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Analysis of factors affecting immune recovery and initial response to tetanus after DT aP vaccination in pediatric allogeneic HSCT patients
Author(s) -
Boles Erin E.,
Chiuzan Codruta,
Ragucci Dominic,
Hudspeth Michelle P.
Publication year - 2014
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12361
Subject(s) - medicine , tetanus , vaccination , logistic regression , titer , immunology , immune system , pediatrics , antibody
Transfer of donor immunity after allo‐ HSCT is limited, requiring re‐vaccination after HSCT . The CDC 2009 guidelines introduced earlier vaccination post‐ HSCT with a uniform vaccination strategy. This study objective was to describe predictors of immune recovery and initial response to tetanus after DT aP vaccination post‐ HSCT . We conducted a retrospective chart review of pediatric allo‐ HSCT patients transplanted between July 1, 2007–June 30, 2012 who survived >1 yr without relapse (N = 27). Response to tetanus one month after the initial dose of DT aP was defined as a ≥4 fold increase in tetanus titers ≥1 month after vaccination. Wilcoxon rank‐sum exact test and Kruskall–Wallis tests were used to analyze CD 4, CD 8, and CD 19 counts. Exact conditional logistic regression was utilized to analyze initial tetanus vaccination response. A statistically significant increase in median CD 4, CD 8, and CD 19 counts occurred from six to 12 months post‐ HSCT (p ≤ 0.0001, 0.005, 0.004). Only 36% of patients had initial tetanus vaccination response at first attempt post‐ HSCT . None of the variables tested were statistically significant in predicting initial tetanus response to vaccination. There was no association between predictors of immune recovery or transplant variables and initial tetanus response. A uniform vaccination strategy is unlikely to provide protective antibodies for many post‐ HSCT patients and should be evaluated in larger studies.