Serologic screening and infectious disease consultation (IDC): Indicated in heart, lung, liver (HLL) solid organ transplants (SOT) for measles, mumps, rubella, and varicella.

BACKGROUND: Solid organ transplant (SOT) recipients are a special group of patients who require comprehensive evaluation for preventable infectious diseases before transplantation. The main aim of our study was to investigate the number of heart, lung, and liver (HLL) transplant recipients who were evaluated for their immune status against measles, mumps, rubella (MMR), and varicella (VZV). As a secondary aim, we investigated whether pre-transplant infectious disease consultation (IDC) improves vaccination rates. METHODS: This study was an institution-based retrospective analysis of HLL transplant recipients born in or after 1957 and evaluated at Mayo Clinic, FL Transplant Center between January 1st, 2016 and December 31st, 2017. Data collection was obtained from electronic medical records. The vaccination rates were compared by univariate analysis based on IDC and no ID consultation (NIDC). RESULTS: One hundred and eighty-seven (77%) of a total 242 patients received an IDC pre-transplantation. Varicella IgG levels were screened in all 187 IDC candidates. Among the 187 IDC patients, mumps, measles, and rubella IgG serologies were performed in 9 (5%), 21 (11%), and 51 (27%), respectively. Among all 242 patients, vaccines given included 2 (0.8%) MMR, 10 (4.1%) varicella and 85 (35.12%) Zostavax. Univariate analysis revealed that Zostavax was given to 76 (40.6%) pre-transplant IDC patients and only in 9 (16.7%) NIDC patients (P < .001). CONCLUSIONS: Despite the relatively high IDC rate, patients' screened numbers for MMR IgG levels were low. Results pointed out the need for MMR protocol-driven serologic screening as well as for VZV and IDC prior to transplantation to increase vaccination rates.

Preventative Care in the Patient with Inflammatory Bowel Disease: What Is New?

Patients with inflammatory bowel disease (IBD) do not receive routine preventative care at the same rate as general medical patients. This patient population is at increased risk of vaccine preventable illness such as influenza and pneumococcal pneumonia. This review will discuss health maintenance needs and preventative care issues in patients with IBD.

Evaluation of the immune status against measles, mumps, and rubella in adult allogeneic hematopoietic stem cell transplantation recipients.

BACKGROUND: Previous studies have shown that most patients lose immunity to measles, mumps, and rubella (MMR) during long-term follow-up after allogeneic hematopoietic stem cell transplantation (HSCT), and immunizations against them have been investigated. However, these previous studies mainly targeted pediatric patients and information in adult patients is still insufficient. METHODS: We evaluated the immunity to MMR in 45 adult allogeneic HSCT patients. None of these patients received vaccination after HSCT. RESULTS: The seropositive rates at six years after allogeneic HSCT were estimated to be less than 44% for measles, less than 10% for mumps, and less than 36% for rubella. Thirteen of the 16 female patients who were 16-39 years old were negative or equivocal for rubella. Patients who developed grade II-IV acute graft-versus-host disease tended to become seronegative for measles and rubella at two years after HSCT, although the difference was not statistically significant. CONCLUSIONS: This study showed that most adult patients lost immunity to MMR after allogeneic HSCT. Although we did not evaluate the safety and efficacy of vaccination in this study, most HSCT guidelines recommend vaccination for HSCT recipients without active chronic graft-versus-host disease or ongoing immunosuppressive therapy at 24 months after HSCT. Immunization against rubella is especially important for female patients of reproductive age. Further studies will be necessary to evaluate the effect of vaccination on the antibody response in adult allogeneic HSCT recipients.

Vaccine-associated varicella and rubella infections in severe combined immunodeficiency with isolated CD4 lymphocytopenia and mutations in IL7R detected by tandem whole exome sequencing and chromosomal microarray.

