Session Name: Liver: Pediatrics
Session Date & Time: None. Available on demand.
*Purpose: Guidelines recommend waiting four weeks between live vaccine administration and transplantation; however, there is little data to support this waiting period and it often results in delay in transplantation, passage on an optimal organ, or foregoing the opportunity to vaccinate. The purpose of this project is to 1) define the time post-vaccination at which measles and varicella viruses become undetectable in the blood of children with liver disease and 2) determine whether children with chronic liver disease awaiting transplant mount a protective immune response to live vaccines.
*Methods: 6 children with chronic liver disease were enrolled and demographic and clinical information were collected. Viral PCRs for measles and varicella were measured weekly for four weeks post-vaccines. Antibodies (Ab) were measured pre-vaccine and again four weeks post-vaccines.
*Results: 6 children (2 with Biliary Atresia, 2 with Alagille Syndrome, 1 with PFIC, and 1 with undefined cirrhosis) received live vaccines between 6-13 months of age. All patients cleared measles and varicella by two weeks post-vaccines. A majority of children mounted a protective antibody response against measles and varicella. (Table 1)
*Conclusions: In this pilot study, no children with chronic liver disease were viremic for measles or varicella beyond two weeks post-vaccination and a majority mounted a protective antibody response. This suggests the four week waiting interval between vaccines and transplant may be unnecessary.
(Age at Vaccination)
|Measles PCR||Pos wk 1; Neg wks 2-4||Neg wks 1-4||Neg wks 1-4||Neg wks 1-4||Pos wk 1; Neg wks 2-4||Pos wk 1; Neg wks 2-4|
|Varicella PCR||Pos wk 2; Neg wks 1, 3, & 4||Pos wk 1; Neg wks 2-4||Neg wks 1-4||Neg wks 1-4||Neg wks 1-4||Neg wks 1-4|
|Measles Ab Pre-Vaccination||Not yet available||Not protected||Not protected||Not protected||Not protected||Not yet available|
|Measles Ab Post-Vaccination||Not yet available||128 EU/mL||136 EU/mL||117 EU/mL||73 EU/mL||Not yet available|
|Varicella Ab Pre-Vaccination||Not yet available||Not protected||Not protected||Not protected||Not protected||Not yet available|
|Varicella Ab Post-Vaccination||Not yet available||2.49||2.25||1.07*||1.67||Not yet available|
* VZV antibody ≥ 1.1 index value indicates immunity, 0.9-1.1 index value is equivocal
To cite this abstract in AMA style:Kemme S, Weinberg A, Feldman AG. Clearance of Viral RNA and DNA and Antibody Response Following Administration of Live Attenuated Measles and Varicella Vaccines in Children with Chronic Liver Disease [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/clearance-of-viral-rna-and-dna-and-antibody-response-following-administration-of-live-attenuated-measles-and-varicella-vaccines-in-children-with-chronic-liver-disease/. Accessed June 15, 2021.
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