Vaccine-associated measles in a hematopoietic cell transplant recipient: case report and comprehensive review of the literature

Abstract Measles is a worldwide viral disease that can cause fatal complications in immunocompromised hosts such as hematopoietic cell transplant (HCT) recipients. The live attenuated measles, mumps, and rubella (MMR) vaccine is generally contraindicated post-HCT due to the risk for vaccine-associated measles. This, combined with decreasing vaccination rates due to vaccine hesitancy and the Coronavirus Disease 2019 pandemic, raise significant concerns for a measles resurgence that could portend devastating consequences for immunocompromised hosts. Multiple guidelines have included criteria to determine which HCT recipients can safely receive the MMR vaccine. Here, we report a case of vaccine-associated measles in a HCT recipient who met guideline-recommended criteria for MMR vaccination. The objective of this paper is to query these criteria, highlight the importance of MMR vaccination, and comprehensively review the literature.

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Safety of Live-Attenuated Measles, Mumps, and Rubella Vaccine Administered Within 2 Years of Hematopoietic Cell Transplant

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab504 ◽

2021 ◽

Vol 8 (12) ◽

Author(s):

Michaël Desjardins ◽

Xhoi Mitre ◽

Amy C Sherman ◽

Stephen R Walsh ◽

Matthew P Cheng ◽

...

Keyword(s):

Adverse Reactions ◽

Maculopapular Rash ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Mmr Vaccine ◽

Hematopoietic Cell Transplant ◽

Live Attenuated Vaccine ◽

Allogeneic Hct ◽

Measles Outbreak ◽

Tract Infections

Abstract Background Measles, mumps, and rubella (MMR) vaccine is a live-attenuated vaccine usually contraindicated within the first 2 years of hematopoietic cell transplant (HCT). The objective of this study was to assess the safety of MMR vaccine when administered within 2 years of HCT. Methods We conducted a retrospective review of patients who received MMR vaccination within 2 years of an autologous or allogeneic HCT, mostly in the context of the 2019 measles outbreak. Adverse reactions were collected for 42 days postvaccination, and all hospitalizations and deaths following vaccination were reviewed. Results A total of 129 patients (75 autologous and 54 allogeneic HCT) were vaccinated 300–729 days after HCT (median, 718 days), and 39 (30%) of these were vaccinated earlier than 23 months post-transplant. Ten adverse reactions in 7 patients (5%) were identified within 42 days of vaccination: 6 respiratory tract infections (3 with fever) and 1 rash. The rash was seen in a 37-year-old female who had an allogeneic HCT 542 days before vaccination. She presented with a centrifugal maculopapular rash, confirmed to be caused by the vaccine strain rubella virus. She fully recovered. No other vaccine-associated illness was identified in the cohort after a median follow-up of 676 days. Conclusions MMR vaccine appears to be well tolerated in select HCT recipients when given between 300 and 729 days after transplant. An uncomplicated case of vaccine-associated rubella illness was seen after vaccination. Assessment of potential risks and benefits of MMR vaccination given within 2 years of HCT remains important.

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What Types of Antibiotic Exposure Associates with Increased Risk of Respiratory Viral Disease Progression in Allogeneic Hematopoietic Cell Transplant Recipients?

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2019.12.355 ◽

2020 ◽

Vol 26 (3) ◽

pp. S329-S330

Author(s):

Chikara Ogimi ◽

Elizabeth Krantz ◽

Alpana Waghmare ◽

Catherine Liu ◽

Jonathan L. Golob ◽

...

Keyword(s):

Disease Progression ◽

Viral Disease ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Antibiotic Exposure ◽

Transplant Recipients ◽

Hematopoietic Cell Transplant ◽

Allogeneic Hematopoietic Cell Transplant ◽

Increased Risk

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The challenges of treating aspergillus abdominal aneurysm after hematopoietic cell transplant: Rapid voriconazole metabolizer

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155217748471 ◽

2017 ◽

Vol 25 (3) ◽

pp. 703-705 ◽

Cited By ~ 1

Author(s):

Justin A Wasko ◽

Celalettin Ustun ◽

Mark Birkenbach ◽

Rumi Faizer ◽

Jaime S Green

Keyword(s):

Genetic Variants ◽

Mycotic Aneurysm ◽

Fungal Infections ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Hematopoietic Cell Transplant ◽

Abdominal Aneurysm ◽

Mycotic Aneurysms ◽

Potential Impact ◽

Immunocompromised Hosts

Mycotic aneurysms are a fatal manifestation of disseminated fungal infections in immunocompromised hosts. We present a patient with an Aspergillus mycotic aneurysm after hematopoietic cell transplant. Due to CYP2C19 rapid metabolizer phenotype (*1/*17), therapeutic levels of voriconazole were unobtainable. Successful therapy was achieved with posaconazole salvage therapy and early, aggressive surgery. This case demonstrates the consequences of voriconazole rapid metabolism and the potential impact of genetic variants.

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