Acta Med. Okayama, 2022
Vol. 76, No. 3, pp. 247‑253
CopyrightⒸ 2022 by Okayama University Medical School.

Original Article

http://escholarship.lib.okayama-u.ac.jp/amo/

Analysis of Immunity against Measles, Mumps, Rubella, and Varicella
Zoster in Adult Recipients of Allogeneic Hematopoietic Stem Cell
Transplantation: A Single-Center Experience
Shohei Yoshidaa, Nobuharu Fujiia,b＊, Chihiro Kamoia,b, Wataru Kitamuraa,
Hideaki Fujiwaraa, Noboru Asadaa, Hisakazu Nishimoria, Keiko Fujiia,b,
Ken-ichi Matsuokaa, and Yoshinobu Maedaa
aDepartment of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry
and Pharmaceutical Sciences, bDivision of Transfusion, Okayama University Hospital, Okayama 700-8558, Japan

Vaccine-preventable disease (VPD) infections are more severe in immunocompromised hosts. Vaccination
against measles, mumps, rubella, and varicella zoster (VZV) (MMRV) is therefore recommended for hematopoietic stem cell transplantation (HCT) recipients. However, studies on adult HCT recipients with VPD infections are limited. At our institution, we have systematically conducted serological MMRV tests as a part ofcheck-up examinations during long-term follow-up (LTFU) after HCT since 2015. This retrospective study
aimed to evaluate changes in the serostatus between before and 2 years after allogeneic HCT. Among 161
patients, the pre-transplant seropositivity was 82.7% for measles, 86.8% for mumps, 84.2% for rubella, and94.3% for VZV. Among 56 patients who underwent LTFU including serological MMRV tests at 2 years after
HCT, the percentages maintaining seroprotective antibody levels for measles, mumps, rubella and VZV were
71.5% (40/56), 51.8% (29/56), 48.2% (27/56), and 60.7% (34/56), respectively. Vaccination was recommendedfor 22 patients, and 12 were vaccinated. Among the 12 vaccinated patients, rates of seroconversion were examined in 2-6 patients for each of the four viruses. They were 100% (3/3) for measles, 33.3% (1/3) for mumps,
50% (3/6) for rubella, and 0% (0/2) for VZV. Further studies are warranted to clarify the effect of vaccination in
adult HCT recipients.
Key words: vaccine-preventable disease, vaccination, allogeneic hematopoietic stem cell transplantation, adultV

accine-preventable disease (VPD) infections aresevere in immunocompromised hosts, including
post-hematopoietic stem cell transplantation (HCT)
recipients. Life-threatening infections with measles[1-3] and varicella zoster [4 , 5] have been reported inpatients after HCT. Immunization against VPD is thus
recommended for patients receiving HCT, because
most long-term survivors after HCT become seronegative for the antigens [6-9]. According to the Vaccina­
Received November 10, 2021 ; accepted December 6, 2021.
Corresponding author. Phone : +81-86-235-7227; Fax : +81-86-232-8226
E-mail : nfujii@md.okayama-u.ac.jp (N. Fujii)＊tion section of the Japanese Society of Hematopoietic
Cell Transplantation (JSHCT) Guidelines (version 3),
inactivated vaccination can be administered at 6 or 12months after transplantation if there is no worsening ofgraft-versus-host disease (GVHD). On the other hand,
live vaccination is recommended for patients who are 2
years post-transplant, free of active GVHD, and notreceiving immunosuppressive drugs. However, themethods and appropriate timing for evaluating VPD
seropositivity and the recommendation criteria for vacConflict of Interest Disclosures: No potential conflict of interest relevantto this article was reported.

248

Yoshida et al.

Acta Med. Okayama Vol. 76, No. 3

cination have not been well established for post-HCT
recipients.
Most previous reports on seropositive rates after
allogeneic HCT (allo-HCT) have focused on pediatricpatients [10-12]. More recently, a few studies have been
conducted in adult patients [13-15], but the information in adults remains insufficient. At our institution,
we have systematically conducted serological tests formeasles, mumps, rubella, and varicella zoster (VZV)(MMRV) as part of the check-up examinations duringlong-term follow-up (LTFU) for allo-HCT recipients
since 2015. For patients who do not have seroprotective antibody titers, we routinely recommend MMRV
vaccination. This study sought to determine the preand post-transplantation prevalence of MMRV antibodies and to evaluate the effectiveness of the vaccination policy for adults undergoing allo-HCT at our
institution.

