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Measles outbreak risk assessment for transplant candidates and recipients
Elana Kreiger-Benson1, Bruce Gelb1,2, Henry J Neumann1,2
1NYU Grossman School of Medicine, New York, New York.
Abstract:
Solid organ transplant (SOT) candidates and recipients are at risk of significant morbidity and mortality from infection, including those circulating in the community from unexpected outbreaks. In late 2018-summer of 2019, a measles outbreak occurred in the New York City area, with a total of 649 cases reported. We developed a systematic 3-part approach to address measles risk in our adult SOT program through: (a) identification of nonimmune adults living in outbreak ZIP codes, (b) education focused on risk reduction for patients from outbreak ZIP codes, and (c) risk reduction for nonimmune patients. All waitlisted or previously transplanted patients residing in outbreak areas received a measles patient education handout. The electronic medical record of patients born in or after 1957 was reviewed for serologic evidence of measles immunity. Measles immunity testing was performed in patients without documentation of immunity. Patients who tested nonimmune were offered MMR vaccination or intravenous immunoglobulin depending on their transplant phase and risk profile. Thus, we demonstrate successful implementation of a systematic risk assessment during a large measles outbreak to identify and protect at-risk SOT patients. As vaccine hesitancy persists, our strategies may be increasingly relevant to transplant centers and those caring for immunocompromised patients.
Insights
Solid organ transplant (SOT) patients face infection risks. A systematic approach identified and protected nonimmune SOT patients during a measles outbreak, highlighting the need for ongoing risk management strategies.
Area of Science:
- Infectious Diseases
- Transplant Immunology
- Public Health
Background:
- Solid organ transplant (SOT) candidates and recipients are highly susceptible to infections, posing significant morbidity and mortality risks.
- Community outbreaks, such as the 2018-2019 New York City measles outbreak (649 cases), present unique challenges for immunocompromised patient populations.
- Maintaining immunity and preventing infections are critical for successful SOT outcomes.
Purpose of the Study:
- To implement and evaluate a systematic, multi-part risk assessment and mitigation strategy for adult SOT patients during a community measles outbreak.
- To identify and protect nonimmune SOT candidates and recipients residing in outbreak-affected areas.
- To provide a replicable model for transplant centers managing infectious disease risks in immunocompromised patients.
Main Methods:
- A 3-part approach was developed: (a) identifying nonimmune patients in outbreak ZIP codes, (b) providing targeted education on risk reduction, and (c) implementing specific risk reduction measures.
- Waitlisted and post-transplant patients in outbreak areas received educational materials.
- Electronic medical records were reviewed for measles immunity documentation; nonimmune patients underwent serologic testing.
- Nonimmune patients were offered measles vaccination (MMR) or intravenous immunoglobulin based on their transplant status and risk profile.
Main Results:
- The systematic approach successfully identified nonimmune SOT patients at risk during the measles outbreak.
- Educational interventions and targeted immunizations/prophylaxis were implemented for at-risk individuals.
- The strategy demonstrated effective risk assessment and protection for a vulnerable patient population.
Conclusions:
- A systematic, proactive strategy is effective in identifying and protecting solid organ transplant patients from community-acquired infectious disease outbreaks like measles.
- These risk mitigation strategies are increasingly relevant for transplant centers and healthcare providers managing immunocompromised patients, especially amidst persistent vaccine hesitancy.
- Successful implementation underscores the importance of integrated public health and clinical care approaches for vulnerable populations.
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