Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Pediatr Transplant. 2024 Aug;28(5):e14822. doi: 10.1111/petr.14822.
Varicella-zoster virus (VZV) pretransplant immunization rates, exposures, and posttransplant disease are poorly characterized among pediatric solid organ transplant (SOT) recipients in the two-dose varicella vaccine era.
A retrospective analysis of the electronic health records among children <18 years old who received SOT from January 1, 2011 through December 31, 2021, was performed at a single center to assess for missed pretransplant varicella vaccination opportunities, characterize VZV exposures, and describe posttransplant disease.
Among 525 children, 444 were ≥6 months old (m.o.) at SOT with a documented VZV vaccine status. Eighty-five (19%) did not receive VZV Dose One; 30 out of 85 (35%) could have been immunized. Infants 6-11 m.o. accounted for 14 out of 30 (47%) missed opportunities. Among children ≥12 m.o. with documented Dose Two status (n = 383), 72 had missed vaccination opportunities; 57 out of 72 (79%) were children 1-4 years old. Most children had unclassifiable pre-SOT serostatus as varicella serology was either not obtained/documented (n = 171) or the possibility of passive antibodies was not excluded (n = 137). Of those with classified serology (n = 188), 69 were seroimmune. Forty-seven of 525 (9%) children had recorded VZV exposures; two developed varicella-neither had documented pre-SOT seroimmunity nor had received post-exposure prophylaxis. Nine additional children had medically attended disease: four primary varicella and five zoster. Of the 11 cases, 10 had cutaneous lesions without invasive disease; one had multi-dermatomal zoster with transaminitis. Seven (64%) received treatment exclusively outpatient.
VZV exposure and disease still occur. Optimizing immunization among eligible candidates and ensuring patients have a defined VZV serostatus pretransplantation remain goals of care.
在两剂水痘疫苗时代，接受小儿实体器官移植（SOT）的患者中，水痘带状疱疹病毒（VZV）的移植前免疫率、接触史和移植后疾病的特征描述并不完善。
对 2011 年 1 月 1 日至 2021 年 12 月 31 日期间在单一中心接受 SOT 的<18 岁儿童的电子健康记录进行回顾性分析，以评估移植前是否错过接种水痘疫苗的机会、描述 VZV 接触史并描述移植后的疾病情况。
在 525 名儿童中，444 名儿童在 SOT 时≥6 个月大（m.o.），并记录了 VZV 疫苗状况。85 名（19%）儿童未接种 VZV 第 1 剂；30 名（35%）儿童本可以接种。6-11 m.o. 的婴儿占 30 名（47%）错过机会的儿童。在记录了第 2 剂接种状态的≥12 m.o.儿童中（n=383），72 名儿童错过了接种机会；72 名（79%）儿童为 1-4 岁。大多数儿童的移植前血清学状态未分类，因为未获得/记录水痘血清学（n=171）或未排除被动抗体的可能性（n=137）。在有分类血清学的 188 名儿童中，69 名具有血清免疫力。525 名儿童中有 47 名（9%）记录了 VZV 接触史；其中 2 名儿童发生了水痘-既没有记录移植前的血清免疫力，也没有接受过接触后预防。另外 9 名儿童出现了需要医学治疗的疾病：4 名原发性水痘和 5 名带状疱疹。在 11 例病例中，10 例为单纯皮疹无侵袭性疾病；1 例为多皮节带状疱疹伴肝酶升高。7 例（64%）接受了单纯门诊治疗。
VZV 暴露和疾病仍在发生。优化合格候选人的免疫接种，并确保患者在移植前具有明确的 VZV 血清学状态仍然是治疗目标。
