Faculty Collaboration Database

Safety and Immunogenicity of Live Viral Vaccines in a Multicenter Cohort of Pediatric Transplant Recipients. JAMA Netw Open 2023 Oct 02;6(10):e2337602

Date

10/12/2023

Pubmed ID

37824141

Pubmed Central ID

PMC10570873

DOI

10.1001/jamanetworkopen.2023.37602

Scopus ID

2-s2.0-85174751429 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

IMPORTANCE: Live vaccines (measles-mumps-rubella [MMR] and varicella-zoster virus [VZV]) have not been recommended after solid organ transplant due to concern for inciting vaccine strain infection in an immunocompromised host. However, the rates of measles, mumps, and varicella are rising nationally and internationally, leaving susceptible immunocompromised children at risk for life-threating conditions.

OBJECTIVE: To determine the safety and immunogenicity of live vaccines in pediatric liver and kidney transplant recipients.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included select pediatric liver and kidney transplant recipients who had not completed their primary MMR and VZV vaccine series and/or who displayed nonprotective serum antibody levels at enrollment between January 1, 2002, and February 28, 2023. Eligibility for live vaccine was determined by individual US pediatric solid organ transplant center protocols.

EXPOSURES: Exposure was defined as receipt of a posttransplant live vaccine. Transplant recipients received 1 to 3 doses of MMR vaccine and/or 1 to 3 doses of VZV vaccine.

MAIN OUTCOME AND MEASURE: Safety data were collected following each vaccination, and antibody levels were obtained at 0 to 3 months and 1 year following vaccination. Comparisons were performed using Mann-Whitney U test, and factors associated with development of postvaccination protective antibodies were explored using univariate analysis.

RESULTS: The cohort included 281 children (270 [96%] liver, 9 [3%] kidney, 2 [1%] liver-kidney recipients) from 18 centers. The median time from transplant to enrollment was 6.3 years (IQR, 3.4-11.1 years). The median age at first posttransplant vaccine was 8.9 years (IQR, 4.7-13.8 years). A total of 202 of 275 (73%) children were receiving low-level monotherapy immunosuppression at the time of vaccination. The majority of children developed protective antibodies following vaccination (107 of 149 [72%] varicella, 130 of 152 [86%] measles, 100 of 120 [83%] mumps, and 124 of 125 [99%] rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 [77%] varicella, 45 of 49 [92%] measles, 35 of 42 [83%] mumps, 51 of 54 [94%] rubella). Five children developed clinical varicella, all of which resolved within 1 week. There were no cases of measles or rubella and no episodes of graft rejection within 1 month of vaccination. There was no association between antibody response and immunosuppression level at the time of vaccination.

CONCLUSIONS AND RELEVANCE: The findings suggest that live vaccinations may be safe and immunogenic after solid organ transplant in select pediatric recipients and can offer protection against circulating measles, mumps, and varicella.

Author List

Feldman AG, Beaty BL, Ferrolino JA, Maron G, Weidner HK, Ali SA, Bitterfeld L, Boulware MA, Campbell KM, Carr E, Chapman S, Chang YC, Cunningham R, Dallas RH, Dantuluri KL, Domenick BN, Ebel NH, Elisofon S, Fawaz R, Foca M, Gans HA, Gopalareddy VV, Gu C, Gupta NA, Harmann K, Hollenbeck J, Huppler AR, Jaramillo C, Kasi N, Kerkar N, Lerret S, Lobritto SJ, Lopez MJ, Marini E, Mavis A, Mehra S, Moats L, Mohandas S, Munoz FM, Mysore KR, Onsan C, Ovchinsky N, Perkins K, Postma S, Pratscher L, Rand EB, Rowe RK, Schultz D, Sear K, Sell ML, Sharma T, Stoll J, Vang M, Villarin D, Weaver C, Wood P, Woodford-Berry O, Yanni G, Danziger-Isakov LA

Authors

Anna H. Huppler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Stacee Lerret PhD Professor Hybrid in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Chickenpox
Chickenpox Vaccine
Child
Child, Preschool
Cohort Studies
Humans
Measles
Mumps
Rubella
Transplant Recipients
Vaccines, Attenuated
Vaccines, Combined
Viral Vaccines