Section of Gastroenterology, Hepatology and Nutrition and the Digestive Health Institute, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children's Hospital Colorado and the University of Colorado School of Medicine, 13123 East 16th Avenue, B290, Aurora, CO, 80045, USA.
Section of Pediatric Infectious Diseases, Children's Hospital Colorado and the University of Colorado School of Medicine, 13123 East 16th Avenue, B290, Aurora, CO, 80045, USA.
Pediatr Res. 2020 Jan;87(2):277-281. doi: 10.1038/s41390-019-0507-4. Epub 2019 Jul 22.
Vaccine-preventable infections (VPIs) are a common and serious complication following transplantation. One in six pediatric solid organ transplant recipients is hospitalized with a VPI in the first 5 years following transplant and these hospitalizations result in significant morbidity, mortality, graft injury, and cost. Immunizations are a minimally invasive, cost-effective approach to reducing the incidence of VPIs. Despite published recommendations for transplant candidates to receive all age-appropriate immunizations, under-immunization remains a significant problem, with the majority of transplant recipients not up-to-date on age-appropriate immunizations at the time of transplant. This is extremely concerning as the rate for non-medical vaccine exemptions in the United States (US) is increasing, decreasing the reliability of herd immunity to protect patients undergoing transplant from VPIs. There is an urgent need to better understand barriers to vaccinating this population of high-risk children and to develop effective interventions to overcome these barriers and improve immunization rates. Strengthened national policies requiring complete age-appropriate immunization for non-emergent transplant candidates, along with improved multi-disciplinary immunization practices and tools to facilitate and ensure complete immunization delivery to this high-risk population, are needed to ensure that we do everything possible to prevent infectious complications in pediatric transplant recipients.
疫苗可预防感染（VPIs）是移植后常见且严重的并发症。在移植后的头 5 年内，每 6 名接受实体器官移植的儿科患者中就有 1 人因 VPI 住院，这些住院导致了严重的发病率、死亡率、移植物损伤和费用。疫苗接种是一种微创且具有成本效益的方法，可以降低 VPIs 的发生率。尽管有出版物建议移植候选人接受所有适龄免疫接种，但免疫接种不足仍然是一个严重的问题，大多数移植受者在移植时未按年龄接受适当的免疫接种。这令人极为担忧，因为美国（US）非医学疫苗豁免的比率正在增加，这降低了群体免疫保护接受移植的患者免受 VPIs 的可靠性。迫切需要更好地了解为这一高危儿童群体接种疫苗的障碍，并制定有效的干预措施来克服这些障碍并提高免疫接种率。需要强化国家政策，要求非紧急移植候选人完成适龄免疫接种，同时改善多学科免疫接种实践和工具，以促进并确保向这一高危人群提供完整的免疫接种，以确保我们尽一切可能预防儿科移植受者的感染性并发症。
