To Vaccinate or Not to Vaccinate: Results of the Pediatric Heart Transplant Study PHTS Vaccination S

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To Vaccinate or Not to Vaccinate Results of the
Pediatric Heart Transplant Study (PHTS)
Vaccination Study
C White-Williams1, D Naftel1, S Webber2, M
Michaels3, A Berg3, E Bullock4, J Dubois5, S
Rodgers6 and the PHTS Transplant Coordinator
Group University of Alabama at Birmingham1,
University of Pittsburgh2, Egleston Childrens
Hospital3, Primary Childrens Medical Center4,
Childrens Hospital of Michigan5, Childrens
Memorial Hospital6
Specific Vaccines -While no centers recommended
the live virus vaccines post transplantation, a
few centers have given live virus
vaccinations. -9/27 centers prophylax with
acyclovir if child is exposed to
Varicella. -11/27 centers vaccinate against
Hepatitis A in children over 2 years of age in
high risk regions. -17/27 centers vaccinate
against meningococcal infection either after 11
years of age or before college. -15/27 centers
recommend palivizumab (synagis) for prevention of
respiratory viruses.
Methods -Current practice regarding influenza,
pneumococcus, live virus vaccinations and contact
precautions were examined. -All centers
participating in the PHTS were surveyed.
Abstract Background Current practice recommends
that immunosuppressed patients (pts) should
receive vaccinations. However, disparity may
exist between current recommendations and
clinical practice. Thus, the purpose of this
study was to examine clinical practices of
pediatric heart transplant (HTX) centers in the
PHTS. Methods PHTS centers were surveyed
regarding current practices and vaccination
protocols for influenza, pneumococcus, live virus
vaccinations, and contact precautions. Results
27/28 (96) PHTS centers responded to the survey.
Between 1992 and 2004, 1776 pts underwent HTX at
27 institutions. 23/27 (85) centers had a
vaccination protocol for pts and obtained
serologies on transplant candidates. 96 of
centers recommended waiting to give vaccines
until 3 to 6 months after HTX. 26/27 (96)
centers recommended yearly influenza vaccination.
All 26 centers used trivalent inactivated vaccine
most commonly in October and November. Only 6/27
(22) use prophylactic medications during flu
season. Most vaccinations are given in the
pediatrician's office as opposed to the
transplant center. Other vaccines specifically
recommended were pneumococcus 24/27 (88),
Hepatitis A 11/27 (41), and meningococcal 17/27
(63). No centers recommended live virus
vaccinations such as varicella or MMR. 15/27
(56) recommended prophylaxis against respiratory
syncytial virus. Most centers (21/27, 78) do not
institute isolation precautions with family
members who receive live virus vaccines, but do
(18/27, 68) require contact precautions with the
vaccinated person. Conclusions While
vaccinations are recommended in the transplant
population, current practice varied among centers
regarding vaccination protocols. Discrepancies
also existed between current recommendations and
practice. This information will guide clinicians
in the development of vaccination protocols for
pediatric HTX pts to improve clinical practice.
Contact Precautions If a person in household
receives live virus vaccination, do you recommend
the Pediatric Transplant patients not to have
contact? Yes 9 No 18 Do you recommend family
members to be vaccinated against
varicella? Yes24 No2 Most centers (n21) do not
require vaccinated person to be isolated from
transplant patient. Those centers who do (n5)
require isolation from 3-10 days.
PHTS Jan 1992-Dec 2004 Vaccination Survey
Transplant dates Jan. 1, 1990 Dec. 31, 2003
Follow-up date Dec. 31, 2004 Institutions 27
Patients 1776
Introduction Current practice recommends that
immunosuppressed patients receive disease
preventing vaccinations. However, disparity
exists between current recommendations and
clinical practice regarding the decision to
administer vaccinations to pediatric heart
transplant patients.

• Inferences
• While vaccinations are recommended in the
  transplant population, current practice varied
  greatly among pediatric transplant centers
  regarding vaccination protocols.
• Discrepancies also existed between current
  recommendations and practice.
• Future research is needed to develop a
  vaccination protocol for pediatric heart
  transplant patients.

Purpose The purpose of this study was to examine
the clinical practices of Pediatric Heart
Transplant Centers in the Pediatric Heart
Transplant Study (PHTS).