In areas without newborn screening for severe combined immunodeficiency (SCID), disease-defining infections may lead to diagnosis, and in some cases, may not be identified prior to the first year of life. We describe a female infant who presented with disseminated vaccine-acquired varicella (VZV) and vaccine-acquired rubella infections at 13 months of age. Immunological evaluations demonstrated neutropenia, isolated CD4 lymphocytopenia, the presence of CD8(+) T cells, poor lymphocyte proliferation, hypergammaglobulinaemia and poor specific antibody production to VZV infection and routine immunizations. A combination of whole exome sequencing and custom-designed chromosomal microarray with exon coverage of primary immunodeficiency genes detected compound heterozygous mutations (one single nucleotide variant and one intragenic copy number variant involving one exon) within the IL7R gene. Mosaicism for wild-type allele (20-30%) was detected in pretransplant blood and buccal DNA and maternal engraftment (5-10%) demonstrated in pretransplant blood DNA. This may be responsible for the patient's unusual immunological phenotype compared to classical interleukin (IL)-7Rα deficiency. Disseminated VZV was controlled with anti-viral and immune-based therapy, and umbilical cord blood stem cell transplantation was successful. Retrospectively performed T cell receptor excision circle (TREC) analyses completed on neonatal Guthrie cards identified absent TREC. This case emphasizes the danger of live viral vaccination in severe combined immunodeficiency (SCID) patients and the importance of newborn screening to identify patients prior to high-risk exposures. It also illustrates the value of aggressive pathogen identification and treatment, the influence newborn screening can have on morbidity and mortality and the significant impact of newer genomic diagnostic tools in identifying the underlying genetic aetiology for SCID patients.

Etiology of a suspected measles outbreak: preceding measles reduction activities in Pakistan.

OBJECTIVE: To characterize patients with suspected measles, determine the magnitude of the outbreak in selected areas, and perform laboratory testing on patients with suspected measles to confirm the etiology of the outbreak. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Islamabad and Rawalpindi in June 2006. METHODOLOGY: Survey and specimen collection from households was carried out in areas affected by rash and fever during the outbreak. Teams asked if household members had rash and fever and administered a detailed questionnaire of clinical signs and symptoms for measles for each person who reported a rash and fever episode. A sample of cases with fever, rash, and either cough, conjunctivitis, or coryza was laboratory tested for measles and rubella. RESULTS: Of 2,225 households visited, 284 individuals met the rash and fever case definition. Laboratory testing of eleven blood specimens revealed that the rash and fever outbreak was caused by rubella in 6 and measles in 2 with three equivocal results. CONCLUSION: Laboratory confirmation of suspected measles cases is essential during measles elimination activities in Pakistan and other countries with endemic rubella.

Perfil soroepidemiológico da rubéola no período pré-vacinal(1989 a 1999) e pós-vacinal (2000 a 2005) de pacientes referenciados ao Instituto Evandro Chagas

Descreve o perfil soroepidemiológico da Rubéola de pacientes referenciados ao Instituto Evandro Chagas/SVS/MS nos períodos pré-vacinal(1989 a 1999) e pós-vacinal (2000 a 2005), foi realizado estudo retrospectivo do banco de dados de 34.221 amostras, cujos testes sorológicos foram analisados através da técnica de pesquisa de IgM e IgG por ELISA com kits do laboratório DADE BEHRING. A taxa de infecção encontrada foi de 17,2% no período pré-vacinal e de 4,0% no pós-vacinal. Entre a sintomatologia apresentada no período pré-vacinal, a linfadenopatia teve maior taxa com 38,4% e no pós-vacinal a artralgia com 11,3%. Nas mulheres em idade fértil, a média da taxa de imunes foi de 78,3% e 84,4% no período pré e pós-vacinal, respectivamente. A taxa de infecção em gestantes no período pré-vacinal foi de 9,3% e no pós-vacinal 1,6%. Os recém-nascidos infectados corresponderam a 2,1% no período pré e 1,0% no período pós-vacinal nesses, houve predomínio de catarata e cardiopatia isoladas ou em associação. Foi concluído que houve diferença significante entre as frequências de todos os seguimentos estudados, em relação aos períodos pré e pós-vacinal, confirmando a eficácia da vacina na prevenção da Rubéola e da SRC, tal fato realça a necessidade de se ampliar as coberturas vacinais para impedir a circulação do VR no país, cumprindo assim o acordo de eliminação até o ano 2010

Rubella, rubeola, and mumps in pregnant women: susceptibilities and strategies for testing and vaccinating.

