Under-immunization of pediatric transplant recipients: a call to action for the pediatric community

Area of Science:

• Pediatric Transplantation
• Infectious Diseases
• Immunology

Background:

• Vaccine-preventable infections (VPIs) are a significant cause of morbidity, mortality, and graft injury in pediatric solid organ transplant recipients.
• Hospitalizations due to VPIs are common, affecting one in six children within five years post-transplant, incurring substantial healthcare costs.
• Declining herd immunity due to increasing vaccine exemptions further endangers this vulnerable population.

Purpose of the Study:

• To highlight the critical issue of under-immunization in pediatric transplant candidates.
• To emphasize the urgent need for understanding barriers to vaccination in high-risk pediatric populations.
• To advocate for interventions and policy changes to improve immunization rates before transplantation.

Main Methods:

• This study is a review and analysis of existing literature and public health data concerning vaccination rates and VPIs in pediatric transplant recipients.
• It examines current immunization recommendations and identifies gaps in their implementation.
• The analysis considers the impact of vaccine exemption rates on herd immunity.

Main Results:

• The majority of pediatric transplant recipients are not up-to-date on age-appropriate immunizations at the time of transplant, despite recommendations.
• Under-immunization poses a substantial risk for VPIs, leading to severe health consequences and increased healthcare utilization.
• Increasing non-medical vaccine exemptions are eroding herd immunity, leaving transplant patients more susceptible.

Conclusions:

• There is an urgent need for improved strategies to increase childhood immunization rates in transplant candidates.
• Strengthening national policies to mandate complete immunization for non-emergent transplant candidates is essential.
• Enhanced multi-disciplinary approaches and improved tools are required to ensure timely and complete vaccine delivery to protect this high-risk group.