Background: Measles is a highly contagious viral infection that rarely affects transplant recipients. Cases remain in the United States due to vaccine refusal and importation of cases from endemic regions. The IDCOP began recommending documentation of measles status in all patients born after 1957, unless proof of two previous vaccine doses is confirmed. Those not protected were recommended to be vaccinated prior to transplant. This study aimed to assess adherence to testing and vaccination for measles in transplant recipients.

Methods: A retrospective cohort of all adult solid organ transplant recipients at Cleveland Clinic from the date of guideline publication in February 2015 until February 2016 were included for study. Measles IgG testing was performed using a fully automated chemiluminescense assay with a level of >30 AU/ml as positive.

Results: 278 eligible patients were included for analysis. Kidney transplants constituted almost half of patients (47.5%) followed by liver (26.1%), lung (14.1 %), and heart (8.3 %). 119 patients (42.8%) had screening measles serologies prior to transplantation. 12 patients (10.0%) who were screened demonstrated unprotected titers and therefore were at increased risk for measles infection after transplant. 50% of patients with unprotected titers failed to receive vaccination prior to transplant. 6 patients received appropriate vaccination, with 1 patient undergoing transplant prior to the recommended 4 week delay (no adverse outcome). 60.5% of screening measles serologies were ordered by the transplant team; however, when vaccination was required this was performed by infectious disease consultants in all cases. A majority of those who failed to receive vaccination were not evaluated by infectious disease prior to transplant.

Conclusion: Despite guidance from the IDCOP, many patients are not receiving screening measles serologies prior to transplant. Appropriate vaccination of those patients determined to be at risk was suboptimal. The current study demonstrates opportunities to improve adherence to established guidelines with the goal of reducing vaccine preventable illnesses. Utilization of pretransplant infectious disease consultation may be of value in these circumstances.

CITATION INFORMATION: Irani F, Butler R, Kovacs C. Measles Screening and Vaccination in Solid Organ Transplant Recipients: Adherence to Infectious Disease Community of Practice (IDCOP) Recommendations. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress