*Purpose: Pediatric transplant recipients are at risk for vaccine preventable infections due to immunosuppression, suboptimal response to vaccines before and after transplant, and potential under-immunization if transplanted early in life; however, the incidence and burden of illness from vaccine preventable infections in this population is unknown. The objectives of this study were to 1) evaluate in pediatric solid organ transplant recipients the number of hospitalizations for vaccine preventable infections in the first 5 years after transplant and 2) determine the associated morbidity, mortality, and costs.

*Methods: A retrospective cohort study of pediatric solid organ transplant recipients at hospitals participating in the Pediatric Health Information System (PHIS) from January 1, 2004 to December 31, 2011 with five years of follow up per participant (unless they died during the study period). Hospitalizations for a vaccine preventable infection during the first 5 years post-transplant were ascertained using ICD9 and ICD10 clinical modification diagnosis codes. Data were collected on clinical care, outcomes, and costs during these hospitalizations.

*Results: There were 6980 transplant recipients identified; 1092 (15.6%) had a total of 1471 cases of vaccine preventable infections. Thirteen (12.7%) percent of cases occurred during transplant hospitalization. The case fatality rate was 1.7% for all infections. Excluding infections that occurred during transplant hospitalization (when all patients go to the intensive care unit), 17.0% of patients hospitalized with a vaccine preventable infection required intensive care. In multivariable analysis, age less than 2 at time of transplant and being a lung, heart, intestine or multi-visceral transplant recipient were positively associated with increased risk of a hospitalization from a vaccine preventable infection.

*Conclusions: Hospitalization for vaccine preventable infections occurred in over 15% of pediatric solid organ transplant recipients in the first 5 years post-transplant at a rate of up to 87 times higher than in the general population. There was significant morbidity, mortality and costs from these infections, demonstrating the importance of immunizing all transplant candidates and recipients. Further research on improving immunization delivery, preventing nosocomial infections, and monitoring response to vaccines in the transplant population is needed.

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