Early experience with varicella vaccination in pediatric heart transplant recipients
Anne I Dipchand1, Mirna Seifert-Hansen1
1Labatt Family Heart Center, Hospital for the Sick Children, Toronto, Ontario, Canada.
Insights
Pediatric heart transplant recipients can now be safely vaccinated against varicella-zoster virus (VZV) with a live-attenuated vaccine. Early studies show a high seroconversion rate and mild side effects, addressing previous safety concerns.
Area of Science:
- Pediatric immunology
- Transplant medicine
- Vaccinology
Background:
- International guidelines exclude pediatric heart transplant (pHT) recipients from live-attenuated varicella (VZV) vaccination due to limited safety and efficacy data.
- Mycophenolate mofetil (MMF) immunosuppression further complicates VZV vaccination recommendations in this population.
- Varicella-zoster virus infection poses a significant risk, potentially leading to severe or fatal outcomes in immunocompromised pediatric patients.
Purpose of the Study:
- To evaluate the safety and immunogenicity of early VZV vaccination in pediatric heart transplant recipients.
- To assess the seroconversion rates and adverse event profiles in this specific patient cohort.
Main Methods:
- A cohort of 31 children post-heart transplantation received VZV vaccination.
- Vaccination protocols were monitored for safety and adverse events.
- Seroconversion rates were assessed in a subset of vaccinated patients.
Main Results:
- An early seroconversion rate of 94% (16/17) was observed.
- No major adverse events were reported following vaccination.
- Mild, self-resolving rashes occurred in 29% of patients within 1-3 days.
Conclusions:
- Live-attenuated VZV vaccination is safe and effective in select pediatric heart transplant recipients.
- High early seroconversion rates and a favorable adverse event profile support VZV vaccination in this population.
- These findings challenge previous exclusion criteria and suggest a revised approach to VZV immunization in pediatric heart transplant patients.
Abstract:
International consensus guidelines to vaccinate children after solid organ transplant with the live-attenuated varicella (VZV) vaccine exclude pediatric heart transplant recipients due to insufficient evidence for safety, seroconversion rate, or adverse event profile. Caution is also recommended in the setting of mycophenolate mofetil (MMF) immunosuppression. However, VZV infection in these patients can be serious or even fatal. We report our novel early experience with VZV vaccination in a cohort of 31 children following heart transplantation, 42% of who were on MMF. The early seroconversion rate was 16/17 (94%) with no major adverse events. Though a rash of some description was reported in 29%, spots were few and self-resolving in 1-3 days. Select pediatric heart transplant patients can be safely vaccinated with VZV vaccine with a high early seroconversion rate and a mild adverse event profile.
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