{
    "abstract": "Live vaccines (measles-mumps-rubella [MMR] and varicella-zoster virus [VZV]) have not been recommended after solid organ transplant due to concern for inciting vaccine strain infection in an immunocompromised host. However, the rates of measles, mumps, and varicella are rising nationally and internationally, leaving susceptible immunocompromised children at risk for life-threating conditions.\nTo determine the safety and immunogenicity of live vaccines in pediatric liver and kidney transplant recipients.\nThis cohort study included select pediatric liver and kidney transplant recipients who had not completed their primary MMR and VZV vaccine series and/or who displayed nonprotective serum antibody levels at enrollment between January 1, 2002, and February 28, 2023. Eligibility for live vaccine was determined by individual US pediatric solid organ transplant center protocols.\nExposure was defined as receipt of a posttransplant live vaccine. Transplant recipients received 1 to 3 doses of MMR vaccine and/or 1 to 3 doses of VZV vaccine.\nSafety data were collected following each vaccination, and antibody levels were obtained at 0 to 3 months and 1 year following vaccination. Comparisons were performed using Mann-Whitney U test, and factors associated with development of postvaccination protective antibodies were explored using univariate analysis.\nThe cohort included 281 children (270 [96%] liver, 9 [3%] kidney, 2 [1%] liver-kidney recipients) from 18 centers. The median time from transplant to enrollment was 6.3 years (IQR, 3.4-11.1 years). The median age at first posttransplant vaccine was 8.9 years (IQR, 4.7-13.8 years). A total of 202 of 275 (73%) children were receiving low-level monotherapy immunosuppression at the time of vaccination. The majority of children developed protective antibodies following vaccination (107 of 149 [72%] varicella, 130 of 152 [86%] measles, 100 of 120 [83%] mumps, and 124 of 125 [99%] rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 [77%] varicella, 45 of 49 [92%] measles, 35 of 42 [83%] mumps, 51 of 54 [94%] rubella). Five children developed clinical varicella, all of which resolved within 1 week. There were no cases of measles or rubella and no episodes of graft rejection within 1 month of vaccination. There was no association between antibody response and immunosuppression level at the time of vaccination.\nThe findings suggest that live vaccinations may be safe and immunogenic after solid organ transplant in select pediatric recipients and can offer protection against circulating measles, mumps, and varicella.",
    "authors": [
        {
            "affiliation": "Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado and Children's Hospital Colorado, Aurora.\nAdult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children's Hospital Colorado, Aurora.",
            "firstname": "Amy G",
            "initials": "AG",
            "lastname": "Feldman"
        },
        {
            "affiliation": "Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children's Hospital Colorado, Aurora.",
            "firstname": "Brenda L",
            "initials": "BL",
            "lastname": "Beaty"
        },
        {
            "affiliation": "Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.",
            "firstname": "Jose A",
            "initials": "JA",
            "lastname": "Ferrolino"
        },
        {
            "affiliation": "Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.",
            "firstname": "Gabriela",
            "initials": "G",
            "lastname": "Maron"
        },
        {
            "affiliation": "Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio.",
            "firstname": "Hillary K",
            "initials": "HK",
            "lastname": "Weidner"
        },
        {
            "affiliation": "Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.",
            "firstname": "Saira A",
            "initials": "SA",
            "lastname": "Ali"
        },
        {
            "affiliation": "Intermountain Primary Children's Hospital, Salt Lake City, Utah.",
            "firstname": "Leandra",
            "initials": "L",
            "lastname": "Bitterfeld"
        },
        {
            "affiliation": "Levine Children's Hospital at Atrium Health, Charlotte, North Carolina.",
            "firstname": "Mary Alice",
            "initials": "MA",
            "lastname": "Boulware"
        },
        {
            "affiliation": "Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio.",
            "firstname": "Kathleen M",
            "initials": "KM",
            "lastname": "Campbell"
        },
        {
            "affiliation": "Yale University, New Haven, Connecticut.",
            "firstname": "Emily",
            "initials": "E",
            "lastname": "Carr"
        },
        {
            "affiliation": "Children's Wisconsin, Medical College of Wisconsin, Milwaukee.",
            "firstname": "Shelley",
            "initials": "S",
            "lastname": "Chapman"
        },
        {
            "affiliation": "Duke University Medical Center, Durham, North Carolina.",
            "firstname": "Yeh-Chung",
            "initials": "YC",
            "lastname": "Chang"
        },
        {
            "affiliation": "NYU Grossman School of Medicine, New York, New York.",
            "firstname": "Ryan",
            "initials": "R",
            "lastname": "Cunningham"
        },
        {
            "affiliation": "Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.",
            "firstname": "Ronald H",
            "initials": "RH",
            "lastname": "Dallas"
        },
        {
