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DOI: 10.1055/a-0796-6719
Revaccination in Children Undergoing Autologous Hematopoietic Stem Cell Transplantation: Results of a Survey in Germany, Austria and Switzerland
Auffrischimpfungen bei Kindern nach autologer Stammzelltransplantation: Ergebnisse einer Umfrage in Deutschland, Österreich und der SchweizPublication History
Publication Date:
02 January 2019 (online)
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Abstract
Background Due to the potential loss of protective antibody titers after autologous hematopoietic stem cell transplantation (HSCT), revaccination is important. The aim of the study was to evaluate the current strategies in Germany, Austria and Switzerland for revaccination of children after autologous HSCT.
Methods An internet-based survey was performed, and results were analyzed in a descriptive way.
Results Twenty-seven out of 31 centers (87%) centers responded, and all centers administer revaccination. More than 90% of the centers re-vaccinate against tetanus, diphtheria, hepatitis B, H. influenzae B, poliomyelitis, measles, mumps, and rubella, whereas considerable less centers vaccinate against encapsulated bacteria, in particular against meningococci. First revaccination with non-live vaccine is performed by almost all centers between 3 and 9 months. Timing of live-attenuated vaccines varied widely [6 months (4 centers), 9 months (1), 12 months (11) and 24 months (4)]. Similarly, there is a wide variation in the delay of live-vaccines after immunoglobulin administration (2 weeks to 9 months), and in the testing of immunological parameters prior to vaccination.
Conclusion Our survey demonstrates a wide variation regarding the timing of live-attenuated vaccines after autologous HSCT or after immunoglobulin administration and regarding immunization against encapsulated bacteria. Many centers do not adhere to current recommendations. Studies should focus on a detailed analysis of the epidemiology of infections with encapsulated bacteria after pediatric autologous HSCT as well as on the immune recovery and the response to revaccination in this setting.
Zusammenfassung
Hintergrund Da viele Patienten nach autologer hämatopoetischer Stammzelltransplantation (HSTZ) ihre protektiven Impfantikörper verlieren, ist eine Revakzinierung von Bedeutung. Das Ziel dieser Studie war die Evaluierung der derzeitigen Strategien zur Revakzinierung von Kindern nach autologer HSZT in Deutschland, Österreich und der Schweiz.
Methoden Die Daten wurden mittels einer internet-basierten Umfrage ermittelt, die Analyse der Daten erfolgte deskriptiv.
Ergebnisse 27/31 Zentren (87%) antworteten auf die Umfrage. Alle Zentren revakzinieren nach autologer HSZT. Während mehr als 90% der Zentren gegen Tetanus, Diphtherie, Hepatitis B, H. influenza B, Poliomyelitis, Masern, Mumps und Röteln impfen, vakzinieren deutlich weniger Zentren gegen bekapselte Erreger, insbesondere gegen Meningokokken. Fast alle Zentren beginnen die Revakzinierung mit Totimpfstoffen 3-9 Monate nach autologer HSZT. Die Zeitpunkte für die Lebendimpfungen nach HSZT variieren deutlich [6 Monate (4 Zentren), 9 Monate (1), 12 Monate (11) und 24 Monate (4)]. Entsprechend findet sich eine große Streuung für den Abstand von Lebendimpfungen nach Immunglobulingaben (2 Wochen bis 9 Monate), und in der Auswahl immunologischer Surrogatmarker vor einer Impfung.
Schlussfolgerung Die vorliegende Umfrage zeigt eine große Variabilität bei den Zeitpunkten von Lebendimpfungen nach autologer HSZT bzw. nach Immunuglobulingabe und bei der Impfung gegen bekapselte Erreger. Viele Zentren folgen nicht derzeitigen Empfehlungen. Zukünftige Untersuchungen sollten insbesondere die Epidemiologie von Infektionen mit bekapselten Erregern nach autologer HSZT von Kindern wie auch die Immunrekonstitution und Impfantwort in diesem Setting evaluieren.
