{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T17:04:29Z","timestamp":1769706269835,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"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 Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>An ongoing quality improvement process was used to increase live and inactivated vaccination rates among vaccine\u2010eligible pediatric liver transplant patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We evaluated 4\u2010year outcomes (2019\u20132023) of Plan\u2010Do\u2010Study\u2010Act (PDSA) cycles to guide vaccine counseling and management for pediatric liver transplant recipients. The annual posttransplant visit was used to provide families education regarding live and inactivated immunizations and obtain antibody titers for varicella, measles, mumps, rubella,\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Haemophilus influenzae<\/jats:italic>\n                      <\/jats:styled-content>\n                      type b, hepatitis A and hepatitis B. Vaccine recommendations were based on clinical criteria determined by our multidisciplinary team. Recommendations were then communicated with families and primary care providers (PCPs). Immunizations were administered by PCPs. Titers were obtained 4\u2009weeks following immunization to assess response.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010four patients met inclusion criteria. Recommendations for live (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200938) and inactivated (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200949) vaccines were given to patients. At the end of cycle 4, there was a notable increase in the number of patients who achieved protective titers to all live and inactivated vaccines in comparison to the start of cycle 1. The protective antibody titers to live vaccines declined in nearly half of our patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923\/54, 43%), with the majority being to varicella vaccine and a smaller number to measles vaccine. However, most patients who were reimmunized (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913\/14, 93%) had protective antibody titers following booster administration. There were no serious adverse effects to live vaccines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We successfully recommended vaccinations and documented vaccine\u2010induced immunity by implementing an active vaccine education and screening program. For PDSA cycle 5, we plan to continue our current practice and offer vaccines in transplant clinic, an identified barrier to vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70259","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T18:24:21Z","timestamp":1767810261000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Vaccinations in the Pediatric Transplant Population: 4\u2010Year Quality Improvement Outcomes"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4390-1904","authenticated-orcid":false,"given":"Lama","family":"Alibrahim","sequence":"first","affiliation":[{"name":"Marshfield Clinic Health System  Marshfield Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9885-3700","authenticated-orcid":false,"given":"Alexis","family":"Gumm","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carly","family":"Knapp","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janelle","family":"Rueter","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna R.","family":"Huppler","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Infectious Disease Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernadette","family":"Vitola","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3760-7127","authenticated-orcid":false,"given":"Stacee M.","family":"Lerret","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition Medical College of Wisconsin  Milwaukee Wisconsin 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https:\/\/www.cdc.gov\/measles\/cases\u2010outbreaks.html."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.12.021"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.4954"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002936"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14502"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2015.01.075"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20103046.2005.00403.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13563"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14076"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14687"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.37602"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16937"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13804"},{"key":"e_1_2_9_17_1","volume-title":"Epidemiology 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