Vaccine-Preventable Infections Common in Pediatric Transplant Patients

By Anne Harding

January 15, 2019

NEW YORK (Reuters Health) - Over 15% of pediatric solid organ transplant recipients are hospitalized for a vaccine-preventable infection in the first five years after transplant, according to new findings in JAMA Pediatrics.

"Vaccine-preventable infections are a significant problem across all pediatric solid organ recipients," Dr. Amy G. Feldman of the University of Colorado Denver School of Medicine and Children's Hospital Colorado in Aurora, the first author of the study, told Reuters Health in a telephone interview. "Primary care providers and subspecialists need to work together to ensure that transplant candidates and recipients are fully immunized."

Transplant recipients must typically be on immunosuppressants for the rest of their lives, which can blunt the effects of immunization, Feldman and her team note in their January 14 report. Also, they point out, transplant patients are actually less likely to be fully immunized than the general population.

To investigate how common hospitalizations were for vaccine-preventable infection and respiratory syncytial virus (RSV) in young organ transplant recipients, the authors looked at data from the Pediatric Health Information System database on 6,980 children who underwent organ transplant in 2004-2011.

In the first five years after transplant, 15.6% were hospitalized at least once for a vaccine-preventable infection or RSV, 15.8% of whom contracted the infection during the initial transplant hospitalization. The most common infections were influenza, rotavirus, varicella, pneumococcus and RSV. The case fatality rate was 1.7.

Transplant hospitalizations in which the patient developed a vaccine-preventable infection cost a median of $120,498 more than hospitalizations in which patients did not contract one of these infections.

The risk of hospitalization for a vaccine-preventable infection was higher for children younger than two years at transplant (hazard ratio 2.2) and for those with intestinal (HR 2.8), multivisceral (HR 2.2), lung (HR 2.1) and heart (HR 1.4) transplants.

"We cannot prove that the children with vaccine-preventable infections were unvaccinated, and we know that children can get vaccine-preventable infections even if they have been immunized, but this data stresses the significant impact of vaccine preventable infections post transplant. We as a pediatric community need to do better at immunizing these high-risk children to provide them every possible degree of protection." Feldman said.

"People in the general pediatric and transplant community are going to be very surprised by these results," she added. "Vaccine preventable infections are a significant problem after transplant and they are a huge source of morbidity, mortality and increased hospital costs."


JAMA Pediatrics 2019.