Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018
Corresponding Author
Sneha Suresh
Division of Infectious Disease and IHOPE, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
Correspondence
Upton D. Allen, Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Email: [email protected]
Sneha Suresh, Division of Immunology, Department of Pediatrics, 3-529 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.
Email: [email protected]
Search for more papers by this authorJulia Upton
Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorMichael Green
Division of Infectious Diseases, Department of Pediatrics, Pediatric Transplant Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Search for more papers by this authorAnne Pham-Huy
Division of Infectious Diseases, Immunology and Allergy, Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
Search for more papers by this authorKlara M. Posfay-Barbe
Division of Pediatric Infectious Diseases, Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
Search for more papers by this authorMarian G. Michaels
Division of Infectious Diseases, Department of Pediatrics, Pediatric Transplant Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Search for more papers by this authorKarina A. Top
Division of Infectious Diseases, Department of Pediatrics, Dalhousie University, Canadian Center for Vaccinology IWK Health Centre, Halifax, NS, Canada
Search for more papers by this authorYaron Avitzur
Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorCatherine Burton
Division of Infectious Diseases, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorPearlie P. Chong
Division of Infectious Diseases, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorLara Danziger-Isakov
Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
Search for more papers by this authorAnne I. Dipchand
Department of Paediatrics, Labatt Family Heart Centre, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorDiane Hébert
Division of Nephrology, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorDeepali Kumar
Department of Medicine, Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
Search for more papers by this authorShaun K. Morris
Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorNadya Nalli
Department of Pharmacy, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorVicky Lee Ng
Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorSarah Kogan Nicholas
Division of Immunology, Allergy and Rheumatology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
Search for more papers by this authorJoan L. Robinson
Division of Infectious Diseases and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorMelinda Solomon
Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorBruce Tapiero
Division of Infectious Diseases, Department of Paediatrics, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
Search for more papers by this authorAnita Verma
Department of Infection Science, Kings College Hospital, London, UK
Search for more papers by this authorJolan E. Walter
Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of South Florida, John's Hopkins All Children's Hospital, St. Petersburg, Florida
Division of Pediatric Allergy/Immunology, Massachusetts General Hospital for Children, Boston, Massachusetts
Search for more papers by this authorCorresponding Author
Upton D. Allen
Division of Infectious Diseases, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Correspondence
Upton D. Allen, Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Email: [email protected]
Sneha Suresh, Division of Immunology, Department of Pediatrics, 3-529 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Sneha Suresh
Division of Infectious Disease and IHOPE, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
Correspondence
Upton D. Allen, Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Email: [email protected]
Sneha Suresh, Division of Immunology, Department of Pediatrics, 3-529 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.
Email: [email protected]
Search for more papers by this authorJulia Upton
Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorMichael Green
Division of Infectious Diseases, Department of Pediatrics, Pediatric Transplant Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Search for more papers by this authorAnne Pham-Huy
Division of Infectious Diseases, Immunology and Allergy, Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
Search for more papers by this authorKlara M. Posfay-Barbe
Division of Pediatric Infectious Diseases, Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
Search for more papers by this authorMarian G. Michaels
Division of Infectious Diseases, Department of Pediatrics, Pediatric Transplant Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Search for more papers by this authorKarina A. Top
Division of Infectious Diseases, Department of Pediatrics, Dalhousie University, Canadian Center for Vaccinology IWK Health Centre, Halifax, NS, Canada
Search for more papers by this authorYaron Avitzur
Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorCatherine Burton
Division of Infectious Diseases, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorPearlie P. Chong
Division of Infectious Diseases, Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorLara Danziger-Isakov
Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
Search for more papers by this authorAnne I. Dipchand
Department of Paediatrics, Labatt Family Heart Centre, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorDiane Hébert
Division of Nephrology, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorDeepali Kumar
Department of Medicine, Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
Search for more papers by this authorShaun K. Morris
Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorNadya Nalli
Department of Pharmacy, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, ON, Canada
Search for more papers by this authorVicky Lee Ng
Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorSarah Kogan Nicholas
Division of Immunology, Allergy and Rheumatology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
Search for more papers by this authorJoan L. Robinson
Division of Infectious Diseases and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
Search for more papers by this authorMelinda Solomon
Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorBruce Tapiero
Division of Infectious Diseases, Department of Paediatrics, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
Search for more papers by this authorAnita Verma
Department of Infection Science, Kings College Hospital, London, UK
Search for more papers by this authorJolan E. Walter
Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of South Florida, John's Hopkins All Children's Hospital, St. Petersburg, Florida
Division of Pediatric Allergy/Immunology, Massachusetts General Hospital for Children, Boston, Massachusetts
Search for more papers by this authorCorresponding Author
Upton D. Allen
Division of Infectious Diseases, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Correspondence
Upton D. Allen, Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Email: [email protected]
Sneha Suresh, Division of Immunology, Department of Pediatrics, 3-529 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.
Email: [email protected]
Search for more papers by this authorAbstract
Growing evidence suggests receipt of live-attenuated viral vaccines after solid organ transplant (SOT) has occurred and is safe and needed due to lapses in herd immunity. A 2-day consortium of experts in infectious diseases, transplantation, vaccinology, and immunology was held with the objective to review evidence and create expert recommendations for clinicians when considering live viral vaccines post-SOT. For consideration of VV and MMR post-transplant, evidence exists only for kidney and liver transplant recipients. For MMR vaccine post-SOT, consider vaccination during outbreak or travel to endemic risk areas. Patients who have received antiproliferative agents (eg. mycophenolate mofetil), T cell–depleting agents, or rituximab; or have persistently elevated EBV viral loads, or are in a state of functional tolerance, should be vaccinated with caution and have a more in-depth evaluation to define benefit of vaccination and net state of immune suppression prior to considering vaccination. MMR and/or VV (not combined MMRV) is considered to be safe in patients who are clinically well, are greater than 1 year after liver or kidney transplant and 2 months after acute rejection episode, can be closely monitored, and meet specific criteria of “low-level” immune suppression as defined in the document.
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