Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Department of Pediatrics, University Center of Pediatric Surgery of Western Switzerland.
Transplantation. 2019 Nov;103(11):e355-e364. doi: 10.1097/TP.0000000000002866.
Chickenpox is a highly contagious vaccine-preventable disease that can lead to severe complications, especially in immunocompromised patients. Varicella-zoster virus (VZV) vaccine appears to be safe and immunogenic in pediatric solid organ transplant recipients, but there are few data on the long-term vaccine-induced seroprotection.
In this prospective interventional study, we offered 2 doses of VZV vaccine to all eligible and nonseroprotected children seen 1 year after liver transplant. Vaccine responses were measured 1 month later and yearly thereafter. Vaccine safety was closely monitored. A supplementary dose was administered if protective levels were not reached/maintained.
Among 121 enrolled patients, 49 were vaccinated and followed during 5.5 years (interquartile range, 3.7-8.0). Their seroconversion rate reached 100% (97.5% confidence interval [CI], 92.7-100). Low VZV-antibody concentration (≤400 UI/L) after the first 1-2 dose/s was associated with the need for a supplementary dose (odds ratio, 15.0; 95% CI, 3.4-67.0, P = 0.001) and was given to 31% (15/47) of children at 1.1 year (interquartile range, 0.9-3.9). Although antibody concentrations declined during follow-up, 96% (95% CI, 86.0-99.5) of patients maintained protective antibody concentrations at a median of 5.5 years after vaccination. One breakthrough disease was identified.
VZV immunization of pediatric solid organ transplant recipients confers sustained seroprotection.
水痘是一种高度传染性的可预防疫苗疾病，可导致严重并发症，尤其是在免疫功能低下的患者中。水痘带状疱疹病毒（VZV）疫苗在儿科实体器官移植受者中似乎是安全且具有免疫原性的，但关于长期疫苗诱导的血清保护作用的数据很少。
在这项前瞻性干预研究中，我们为所有在肝移植后 1 年接受检查且未产生血清保护作用的合格非血清保护儿童提供了 2 剂 VZV 疫苗。1 个月后测量疫苗反应，此后每年测量一次。密切监测疫苗安全性。如果未达到/维持保护水平，则给予补充剂量。
在 121 名入组患者中，有 49 名接种疫苗并随访了 5.5 年（四分位间距，3.7-8.0）。他们的血清转化率达到 100％（97.5％置信区间[CI]，92.7-100）。首次接种 1-2 剂后 VZV 抗体浓度较低（≤400 UI/L）与需要补充剂量有关（优势比，15.0；95％CI，3.4-67.0，P = 0.001），31％（15/47）的儿童在 1.1 年（四分位间距，0.9-3.9）时给予补充剂量。尽管抗体浓度在随访期间下降，但96％（95％CI，86.0-99.5）的患者在接种疫苗后中位数 5.5 年内保持保护性抗体浓度。发现 1 例突破性疾病。
为儿科实体器官移植受者接种 VZV 疫苗可提供持续的血清保护作用。