Materials and Methods
Patients. We retrospectively reviewed the clinicalcharts of adult patients with hematological malignancies who underwent allogeneic HCT at Okayama
University Hospital from January 2015 to December
2018. A flowchart of the patient enrollment is shown in
Fig. 1. Antibody titers before HCT were assessed in 161
patients at the discretion of the attending physician(Group 1). Post-transplant serological tests to determine the recommendation for live attenuated vaccinaAllo-HSCT 2015-2018

Group 1

161

105

Pts receiving 2yr LTFUGroup 2

75: Death within 2 yrs
30: Other reasons

56

Recommenda�on oflive a�enuated vaccine

Yes
22

No
34

vaccina�on

No
10

Yes
12
Fig. 1

Flowchart of the patient enrollment.

tion were performed annually beginning with the LTFU
visit at 2 years after HCT. The 56 patients (Group 2)
who received annual check-ups beginning at 2 years
post-HCT were included in the analysis for detecting
factors associated with the loss of antibodies against
MMRV. This retrospective analysis was conducted inaccordance with the Declaration of Helsinki andapproved by the institutional review board of Okayama
University Hospital.
Serological tests and criteria for vaccination.
In
serological tests before HCT, immunoglobulin G (IgG)
antibody titers of measles, mumps, and rubella were
measured using a VIDAS assay kit [16-18]. The threshold for seropositive titers was ≥ 0.7 TV for measles,≥ 0.5 TV for mumps, and ≥ 15 IU/ml for rubella. An
enzyme immunoassay (EIA) was performed to determine the VZV serological status. The seropositive titerthreshold was ≥ 5I U/ml.
In the post-HCT serological tests, we evaluated IgG
antibodies for VZV using EIA and for mumps using the
VIDAS assay kit, just as in the pre-HCT tests. For
measles and rubella we used the neutralization test andhemagglutination inhibition (HI) test, respectively,
according to the guidelines for vaccination by the
JSHCT. The titer thresholds for recommending vaccination were < 1 : 4 for measles, < 1 : 16 for rubella, and< 5 IU/ml for VZV. As for mumps, we recommended
vaccination for all patients not under immunosuppressant medication and without active GVHD, because no
definite threshold for vaccination recommendation was
indicated by the VIDAS assay.
Statistical analysis. Multivariate analyses of the
MMRV serostatus at 2 years after HCT were performed
using the Cox proportional hazards model. The following variables were considered: age at HCT (< 45 years
versus ≥ 45 years), sex (male versus female), underlying disease (leukemia versus lymphoma versus others),
donor source (bone marrow versus peripheral blood
stem cell versus cord blood), conditioning regimen(myeloablative versus reduced-intensity), and history ofacute GVHD (Grades 0-I versus II-IV) or chronic
GVHD occurring within 1 year after HCT (no versusyes). All statistical tests were two-sided, with values ofp < 0.05 considered to indicate statistical significance.
All statistical analyses were performed with EZR(Saitama Medical Center, Jichi Medical University,
Saitama, Japan) [19].

Immunity against MMRV after HCT

June 2022

Results
Patient characteristics.
The patient characteristics are presented in Table 1. In Group 1, the percentages of patients with pre-transplant seropositivity formeasles, mumps, rubella and VZV were 82.7%(62/75), 86.8% (92/106), 84.2% (133/158) and 94.3%(150/159), respectively, as shown in Fig. 2. A total of
103 patients were excluded from further analysis
Table 1

Patient characteristics
n = 56

Age at HSCTMedian (range)
Sex
Male
FemaleDisease
AML
ALL
MPAL
MDS
MF
CAEBV
NHL
Other malignancies
Donor source
Unrelated bone marrow
Related bone marrow
Unrelated peripheral blood
Related peripheral blood
Haploidentical
Unrelated cord blood
Conditioning regimen
Myeloablative
Reduced-intensity
Acute GVHD
Grade 0-I