            "affiliation": "Levine Children's Hospital at Atrium Health, Charlotte, North Carolina.",
            "firstname": "Keerti L",
            "initials": "KL",
            "lastname": "Dantuluri"
        },
        {
            "affiliation": "Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.",
            "firstname": "Bryanna N",
            "initials": "BN",
            "lastname": "Domenick"
        },
        {
            "affiliation": "Lucile Packard Children's Hospital at Stanford, Palo Alto, California.",
            "firstname": "Noelle H",
            "initials": "NH",
            "lastname": "Ebel"
        },
        {
            "affiliation": "Boston Children's Hospital, Boston, Massachusetts.",
            "firstname": "Scott",
            "initials": "S",
            "lastname": "Elisofon"
        },
        {
            "affiliation": "Yale University, New Haven, Connecticut.",
            "firstname": "Rima",
            "initials": "R",
            "lastname": "Fawaz"
        },
        {
            "affiliation": "Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.",
            "firstname": "Marc",
            "initials": "M",
            "lastname": "Foca"
        },
        {
            "affiliation": "Lucile Packard Children's Hospital at Stanford, Palo Alto, California.",
            "firstname": "Hayley A",
            "initials": "HA",
            "lastname": "Gans"
        },
        {
            "affiliation": "Levine Children's Hospital at Atrium Health, Charlotte, North Carolina.",
            "firstname": "Vani V",
            "initials": "VV",
            "lastname": "Gopalareddy"
        },
        {
            "affiliation": "Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York.",
            "firstname": "Cindy",
            "initials": "C",
            "lastname": "Gu"
        },
        {
            "affiliation": "Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.",
            "firstname": "Nitika A",
            "initials": "NA",
            "lastname": "Gupta"
        },
        {
            "affiliation": "Lucile Packard Children's Hospital at Stanford, Palo Alto, California.",
            "firstname": "Katherine",
            "initials": "K",
            "lastname": "Harmann"
        },
        {
            "affiliation": "C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor.",
            "firstname": "Jessica",
            "initials": "J",
            "lastname": "Hollenbeck"
        },
        {
            "affiliation": "Children's Wisconsin, Medical College of Wisconsin, Milwaukee.",
            "firstname": "Anna R",
            "initials": "AR",
            "lastname": "Huppler"
        },
        {
            "affiliation": "Intermountain Primary Children's Hospital, Salt Lake City, Utah.",
            "firstname": "Catalina",
            "initials": "C",
            "lastname": "Jaramillo"
        },
        {
            "affiliation": "Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston.",
            "firstname": "Nagraj",
            "initials": "N",
            "lastname": "Kasi"
        },
        {
            "affiliation": "Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York.",
            "firstname": "Nanda",
            "initials": "N",
            "lastname": "Kerkar"
        },
        {
            "affiliation": "Children's Wisconsin, Medical College of Wisconsin, Milwaukee.",
            "firstname": "Stacee",
            "initials": "S",
            "lastname": "Lerret"
        },
        {
            "affiliation": "Children's Hospital of New York, NewYork-Presbyterian Hospital, New York.",
            "firstname": "Steven J",
            "initials": "SJ",
            "lastname": "Lobritto"
        },
        {
            "affiliation": "C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor.",
            "firstname": "Maclovio J",
            "initials": "MJ",
            "lastname": "Lopez"
        },
        {
            "affiliation": "Boston Children's Hospital, Boston, Massachusetts.",
            "firstname": "Elizabeth",
            "initials": "E",
            "lastname": "Marini"
        },
        {
            "affiliation": "Levine Children's Hospital at Atrium Health, Charlotte, North Carolina.",
            "firstname": "Alisha",
            "initials": "A",
            "lastname": "Mavis"
        },
        {
            "affiliation": "Intermountain Primary Children's Hospital, Salt Lake City, Utah.",
            "firstname": "Sonia",
            "initials": "S",
            "lastname": "Mehra"
        },
        {
            "affiliation": "Duke University Medical Center, Durham, North Carolina.",
            "firstname": "Lynnette",
            "initials": "L",
            "lastname": "Moats"
        },
        {
            "affiliation": "Children's Hospital Los Angeles, Los Angeles, California.",
            "firstname": "Sindhu",
            "initials": "S",
            "lastname": "Mohandas"
        },
        {
            "affiliation": "Texan Children's Hospital, Baylor College of Medicine, Houston, Texas.",
            "firstname": "Flor M",
            "initials": "FM",
            "lastname": "Munoz"
        },
        {
            "affiliation": "Texan Children's Hospital, Baylor College of Medicine, Houston, Texas.",
            "firstname": "Krupa R",
            "initials": "KR",
            "lastname": "Mysore"
        },
        {
            "affiliation": "C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor.",
            "firstname": "Ceren",
            "initials": "C",
            "lastname": "Onsan"
        },
        {
            "affiliation": "NYU Grossman School of Medicine, New York, New York.",