Schlüsselwörter
Kind - Krebserkrankung - Autologe hämatopoetische Stammzelltransplantation - Impfung-
References
- 1 Ariza-Heredia EJ, Gulbis AM, Stolar KR. et al. Vaccination guidelines after hematopoietic stem cell transplantation: practitionersʼ knowledge, attitudes, and gap between guidelines and clinical practice. Transpl Infect Dis 2014; 16: 878-886
- 2 Bochennek K, Allwinn R, Langer R. et al. Differential loss of humoral immunity against measles, mumps, rubella and varicella-zoster virus in children treated for cancer. Vaccine 2014; 32: 3357-3361
- 3 Centers for Disease Contol. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6-18 years with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2013; 62: 521-524
- 4 Cordonnier C, Einarsdottir S, Cesaro S et al. Vaccination of Haematopoietic Stem Cell Transplant Recipients: Guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis (in press)
- 5 Gouveia-Alves F, Gouveia R, Ginani VC. et al. Adherence and immune response to revaccination following hematopoietic stem cell transplantation at a pediatric onco-hematology reference center. Transpl Infect Dis 2018; 20: e12903
- 6 Henry O, Brzostek J, Czajka H. et al. One or two doses of live varicella virus-containing vaccines: Efficacy, persistence of immune responses, and safety six years after administration in healthy children during their second year of life. Vaccine 2018; 36: 381-387
- 7 Hoepfner S, Haut PR, O'Gorman M. et al. Rapid immune reconstitution following autologous hematopoietic stem cell transplantation in children: a single institution experience. Bone Marrow Transplant 2003; 31: 285-290
- 8 Hudspeth MP, Hill TN, Lewis JA. et al. Post-hematopoietic stem cell transplant immunization practices in the Pediatric Blood and Marrow Transplant Consortium. Pediatr Blood Cancer 2010; 54: 970-975
- 9 Kalwak K, Gorczynska E, Toporski J. et al. Immune reconstitution after haematopoietic cell transplantation in children: immunophenotype analysis with regard to factors affecting the speed of recovery. Br J Haematol 2002; 118: 74-89
- 10 Ljungman P, Cordonnier C, Einsele H. et al. Vaccination of hematopoietic cell transplant recipients. Bone Marrow Transplant 2009; 44: 521-526
- 11 Nassin ML, Nicolaou E, Gurbuxani S. et al. Immune Reconstitution Following Autologous Stem Cell Transplantation in Patients with High-Risk Neuroblastoma at the Time of Immunotherapy. Biol Blood Marrow Transplant 2018; 24: 452-459
- 12 Nordoy T, Husebekk A, Aaberge IS. et al. Humoral immunity to viral and bacterial antigens in lymphoma patients 4-10 years after high-dose therapy with ABMT. Serological responses to revaccinations according to EBMT guidelines. Bone Marrow Transplant 2001; 28: 681-687
- 13 Patel SR, Bate J, Borrow R. et al. Serotype-specific pneumococcal antibody concentrations in children treated for acute leukaemia. Arch Dis Child 2012; 97: 46-48
- 14 Patel SR, Ortin M, Cohen BJ. et al. Revaccination of children after completion of standard chemotherapy for acute leukemia. Clin Infect Dis 2007; 44: 635-642
- 15 Patel SR, Ortin M, Cohen BJ. et al. Revaccination with measles, tetanus, poliovirus, Haemophilus influenzae type B, meningococcus C, and pneumococcus vaccines in children after hematopoietic stem cell transplantation. Clin Infect Dis 2007; 44: 625-634
- 16 Prymula R, Bergsaker MR, Esposito S. et al. Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled trial. Lancet 2014; 383: 1313-1324
- 17 Rieger CT, Liss B, Mellinghoff S. et al. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors-Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol 2018; 29: 1354-1365
- 18 Rubin LG, Levin MJ, Ljungman P. et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58: 309-318
- 19 Siber GR, Werner BG, Halsey NA. et al. Interference of immune globulin with measles and rubella immunization. J Pediatr 1993; 122: 204-211
- 20 Sung L, Phillips R, Lehrnbecher T. Time for paediatric febrile neutropenia guidelines – children are not little adults. Eur J Cancer 2011; 47: 811-813