Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children

doi:10.4254/wjh.v13.i1.120

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Hepatol. Jan 27, 2021; 13(1): 120-131
Published online Jan 27, 2021. doi: 10.4254/wjh.v13.i1.120

Table 1 The immunization schedule in Thailand and accelerated vaccines by the Infectious Disease Society of America

	Vaccine	Birth	1 mo	2 mo	4 mo	6 mo	7 mo	9 mo	12 mo	18 mo	24 mo	4 yr	9 yr	11 yr
Thai’s EPI vaccines	BCG	1
	HBV	1	(For positive maternal HBsAg)	2		3
	DTP, OPV/IPV			1	2	3				4		5
	MMR					Acc¹		1	Acc¹		2
	JE							1			2
	Influenza					1	2
	Tdap													1
	HPV												Acc	1-2²
Optional vaccine in Thailand	Rota			1	2	(3)
	PCV			1	2	3			4
	Varicella					Acc¹		Acc¹	1	2
	HAV								1	2
	Dengue												1-3³

¹Acc denotes accelerated vaccines from the 2013 Infectious Diseases Society of America Clinical Practice Guideline for Vaccination of the Immunocompromised Host in which measles-mumps-rubella (MMR) at 6 and 12 mo of age and varicella at 6 mo of age and 3 mo apart from the first dose.

²Indicates 0 and 6 mo.

³Indicates 0, 6, 12 mo.

BCG: Bacillus Calmette-Guerin vaccine; DTP: Diphtheria-tetanus-pertussis; EPI: Expanded Program on Immunization; HAV: Hepatitis A vaccine; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B vaccine; HPV: Human papillomavirus vaccine; JE: Japanese encephalitis; OPV/IPV: Oral polio vaccine/inactivated polio vaccine; PCV: Pneumococcal conjugate vaccine; Tdap: Tetanus-diphtheria-acellular pertussis.

Table 2 Vaccination history in children at liver transplant and up to 5 years follow-up (n = 48)

Vaccines	Incomplete vaccination for age at transplantation		Incomplete vaccination for age after liver transplant, n (%)
Vaccines	Thai EPI program, n (%)	Accelerated vaccine from IDSA, n (%)
DTP-OPV/IPV	12 (25)	N/A	6 (12.5)
HBV	6 (12.5)		0
MMR	12 (25)	30 (62.5)^b	27 (56.3)^b
JE	16 (33.3)	N/A	10 (20.8)
Varicella	16 (33.3)	34 (70.8)^b	34 (70.8)^b
HAV	26 (54)		23 (47.9)
Influenza	30 (62.5)		18 (37.5)^a
PCV	36 (75)		22 (45.8)^b
Rota	37 (77)	N/A	37 (77)
All	25 (52)	43 (89.5)^b	23 (47.9)
	(not included rota vaccine)		(not included lived vaccine)

^aP < 0.05 vs Thai Expanded Program on Immunization (EPI).

^bP < 0.001 vs Thai EPI program.

DTP: Diphtheria-tetanus-pertussis; HAV: Hepatitis A vaccine; HBV: Hepatitis B vaccine; IDSA: Infectious Diseases Society of America; JE: Japanese encephalitis; MMR: Measles-mumps-rubella; N/A: Not applicable; OPV/IPV: Oral polio vaccine/inactivated polio vaccine; PCV: Pneumococcal conjugate vaccine.

Table 3 Characteristics of hospitalization from vaccine-preventable infections and non-vaccine-preventable infections up to 5 years follow-up

