High Risk of Vaccine Preventable Infections in Kids with Organ Transplants

Pediatric organ transplant recipients are at greatly increased risk of hospitalization for vaccine-preventable infections (VPIs), reports a study in JAMA Pediatrics.

The retrospective study included 6980 patients who were less than 18 years old (mean 6.2 years) when they underwent a solid organ transplant from 2004 through 2011. Transplants were performed at 45 not-for-profit US children’s hospitals participating in the Pediatric Health Information System database. There were 2,583 kidney transplant recipients, comprising 37.0% of the sample.

Numbers of hospitalizations for VPIs in the 5 years after transplantation were analyzed, based on diagnostic codes. The morbidity, mortality, and costs of these hospitalizations were assessed as well.

A total of 1,490 VPIs occurred within 5 years after transplantation in 1,092 patients, representing 15.6% of the sample. Influenza was the most common VPI (7.4%), followed by rotavirus (3.7%), varicella (2.1%), pneumococcus (2.0%), and respiratory syncytial virus (1.8%). Risk of VPI was lowest (11.3%) for kidney transplant recipients.

Overall case fatality was 1.7%. About 13% of all infections occurred during the transplant hospitalization. Excluding these cases, 17.0% of vaccine-preventable infections required intensive care unit admission. On multivariable analysis, risk of hospitalization for VPI was higher for children undergoing lung, heart, intestine, or multiorgan transplant, relative to kidney transplant; and for those younger than 2 years at transplantation. Median cost was $120,000 higher for pediatric transplant hospitalizations complicated by VPI.

More than 15% of children undergoing solid organ transplants are hospitalized for VPI within 5 years after transplantation. The risk of hospitalization for influenza in the first year after transplantation is more than 50 times higher than in the general population, and the risk of death is four times higher. The researchers conclude, “[M]aximal efforts must be made to ensure complete immunization of transplant candidates and recipients” [Feldman AG, et al. Incidence of hospitalization for vaccine-preventable infections in children following solid organ transplant and associated morbidity, mortality, and costs. JAMA Pediatrics 2019; DOI: 10.1001/jamapediatrics.2018.4954].

February 2019 (Vol. 11, Number 2)