Grade II-IV
Chronic GVHD
No
Yes

52.5 (18-71)
30
26
21

38%

11

20%

2

4%

11

20%

1

2%

2

4%

6

11%

2

4%

24

43%

1

2%

10

18%

7

13%

5

9%

9

16%

38

68%

18

32%

46

82%

10

18%

17

30%

39

70%

HSCT, hematopoietic stem cell transplantation; AML, acute
myeloid leukemia; ALL, acute lymphoblastic leukemia; MPAL,
mixed phenotype acute leukemia; MDS, myelodysplastic syndrome; MF, myeloﬁbrosis; CAEBV, chronic active Epstein-Barrvirus infection; NHL, non-Hodgkin lymphoma.

249

because they were unable to continue LTFU due todeath (n = 75) or for other reasons (n = 30); thus, a final
total of 56 patients were analyzed for serological status
at 2 years after HCT (Group 2). The study population
had a median age of 52.5 years (range: 18-71 years) andwas composed of 30 men and 26 women. The primarydiseases included acute myeloid leukemia (n = 21),acute lymphoblastic leukemia (n = 11), myelodysplastic
syndrome (n = 11), non-Hodgkin lymphoma (n = 6),
and others (n = 7). The donor sources included unrelated bone marrow (n = 24), related bone marrow(n = 1), unrelated peripheral blood (n = 10), related
peripheral blood (n = 12), and unrelated cord blood(n = 9). The conditioning regimen included myeloablative (n = 38) and reduced-intensity (n = 18) regimens.
Ten of the 56 patients had a history of grades II-IV
acute GVHD, whereas 39 had chronic GVHD.
Serostatus of MMRV at 2 years after HCT and recommendation regarding vaccination. None of thepatients who were initially seronegative before transplantation became seropositive without vaccination at 2
years after transplantation. Among the 56 patients who
underwent annual serological MMRV tests beginning at
2 years after HCT, the percentages of patients maintaining seroprotective antibody levels for measles,
mumps, rubella and VZV were 71.5% (40/56), 51.8%(29/56), 48.2% (27/56), and 60.7% (34/56), respectively (Fig. 3). Vaccination was recommended for 22
patients, and 12 of these patients (54.5%) received vaccination.
Risk factors associated with loss of immunity
against MMRV. We selected patients who were seropositive before transplant and analyzed whether loss of
immunity could be predicted. Age, sex, underlying
disease, donor source, conditioning regimen, historyof acute GVHD, and history of chronic GVHD wereassigned as covariates. However, we did not detect any
factors associated with loss of antibodies against MMRV
(Table 2).
Changes in antibody titers after vaccination.
1. Measles
Among 9 patients who received vaccination, 3 did
not have seroprotective titers (< 1 : 4) before vaccination. All 3 of these patients achieved sufficient titers at
1 year after vaccination. On the other hand, the antibody titers of 3 patients that were ≥ 1 : 4 before vaccination decreased to < 1 : 4 (Fig. 4).

250

Yoshida et al.

Acta Med. Okayama Vol. 76, No. 3

Measles

Mumps

Rubella

VZV

82.7%

86.8%

84.2%

94.3%

(+)

(+)

(+)

(+)

(-)

(-)

(-)

(-)

Fig. 2Pre-transplant seropositivity against measles, mumps, rubella, and varicella zoster. The seropositive titer thresholds were ≥ 0.7
TV for measles, ≥ 0.5 TV for mumps, and ≥ 15 IU/ml for rubella by VIDAS assay. The seropositive titer threshold for VZV was ≥ 5 IU/ml
by enzyme immunoassay.

