Revaccination in Children Undergoing Autologous Hematopoietic Stem Cell Transplantation: Results of a Survey in Germany, Austria and Switzerland

Abstract

Abstract Background Due to the potential loss of protective antibody titers after autologous hematopoietic stem cell transplantation (HSCT), revaccination is important. The aim of the study was to evaluate the current strategies in Germany, Austria and Switzerland for revaccination of children after autologous HSCT. Methods An internet-based survey was performed, and results were analyzed in a descriptive way. Results Twenty-seven out of 31 centers (87%) centers responded, and all centers administer revaccination. More than 90% of the centers re-vaccinate against tetanus, diphtheria, hepatitis B, H. influenzae B, poliomyelitis, measles, mumps, and rubella, whereas considerable less centers vaccinate against encapsulated bacteria, in particular against meningococci. First revaccination with non-live vaccine is performed by almost all centers between 3 and 9 months. Timing of live-attenuated vaccines varied widely [6 months (4 centers), 9 months (1), 12 months (11) and 24 months (4)]. Similarly, there is a wide variation in the delay of live-vaccines after immunoglobulin administration (2 weeks to 9 months), and in the testing of immunological parameters prior to vaccination. Conclusion Our survey demonstrates a wide variation regarding the timing of live-attenuated vaccines after autologous HSCT or after immunoglobulin administration and regarding immunization against encapsulated bacteria. Many centers do not adhere to current recommendations. Studies should focus on a detailed analysis of the epidemiology of infections with encapsulated bacteria after pediatric autologous HSCT as well as on the immune recovery and the response to revaccination in this setting.