Efficacy and safety of measles, mumps, rubella and varicella live viral vaccines in transplant recipients receiving immunosuppressive drugs.

BACKGROUND

This review was designed to summarize published data on the efficacy and safety of live viral vaccines for measles, mumps, rubella, or varicella in post-transplant patients currently on immunosuppression.

DATA SOURCES: Medline, EMBASE and Evidence Based Medicine Reviews were searched from 1966 to November 2007 for case reports or studies describing the efficacy and/or safety of live attenuated measles, mumps, rubella, or varicella vaccine in children on immunosuppression following solid organ, bone marrow or stem cell transplantation.

RESULTS

The review identified 6 case series and 2 case reports describing 114 solid organ transplant recipients and one case series describing 27 bone marrow transplant recipients who had received a combined total of 206 doses of live varicella, measles, mumps, or rubella vaccine while on immunosuppression. Post-immunization titers were in the immune range in 109 of the 171 situations where they were measured following a single dose of vaccine (64%) and in 15 of 22 situations following 2 doses (68%). There were no major safety concerns in this small sample.

CONCLUSION

There are insufficient published data to derive evidence-based guidelines for use of live viral vaccines in transplant recipients on immunosuppression but preliminary data on efficacy and safety suggest that the use of these live viral vaccines in transplant recipients still on immunosuppression could be a reasonable strategy.