Measles

Mumps

71.5%

(+)

(-)

Rubella

48.2%

51.8%

(+)

(-)

VZV

(+)

(-)

60.7%

(+)

(-)

Fig. 3
Serostatus of measles, mumps, rubella, and varicella zoster at 2 years after HCT. The protective antibody titer threshold was≥ 1 : 4 for measles on the neutralization test, ≥ 1 : 16 for rubella on the hemagglutination inhibition test, and ≥ 5 IU/ml for VZV on enzyme
immunoassay. In mumps, ≥ 0.5 on the VIDAS assay was considered the seroprotective antibody titer threshold.

2. Mumps
Ten patients received vaccination against mumps.
Among them, 3 were negative for antibodies (< 0.5 TV)
before vaccination; however, only 1 patient achieved aseroprotective antibody titer at 1 year after vaccination.
3. Rubella
Nine patients received vaccination against rubella.
Among 6 patients who did not have seroprotective
titers before vaccination (< 1 : 16), 3 achieved a significant increase in titers at 1 year after vaccination,
whereas 3 did not achieve sufficient immunity evenafter vaccination.
4. VZV
Only 4 patients received vaccination against VZV.
Among them, the 2 patients who already had VZVantibodies achieved higher titers after vaccination.
However, the 2 patients without seroprotective antibody titers before vaccination showed no further
response after vaccination.

Discussion
In this study, pre-transplant MMRV antibody titers
were maintained above 80% in most patients, even after
chemotherapy. At 2 years post-transplant, the percentage of patients maintaining seroprotective titers wasclearly reduced for all four viruses. Vaccine-induced
seroconversion was seen in a certain number ofpatients, but a portion of patients showed no responseto the vaccination.
Measles antibody titers were maintained in many ofour patients at 2 years post-transplant. Kawamura et al.
[15] reported a 2-year post-transplant seropositive rateof 60.6% in patients who were seropositive prior totransplant. Furthermore, Bogeholz et al. [20] found aseropositive rate of 72% even at 5 years after transplantation without vaccination. These results were comparable to the findings of the current study. On the other
hand, previous reports without regard to the time oftesting demonstrated that seropositive rates were only
20-30% [12 , 13]. Ljungman et al. [21] showed that antibody titers decay over time, so differences in the timing

Immunity against MMRV after HCT

June 2022
Table 2

251

Results of the univariate and multivariate analyses

Univariate analysis
Meales
Factors
Age< 45 years≥ 45 years
Sex
Male
FemaleDisease
Leukemia

Mumps

VZV

RubellaHR (95% CI)

P-valueHR (95% CI)

P-valueHR (95% CI)

P-valueHR (95% CI)

P-value

1.00
1.33 (0.14-12.82)

Reference
0.80

1.00
1.57 (0.51-4.85)

Reference
0.44

1.00
0.79 (0.29-2.13)

Reference
0.63

1.00
1.14 (0.41-3.16)

Reference
0.80

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

0.24 (0.03-2.35)

0.22

1.47 (0.51-4.22)

0.48

2.86 (0.82-9.95)

0.10

0.81 (0.33-2.00)

0.65

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

Lymphoma

3.75 (0.23-59.95)

0.35

1.78 (0.55-5.77)

0.34

1.11 (0.31-3.92)

0.87

0.93 (0.21-4.17)

0.93

Others4.27 (0.39-47.26)

0.23

0.67 (0.18-2.46)

0.54

0.43 (0.10-1.92)

0.27

0.97 (0.34-2.76)

0.96

Donor source
Bone marrow

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

Peripheral blood stem cell

0.35 (0.03-3.82)

0.39

0.93 (0.30-2.89)

0.90

0.81 (0.29-2.27)

0.68

0.61 (0.13-2.83)

0.53

Cord blood

1.13 (0.10-12.41)

0.92

1.56 (0.44-5.51)

0.49

0.57 (0.14-2.96)

0.57

1.30 (0.50-3.38)

0.59

Conditioning regimen
Myeloablative

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

Reduced-intensity

NANA

1.73 (0.63-4.77)

0.29

0.89 (0.31-2.51)

0.82

0.96 (0.39-2.44)

0.93

Acute GVHD
Grade 0-I

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

Grade II-IV

1.83 (0.19-17.62)

0.60

0.69 (0.16-3.04)

0.62

0.86 (0.25-2.98)

