532. Prior Corticosteroid Use is Associated with Varicella Vaccine Failure in Children with Liver Transplantation
Session: Poster Abstract Session: Vaccine Use in Immunocompromised Hosts
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek2013_Satoshi.Kamidani_Vaccine.pdf (1.2 MB)
  • Background:

    A varicella vaccine is recommended for children prior to liver transplantation (LT). While many of these children have received corticosteroids as a part of therapy for their underlying diseases such as biliary atresia, the association between prior corticosteroid use and varicella vaccine failure is unknown. 

    Methods:

    This nested case-control study involved a cohort of 78 patients who underwent LT at a tertiary care children’s hospital in Japan between January 2011 and October 2012. We enrolled 29 patients who received varicella vaccine without history of varicella before LT and excluded patients whose laboratory data at the time of vaccination was not available. Patients’ demographics, laboratory data, and prior corticosteroid use were evaluated. A serum antibody titer for varicella was measured by glycoprotein enzyme-linked immunosorbent assay (cutoff level <50 units/ml) before (6 patients) or after LT (23 patients). We defined corticosteroid use as prednisolone therapy ≤3 months of vaccination or pulse intravenous methylprednisolone therapy ≤6 months before vaccination. Univariate and multivariate logistic regression analyses were used for case-control comparisons.

    Results:

    We found 14 patients (48%) who failed to develop varicella antibody (vaccine failure group). The remaining 15 patients (52%) had positive serology (controls). There were no significant differences in the demographic information between the two groups (P>0.13). Univariate analyses demonstrated that a history of corticosteroid use was more common in vaccine failure group compared with the control (43% vs. 7%; P<0.05), whereas other parameters examined did not differ significantly (P>0.17). Furthermore, a multivariate analysis showed that prior corticosteroid use was an independent risk factor for varicella vaccine failure (adjusted OR: 10.5; 95% CI: 1.1 - 103.5).

    Conclusion:

    Approximately a half of patients who received corticosteroid before LT experienced varicella vaccine failure. Prior corticosteroid use was an independent risk factor for varicella vaccine failure in children undergoing LT. These data suggest the catch up varicella vaccine after LT needs to be considered in patients with corticosteroid use.

    Satoshi Kamidani, MD1, Takanori Funaki, MD1, Seisuke Sakamoto, MD, PhD1, Mureo Kasahara, MD1, Hironori Yoshii2, Isao Miyairi, MD1 and Akihiko Saitoh, MD, PhD1,3, (1)National Center for Child Health and Development, Tokyo, Japan, (2)Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan, (3)Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Disclosures:

    S. Kamidani, None

    T. Funaki, None

    S. Sakamoto, None

    M. Kasahara, None

    H. Yoshii, None

    I. Miyairi, None

    A. Saitoh, None

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