Time	Type of infections				Organ specific infections, n (%)						The severity of infections, n (%)
	VPIs		Non-VPIs		RS	GI	Blood	Renal	Skin	Others	ICU	Ventilator dependence	Death
	Times, n (%)	LOS (d)¹	Times, n (%)	LOS (d)¹	RS	GI	Blood	Renal	Skin	Others	ICU	Ventilator dependence	Death
During transplant	4 (5.2)	51 (24,79)	73 (94.8)^b	35 (27,49)	25 (35.2)	24 (31.2)	20 (26)	6 (7.8)	2 (2.6)	0	All	All	0
< 3 mo	2 (6.9)	3 (3,3)	27 (93.1)^b	12 (7,28)^a	13 (44.8)	10 (34.5)	2 (6.9)	2 (6.9)	1 (3.4)	1 (3.4)	6 (20.7)	5 (17.2)	2 (6.9)
3-6 mo	5 (17.9)	8 (5,39)	23 (82.1)^b	10 (4,15)	11 (39.3)	13 (46.4)	2 (7.1)	1 (3.6)	0	1 (3.6)	8 (28.6)	6 (21.4)	0
> 6-12 mo	3 (8.3)	5 (3,5)	33 (91.7)^b	7 (6,17)	15 (41.7)	11 (30.6)	6 (16.7)	0	2 (5.6)	2 (5.6)	10 (27.8)	6 (8.3)	0
> 12-24 mo	6 (15)	5 (4,9)	34 (85)^b	7.5 (5,10)	18 (45)	12 (30)	1 (2.5)	1 (2.5)	4 (10)	4 (10)	11 (27.5)	9 (22.5)	0
> 2-5 yr	11 (40.7)	6 (3,8)	16 (59.3)	5 (4,9)	7 (25.9)	10 (37)	1 (3.7)	0	6 (22.2)	3 (1.9)	5 (18.5)	1 (3.7)	0
Total	31 (13.1)	6 (3,8)	206 (86.9)^b	8 (5,15)	89 (37.6)	80 (33.8)	32 (13.5)	10 (4.2)	15 (6.3)	11 (4.6)	40 (16.9)	27 (11.4)	2 (0.84)

^aP < 0.05 vs vaccine-preventable infection (VPI) group.

^bP < 0.001 vs VPI group.

¹Data are presented as median (interquartile range).

GI: Gastrointestinal; ICU: Intensive care unit; LOS: Length of stay; RS: Respiratory system.

Table 4 Children with vaccination records who developed vaccine-preventable or non-vaccine-preventable diseases

Age-appropriate immunization	Thai’s Expanded Program on Immunization				2013 Infectious Diseases Society of America
	Infection and hospitalization, n			Total	Infection and hospitalization, n			Total
	None	VPIs and non-VPIs	Non-VPIs	Total	None	VPIs and non-VPIs	Non-VPIs	Total
Complete immunization	5	5	12	22	9	9	25	43
Incomplete immunization	5	6	15	26	1	2	2	5
Total	10	11	27	48	10	11	27	48

VPIs: Vaccine-preventable infections.

