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Am J Transplant. 2019 Mar;19(3):844-854. doi: 10.1111/ajt.15101. Epub 2018 Oct 1.

Multimodal safety assessment of measles-mumps-rubella vaccination after pediatric liver transplantation.

Author information

1
Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
2
Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition Unit, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
3
Department of Pediatrics, University Center of Pediatric Surgery of Western Switzerland, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
4
Laboratory of Virology, Division of Infectious Diseases, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
5
Centre for Vaccinology, Departments of Pathology-Immunology and Pediatrics, University of Geneva, Geneva, Switzerland.

Abstract

Live-attenuated vaccines are currently contraindicated in solid-organ transplant recipients. However, the risk of vaccine-preventable infections is lifelong, and can be particularly severe after transplantation. In this prospective interventional national cohort study, 44 pediatric liver transplant recipients with measles IgG antibodies <150 IU/L (below seroprotection threshold) received measles-mumps-rubella vaccine (MMR) at a median of 6.3 years posttransplantation (interquartile range, 4.0 to 10.9). A maximum of two additional doses were administered in nonresponders or when seroprotection was lost. Vaccine responses occurred in 98% (95% confidence interval [CI], 88-100) of patients. Seroprotection at 1-, 2-, and 3-year follow-up reached 62% (95% CI, 45-78), 86% (95% CI, 70-95), and 89% (95% CI, 67-99), respectively. All patients responded appropriately to the booster dose(s). Vaccinations were well tolerated and no serious adverse event attributable to vaccination was identified during the 8-week follow-up period (or later), using a multimodal approach including standardized telephone interviews, diarized side effect reporting, and monitoring of vaccinal virus shedding. We conclude that live attenuated MMR vaccine can be administered in liver transplant recipients fulfilling specific eligibility criteria (>1 year posttransplantation, low immunosuppression, lymphocyte count ≥0.75 G/L), inducing seroprotection in most subjects. (Clinicaltrials.gov number NCT01770119).

KEYWORDS:

clinical research/practice; clinical trial; infection and infectious agents-viral; infectious disease; liver transplantation/hepatology; pediatrics; vaccine

PMID:
30171797
DOI:
10.1111/ajt.15101

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