Booster Vaccinations Are Required

Letters to the Editor regarding the article The Epidemiology and Diagnosis of Measles Special Aspects Relating to Low Incidence by Dorothea Matysiak-Klose, Annette Mankertz, and Heidemarie Holzmann in issue 26/2024

Measles weakens the immune system on a sustained basis and leads to so called immune amnesia (1). Antineoplastic therapies, immunotherapies, and cellular therapies are immunosuppressant to an equally pronounced degree—for example, allogeneic hematopoietic cell transplantation (alloHCT) (2). Repeated booster vaccinations, for example against measles, are therefore necessary after alloHCT (2, 3). Matysiak-Klose et al recommend that all unvaccinated adults born after 1970 or insufficiently vaccinated persons should/could be vaccinated against measles (1). For persons who do not have hemato-oncological disorders this is a sensible recommendation. But in persons who have gone through alloHCT—a situation that is equivalent to an unvaccinated status—some particularities need to be heeded in measles vaccination; an unrestricted recommendation to be vaccinated at any time does not apply to these patients.

Live vaccines—for example the measles vaccine—are contraindicated after alloHCT within 24 months and if graft versus host disease is present or patients are undergoing immunosuppressive therapy (3), since this may trigger a life-threatening measles infection.

To carry out measles vaccination in patients after alloHCT requires good timing with regard to alloHCT or the end of immunosuppression. As a rule of thumb, a 24-month interval after alloHCT should be observed; but the time lag may be completely different on an individual basis. The vaccinations should therefore be carried out only in close collaboration with hematologists or transplant centers so as to avoid risk for these patients. For the general population, recommending measles protection by means of vaccination is obviously sensible, especially as good herd immunity also protects patients who have undergone alloHCT from transmission of an infection.

DOI: 10.3238/arztebl.m2025.0049

PD Dr. med. habil. Enrico Schalk

Klinik für Hämatologie, Onkologie und Zelltherapie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg

Prof. Dr. med. Christina T. Rieger

Hämatologie Onkologie Germering

On behalf of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).

Conflict of interest statement

ES is an advisory board member of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).

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CTR is deputy chair of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). She received consultancy fees for vaccines from GSK and is on the advisory board for RSV [respiratory syncytial virus] and VZV [varicella zoster virus] vaccines from GSK.

References

1. Matysiak-Klose D, Mankertz A, Holzmann H: The epidemiology and diagnosis of measles—special aspects relating to low incidence. Dtsch Arztebl Int 2024; 121: 875–81

2. Mehta RS, Rezvani K: Immune reconstitution post allogeneic transplant and the impact of immune recovery on the risk of infection. Virulence 2016; 7: 901–16

3. Rieger CT, Liss B, Mellinghoff S, et al.: Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors—Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol 2018; 29: 1354–65