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April 9, 1997, Vol 277, No. 14 >
ARTICLE | April 9, 1997

A National Survey of Immunization Practices Following Allogeneic Bone Marrow Transplantation FREE

Kelly J. Henning, MD; Mary H. White, MD; Kent A. Sepkowitz, MD; Donald Armstrong, MD
[+] Author Affiliations

The 45 centers that participated in this study are listed at the end of this article.

Reprints: Kelly J. Henning, MD, Thomas Jefferson University, 1015 Chestnut St, Suite 610, Philadelphia, PA 19107.


JAMA. 1997;277(14):1148-1151. doi:10.1001/jama.1997.03540380062032
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Article
References

Objectives.  —To describe the frequency and patterns of use of routine childhood and hepatitis B, pneumococcal, influenza, and meningococcal vaccines following allogeneic bone marrow transplantation (BMT).

Design, Setting, and Participants.  —Survey of all US transplantation centers participating in the National Marrow Donor Program (NMDP) during 1994.

Main Outcome Measures.  —Use, timing, and total doses of selected vaccines given to patients younger than 7 years and patients aged 7 years or older following allogeneic BMT.

Results.  —Of 66 centers associated with the NMDP, 45 (68%) responded. A total of 97% of centers performing transplants on patients younger than 7 years and 88% of centers performing transplants on patients aged 7 years or older gave either the diphtheria-tetanus vaccine or the diphtheria-tetanus-pertussis vaccine compared with 77% and 58% usage, respectively, of Haemophilus influenza type b conjugate vaccine (P=.03 and.003, respectively). Centers were more likely to administer inactivated poliovirus and measles-mumps-rubella vaccines to patients younger than 7 years than to the older age group (94% vs 73% for poliovirus, P=.02; and 94% vs 70% for measles-mumps-rubella, P=.01). About one half of centers routinely administer hepatitis B vaccine and approximately three quarters immunize with pneumococcal and influenza vaccines. Few programs, regardless of age of bone marrow recipient, use multiple vaccine (≥2) doses. The number of schedules reported for specific vaccines varied widely (3-11 schedules per vaccine).

Conclusions.  —Despite convincing evidence that patients lose protective antibodies to vaccine-preventable diseases following allogeneic BMT and accumulating data showing the safety and efficacy of many vaccines after BMT, vaccines are underutilized and schedules vary widely at US transplant centers. National guidelines for optimal doses and timing of vaccines after BMT are warranted.

