二价水痘带状疱疹病毒疫苗时代儿科实体器官受者移植前接种和移植后感染：单中心多器官回顾性研究。

Varicella-Zoster Virus Pretransplant Vaccination and Posttransplant Infections Among Pediatric Solid Organ Recipients in the Two-Dose Varicella Era: A Single-Center, Multi-Organ Retrospective Study.

机构信息

Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

出版信息

Pediatr Transplant. 2024 Aug;28(5):e14822. doi: 10.1111/petr.14822.

DOI:10.1111/petr.14822

PMID:39054880

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

VZV exposure and disease still occur. Optimizing immunization among eligible candidates and ensuring patients have a defined VZV serostatus pretransplantation remain goals of care.

摘要

背景

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。

方法

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。

结果

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。