In the Journals

Kids receiving liver transplants immunized at lower rate than general public

Amy G. Feldman, MD, MSCS
Amy G. Feldman

In the United States and Canada, pediatric patients who undergo liver transplant show lower age-appropriate immunization rates at time of transplant than nontransplant recipients in a similar age group, according to a study published in JAMA.

Barely half of transplant recipients were up to date on the National Immunization Survey (NIS) seven-vaccine series compared with 70% of healthy children aged 19 to 35 months, researchers found.

“Despite the high risk for vaccine-preventable infections post-transplant, the majority of pediatric liver transplant recipients are not up to date on age-appropriate immunizations at the time of transplant,” Amy G. Feldman, MD, MSCS, assistant professor of pediatrics at the University of Colorado School of Medicine and the Children’s Hospital of Colorado, told Infectious Diseases in Children. “Clinicians caring for transplant candidates should carefully review immunization records and work to get a child up to date on age-appropriate immunizations before the time of transplant.”

Feldman and colleagues examined the records of 281 patients aged younger than 18 years who underwent a liver transplant between August 2017 and August 2018 at 39 U.S. and Canadian centers, excluding children who underwent transplant for acute liver failure. Immunization status was determined via the seven-vaccine benchmark from the NIS, the CDC Prevention Immunization Schedule for Healthy Children and the 2013 Infectious Diseases Society of America Clinical Practice Guideline for Vaccination of the Immunocompromised Host.

Of the eligible patients, 55% (95% CI, 49%-61%) were up to date according to the NIS seven-vaccine series, 29% (95% CI, 24%-35%) were up to date per the CDC schedule requirement and 19% (95% CI, 14%-24%) were up to date according to the IDSA schedule. The proportion of children up to date for individual vaccines ranged from 50% for Haemophilus influenzae type b to 94% for meningococcus, with 51% of the children not up to date on the CDC schedule missing at least four immunizations.

Of the 52 patients eligible under IDSA guidelines aged 6 to 11 months at time of transplant, 15% received varicella vaccinations (95% CI, 7%-28%) and 25% received MMR vaccinations (95% CI, 14%-39%). No clinical or demographic factors were significantly associated with underimmunization, with only 5% of patients reporting a delayed transplant listing for immunization compliance, according to the researchers.

“Further research is needed to understand transplant-specific barriers to immunization,” Feldman said. “Novel tools such as a cloud-based health information technology tool that stores immunization records, provides pretransplant vaccine education and delivers reminders when immunizations are due could increase immunization rates in these high-risk children.” – by Eamon Dreisbach

Disclosures: Feldman reports funding from a Children’s Hospital Colorado Research Institute Research Scholar Award, grants from the NIH and National Center for Advancing Translational Sciences TR002534 and the Agency for Healthcare Research and Quality.

Amy G. Feldman, MD, MSCS
Amy G. Feldman

In the United States and Canada, pediatric patients who undergo liver transplant show lower age-appropriate immunization rates at time of transplant than nontransplant recipients in a similar age group, according to a study published in JAMA.

Barely half of transplant recipients were up to date on the National Immunization Survey (NIS) seven-vaccine series compared with 70% of healthy children aged 19 to 35 months, researchers found.

“Despite the high risk for vaccine-preventable infections post-transplant, the majority of pediatric liver transplant recipients are not up to date on age-appropriate immunizations at the time of transplant,” Amy G. Feldman, MD, MSCS, assistant professor of pediatrics at the University of Colorado School of Medicine and the Children’s Hospital of Colorado, told Infectious Diseases in Children. “Clinicians caring for transplant candidates should carefully review immunization records and work to get a child up to date on age-appropriate immunizations before the time of transplant.”

Feldman and colleagues examined the records of 281 patients aged younger than 18 years who underwent a liver transplant between August 2017 and August 2018 at 39 U.S. and Canadian centers, excluding children who underwent transplant for acute liver failure. Immunization status was determined via the seven-vaccine benchmark from the NIS, the CDC Prevention Immunization Schedule for Healthy Children and the 2013 Infectious Diseases Society of America Clinical Practice Guideline for Vaccination of the Immunocompromised Host.

Of the eligible patients, 55% (95% CI, 49%-61%) were up to date according to the NIS seven-vaccine series, 29% (95% CI, 24%-35%) were up to date per the CDC schedule requirement and 19% (95% CI, 14%-24%) were up to date according to the IDSA schedule. The proportion of children up to date for individual vaccines ranged from 50% for Haemophilus influenzae type b to 94% for meningococcus, with 51% of the children not up to date on the CDC schedule missing at least four immunizations.

Of the 52 patients eligible under IDSA guidelines aged 6 to 11 months at time of transplant, 15% received varicella vaccinations (95% CI, 7%-28%) and 25% received MMR vaccinations (95% CI, 14%-39%). No clinical or demographic factors were significantly associated with underimmunization, with only 5% of patients reporting a delayed transplant listing for immunization compliance, according to the researchers.

“Further research is needed to understand transplant-specific barriers to immunization,” Feldman said. “Novel tools such as a cloud-based health information technology tool that stores immunization records, provides pretransplant vaccine education and delivers reminders when immunizations are due could increase immunization rates in these high-risk children.” – by Eamon Dreisbach

Disclosures: Feldman reports funding from a Children’s Hospital Colorado Research Institute Research Scholar Award, grants from the NIH and National Center for Advancing Translational Sciences TR002534 and the Agency for Healthcare Research and Quality.