Infections preventable by live virus vaccines are surging in the setting of decreased herd immunity. Many children with chronic liver diseases (CLDs) are unimmunized and at increased risk for infection due to guidelines recommending against live vaccines within 4 weeks pretransplant. This prospective study of 21 children with CLD and 13 healthy controls defined the timing of measles virus and varicella-zoster virus (VZV) RNA- and DNA-emia following vaccination and compared immune responses to measles and varicella vaccines in both groups. Measles virus RNA and VZV DNA real-time PCR were measured weekly following vaccination; measles virus RNA was undetectable in all by 14 days postvaccination, but VZV DNA, which can be managed with antivirals, was detected in 1 child in the CLD group at 21 days and 1 control at 28 days postvaccination. Humoral or cell-mediated vaccine response was 100% to measles virus and 94% to VZV in the CLD group postvaccination, whereas it was 100% to both vaccines in controls. Our pilot study suggests that both live vaccines can be safely and effectively administered up to 14 days prior to transplantation in children with CLD. We anticipate this will improve vaccination rates and thus decrease rates of vaccine-preventable infections in vulnerable children with CLD.

中文翻译：

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慢性肝病儿童接种麻疹和水痘减毒活疫苗后病毒 RNA 和 DNA 的检测及免疫反应


在群体免疫力下降的情况下，活病毒疫苗可预防的感染正在激增。由于指南建议在移植前 4 周内不要接种活疫苗，许多患有慢性肝病 (CLD) 的儿童未进行免疫接种，感染风险增加。这项前瞻性研究对 21 名慢性肺病儿童和 13 名健康对照者进行了研究，确定了接种疫苗后出现麻疹病毒和水痘带状疱疹病毒 (VZV) RNA 和 DNA 血症的时间，并比较了两组对麻疹和水痘疫苗的免疫反应。接种疫苗后每周测量麻疹病毒 RNA 和 VZV DNA 实时 PCR 数据；接种后 14 天，麻疹病毒 RNA 已检测不到，但 CLD 组的 1 名儿童和 1 名对照儿童在接种后 28 天检测到了 VZV DNA，而 VZV DNA 可以用抗病毒药物控制。 CLD 组接种后的体液或细胞介导的疫苗应答对麻疹病毒为 100%，对 VZV 为 94%，而对照组对两种疫苗的应答均为 100%。我们的试点研究表明，对于 CLD 儿童，在移植前 14 天可以安全有效地接种这两种活疫苗。我们预计这将提高疫苗接种率，从而降低患有慢性肺病的弱势儿童的疫苗可预防感染率。