Vaccination against tick-borne encephalitis under therapeutic immunosuppression. Reduced efficacy in heart transplant recipients

• Published in: Vaccine Vol. 17; no. 7; pp. 867 - 874
• Main Authors: Dengler, Thomas J, Zimmermann, Rainer, Meyer, Joachim, Sack, Falk-U, Girgsdies, Otto, Kübler, Wolfgang E
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 26.02.1999; Elsevier
• Subjects: Adult; Aged; Antibodies, Viral - blood; Biological and medical sciences; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Encephalitis, Tick-Borne - immunology; Encephalitis, Tick-Borne - prevention & control; Epidemiology. Vaccinations; Female; General aspects; Heart transplantation; Heart Transplantation - immunology; Humans; Immunization Schedule; Immunosuppression; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Infectious diseases; Male; Medical sciences; Middle Aged; Tick-borne encephalitis; Tick-borne encephalitis virus; Vaccination; Viral Vaccines - adverse effects; Viral Vaccines - immunology; Viral Vaccines - therapeutic use; Immunosuppression; Tick-borne encephalitis; Vaccination; Heart transplantation; Heart; Human; Nervous system diseases; Tick borne encephalitis; Recipient; Transplantation; Flavivirus; Cerebral disorder; Infection; Tick borne encephalitis group virus; Virus; Immunogenicity; Viral disease; Arbovirus disease; Central nervous system disease; Flaviviridae; Tick borne encephalitis virus
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/S0264-410X(98)00272-2

Patients after organ transplantation are at an increased risk of microbial infections and might benefit from active vaccination. Due to therapeutic immunosuppression the efficacy of immunizations is, however, reduced and difficult to predict. Efficacy of vaccination against tick-borne encephalitis (TBE) using an abbreviated immunization schedule was compared in 31 heart transplant recipients (age: 54.5±11.5 years, mean time after transplantation: 53.5±23.7 months) under cyclosporine-based immunosuppression and 29 controls. TBE vaccination was well tolerated by the transplant recipients; spectrum and frequency of adverse events were similar to controls. In the transplant patients, seroconversion rate (35% versus 100%; p<0.001) and the geometric mean of post-vaccinal antibody titres (0.98 (SF: 2.3) U/ml versus 5.46 (2.2) U/ml; p<0.001) were markedly reduced in comparison to the control group. No clinical or demographic predictors of vaccination success could be established in the transplant patients. Due to the limited efficacy, TBE vaccination cannot be recommended as a routine procedure in heart transplant recipients at risk of TBE virus infection. TBE vaccination may be performed safely in selected cases, but repeated titre controls to confirm vaccination success would be required.