            "firstname": "Nadia",
            "initials": "N",
            "lastname": "Ovchinsky"
        },
        {
            "affiliation": "Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio.",
            "firstname": "Kerrigan",
            "initials": "K",
            "lastname": "Perkins"
        },
        {
            "affiliation": "Washington University School of Medicine, St Louis, Missouri.",
            "firstname": "Stacy",
            "initials": "S",
            "lastname": "Postma"
        },
        {
            "affiliation": "Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado and Children's Hospital Colorado, Aurora.",
            "firstname": "Lauren",
            "initials": "L",
            "lastname": "Pratscher"
        },
        {
            "affiliation": "Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.",
            "firstname": "Elizabeth B",
            "initials": "EB",
            "lastname": "Rand"
        },
        {
            "affiliation": "Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York.",
            "firstname": "Regina K",
            "initials": "RK",
            "lastname": "Rowe"
        },
        {
            "affiliation": "C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor.",
            "firstname": "Danielle",
            "initials": "D",
            "lastname": "Schultz"
        },
        {
            "affiliation": "Lucile Packard Children's Hospital at Stanford, Palo Alto, California.",
            "firstname": "Katherine",
            "initials": "K",
            "lastname": "Sear"
        },
        {
            "affiliation": "Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston.",
            "firstname": "Megan L",
            "initials": "ML",
            "lastname": "Sell"
        },
        {
            "affiliation": "Boston Children's Hospital, Boston, Massachusetts.",
            "firstname": "Tanvi",
            "initials": "T",
            "lastname": "Sharma"
        },
        {
            "affiliation": "Washington University School of Medicine, St Louis, Missouri.",
            "firstname": "Janis",
            "initials": "J",
            "lastname": "Stoll"
        },
        {
            "affiliation": "Children's Wisconsin, Medical College of Wisconsin, Milwaukee.",
            "firstname": "Mychoua",
            "initials": "M",
            "lastname": "Vang"
        },
        {
            "affiliation": "Texan Children's Hospital, Baylor College of Medicine, Houston, Texas.",
            "firstname": "Dominique",
            "initials": "D",
            "lastname": "Villarin"
        },
        {
            "affiliation": "Children's Hospital Los Angeles, Los Angeles, California.",
            "firstname": "Carly",
            "initials": "C",
            "lastname": "Weaver"
        },
        {
            "affiliation": "Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.",
            "firstname": "Phoebe",
            "initials": "P",
            "lastname": "Wood"
        },
        {
            "affiliation": "Children's Hospital of New York, NewYork-Presbyterian Hospital, New York.",
            "firstname": "Olivia",
            "initials": "O",
            "lastname": "Woodford-Berry"
        },
        {
            "affiliation": "Children's Hospital Los Angeles, Los Angeles, California.",
            "firstname": "George",
            "initials": "G",
            "lastname": "Yanni"
        },
        {
            "affiliation": "Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio.",
            "firstname": "Lara A",
            "initials": "LA",
            "lastname": "Danziger-Isakov"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1001/jamanetworkopen.2023.37602\n10.1093/cid/cit684\n10.1001/jama.1992.03480090085032\n10.1016/S0140-6736(17)31463-0\n10.1001/jama.2022.23241\n10.1111/j.1600-6143.2005.01210.x\n10.1111/j.1600-6143.2012.04273.x\n10.1016/j.vaccine.2015.01.075\n10.1016/j.vaccine.2014.11.052\n10.1111/ajt.15101\n10.1016/S0022-3476(05)81545-8\n10.1111/petr.13571\n10.1111/ctr.13563\n10.1111/petr.13804\n10.1016/S0140-6736(07)61602-X\n10.1111/petr.12765",
    "journal": "JAMA network open",
    "keywords": [],
    "methods": null,
    "publication_date": "2023-10-12",
    "pubmed_id": "37824141\n24311479\n1538561\n28673424\n36520451\n16468967\n22994936\n25665961\n25510391\n30171797\n8320632\n31497926\n31002409\n32845536\n18064739\n27449120",
    "results": "The cohort included 281 children (270 [96%] liver, 9 [3%] kidney, 2 [1%] liver-kidney recipients) from 18 centers. The median time from transplant to enrollment was 6.3 years (IQR, 3.4-11.1 years). The median age at first posttransplant vaccine was 8.9 years (IQR, 4.7-13.8 years). A total of 202 of 275 (73%) children were receiving low-level monotherapy immunosuppression at the time of vaccination. The majority of children developed protective antibodies following vaccination (107 of 149 [72%] varicella, 130 of 152 [86%] measles, 100 of 120 [83%] mumps, and 124 of 125 [99%] rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 [77%] varicella, 45 of 49 [92%] measles, 35 of 42 [83%] mumps, 51 of 54 [94%] rubella). Five children developed clinical varicella, all of which resolved within 1 week. There were no cases of measles or rubella and no episodes of graft rejection within 1 month of vaccination. There was no association between antibody response and immunosuppression level at the time of vaccination.",
    "title": "Safety and Immunogenicity of Live Viral Vaccines in a Multicenter Cohort of Pediatric Transplant Recipients.",
    "xml": "<Element 'PubmedArticle' at 0x788502c06660>"
}