Background: Ensuring complete vaccination is important during a pre-transplant evaluation (PTE), especially for live viral vaccines which are generally contraindicated after transplant. After one dose of the varicella vaccine 97% of children will develop antibodies. The Advisory Committee on Immunization Practices does not recommend testing following 2 doses of the vaccine. Commercial laboratory assays are not considered sensitive enough to detect immunity; however, current solid organ transplantation guidelines recommend vaccinating transplant candidates who are seronegative. Objective: Determine measles and varicella vaccination coverage at the time of the PTE among organ transplant candidates and evaluate serological immunity by commercial laboratory assays when having received at least 2 doses of the appropriate vaccination. Secondary aims include describing the approach to seronegative recipients. Materials and Methods: Retrospective chart review of 94 pediatric heart (n=40), liver (n=21), kidney (n=18), and intestine/multi-visceral (n=15) candidates over 12 months of age undergoing a PTE at our institution from 2010-2016. Complete schedules were defined as having more than two doses of the vaccines documented. Results: Complete schedules (measles/varicella) at the time of the PTE was documented in 83%/72% kidney, 65%/37.5% heart, 43%/24% liver, and 27%/13.3% intestinal/multi-visceral transplant candidates. Seropositive status (measles/varicella) was documented in 100%/100% liver, 80%/46% kidney, 80%/50% heart, and 67%/50% intestinal/multi-visceral candidates. Intestinal/multi-visceral candidates had the highest percentage of unknown vaccination status (53%) and lowest seropositive status. Variable approaches were taken for seronegative patients. Measles booster was given to 7 of 20 seronegative patients with repeat serology in 2 patients;1 became seropositive. Varicella booster was given to 14 of 45 seronegative patients with repeat serology in 4 patients, all became seropositive. Conclusion: Measles and varicella vaccine coverage was higher in kidney and heart transplant candidates at the time of the PTE. Patients were more likely to be seropositive for measles than varicella when completing the 2 vaccine series. There was not a unified approach to seronegative patients. Clear guidelines regarding serological testing and booster dosing in children who are seronegative are needed as this becomes relevant in the event of exposure.

CITATION INFORMATION: Daniels H., Saracusa C., Worley S., Gonzalez B. Measles and Varicella Vaccination Status and Evidence of Immunity during Solid Organ Pre-Transplantation Evaluation Am J Transplant. 2017;17 (suppl 3).

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