OBJECTIVE: To estimate rubella, rubeola, and mumps (MMR) susceptibilities in pregnant women and determine the percentage not immune to rubeola or mumps, depending on rubella immunity status. A secondary objective was to assess costs of vaccination and testing programs aimed at eliminating these viral susceptibilities to determine an optimal strategy. METHODS: This was an observational study of women presenting for prenatal care. All women had MMR antibody titers measured. Viral susceptibilities were compared by age, gravidity, parity, and recall of vaccine booster. A logistic regression was performed to assess for predictors of MMR immunity. A cost comparison of different screening and vaccination strategies was performed. RESULTS: Overall, 91 (9.4%) women were susceptible to rubella, 161 (16.5%) to rubeola, and 159 (16.3%) to mumps. Three hundred seventeen (32.6%) were susceptible to at least 1 virus, whereas only 17 (1.7%) were susceptible to all 3. Of the women who were immune to rubella, a large percentage were not immune to either rubeola or mumps (n = 226, 25.6%). Only 74.2% of women who knew they had a booster vaccine were immune to all components of the MMR vaccine. Receiving a booster was predictive of immunity to all 3 viruses. A cost analysis demonstrated that broader screening strategies are more comprehensive and more expensive. CONCLUSION: The current screening and vaccine program has left many reproductive-aged women susceptible to rubella, rubeola, and mumps infections. Perhaps a more comprehensive viral screening program is needed to ensure immunity.

Increase of immunity to rubella and interruption of rubella transmission in Gipuzkoa (Basque Country, Spain) after an enhanced vaccination programme.

In Spain, vaccination against rubella was initiated in schoolgirls in the mid-1970s. In Gipuzkoa, subsequent extensions to the vaccination schedule culminated in 1992 with the introduction of the two-dose measles, mumps and rubella vaccine in children and adolescents of both sexes. Moreover, in 1985 a programme for the identification and vaccination of non-immune parturient women was implemented in the region's main hospital. The prevalence of rubella-susceptible parturient women decreased from 3.7 % at the beginning of the study to < 1.5 % by 1992. Despite this overall decrease, 4.8 % of adolescent parturients were susceptible to rubella during 2001--2002. From 1984, the number of reported cases of rubella (children and adults) progressively decreased until 1997, after which there have been no cases of indigenous rubella. There have been no cases of reported congenital rubella since 1984. These results indicate that the vaccine policy carried out in this geographical area has been effective in achieving considerable progress towards rubella elimination.

Long-term immunity to measles, mumps and rubella after MMR vaccination among children with bone marrow transplants.

Measles, mumps and rubella (MMR) vaccine-induced long-term immunity was studied in 30 children with bone marrow transplants (BMT). Immunity at baseline for MMR was 13.3, 33.3 and 66.6%, respectively. MMR vaccination failed to induce adequate and persistent responses to measles and mumps; seropositivity at 1 and 12 months for measles was 26.6 and 23.3% and for mumps 46.6 and 36.6%, respectively. In contrast, 27 of 30 children with a BMT were immune to rubella 1 month after immunization and retained protective antibody levels at 12 months. The MMR-induced anamnestic responses to rubella among all responders were associated with the production of high avidity antibodies. We conclude that a single dose of MMR given at 2 years after BMT induces suboptimal and short-lived immune responses to measles and mumps; a second dose should be recommended for paediatric BMT recipients.