0.81

1.12 (0.64-1.95)

0.70

Chronic GVHD
No
Yes

1.00
1.88 (0.20-18.03)

Reference
0.59

1.00
1.20 (0.39-3.72)

Reference
0.75

1.00
0.86 (0.32-2.33)

Reference
0.77

1.00
1.14 (0.41-3.16)

Reference
0.80

Multivariate analysis
Meales
Factors
Sex
Male
FemaleChronic GVHD
No
Yes

Mumps

HR (95% CI)

P-valueVZV

HR (95% CI)

P-value

RubellaHR (95% CI)

P-valueHR (95% CI)

P-value

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

0.26 (0.02-3.00)

0.28

1.51 (0.52-4.37)

0.45

2.84 (0.81-9.93)

0.10

0.82 (0.33-2.01)

0.66

1.00

Reference

1.00

Reference

1.00

Reference

1.00

Reference

1.00 (0.08-11.85)

1.00

1.27 (0.41-3.96)

0.68

0.94 (0.35-2.55)

0.90

1.13 (0.40-3.13)

0.82

of testing may have contributed to the variability of
results among these studies. They also showed thatpatients who acquired antibodies through vaccination
tended to lose them earlier than those who acquired
them through natural infection. In addition, bloodtransfusions and immunoglobulin supplementation
may have also affected the results, but these data were
not available in this study.
In mumps, about half of the patients were seronegative by the VIDAS assay in our study. A previous study
reported that about 39.7% of patients were antibody

positive at 2 years post-HCT, as determined by EIA[15]. However, the same group reported less than 10%
seropositivity for mumps at 6 years post-transplant [21].
Since the antibody titer threshold for mumps has not yet
been determined, vaccination is currently recommended for all patients undergoing HCT at our institute. Vaccination for rubella was also recommended forabout half of our patients. A previous report showedthat the seropositive rate for rubella at 2 years posttransplant was 52.2% [15]. Another report suggested
that seropositivity against rubella at 5 years post-

252

Yoshida et al.

Acta Med. Okayama Vol. 76, No. 3

Measles

20

3

Mumps

2.5

15

2
1.5

10

1

5

<4

0

Before

0

After

< 0.5

0.5

BeforeRubella

VZV

300

12

250

10

200

8

150

6

100

4

50

< 16

0

Before

After

After

<5

2
0

Beforetransplant was less than 65% [20]. Reports on VZV
serostatus are limited. Aoki et al. [13] reported that
55.4% of their patients undergoing allo-HCT were antibody positive at a median of 4.4 years post-transplant.
Another study demonstrated that the antibody titers formeasles and mumps decreased to 10% at 10 years
post-transplant [21]. Thus, long-term follow-up of
antibody titers is necessary, especially in patients who
cannot be vaccinated.
In this study, we also examined factors associatedwith antibody loss in pre-transplant seropositive
patients. Previous reports have shown that a history ofacute GVHD may be associated with antibody negativity [22]. Some reports have suggested an association
between chronic GVHD and antibody loss [13 , 15 , 20].
In our analysis, however, we did not find any factors
associated with the loss of immunity. Future studies
with a larger number of cases are needed.
Finally, we assessed the response to vaccination. In
our study, the seroconversion rate was 100% (3/3) for
measles, 33.3% (1/3) for mumps, 50% (3/6) for rubella,and 0% (0/2) for VZV. Inaba et al. [12] conducted alongitudinal analysis in pediatric cases. They reported
that more than 60% of patients vaccinated for measles

After

Fig. 4
Changes in antibody titers between
before and 1 year after vaccination. The
threshold of the protective antibody titer isindicated by the dotted line for each virus.

