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Response to varicella immunization in pediatric liver transplant recipients
M Donati1, M Zuckerman, A Dhawan
1Department of Virology, Guy's King's and St Thomas' School of Medicine, King's College Hospital, Dulwich, London, United Kingdom.
Insights
This study found that varicella vaccine provided a limited antibody response in children undergoing immunosuppression before liver transplants. Varicella-zoster virus (VZV) vaccine administration did not alter the management of VZV exposures in these high-risk pediatric patients.
Area of Science:
- Immunology
- Pediatric Medicine
- Virology
Background:
- Therapeutic immunosuppression increases the risk of severe varicella-zoster virus (VZV) infection.
- This risk is particularly high in individuals without prior VZV exposure.
- Pediatric patients undergoing transplantation are a vulnerable population.
Purpose of the Study:
- To evaluate the serological response to varicella vaccine in children before liver transplantation.
- To assess the impact of varicella vaccination on the management of subsequent VZV exposures in this cohort.
- To determine the efficacy of varicella vaccine in immunocompromised children.
Main Methods:
- Eleven children (median age 10 months) received a single dose of varicella vaccine (Varilrix) prior to liver transplantation.
- Serological responses were assessed retrospectively.
- Outcomes and management of VZV exposures post-transplantation were recorded.
Main Results:
- Only 3 out of 11 children demonstrated a clear antibody response to the varicella vaccine.
- Six children showed no detectable immune response.
- Four children required VZV immunoglobulin prophylaxis post-transplantation, with two developing mild chickenpox.
Conclusions:
- The varicella vaccine elicited a poor antibody response in the majority of immunosuppressed children studied.
- Vaccine administration did not significantly change the approach to managing VZV exposures.
- Further research may be needed to optimize VZV prevention strategies in this population.
Background:
Individuals undergoing therapeutic immunosuppression are at risk of severe varicella-zoster virus (VZV) infection, particularly those without evidence of previous infection.
Methods:
Eleven children, median age 10 months (range 5.5 months to 7 years and 9 months) received one dose of varicella vaccine (Varilrix, SmithKline Beecham plc, UK) before liver transplantation (median interval 95 days, range 40-289 days). The serological response to varicella vaccine was evaluated retrospectively and matched with the outcome and management of any subsequent exposures to VZV.
Results:
Three children responded postimmunization, six children showed no response, and in two children the outcome was difficult to interpret having received blood products. Four children required varicella-zoster immunoglobulin prophylaxis posttransplantation, two of whom developed mild chickenpox.
Conclusions:
Only 3 of 11 children developed a clear antibody response to varicella vaccine. Administration of varicella vaccine did not affect the management of subsequent VZV exposures.