{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:21:28Z","timestamp":1783113688393,"version":"3.54.6"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Live vaccination in patients with vascular anomalies (VA) receiving sirolimus remains controversial due to immunosuppressive effects and theoretical risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>This single\u2010center retrospective study included patients with VA less than 4\u00a0years old at the start of sirolimus therapy who were incompletely vaccinated. Immunologic evaluation during sirolimus therapy was categorized as normal, abnormal, or no\/partial evaluation. Based on results, patients were encouraged to proceed with live attenuated vaccinations (varicella zoster virus [VZV]; measles\u2013mumps\u2013rubella [MMR]) or discussed with immunology. Vaccination outcomes were reviewed and reported descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 45 eligible patients, 24 (53%) underwent complete immunologic evaluation. Thirteen of these (54%) had normal results; five of these (38%) were vaccinated while on sirolimus without complication. Eleven (46%) had abnormal evaluations; four of these (36%) were vaccinated while on sirolimus, with one developing a self\u2010limiting varicella\u2010like rash and fever. Twenty\u2010one patients (47%) had partial or no immunological evaluation; 10 of these (48%) proceeded with vaccination while on sirolimus without complications. Overall, 24 patients (53%) received live vaccines (19 on sirolimus, five after holding sirolimus therapy for at least 2\u00a0months), with only one experiencing a mild vaccine\u2010related event. No life\u2010threatening complications occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In young patients with VA receiving sirolimus, live vaccine\u2010associated infection risk appears low and comparable to rates in solid organ transplant recipients on immunosuppression. Immunologic evaluation may help identify those at higher risk, though most tolerated vaccination without adverse events. Our practice prioritizes varicella vaccination first, given the availability of effective treatment for potential complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70335","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:54:32Z","timestamp":1776772472000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Live Virus Vaccination in Patients With Vascular Anomalies Being Treated With Sirolimus"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7604-3849","authenticated-orcid":false,"given":"Svatava","family":"Merkle","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Division of Hematology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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Bone Marrow Transplant and Immunology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0820-4924","authenticated-orcid":false,"given":"Adrienne M.","family":"Hammill","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Division of Hematology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissa","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Division of Hematology Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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