and mumps and more than 90% of patients vaccinated
for rubella were seropositive one year after vaccination.
Furthermore, these antibody titers were maintainedeven after 5 years. A study in adult patients after allogeneic transplantation found a combined seroconversion
rate by vaccination of > 60% for mumps and rubella,but only 35.7% for mumps alone [15]. These results
might be due to the stricter seropositivity threshold in
the present analysis compared to the latter study.
Because the seroprotective antibody titer threshold formumps has not been defined, the results for mumps
serostatus should be interpreted with caution. It has
been reported that seroconversion was not obtained inabout 30% of cases even after vaccination [7], or that
antibody titer decreased even if seroprotective antibody
was obtained. Thus, it is important to monitor antibody titers even after vaccination.
This study has some limitations. First, this is a retrospective observation study with a small sample size.
Second, the serological testing methods varied between
before and after transplantation. Therefore, analyzing
the quantitative changes in antibody titers was not possible. Third, no information was available on the
MMRV serostatus of donors, which could have affectedImmunity against MMRV after HCT

June 2022

the seropositivity of recipients after transplant.
Our analysis of the serostatus of MMRV before and2 years after transplant and the response to vaccination
revealed that 30-50% of patients did not have protective
antibodies at 2 years after allo-HCT. A response to vaccination was observed in a subset of patients, but further studies are warranted to clarify the effects of vaccination.
Acknowledgments. The authors would like to express their appreciation for the contributions of all the doctors and nurses at Okayama
University Hospital. The authors also thank Enago (www.enago.jp) for the
English language review.

12.

13.

14.

References
1.
2.

3.
4.

5.

6.

7.
8.
9.

10.

11.

Kaplan LJ, Daum RS, Smaron M and McCarthy CA: Severe measles in immunocompromised patients. JAMA (1992) 267: 12371241.
Nakano T, Shimono Y, Sugiyama K, Nishihara H, Higashigawa M,
Komada Y, Ito M, Sakurai M, Yoshida A, Kitamura K, Ihara T,
Kamiya H, Hamazaki M and Sata T: Clinical features of measles
in immunocompromised children. Acta Paediatr Jpn (1996) 38:
212-217.
Machado CM, Goncalves FB, Pannuti CS, Dulley FL and de
Souza VA: Measles in bone marrow transplant recipients during an
outbreak in Sao Paulo, Brazil. Blood (2002) 99: 83-87.
Hackanson B, Zeiser R, Bley TA, Pantazis G, Huzly D and Finke J:
Fatal varicella zoster virus encephalitis in two patients following
allogeneic hematopoietic stem cell transplantation. Clin Transplant(2005) 19: 566-570.
Kikuchi T, Arai M, Koda Y, Kato J, Shimizu T, Katano H, FujiiNishimura Y, Sakamoto M, Ebinuma H, Nakamoto N, Kanai T,
Okamoto S and Mori T: Late-onset visceral varicella-zoster virus
infection presented as acute liver failure after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis (2019) 21:
e13121.
Ljungman P, Engelhard D, de la Camara R, Einsele H,
Locasciulli A, Martino R, Ribaud P, Ward K and Cordonnier C:
Vaccination of stem cell transplant recipients: recommendationsof the Infectious Diseases Working Party of the EBMT. Bone
Marrow Transplant (2005) 35: 737-746.
Small T: Vaccination of children following allogeneic stem celltransplantation. Biol Blood Marrow Transplant (2008) 14: 54-58.
Ljungman P, Cordonnier C, Einsele H, Englund J, Machado CM,
Storek J and Small T: Vaccination of hematopoietic cell transplant
recipients. Bone Marrow Transplant (2009) 44: 521-526.
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M,
Bousvaros A, Djanireddy S, Sung L, Keyserling H and Kang I:
2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis (2014) 58: 309-318.
Spoulou V, Giannaki M, Vounatsou M, Bakoula C and Grafakos S:
Long-term immunity to measles, mumps and rubella after MMR
vaccination among children with bone marrow transplants. Bone
Marrow Transplant (2004) 33: 1187-1190.
Patel SR, Ortin M, Cohen BJ, Borrow R, Irving D, Sheldon J andHeath PT: Revaccination with measles, tetanus, poliovirus,

15.

16.

17.

18.

19.
20.

21.

22.

