentos gratuitamente disponíveis, que podem melhorar as condições de vida destes pacientes e mesmo contribuir para aumento da sobrevida 72 . Consideramos este estudo, cuja publicação está no prelo 73 , muito importante por vários aspectos A soroprevalência de anticorpos anti-VVZ encontrada nesta população foi de 88%, sendo que 12 crianças (24,5%) apresentavam títulos de anticorpos menores que o índice arbitrariamente considerado protetor. Seis destes 12 pacientes foram vacinados contra varicela e quatro (66,6%) responderam à vacinação, sem apresentar reações adversas.…”