Revaccination with measles, tetanus, poliovirus, Haemophilus influenzae type B, meningococcus C, and pneumococcus vaccines in children after hematopoietic stem cell transplantation.

Abstract

BACKGROUND:

There is a decrease in antibody levels after hematopoietic stem cell transplant (HSCT), and such patients may be at increased risk of acquiring vaccine-preventable infection. A simple and validated revaccination schedule is required. The aim of this study was to evaluate the immunogenicity of a revaccination schedule for pediatric HSCT recipients.

METHODS:

Thirty-eight children (age, 1-18 years) who had undergone autologous or allogeneic HSCT for malignant diseases were recruited. All children received vaccinations in accordance with a predefined schedule. Antibody concentrations were measured before and 2-4 weeks after vaccination against tetanus; Haemophilus influenzae type b (Hib); meningococcus C; measles; poliovirus serotypes 1, 2, and 3; and 9 pneumococcus serotypes.

RESULTS:

Before vaccination, protective antibody levels were found for tetanus in 95% of patients (geometric mean concentration [GMC], 0.07 IU/mL; 95% CI, 0.05-0.1 IU/mL), for Hib in 63% (GMC, 0.34 microg/mL; 95% CI, 0.21-0.57 microg/mL), for measles in 60% (GMC, 102 mIU/mL; 95% CI, 41-253 mIU/mL), for meningococcus C in 11% (geometric mean titer [GMT], 1:4; 95% CI, 1:2-1:8.4), for all 3 poliovirus serotypes in 29%, and for all 9 pneumococcal serotypes in 0%. Vaccination resulted in a significant increase (P < or = .05) in antibody levels to each vaccine antigen studied, with 100% of patients achieving protection against tetanus (GMC, 2.2 IU/mL; 95% CI, 1.8-2.7 IU/mL), 100% achieving protection against Hib (GMC, 8.4 microg/mL; 95% CI, 7.6-9.3 microg/mL), 100% achieving protection against measles (GMC, 2435 mIU/mL; 95% CI, 1724-3439 mIU/mL), 100% achieving protection against meningococcus C (GMT, 1:5706; 95% CI, 1:3510-1:9272), 92% achieving protection against the 3 poliovirus serotypes, and > or = 80% achieving protection against each of the heptavalent pneumococcal conjugate vaccine-associated serotypes. No factors relevant to age, underlying disease, or treatment type were found to significantly influence responses.

CONCLUSION:

Revaccination of pediatric HSCT recipients in accordance with this revaccination schedule provides a high level of protection against these vaccine-preventable diseases.

• Authors: Soonie R Patel, Miguel Ortín, Bernard J Cohen, Ray Borrow, Diane Irving, Joanne Sheldon, Paul T Heath
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 44 Issue 5 Pg. 625-34 (Mar 01 2007) ISSN: 1537-6591 [Electronic] United States
• PMID: 17278051 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Haemophilus Vaccines
• Measles Vaccine
• Meningococcal Vaccines
• Pneumococcal Vaccines
• Poliovirus Vaccines
• Tetanus Toxoid
• Vaccines

Topics

• Adolescent
• Age Factors
• Child
• Child, Preschool
• Haemophilus Vaccines (administration & dosage, immunology)
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunization Schedule
• Infant
• Measles Vaccine (administration & dosage, immunology)
• Meningococcal Vaccines (administration & dosage, immunology)
• Pneumococcal Vaccines (administration & dosage, immunology)
• Poliovirus Vaccines (administration & dosage, immunology)
• Tetanus Toxoid (administration & dosage, immunology)
• Vaccines (immunology)