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Almost 16% of pediatric transplant recipients hospitalized with vaccine-preventable diseases
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Children receiving solid organ transplants — especially lung, heart, intestine and multivisceral transplants — are hospitalized with vaccine-preventable infections in the first 5 years after surgery at a rate that is 87 times higher than that of the general population, according to research published in JAMA Pediatrics.
“Infectious diseases are a well-known cause of morbidity and mortality in immunocompromised transplant recipients,” Amy G. Feldman, MD, MSCS, assistant professor of pediatric gastroenterology, hepatology and nutrition and program director of the Liver Transplant Fellowship at Children’s Hospital Colorado, and colleagues wrote. “Some of these infections are potentially preventable by vaccines. Unfortunately, many pediatric transplant recipients are not fully immunized at the time of transplant.”
Feldman and colleagues conducted a multicenter retrospective cohort study of children aged younger than 18 years who received a solid organ transplant between Jan. 1, 2004, and Dec. 31, 2011. All recipients were followed up for 5 years after their transplant, and the researchers examined the number of hospitalizations for vaccine-preventable diseases during this time.
During the study period, 6,980 children received a solid organ transplant. Vaccine-preventable infections were acquired by 15.6% of recipients. Of these cases, 13.1% were infected during transplant hospitalization. Approximately 2% of children with a vaccine-preventable infection following transplantation died. Feldman and colleagues found that 17% of children who were not infected during transplant hospitalization eventually required ICU care for a vaccine-preventable infection.
In a multivariable analysis, the researchers found that children were more likely to require hospitalization for vaccine-preventable infection if they were aged 2 years or younger when they received a transplant or if they received a lung, heart, intestine or multivisceral organ transplant.
The researchers wrote that the median cost of vaccine-preventable infection associated with transplantation surgery was $120,498 more than transplant hospitalizations without a vaccine-preventable infection.
“Overall, the huge burden of illness from vaccine-preventable infections shown in this article should stress to specialty and primary care physicians the critical importance of ensuring that all transplant patients receive age-appropriate immunizations,” Feldman and colleagues wrote. “Unfortunately, underimmunization of transplant patients remains a significant problem, with less than half of all transplant recipients reported being up to date for age on immunizations at time of transplant.”
The researchers added that collaboration between subspecialists and primary care physicians is necessary to create new immunization strategies that target vaccine rates among pediatric transplant recipients. – by Katherine Bortz
Disclosures: Feldman received funding from the Children’s Hospital Colorado Research Institute Research Scholar Award and the NIH/National Center for Advancing Translational Sciences Colorado. Please see the study for all other authors’ relevant financial disclosures.
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