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Review
. 2023 Jun;27(4):e14502.
doi: 10.1111/petr.14502. Epub 2023 Mar 15.

Spotting a potential threat: Measles among pediatric solid organ transplantation recipients

Victoria A Statler  1 , Thomas Fox  2 , Monica I Ardura  3
Affiliations
Review

Spotting a potential threat: Measles among pediatric solid organ transplantation recipients

Victoria A Statler et al. Pediatr Transplant. 2023 Jun.

Abstract

Background: Low-vaccination rates worldwide have led to the re-emergence of vaccine-preventable infections, including measles. Immunocompromised patients, including pediatric solid organ transplant (SOT) recipients, are at risk for measles because of suboptimal vaccination, reduced or waning vaccine immunity, lifelong immunosuppression, and global re-emergence of measles.

Objectives: To review published cases of measles in pediatric SOT recipients to heighten awareness of its clinical manifestations, summarize diagnostic and treatment strategies, and identify opportunities to optimize prevention.

Methods: We conducted a literature review of published natural measles infections in SOT recipients ≤21 years of age, summarizing management and outcomes. We describe measles epidemiology, recommended diagnostics, treatment, and highlight prevention strategies.

Results: There are seven published reports of measles infection in 12 pediatric SOT recipients, the majority of whom were unvaccinated or incompletely vaccinated. Subjects had atypical or severe clinical presentations, including lack of rash and complications, most frequently with encephalitis and pneumonitis, resulting in 33% mortality. Updated recommendations on testing and vaccination are provided. Treatment options beyond supportive care and vitamin A are limited, with no approved antivirals.

Conclusion: While measles is infrequently reported in pediatric SOT recipients, morbidity and mortality remain significant. A high index of suspicion is warranted in susceptible SOT recipients with clinically compatible illness or exposure. Providers must recognize this risk, educate families, and be aware of both classic and atypical presentations of measles to rapidly identify, isolate, and diagnose measles in pediatric SOT recipients. Continued efforts to optimize measles vaccination both pre- and post-SOT are warranted.

Keywords: measles; pediatric; solid organ transplantation; vaccination.

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References

REFERENCES

    1. Rota PA, Moss WJ, Takeda M, de Swart RL, Thompson KM, Goodson JL. Measles. Nat Rev Dis Primers. 2016;2:16049.
    1. Permar SR, Griffin DE, Letvin NL. Immune containment and consequences of measles virus infection in healthy and immunocompromised individuals. Clin Vaccine Immunol. 2006;13:437-443.
    1. Guerra FM, Bolotin S, Lim G, et al. The basic reproduction number (R0) of measles: a systematic review. Lancet Infect Dis. 2017;17:e420-e428.
    1. Measles Cases and Outbreaks. 2019. Accessed 12/1/2019. https://www.cdc.gov/measles/cases-outbreaks.html
    1. World Health Organization. Measles. Accessed September 19, 2022. https://www.who.int/news-room/fact-sheets/detail/measles

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