Chong Pearlie P, Avery Robin K
Division of Infectious Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Clin Ther. 2017 Aug;39(8):1581-1598. doi: 10.1016/j.clinthera.2017.07.005. Epub 2017 Jul 24.
Vaccine-preventable diseases, especially influenza, varicella, herpes zoster, and invasive pneumococcal infections, continue to lead to significant morbidity and mortality in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients.
We highlight guideline recommendations for the use of key vaccines in SOT and HSCT recipients and to review the latest evidence and developments in the field.
Physicians should vaccinate individuals with end-stage organ disease, as vaccine seroresponse rates are higher pretransplantation. Most live attenuated vaccines continue to be contraindicated post-transplantation, but there are emerging safety profile and efficacy data to support the use of specific live attenuated vaccines, such as measles, mumps, and rubella in pediatric liver or kidney transplant recipients who are on low-level maintenance immunosuppression and without recent history of allograft rejection. An inactivated subunit varicella zoster virus vaccine is currently awaiting US Food and Drug Administration approval. While we await the safety profile and efficacy data of this subunit vaccine in transplant recipients, it will likely benefit immunocompromised individuals, including transplant recipients, because the live attenuated herpes zoster vaccine is currently contraindicated in transplant recipients and transplantation candidates receiving immunosuppression.
There is currently no evidence that vaccines lead to allograft rejection in SOT recipients. Household contacts of SOT and HSCT recipients should be vaccinated per the Advisory Committee on Immunization Practices schedule and recommendations.
Immunizations remain underutilized in transplantation patients. Although efficacy of vaccines in SOT and HSCT may be suboptimal, partial protection is preferred over no protection.
疫苗可预防疾病，尤其是流感、水痘、带状疱疹和侵袭性肺炎球菌感染，在实体器官移植（SOT）和造血干细胞移植（HSCT）受者中仍导致显著的发病率和死亡率。
我们重点介绍SOT和HSCT受者使用关键疫苗的指南建议，并回顾该领域的最新证据和进展。
医生应为患有终末期器官疾病的个体接种疫苗，因为移植前疫苗血清反应率更高。大多数减毒活疫苗在移植后仍属禁忌，但有新出现的安全性和有效性数据支持在低水平维持免疫抑制且近期无移植排斥史的儿科肝或肾移植受者中使用特定的减毒活疫苗，如麻疹、腮腺炎和风疹疫苗。一种灭活亚单位水痘带状疱疹病毒疫苗目前正在等待美国食品药品监督管理局的批准。在等待该亚单位疫苗在移植受者中的安全性和有效性数据期间，它可能会使免疫功能低下的个体（包括移植受者）受益，因为目前移植受者和接受免疫抑制的移植候选者禁忌使用减毒活带状疱疹疫苗。
目前没有证据表明疫苗会导致SOT受者发生移植排斥。SOT和HSCT受者的家庭接触者应按照免疫实践咨询委员会的时间表和建议进行接种。
移植患者的免疫接种仍未得到充分利用。虽然疫苗在SOT和HSCT中的疗效可能不理想，但部分保护总比没有保护要好。
