NYU Grossman School of Medicine, New York, New York.
NYU Langone Transplant Institute, New York, New York, USA.
Am J Transplant. 2021 Jan;21(1):338-343. doi: 10.1111/ajt.16278. Epub 2020 Sep 29.
Solid organ transplant (SOT) candidates and recipients are at risk of significant morbidity and mortality from infection, including those circulating in the community from unexpected outbreaks. In late 2018-summer of 2019, a measles outbreak occurred in the New York City area, with a total of 649 cases reported. We developed a systematic 3-part approach to address measles risk in our adult SOT program through: (a) identification of nonimmune adults living in outbreak ZIP codes, (b) education focused on risk reduction for patients from outbreak ZIP codes, and (c) risk reduction for nonimmune patients. All waitlisted or previously transplanted patients residing in outbreak areas received a measles patient education handout. The electronic medical record of patients born in or after 1957 was reviewed for serologic evidence of measles immunity. Measles immunity testing was performed in patients without documentation of immunity. Patients who tested nonimmune were offered MMR vaccination or intravenous immunoglobulin depending on their transplant phase and risk profile. Thus, we demonstrate successful implementation of a systematic risk assessment during a large measles outbreak to identify and protect at-risk SOT patients. As vaccine hesitancy persists, our strategies may be increasingly relevant to transplant centers and those caring for immunocompromised patients.
实体器官移植（SOT）候选人和受者存在严重感染的发病率和死亡率风险，包括那些由社区中意外爆发的感染引起的感染。2018 年末至 2019 年夏季，纽约市地区发生了麻疹爆发，共报告了 649 例病例。我们开发了一种系统的三部分方法，通过以下方式解决我们的成人 SOT 计划中的麻疹风险：（a）确定居住在爆发邮政编码区域内的非免疫成年人，（b）针对来自爆发邮政编码区域的患者的重点教育，以降低风险，（c）降低非免疫患者的风险。所有在候补名单上或以前接受过移植的居住在爆发地区的患者都收到了麻疹患者教育传单。对出生于 1957 年或之后的患者的电子病历进行了麻疹免疫血清学证据的审查。对没有免疫记录的患者进行了麻疹免疫检测。对检测结果为非免疫的患者根据其移植阶段和风险状况提供了 MMR 疫苗接种或静脉注射免疫球蛋白。因此，我们证明了在大规模麻疹爆发期间成功实施了系统的风险评估，以识别和保护处于危险中的 SOT 患者。由于疫苗犹豫持续存在，我们的策略可能对移植中心和那些照顾免疫功能低下患者的机构越来越重要。