REFERENCES

1 +
Horowitz MM.  New IBMTR/ABMTR slides summarize current use and outcome of allogeneic and autologous transplants . IBMTR Newslett . (July) 1995;; 2:1,3-8.
2 +
Ljungman P, Wikland-Hammarsten M, Duraj V, et al.  Response to tetanus toxoid immunization after allogeneic bone marrow transplantation . J Infect Dis . 1990;;162:496-500.
3 +
Lum LG, Munn NA, Schanfield MS, Storb R.  The detection of specific antibody formation to recall antigens after human bone marrow transplantation . Blood . 1986;;67;582-587.
4 +
Lum LG, Noges JE, Beatty P, et al.  Transfer of specific immunity in marrow recipients given HL Amismatched, T cell-depleted or HLA identical marrow grafts . Bone Marrow Transplant . 1988;;3:399-406.
5 +
Volti SL, Mauro L, Di Gregorio F, et al.  Immune status and immune response to diphtheria-tetanus and polio vaccines in allogeneic bone marrow-transplanted thalassemic patients . Bone Marrow Transplant . 1994;;14:225-227.
6 +
Ljungman P, Lewensohon-Fuchs I, Hammarstrom V, et al.  Long-term immunity to measles, mumps, and rubella after allogeneic bone marrow transplantation . Blood . 1994;;84:657-663.
7 +
Ljungman P, Fridell E, Lonnqvist B, et al.  Efficacy and safety of vaccination of marrow transplant recipients with a live attenuated measles, mumps, and rubella vaccine . J Infect Dis . 1989;;159:610-615.
8 +
Ljungman P, Duraj V, Magnius L.  Response to immunization against polio after allogeneic marrow transplantation . Bone Marrow Transplant . 1991;; 7:89-93.
9 +
Ljungman P, Levenshohn-Fuchs I, Aschan J, Lonnqvist B, Ringden O, Winiarskl J.  Immunization of bone marrow transplant patients with live attenuated measles vaccine: efficacy and safety . In: Program and abstracts of the Eighth International Symposium on Infections in the Immunocompromised Host ; June 19-22, 1994;; Davos, Switzerland. Abstract 50.
10 +
Wingard JR.  Advances in the management of infectious complications after bone marrow transplantation . Bone Marrow Transplant . 1990;;6:371-383.
11 +
Aucouturier P, Barra A, Intrator L.  Long lasting IgG subclass and antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation . Blood . 1987;;70:779-785.
12 +
Winston DJ, Ho WG, Schiffman G, Champlain RE, Feig SA, Gale P.  Pneumococcal vaccination of recipients of bone marrow transplants . Arch Intern Med . 1983;;143:1735-1737.
13 +
Guinan EC, Molrine DC, Antin JH, et al.  Polysaccharide conjugate vaccine responses in bone marrow transplant patients . Transplantation . 1994;;57: 677-684.
14 +
Giebink GS, Warkentin PI, Ramsey NK, Kersey JH.  Titers of antibody to pneumococci in allogeneic bone marrow transplant recipients before and after vaccination with pneumococcal vaccine . J Infect Dis . 1986;;154:590-596.
15 +
Quinti I, Velardi A, LeMoli S, et al.  Antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation . J Clin Immunol . 1990;;10:160-166.
16 +
Engelhard D, Nagler A, Hardan I, et al.  Antibody response to a two-dose regimen of influenza vaccine in allogeneic T-cell depleted and autologous BMT recipients . Bone Marrow Transplant . 1993;; 11:1-5.
17 +
Ambrosino DM, Molrine DC.  Critical appraisal of immunization strategies for prevention of infection in the compromised host . Hematol Oncol Clin North Am . 1993;;7:1027-1050.
18 +
Ljungman P, Cordonnier C, de Block R, et al.  Immunisations after bone marrow transplantation: results of a European survey and recommendations from the infectious diseases working party of the European group for blood and marrow transplantation . Bone Marrow Transplant . 1995;;15:455-460.
19 +
Somani J, Larson RA.  Reimmunization after allogeneic bone marrow transplantation . Am J Med . 1995;;98:389-398.
20 +
Brandt L, Broadbent V.  A survey of recommendations given to patients going home after bone marrow tranplant . Arch Dis Child . 1994;;71:529-531.
21 +
National Marrow Donor Program. Transplant Center Access Directory . 10th ed. Minneapolis, Minn: National Marrow Donor Program; April 1995;.
22 +
Dean AD, Dean JA, Burton JH, Dicker RC. Epi Info, Version 5 . Atlanta, Ga: Centers for Disease Control; 1990;.
23 +
Gardner P, Schaffner W.  Immunization of adults . N Engl J Med . 1993;;328:1252-1258.
24 +
Centers for Disease Control and Prevention.  Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence . MMWR Morb Mortal Wkly Rep . 1993;;42:1-18.
25 +
Winston DJ, Schiffman G, Wang DC, et al.  Pneumococcal infections after human bone marrow transplantation . Ann Intern Med . 1979;;91:835-841.
26 +
Whimbey E, Elting LS, Couch RB, et al.  Influenza A virus infections among hospitalized adult bone marrow transplant recipients . Bone Marrow Transplant . 1994;;13:437-440.
27 +
Aschan J, Ringden 0, Ljungman P, Anderson J, Lewensohn-Fuchs I, Forsgren M.  Influenza B in transplant patients . Scand J Infect Dis . 1989;;21: 349-350.
28 +
Centers for Disease Control and Prevention.  Prevention and control of influenza: recommendations of the Advisory Committee on immunization practices (ACIP) . MMWR Morb Mortal Wkly Rep . 1996;;45( (RR-5) ):1-24.
29 +
Rosendahl C, Bender-Goetze C, Deinhardt F, Kolb HJ, Hass R.  Immunization against hepatitis B in BMT and leukemia patients . Exp Hematol . 1985;; 13( (suppl 17) ):104-111.
30 +
Ilan Y, Nagler A, Adler R, et al.  Adoptive transfer of immunity to hepatitis B virus after T celldepleted allogeneic bone marrow transplantation . Hepatology . 1993;;18:246-252.
31 +
Ilan Y, Nagler A, Shouval D, et al.  Development of antibodies to hepatitis B virus surface antigen in bone marrow transplant recipients following treatment with peripheral blood lymphocytes from immunized donors . Clin Exp Immunol . 1994;; 97:299-302.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Horowitz MM.  New IBMTR/ABMTR slides summarize current use and outcome of allogeneic and autologous transplants . IBMTR Newslett . (July) 1995;; 2:1,3-8.
