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Varicella-zoster immunization in pediatric liver transplant recipients: safe and immunogenic

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Published in American journal of transplantation. 2012, vol. 12, no. 11, p. 2974-85
Abstract Varicella can have a severe course in immunosuppressed patients. Although prevention is fundamental, live-attenuated varicella-zoster (VZV) vaccine is not currently recommended in transplant recipients. Our aims were to (1) evaluate VZV immunity in pediatric liver transplant (LT) recipients; (2) immunize (two doses) seronegative patients post-LT; (3) monitor vaccine safety, (4) assess B and T cell vaccine responses. All patients followed at the Swiss National Pediatric LT Center were approached and 77/79 (97.5%) were enrolled (median age 7.8 years). Vaccine safety was monitored by standardized diary cards and phone calls. VZV-specific serology and CD4(+) T cells were assessed before and after immunization. Thirty-nine patients (51.1%) were seronegative including 14 children immunized pre-LT. Thirty-six of 39 seronegative patients were immunized post-LT (median 3.0 years post LT). Local (54.8%) and systemic (64.5%) reactions were mild and transient. The frequency of VZV-specific CD4(+) T cells and antibody titers increased significantly (respectively from 0.085% to 0.16%, p = 0.04 and 21.0 to 1134.5 IU/L, p < 0.001). All children reached seroprotective titers and 31/32 (97%) patients assessed remained seroprotected at follow-up (median 1.7 years). No breakthrough disease was reported during follow-up (median 4.1 years). Thereby, VZV vaccine appears to be safe, immunogenic and provide protection against disease in pediatric LT patients.
Keywords Antibodies, Viral/immunologyChickenpox/immunology/prevention & controlChickenpox Vaccine/administration & dosageChildChild, PreschoolFemaleFollow-Up StudiesGraft Rejection/prevention & controlGraft SurvivalHerpes Zoster/immunology/prevention & controlHerpes Zoster Vaccine/administration & dosageHumansImmunization/methodsImmunocompromised Host/immunologyInfantLiver Transplantation/adverse effects/methodsMaleRetrospective StudiesRisk AssessmentSafety ManagementTransplantation ImmunologyTreatment Outcome
PMID: 22994936
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Research groups Centre de Vaccinologie et d'Immunologie néonatale (177)
Développement du tube digestif chez les vertébrés (900)
Gastroentérologie et transplantation (pédiatrie) (181)
Groupe Laurent Kaiser (virologie clinique) (668)
Recherche clinique en chirurgie pédiatrique (886)
Recherche en infectiologie pédiatrique et en pédiatrie générale (853)
(ISO format)
POSFAY BARBE, Klara et al. Varicella-zoster immunization in pediatric liver transplant recipients: safe and immunogenic. In: American journal of transplantation, 2012, vol. 12, n° 11, p. 2974-85. doi: 10.1111/j.1600-6143.2012.04273.x https://archive-ouverte.unige.ch/unige:30602

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Deposited on : 2013-10-23

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