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

Authors:
Laure F Pittet
Laure F Pittet
University Hospitals of Geneva
Switzerland
Charlotte M Verolet
Charlotte M Verolet
Children's Hospital-University Hospitals of Geneva
Barbara E Wildhaber
Barbara E Wildhaber
C.S. Mott Children's Hospital
United States
Maria Rodriguez
Maria Rodriguez
University of California
United States
Pascal Cherpillod
Pascal Cherpillod
Department of Clinical Veterinary Medicine
Switzerland
Laurent Kaiser
Laurent Kaiser
University of Geneva Hospitals
Switzerland

Am J Transplant 2019 Mar 1;19(3):844-854. Epub 2018 Oct 1.

Department of Pediatrics, Division of General Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

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).

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http://dx.doi.org/10.1111/ajt.15101DOI Listing
March 2019
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References

(Supplied by CrossRef)
Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP)
McLean HQ et al.
MMWR Recommen Rep 2013

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