Revaccination in Children Undergoing Autologous Hematopoietic Stem Cell Transplantation: Results of a Survey in Germany, Austria and Switzerland

Abstract

Background Due to the potential loss of protective antibody titers after autologous hematopoietic stem cell transplantation (HSCT), revaccination is important. The aim of the study was to evaluate the current strategies in Germany, Austria and Switzerland for revaccination of children after autologous HSCT.

Methods An internet-based survey was performed, and results were analyzed in a descriptive way.

Results Twenty-seven out of 31 centers (87%) centers responded, and all centers administer revaccination. More than 90% of the centers re-vaccinate against tetanus, diphtheria, hepatitis B, H. influenzae B, poliomyelitis, measles, mumps, and rubella, whereas considerable less centers vaccinate against encapsulated bacteria, in particular against meningococci. First revaccination with non-live vaccine is performed by almost all centers between 3 and 9 months. Timing of live-attenuated vaccines varied widely [6 months (4 centers), 9 months (1), 12 months (11) and 24 months (4)]. Similarly, there is a wide variation in the delay of live-vaccines after immunoglobulin administration (2 weeks to 9 months), and in the testing of immunological parameters prior to vaccination.

Conclusion Our survey demonstrates a wide variation regarding the timing of live-attenuated vaccines after autologous HSCT or after immunoglobulin administration and regarding immunization against encapsulated bacteria. Many centers do not adhere to current recommendations. Studies should focus on a detailed analysis of the epidemiology of infections with encapsulated bacteria after pediatric autologous HSCT as well as on the immune recovery and the response to revaccination in this setting.

Zusammenfassung

Hintergrund Da viele Patienten nach autologer hämatopoetischer Stammzelltransplantation (HSTZ) ihre protektiven Impfantikörper verlieren, ist eine Revakzinierung von Bedeutung. Das Ziel dieser Studie war die Evaluierung der derzeitigen Strategien zur Revakzinierung von Kindern nach autologer HSZT in Deutschland, Österreich und der Schweiz.

Methoden Die Daten wurden mittels einer internet-basierten Umfrage ermittelt, die Analyse der Daten erfolgte deskriptiv.

Ergebnisse 27/31 Zentren (87%) antworteten auf die Umfrage. Alle Zentren revakzinieren nach autologer HSZT. Während mehr als 90% der Zentren gegen Tetanus, Diphtherie, Hepatitis B, H. influenza B, Poliomyelitis, Masern, Mumps und Röteln impfen, vakzinieren deutlich weniger Zentren gegen bekapselte Erreger, insbesondere gegen Meningokokken. Fast alle Zentren beginnen die Revakzinierung mit Totimpfstoffen 3-9 Monate nach autologer HSZT. Die Zeitpunkte für die Lebendimpfungen nach HSZT variieren deutlich [6 Monate (4 Zentren), 9 Monate (1), 12 Monate (11) und 24 Monate (4)]. Entsprechend findet sich eine große Streuung für den Abstand von Lebendimpfungen nach Immunglobulingaben (2 Wochen bis 9 Monate), und in der Auswahl immunologischer Surrogatmarker vor einer Impfung.

Schlussfolgerung Die vorliegende Umfrage zeigt eine große Variabilität bei den Zeitpunkten von Lebendimpfungen nach autologer HSZT bzw. nach Immunuglobulingabe und bei der Impfung gegen bekapselte Erreger. Viele Zentren folgen nicht derzeitigen Empfehlungen. Zukünftige Untersuchungen sollten insbesondere die Epidemiologie von Infektionen mit bekapselten Erregern nach autologer HSZT von Kindern wie auch die Immunrekonstitution und Impfantwort in diesem Setting evaluieren.

Key words

Child - Cancer - Autologous hematopoietic stem cell transplantation - Vaccination

Schlüsselwörter

Kind - Krebserkrankung - Autologe hämatopoetische Stammzelltransplantation - Impfung

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