Table 5 Pathogen causing hospitalization in children after liver transplantation

Time	The rank of the pathogen, n (%)
Time	Bacteria	Total	Virus, fungus, and unidentified	Total
During transplant	E. coli (n = 19, 24.7), K. pneumoniae (n = 12, 15.6), A. baumannii (n = 11, 14.3), Enterococcus/Staphylococcus (n = 4, 5.2), Salmonella (n = 3, 3.9), P. aeruginosa (n = 2, 2.6), B. cereus/Corynebacterium/S. pneumoniae/Elizabethkingia meningoseptica/Stenotrophomonas/Streptococcus mirabilis/C. difficile (n = 1, 1.3)	62	Rotavirus/adenovirus/bocavirus (n = 2, 2.6), parainfluenza/fungus/varicella-zoster virus (n = 1, 1.3)	9^b
< 3 mo	E. coli/K. pneumoniae/Enterococcus/Salmonella/Aeromonas (n = 2, 6.9), Corynebacterium/C. difficile/Plesiomonas (n = 1, 3.4)	13	Parainfluenza (n = 3, 10.3), coronavirus (n = 2, 6.9), rotavirus/bocavirus/RSV/dengue/fungus/norovirus/rhinovirus/parvovirus B19 (n = 1, 3.4), unidentified (n = 6, 20.7)	19
3-6 mo	Salmonella/E. coli (n = 2, 7.1), K. pneumoniae/Enterococcus/S. pneumoniae/Staphylococcus (n = 1, 3.6)	8	RSV (n = 4, 14.3), influenza (n = 2, 7.1), rotavirus/parainfluenza/rhinovirus/measles/HHV6 (n = 1, 3.6), unidentified (n = 9, 32.1)	20
> 6-12 mo	E. coli (n = 4, 11.1), Salmonella (n = 3, 8.3), A. baumannii/Enterococcus/mycoplasma/C. difficile (n = 2, 5.6), Stenotrophomonas/Staphylococcus/Aeromonas/Pseudomonas/Plesiomonas/P. jirovecii (n = 1, 2.8)	21	Parainfluenza (n = 3, 8.3), norovirus/herpes simplex virus (n = 2, 5.6), fungus/RSV/rhinovirus/influenza/measles (n = 1, 2.8), unidentified (n = 3, 8.3)	15
> 12-24 mo	Salmonella (n = 8, 12.5), E. coli (n = 3, 7.5), Aeromonas/Pseudomonas/mycoplasma/Plesiomonas (n = 1, 2.5)	15	Parainfluenza (n = 6, 15), rotavirus (n = 2, 5), adenovirus/varicella-zoster virus/dengue/rhinovirus/influenza/measles/metapneumovirus/hepatitis E/coxakie AB (n = 1, 2.5) unidentified (n = 11, 27.5)	28
> 2-5 yr	Salmonella/mycoplasma (n = 2, 7.4), E. coli/K. pneumoniae/Staphylococcus/Vibrio cholera/B. cereus (n = 1, 3.7)	9	Varicella-zoster virus (n = 3, 11.1), rotavirus/RSV/dengue/influenza (n = 2, 7.4), fungus/norovirus/herpes simplex virus/hepatitis B (n = 1, 3.7), unidentified (n = 3, 11.1)	18
Overall	E. coli (n = 31, 13.1), Salmonella (n = 20, 8.1), K. pneumoniae (n = 16, 6.8), A. baumannii (n = 13, 5.5), Enterococcus (n = 9, 3.8), Staphylococcus (n = 8, 3.3), mycoplasma (n = 5, 2.1), C. difficile (n = 4, 1.7), Plesiomonas Shigelloides/Aeromonas (n = 3, 1.3), Corynebacterium/S. pneumononiae/Stenotrophomonas/P. aeruginosa/Aeromonas (n = 2, 0.8), Bacillus/Elizabethkingia meningoseptica/Streptococcus mirabilis/P. jirovecii/Vibrio cholera/B. cereus (n = 1, 0.4)	128	Parainfluenza (n = 14, 5.9), rotavirus/RSV (n = 8, 3.4), influenza (n = 6, 2.5), varicella-zoster virus (n = 5, 2.1), dengue/norovirus/fungus/rhinovirus (n = 4, 1.7), adenovirus/bocavirus/herpes simplex virus/measles (n = 3, 1.3), coronavirus (n=2, 0.8), HHV6/metapneumovirus/hepatitis E/coxakie AB/hepatitis B (n = 1, 0.4), unidentified (n = 32, 13.5)	109^b

^bP < 0.001; virus vs bacterial causes of infections at each time point. A. baumannii: Acinetobacter baumannii; B. cereus: Bacillus cereus; C. difficile: Clostridium difficile; E. coli: Escherichia coli; HHV6: Human herpes virus 6; K. pneumoniae: Klebsiella pneumoniae; P. aeruginosa: Pseudomonas aeruginosa; P. jirovecii: Pneumocystis jirovecii; RSV: Respiratory syncytial virus; S. pneumoniae: Streptococcus pneumoniae.

Table 6 Vaccine-preventable infections causing hospitalization in children after liver transplantation

Time	During transplant	< 3 mo	3-6 mo	> 6-12 mo	> 12-24 mo	> 2-5 yr	Overall
Rota	2	1	1	0	2	2	8
Influenza	0	0	2	1	1	2	6
Varicella	1	0	0	0	1	3	5
Dengue	0	1	0	0	1	2	4
Measles	0	0	1	1	1	0	3
Streptococcus pneumoniae	1	0	1	0	0	0	2
Hepatitis B	0	0	0	0	0	1	1
Hepatitis E	0	0	0	0	1	0	1
Vibrio cholera	0	0	0	0	0	1	1

Citation: Sintusek P, Poovorawan Y. Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children. World J Hepatol 2021; 13(1): 120-131
URL: https://www.wjgnet.com/1948-5182/full/v13/i1/120.htm
DOI: https://dx.doi.org/10.4254/wjh.v13.i1.120