Cytomegalovirus Viremia in Renal Transplant Recipients After Influenza Vaccination

Abstract

Vaccination with the inactivated influenza vaccine is routinely recommended for all patients before and after transplant, with reduction in complications noted in transplant recipients. The vaccine is relatively well tolerated with few mild side effects. Cytomegalovirus (CMV) infection can reactivate in both solid organ transplant and hematopoietic stem cell transplant recipients, with some patients progressing to disease. There are multiple factors known to contribute to reactivation and subsequent CMV disease, however vaccination has not been reported as a specific risk factor. We report on two renal transplant recipients who were seen to develop CMV viremia and CMV disease after receiving the Influenza vaccine. We review the literature regarding viremia occurring after vaccination in HIV patients (a similar group of immunocompromised patients).

CMV Infection Following mRNA SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients

“…Overall, CMV reactivation after vaccination in solid organ transplant recipients appears to be very rare, and to our knowledge there is only 1 published report of 2 cases of CMV DNAemia viremia in kidney transplant recipients after receiving an inactivated influenza vaccine. 8 Our case series is the first to describe CMV DNAemia after COVID-19 vaccination in solid organ transplant recipients. By virtue of its observational nature, our study is unable to draw a causal association between vaccination and CMV infections.…”

“…Potential causes of CMV infection following COVID-19 mRNA vaccination may include "immune senescence" or dysregulation of the immune system. [7][8][9][10][11][12] As patients with latent CMV age, more of their T-cell pool is directed toward keeping CMV latent. Thus, when faced with a novel virus like SARS-CoV-2, the immune system may be unable to appropriately expand the naïve T-cell pool and develop an adequate immune response 13 without compromising immunity geared toward keeping CMV at bay.…”