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Reevaluating immunization delays after red blood cell transfusion
Alexandra Zabeida1,2, Marc H Lebel3,4, Christian Renaud3,4
1Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.
Insights
Children receiving frequent blood transfusions can be safely immunized with the measles, mumps, and rubella (MMR) vaccine. This study found high vaccine immunogenicity, suggesting current immunization delay guidelines may be unnecessary.
Area of Science:
- Pediatrics
- Immunology
- Hematology
Background:
- Current guidelines recommend delaying live vaccines like MMR by 5-6 months post-RBC transfusion.
- These recommendations, based on limited data, may hinder timely vaccination for children needing frequent transfusions.
- This study investigates MMR vaccine immunogenicity in chronically transfused pediatric patients.
Purpose of the Study:
- To assess measles, mumps, rubella (MMR) vaccine immunogenicity in pediatric patients receiving chronic red blood cell (RBC) transfusions.
- To quantify MMR vaccine antibodies present in RBC donations.
Main Methods:
- Quantified MMR-specific antibodies in 25 pediatric patients post-vaccination while on chronic RBC transfusion.
- Analyzed MMR antibodies in supernatants from 30 RBC donations.
- Compared antibody levels with vaccination dates and blood donor birth years.
Main Results:
- Measles, mumps, and rubella vaccine immunity ranged from 68% to 76% in transfused patients.
- Pre-1976 blood donors (pre-MMR vaccine era) showed higher MMR antibody levels (67%) in donations compared to post-1976 donors (7%).
- MMR antibody levels in RBC donations appear to decrease over time.
Conclusions:
- This is the first study demonstrating MMR vaccine immunogenicity in chronically transfused patients.
- Despite lower rates than general populations, MMR vaccine immunogenicity is significant in this cohort.
- Re-evaluation of current immunization delay guidelines after RBC transfusions is warranted to optimize disease prevention in vulnerable children.
Background:
Current American and Canadian guidelines recommend delaying live vaccine immunization by 5 to 6 months after transfusion of red blood cells (RBCs) due to potential interference by serum antibodies. Due to lack of data, the recommendations may be unfounded and prevent valuable vaccination opportunities for children with frequent blood transfusions. The primary aim of this study was to determine measles, mumps, rubella (MMR) vaccine immunogenicity in patients chronically transfused with RBCs. A secondary aim was to quantify vaccine antibodies in RBC donations.
Study Design And Methods:
MMR-specific antibodies were quantified in 25 pediatric patients who received both doses of MMR vaccine while on a chronic RBC transfusion program (median, 6.6 years after vaccination). MMR antibodies were also quantified in 30 samples of supernatants from RBC donations.
Results:
Immunity to each of the MMR components was 68% to 76%. In blood donors born before 1976 (pre-MMR vaccine), 67% of MMR serologies in the supernatants of RBC donations were at the immune level versus 7% in blood donors born after 1976.
Conclusion:
This is the first study of the impact of RBC transfusions on MMR vaccine immunogenicity. Although lower than in the literature (immunity rates, ≥90%), the results show a high rate of immunogenicity of the MMR vaccine in chronically transfused patients. Additionally, results suggest that MMR antibody content in transfusions will continue to decrease with time. Weighing the risks and benefits of disease prevention in a vulnerable population, a reevaluation of immunization delays after RBC transfusions is called for.
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