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Hospitalizations for vaccine-preventable infections among pediatric hematopoietic cell transplantation recipients in the first 5 years after transplantation

Bone Marrow Transplantation volume 56, pages 2656–2663 (2021)Cite this article

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Abstract

Despite recommendations for vaccination after hematopoietic cell transplantation (HCT), immunization rates remain low leaving children at high risk for vaccine preventable infections (VPIs). However, the burden from VPIs in pediatric HCT recipients is not well known. We describe the prevalence, risk factors, and outcomes of VPI-associated hospitalizations at centers participating in the Pediatric Health Information System database. Children <18 years who underwent allogeneic or autologous-HCT between 1/1/2010–31/12/2018, were identified and prevalence of overall VPI and of each infection were determined at five time-points within 5 years post-HCT. In total, 684 of 9591 pediatric HCT recipients had a VPI-associated hospitalization, most frequently in the first 6–12 months, for an overall prevalence of 7.1% (95% CI: 6.6–7.7%). Influenza, varicella, and invasive pneumococcal infections were the most frequent. Multivariable analyses identified younger age (OR = 0.96 [95% CI: 0.93–0.99]; p = 0.013), primary immune deficiency (PID) (OR = 1.78 [95% CI: 1.11–2.84]; p = 0.016), and GVHD (OR = 1.62 [95% CI: 1.05–2.48]; p = 0.028) as independent risk factors during the initial HCT-hospitalization. Children with VPI had longer duration of hospitalization (55[51] vs 36[24] days, p < 0.001), higher rates of ICU admission (42 vs 26%, p < 0.001), and mortality (11% [n = 17) vs 6% [n = 519]; p = 0.003). Continued efforts to improve vaccination early post-HCT are warranted.

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Fig. 1: Yearly rates and timing of vaccine preventable infections (VPI) hospitalizations.
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Authors and Affiliations

  1. Department of Pediatrics, Divisions of Infectious Diseases & Host Defense, The Ohio State University, Columbus, OH, USA

    Dana Danino & Monica I. Ardura

  2. Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA

    Joseph R. Stanek & Hemalatha Rangarajan

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Correspondence to Dana Danino.

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Danino, D., Stanek, J.R., Rangarajan, H. et al. Hospitalizations for vaccine-preventable infections among pediatric hematopoietic cell transplantation recipients in the first 5 years after transplantation. Bone Marrow Transplant 56, 2656–2663 (2021). https://doi.org/10.1038/s41409-021-01373-z

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