Characteristics and mechanisms of isolated rubella virus, strain JR23: infection of the central nervous system of BALB/c mice.

OBJECTIVE: To investigate the correlation between rubella virus (RuV) antigen in peripheral lymphocytes, the immune status and RuV infection in the central nervous system (CNS). METHODS: BALB/c mice were used as a model and treated with immunoaffecting medicines. Then, the mice were infected with RuV via the abdominal cavity, and the antigen level in peripheral lymphocytes was examined 1, 3, 7 and 14 days postinfection. RuV in the CNS was detected by immunohistochemical methods. BALB/c mice were given dexamethasone and cytoxan before infection with the RuV JR23 strain. Immune functions and RuV invasion of the CNS were assayed on day 21 postinfection via the abdominal cavity, and their relationship was analyzed. RESULTS: The mean antigen detection rates at different times were 3.1, 4.1, 9.6 and 2.4%, respectively, in the dexamethasone group, and 14.2, 12.7, 9.9 and 3.1%, respectively, in the cytoxan group. In the group without any intervention, the detection rates were 4.63, 10.25, 6.88 and 1.75%, respectively. The antigen detection rates in peripheral lymphocytes among the three groups 24 h postinfection were significantly different (F = 0.0317, p < 0.05). Comparisons between groups showed that antigen detection rates in the cytoxan group were much higher than those in other groups, but there was no difference between the dexamethasone and control groups. The animals with persistent presence of antigen were much more susceptible to cerebral infection than those with short-term presence (p < 0.001). T cell functions of the cytoxan group were significantly lower than those of other groups (p < 0.05), as detected by the MTT method. Infection rates of the dexamethasone, cytoxan and control groups were 60, 90 and 50%, respectively. Cell immune functions of the mice with CNS infection were obviously worse than those of the mice without CNS infection (p < 0.001). RuV-specific antibodies were assayed in all groups by ELISA and the results showed that there were no significant differences among groups (p < 0.05) or between the groups with and without CNS infection. CONCLUSION: Cytoxan can affect virus detection rates in peripheral lymphocytes. At the early phase of infection, the persistent presence of RuV in peripheral lymphocytes increases the incidence of CNS infection. RuV infection in the CNS was related to the cell immune situation before specific antibody was produced in the body.

Rubella among Hispanic adults--Kansas, 1998, and Nebraska, 1999.

Since 1994, the incidence of rubella has been low; most reported rubella cases have been associated with outbreaks (1,2). Recent outbreaks have occurred primarily among adult Hispanics, many of whom are natives of countries where rubella vaccination is not routine or has been implemented recently (1). This report describes two workplace-associated outbreaks of rubella and summarizes the characteristics of the recent outbreaks in the United States.

Etiology of measles- and rubella-like illnesses in measles, mumps, and rubella-vaccinated children.

The viral etiology of measles- or rubella-like illnesses after MMR (measles, mumps, and rubella) vaccination was studied prospectively in 993 acutely ill Finnish children with fever and rash in 1983-1995. Their sera were tested for adeno-, entero-, and parvovirus B19 antibodies. Sera of 300 children <4 years old were also tested for human herpesvirus 6 (HHV-6) antibodies. Measles and rubella had been excluded by previous antibody testing. Serologic diagnosis of adeno-, entero-, or parvovirus infection was based on EIA (IgM or IgG antibodies) and that of HHV-6 on indirect immunofluorescence. A viral etiology was verified in 368 cases, most commonly parvovirus (20%), followed by enterovirus (9%) and adenovirus (4%). Among young children, HHV-6 infection was found in 37 (12%). Thirty-eight children (4%) had double infections. This study confirms that measles- or rubella-like illnesses in MMR-vaccinated children are often caused by other viruses. Each suspected vaccine failure requires laboratory confirmation to maintain reliable surveillance and control and to establish the specific etiology of the disease.