The Burden of Hospitalizations for Vaccine-Preventable Infections in Heart Transplant Recipients

Dang, Alexander; Soufi, Mohamad Khaled; Nguyen, Christopher; Orndorff, Joseph; Baliss, Michelle; Berbarie, Rafic F.; Khalife, Wissam

doi:10.1016/j.amjcard.2021.07.010

Cited by 1 publication

(4 citation statements)

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“…A previous pediatric study showed that hospitalization rates due to VPIs were higher in transplant recipients compared with control individuals who did not undergo transplant 9 ; similar findings were published for heart transplant recipients. 10 In our analysis, VPIs occurred more frequently among SOT recipients than in the general population. This finding highlights the importance of ongoing efforts to decrease the incidence of these potentially preventable infections, including attempts to increase vaccine uptake in transplant recipients 5 , 30 , 31 and to improve the immunogenicity of vaccines in immunocompromised patients.…”

Section: Discussionmentioning

confidence: 53%

“…Infection with a vaccine-preventable pathogen was associated with health care utilization. A previous pediatric study showed that hospitalization rates due to VPIs were higher in transplant recipients compared with control individuals who did not undergo transplant; similar findings were published for heart transplant recipients . In our analysis, VPIs occurred more frequently among SOT recipients than in the general population.…”

Section: Discussionmentioning

confidence: 87%

“…The costs of initial transplant hospitalizations complicated by VPIs were higher compared with those not complicated by VPIs. Similar findings were reported for heart transplant recipients . However, whether SOT recipients are at increased risk for infections with vaccine-preventable pathogens in comparison with the general population remains largely unexplored .…”

Section: Introductionmentioning

confidence: 99%

“…Similar findings were reported for heart transplant recipients. 10 However, whether SOT recipients are at increased risk for infections with vaccine-preventable pathogens in comparison with the general population remains largely unexplored. 11 Influenza, 12 , 13 , 14 varicella zoster virus (VZV) infection, 15 , 16 and invasive pneumococcal disease (IPD) 17 , 18 , 19 have been identified as important VPIs in the posttransplant setting, and having a lung transplant was previously shown to be associated with an increased risk for influenza compared with other transplanted organs.…”

Section: Introductionmentioning

confidence: 99%

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Vaccine-Preventable Infections Among Solid Organ Transplant Recipients in Switzerland

et al. 2023

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ImportanceVaccine responses are decreased in solid organ transplant (SOT) recipients, and given the complexity of implementation, vaccination programs may be suboptimal. The actual burden of vaccine-preventable infections (VPIs) among SOT recipients remains unclear.ObjectivesTo assess the incidence rate of VPIs among SOT recipients and to evaluate whether SOT recipients are at increased risk for specific VPIs compared with the general population.Design, Setting, and ParticipantsThis nationwide cohort study used data from the Swiss Transplant Cohort Study on VPIs in individuals who underwent SOT from May 2008 to June 2019 (follow-up until December 2019) and data from the Swiss Federal Office of Public Health on notifiable VPIs in the general population in the same period. Data were analyzed from January 2021 to June 2022.ExposuresSolid organ transplant.Main Outcomes and MeasuresThe main outcomes were the incidence rate of the following VPIs in SOT recipients: hepatitis A and B, diphtheria, Haemophilus influenzae infection, influenza, measles, mumps, pertussis, pneumococcal disease, poliomyelitis, meningococcal disease, rubella, tetanus, tick-borne encephalitis, and varicella zoster virus infection. Age-adjusted standardized incidence ratios were used to assess whether VPIs occurred more frequently in SOT recipients compared with the general population. For SOT recipients, factors associated with occurrence of VPIs were explored and the associated morbidity and mortality assessed.ResultsOf 4967 SOT recipients enrolled (median age, 54 years [IQR, 42-62 years]; 3191 [64.2%] male), 593 (11.9%) experienced at least 1 VPI. The overall VPI incidence rate was higher in the population that underwent SOT (30.57 per 1000 person-years [PY]; 95% CI, 28.24-33.10 per 1000 PY) compared with the general population (0.71 per 1000 PY). The standardized age-adjusted incidence ratio for notifiable VPIs in SOT recipients was higher compared with the general population (27.84; 95% CI, 25.00-31.00). In SOT recipients, influenza and varicella zoster virus infection accounted for most VPI episodes (16.55 per 1000 PY [95% CI, 14.85-18.46 per 1000 PY] and 12.83 per 1000 PY [95% CI, 11.40-14.44 per 1000 PY], respectively). A total of 198 of 575 VPI episodes in the population that underwent SOT (34.4%) led to hospital admission, and the occurrence of a VPI was associated with an increased risk for death and/or graft loss (hazard ratio, 2.44; 95% CI, 1.50-3.99; P = .002). In multivariable analysis, age 65 years or older at the time of transplant (incidence rate ratio [IRR], 1.29; 95% CI, 1.02-1.62) and receipt of a lung (IRR, 1.77; 95% CI, 1.38-2.26) or a heart (IRR, 1.40; 95% CI, 1.05-1.88) transplant were associated with an increased risk of VPI occurrence.Conclusions and RelevanceIn this study, 11.9% of SOT recipients experienced VPIs, and the incidence rate was higher than in the general population. There was significant morbidity and mortality associated with these infections in the population that underwent SOT, which highlights the need for optimizing immunization strategies.

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