Early measles vaccination in bone marrow transplant recipients.
Measles vaccination has been recommended after the second year following bone marrow transplant (BMT) in patients not receiving immunosuppressive drugs. During a measles outbreak, we vaccinated all patients after the first year of transplant, and conducted a prospective trial to evaluate safety, effectiveness and sustained immunity after early vaccination. Patients received attenuated virus vaccine between 9 and 18 months after BMT. A total of 51 patients were evaluated and 27 of them (52.9%) were receiving immunosuppressive drugs. Only mild adverse reactions were noted. Nine patients (17.6%) were susceptible (IgG< or =100 mIU/ml) at vaccination, and all seroconverted. In those immune at vaccination, a four-fold increase in measles IgG titers was found in one of 34 patients (2.9%) with specific IgG> or =200 mIU/ml compared to 14 of 17 (82.3%) with IgG<200 mIU/ml (P< 0.0001). Sustained immunity after 24 months was more likely to occur in patients with specific IgG levels< or =200 or > or =500 mIU/mL (83.4 and 100%, respectively) in comparison to patients with 200<IgG<499 mIU/ml at vaccination (50% P=0.017). We conclude that even though early measles vaccination is safe, few patients are susceptible on day +365 and this strategy should be reserved for epidemic situations posing significant threat for the patients.
Machado
C M
CM
Virology Laboratory (LIM 52-HCFMUSP)--Institute of Tropical Medicine, University of São Paulo Medical School, São Paulo, Brazil. clarimm@usp.br
de Souza
V A U F
VA
Sumita
L M
LM
da Rocha
I F
IF
Dulley
F L
FL
Pannuti
C S
CS
D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods*; D002648:Child; D004196:Disease Outbreaks / Q000517:prevention & control; D006801:Humans; D007115:Immunization Schedule; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000097:blood / Q000737:chemistry; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine / Q000627:therapeutic use*; D008875:Middle Aged; D009894:Opportunistic Infections / Q000517:prevention & control; D011446:Prospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods
D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D008458:Measles Vaccine