Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
Transplant Center, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Transplant. 2020 Sep;24(6):e13766. doi: 10.1111/petr.13766. Epub 2020 Jun 18.
The strategy to eradicate polio is based on preventing infection by immunizing all children until the world is polio-free. However, data regarding efficacy of polio-containing vaccination in immunocompromised patients such as LT recipients are limited.
We conducted an observational study at the largest pediatric transplant center in Japan from January 2011 to January 2015. LT recipients were enrolled after transplantation, and those who had completed the Japanese polio vaccination program were eligible for the study. Patients' demographics were collected from their medical records. Antibody titers against poliovirus serotypes 1-3 were measured using the neutralization test at the routine follow-up visits after enrollment. Factors associated with seropositivity against each type of poliovirus were evaluated.
Sixty-four patients who had received the complete polio vaccination series were enrolled in the study. Of these, 37 patients had received all series of polio-containing vaccination before LT. Median age of the patients was 75 months. Their underlying diseases included the following: 40 (63%) with cholestatic liver diseases and 11 (17%) with metabolic disorders. After a median interval of 43 months after LT, seropositivity rates against poliovirus 1, 2, and 3 were 93.8% (60/64), 92.2% (59/64), and 54.7% (35/64), respectively. Among 32 patients who had received only oral polio vaccine (OPV), seropositivity against poliovirus 3 was particularly low (25.0%). No factors associated with seropositivity against each type of poliovirus were identified.
In the LT recipients, seropositivity for poliovirus 3 was low, suggesting a need for additional inactivated polio-containing vaccination after LT, especially for patients who had received only OPV.
消灭脊灰的策略基于用疫苗免疫所有儿童，直至全球无脊灰为止。然而，关于接受 LT 治疗的免疫功能低下患者（如 LT 受者）中含脊灰疫苗接种的疗效的数据有限。
我们在日本最大的儿科移植中心进行了一项观察性研究，时间为 2011 年 1 月至 2015 年 1 月。LT 受者在移植后入组，且已完成日本脊灰疫苗接种计划的患者有资格入组。从病历中收集患者的人口统计学数据。在入组后的常规随访中，使用中和试验测定针对脊灰病毒血清型 1-3 的抗体滴度。评估了与每种脊灰病毒血清阳性相关的因素。
64 名已接受完整脊灰疫苗系列接种的患者入组本研究。其中，37 名患者在 LT 前已接受所有系列含脊灰疫苗接种。患者的中位年龄为 75 个月。其基础疾病包括：40 名（63%）胆汁淤积性肝病和 11 名（17%）代谢紊乱。LT 后中位时间为 43 个月后，脊灰病毒 1、2 和 3 的血清阳性率分别为 93.8%（60/64）、92.2%（59/64）和 54.7%（35/64）。在仅接受口服脊灰疫苗（OPV）的 32 名患者中，脊灰病毒 3 的血清阳性率特别低（25.0%）。未确定与每种脊灰病毒血清阳性相关的因素。
在 LT 受者中，脊灰病毒 3 的血清阳性率较低，提示 LT 后需要额外接种含脊灰灭活疫苗，尤其是接受 OPV 接种的患者。