253

Haemophilus inﬂuenzae type B, meningococcus C, and pneumococcus vaccines in children after hematopoietic stem cell transplantation. Clin Infect Dis (2007) 44: 625-634.
Inaba H, Hartford CM, Pei D, Posner MJ, Yang J, Hayden RT,
Srinvasan A, Triplett BM, McCullers JA, Pui CH and Leung W:
Longitudinal analysis of antibody response to immunization in paediatric survivors after allogeneic haematopoietic stem cell transplantation. Br J Haematol (2012) 156: 109-117.
Aoki T, Kamimura T, Yoshida S, Mori Y, Kadowaki M, Kohno K,
Ishinara D, Urata S, Sugio T, Kamezaki K, Kato K, Ito Y, Eto T,
Akashi K and Miyamoto T: Safety and Seropositivity after Live
Attenuated Vaccine in Adult Patients Receiving Hematopoietic
Stem Cell Transplantation. Biol Blood Marrow Transplant (2019)25: 1576-1585.
Robin C, Mariaggi AA, Redjoul R, Leclerc M, Beckerich F,
Cabanne L, Pautas C, Maury S, Rozenberg F and Cordonnier C:
Long-Term Immunity to Measles after Allogeneic Hematopoietic
Cell Transplantation: Factors Associated with Seroprotection before
Revaccination. Biol Blood Marrow Transplant (2020) 26: 985-991.
Kawamura K, Wada H, Nakasone H, Akahoshi Y, Kawamura S,
Takeshita J, Yoshino N, Misaki Y, Yoshimura K, Gomyo A,
Tamaki M, Kusuda M, Kameda K, Sato M, Tanihara A, Kimura
SI, Kako S and Kanda Y: Immunity and Vaccination Against
Measles, Mumps, and Rubella in Adult Allogeneic Hematopoietic
Stem Cell Transplant Recipients. Transplant Cell Ther (2021) 27:
436 e1-e8.
Zuﬀerey J, Jacquier P, Chappuis S, Spinnler O, Hohlfeld P,
Zuber PL and Bille J: Seroprevalence of rubella among women ofchildbearing age in Switzerland. Eur J Clin Microbiol Infect Dis(1995) 14: 691-696.
Dina J, Creveuil C, Gouarin S, Viron F, Hebert A, Freymuth F
and Vabret A: Performance Evaluation of the VIDAS((R)) Measles
IgG Assay and Its Diagnostic Value for Measuring IgG Antibody
Avidity in Measles Virus Infection. Viruses (2016) 8: 234.
Rezahosseini O, Sorensen SS, Perch M, Ekenberg C, Moller DL,
Knudsen AD, Kirkby N, Lundgren J, Lodding, IP, Wareham NE,
Gustafsson F, Rasmussen A and Nielsen SD: Measles, mumps,
rubella, and varicella-zoster virus serology and infections in solidorgan transplant recipients during the ﬁrst year post-transplantation.
Clin Infect Dis (2020) in press.
Kanda Y: [Statistical analysis using freely-available “EZR (Easy R)”
software]. Rinsho Ketsueki (2015) 56: 2258-2266.
Bogeholz J, Russkamp NF, Wilk CM, Gourri E, Haralambieva E,
Schanz U, Mueller NJ, Manz MG and Muller AMS: Long-Term
Follow-Up of Antibody Titers Against Measles, Mumps, and Rubella
in Recipients of Allogenic Hematopoietic Cell Transplantation. Biol
Blood Marrow Transplant (2020) 26: 581-592.
Ljungman P, Lewensohn-Fuchs I, Hammarstrom V, Aschan J,
Brandt L, Bolme P, Lonnqvist B, Johansson N, Ringden O and
Gahrton G: Long-term immunity to measles, mumps, and rubella
after allogeneic bone marrow transplantation. Blood (1994) 84:
657-663.
Kawamura K, Yamazaki R, Akahoshi Y, Nakano H, Ugai T,
Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Ashizawa M,
Sato M, Terasako-Saito K, Kimura S, Kikuchi M, Nakasone H,
Kanda J, Kako S, Tanihara A, Nishida J and Kanda Y: Evaluationof the immune status against measles, mumps, and rubella inadult allogeneic hematopoietic stem cell transplantation recipients.
Hematology (2015) 20: 77-82.