Sociodemographic and Clinical Factors Impact Non‐Live Vaccine Coverage After Pediatric Solid Organ Transplantation: A Single Center Study

TL;DR

A study finds that many children who received organ transplants are not getting recommended vaccines on time, with factors like insurance type and transplant age playing a role.

Contribution

The study identifies sociodemographic and clinical factors linked to delayed vaccine schedules in pediatric organ transplant recipients.

Findings

Serologic monitoring was used after only 8% of recommended vaccines.

Older transplant age, heart transplantation, and private insurance were linked to delayed vaccine schedules.

Low adherence to post-transplant vaccination guidelines was observed.

Abstract

Pediatric solid organ transplant (SOT) recipients are at increased risk of vaccine preventable diseases (VPD) due to both under‐vaccination and ineffective responses to vaccines while immunosuppressed. Current guidelines recommend timely post‐transplant immunization with non‐live vaccines and surveillance of vaccine‐specific titers to assess vaccine responses; however, institutional adherence to these recommendations may be variable.

This single‐center retrospective study of 199 pediatric SOT recipients (59 heart, 10 intestinal/multi‐visceral, 34 kidney, and 96 liver) evaluated guideline adherence to post‐vaccine serologic monitoring and identified sociodemographic and clinical factors associated with delayed and incomplete schedules for routine childhood non‐live vaccines after transplant.

Serologic monitoring was utilized after only 8% of recommended vaccines, while participants' age at transplant (odds ratio [OR], 95% confidence interval [CI]: 0.86, 0.81–0.91), receipt of a heart transplant (OR, 95% CI: 0.32, 0.17–0.60), and coverage with private insurance (OR, 95% CI: 0.46, 0.25–0.85) were factors negatively associated with timely initiation or completion of non‐live vaccines after transplant.

The associations between age at transplant, heart transplantation, and type of insurance with under‐immunization warrant further investigation to address modifiable gaps in vaccine coverage and ensure pediatric SOT recipients are optimally protected from VPD.

This single‐center retrospective study of pediatric solid organ transplant recipients found that vaccine‐specific serologies were rarely utilized to guide post‐transplant vaccination practices. Additionally, older age at the time of transplant, private insurance, and heart transplantation were identified as risk factors for delayed and incomplete non‐live vaccine schedules after transplant.

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