2 +
Ljungman P, Wikland-Hammarsten M, Duraj V, et al.  Response to tetanus toxoid immunization after allogeneic bone marrow transplantation . J Infect Dis . 1990;;162:496-500.
3 +
Lum LG, Munn NA, Schanfield MS, Storb R.  The detection of specific antibody formation to recall antigens after human bone marrow transplantation . Blood . 1986;;67;582-587.
4 +
Lum LG, Noges JE, Beatty P, et al.  Transfer of specific immunity in marrow recipients given HL Amismatched, T cell-depleted or HLA identical marrow grafts . Bone Marrow Transplant . 1988;;3:399-406.
5 +
Volti SL, Mauro L, Di Gregorio F, et al.  Immune status and immune response to diphtheria-tetanus and polio vaccines in allogeneic bone marrow-transplanted thalassemic patients . Bone Marrow Transplant . 1994;;14:225-227.
6 +
Ljungman P, Lewensohon-Fuchs I, Hammarstrom V, et al.  Long-term immunity to measles, mumps, and rubella after allogeneic bone marrow transplantation . Blood . 1994;;84:657-663.
7 +
Ljungman P, Fridell E, Lonnqvist B, et al.  Efficacy and safety of vaccination of marrow transplant recipients with a live attenuated measles, mumps, and rubella vaccine . J Infect Dis . 1989;;159:610-615.
8 +
Ljungman P, Duraj V, Magnius L.  Response to immunization against polio after allogeneic marrow transplantation . Bone Marrow Transplant . 1991;; 7:89-93.
9 +
Ljungman P, Levenshohn-Fuchs I, Aschan J, Lonnqvist B, Ringden O, Winiarskl J.  Immunization of bone marrow transplant patients with live attenuated measles vaccine: efficacy and safety . In: Program and abstracts of the Eighth International Symposium on Infections in the Immunocompromised Host ; June 19-22, 1994;; Davos, Switzerland. Abstract 50.
10 +
Wingard JR.  Advances in the management of infectious complications after bone marrow transplantation . Bone Marrow Transplant . 1990;;6:371-383.
11 +
Aucouturier P, Barra A, Intrator L.  Long lasting IgG subclass and antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation . Blood . 1987;;70:779-785.
12 +
Winston DJ, Ho WG, Schiffman G, Champlain RE, Feig SA, Gale P.  Pneumococcal vaccination of recipients of bone marrow transplants . Arch Intern Med . 1983;;143:1735-1737.
13 +
Guinan EC, Molrine DC, Antin JH, et al.  Polysaccharide conjugate vaccine responses in bone marrow transplant patients . Transplantation . 1994;;57: 677-684.
14 +
Giebink GS, Warkentin PI, Ramsey NK, Kersey JH.  Titers of antibody to pneumococci in allogeneic bone marrow transplant recipients before and after vaccination with pneumococcal vaccine . J Infect Dis . 1986;;154:590-596.
15 +
Quinti I, Velardi A, LeMoli S, et al.  Antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation . J Clin Immunol . 1990;;10:160-166.
16 +
Engelhard D, Nagler A, Hardan I, et al.  Antibody response to a two-dose regimen of influenza vaccine in allogeneic T-cell depleted and autologous BMT recipients . Bone Marrow Transplant . 1993;; 11:1-5.
17 +
Ambrosino DM, Molrine DC.  Critical appraisal of immunization strategies for prevention of infection in the compromised host . Hematol Oncol Clin North Am . 1993;;7:1027-1050.
18 +
Ljungman P, Cordonnier C, de Block R, et al.  Immunisations after bone marrow transplantation: results of a European survey and recommendations from the infectious diseases working party of the European group for blood and marrow transplantation . Bone Marrow Transplant . 1995;;15:455-460.
19 +
Somani J, Larson RA.  Reimmunization after allogeneic bone marrow transplantation . Am J Med . 1995;;98:389-398.
20 +
Brandt L, Broadbent V.  A survey of recommendations given to patients going home after bone marrow tranplant . Arch Dis Child . 1994;;71:529-531.
21 +
National Marrow Donor Program. Transplant Center Access Directory . 10th ed. Minneapolis, Minn: National Marrow Donor Program; April 1995;.
22 +
Dean AD, Dean JA, Burton JH, Dicker RC. Epi Info, Version 5 . Atlanta, Ga: Centers for Disease Control; 1990;.
23 +
Gardner P, Schaffner W.  Immunization of adults . N Engl J Med . 1993;;328:1252-1258.
24 +
Centers for Disease Control and Prevention.  Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence . MMWR Morb Mortal Wkly Rep . 1993;;42:1-18.
25 +
Winston DJ, Schiffman G, Wang DC, et al.  Pneumococcal infections after human bone marrow transplantation . Ann Intern Med . 1979;;91:835-841.
26 +
Whimbey E, Elting LS, Couch RB, et al.  Influenza A virus infections among hospitalized adult bone marrow transplant recipients . Bone Marrow Transplant . 1994;;13:437-440.
27 +
Aschan J, Ringden 0, Ljungman P, Anderson J, Lewensohn-Fuchs I, Forsgren M.  Influenza B in transplant patients . Scand J Infect Dis . 1989;;21: 349-350.
28 +
Centers for Disease Control and Prevention.  Prevention and control of influenza: recommendations of the Advisory Committee on immunization practices (ACIP) . MMWR Morb Mortal Wkly Rep . 1996;;45( (RR-5) ):1-24.
29 +
Rosendahl C, Bender-Goetze C, Deinhardt F, Kolb HJ, Hass R.  Immunization against hepatitis B in BMT and leukemia patients . Exp Hematol . 1985;; 13( (suppl 17) ):104-111.
30 +
Ilan Y, Nagler A, Adler R, et al.  Adoptive transfer of immunity to hepatitis B virus after T celldepleted allogeneic bone marrow transplantation . Hepatology . 1993;;18:246-252.
31 +
Ilan Y, Nagler A, Shouval D, et al.  Development of antibodies to hepatitis B virus surface antigen in bone marrow transplant recipients following treatment with peripheral blood lymphocytes from immunized donors . Clin Exp Immunol . 1994;; 97:299-302.

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