#PedsTID #IDWeek2020 Exploring Viral Infections in Pediatric Solid Organ Transplantation Through a New Lens Dr. Klara Posfay-Barbe @posfay "The Time Has Come: Bringing Live Viral Vaccination into the Post-transplant period in Ped SOT"

Guidelines open option for live virus vaccines in selected pts with safety monitoring. Some centers have track record of doing so safely. Questions still: are the live vaccines protective? Defining population in which vaccines safe?

VZV & measles continue to circulate, threaten childrens health. Non-immune transplant recipients high risk for dissem VZV. Minimal tx option for measles, risk for complications.

Schematic immune response to vaccine in immunosuppressed transplant recipients - both generation & maintenance impaired, but depending on pathogen this could meet threshold for protection. However the specifics poorly understood in immunocompromised persons.

Ongoing study but encouraging data suggesting VZV vaccine in selected ped SOT recipients generated immune response, follow-up showing maintenance - may need to be boosted, have modified schedule from usual.

Clinical efficacy (protecting against VZV disease) similar efficacy to healthy children!

Safety - few cases vaccine-associated virus disease; however the described cases have been self-limited. Conclusion: Likely to be safe in appropriately selected pts.

Consensus statement for live immunization in selected ped SOT recipients.

Consensus statement criteria for selection ped SOT recipients for live immunization

Note that many ped SOT recipients will not meet consensus criteria for live immunization; evaluation of non-live vaccine candidates in progress, to protect greater proportion of pts in ped SOT population. Also emphasize rec to immunize pre-txp if possible.

Similar encouraging early data for measles.