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Shan DM, Chandy RJ, Fultz A, Sanders JW, Feldman SR. Live vaccinations in dermatology for immunosuppressed patients: a narrative review. Arch Dermatol Res 2024; 316:96. [PMID: 38430244 DOI: 10.1007/s00403-024-02827-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/06/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
Given the higher susceptibility to infectious disease in patients receiving immunosuppressive therapies for inflammatory dermatologic conditions, immunization is important in this population. While live vaccines protect against life-threatening diseases, they can be harmful in immunosuppressed patients given the risk of replication of the attenuated pathogen and adverse reactions. The utilization of live vaccines in immunosuppressed patients depends on multiple factors such as the vaccine and therapy regimen. To provide an overview of evidence-based recommendations for the use of live vaccines in patients receiving immunosuppressive therapies for dermatological conditions. A literature search of the PubMed database was performed using keywords live vaccine, live-attenuated vaccine, dermatology, immunosuppressed, and immunocompromised, and specific immunosuppressive therapies: corticosteroids, glucocorticoids, methotrexate, azathioprine, cyclosporine, mycophenolate mofetil, biologics. Relevant articles written in English were included. Using these keywords, 125 articles were reviewed, of which 28 were ultimately selected. Recommendations for live vaccines can be determined on a case-by-case basis. Measles, mumps, rubella, varicella (MMRV) vaccines may be safely administered to patients on low-dose immunosuppressive agents while the yellow fever vaccine is typically contraindicated. It may be safe to administer live MMRV boosters to children on immunosuppressive therapies and the live herpes zoster vaccine to patients on biologics. Given poor adherence to immunization guidelines in immunosuppressed patients, dermatologists have a critical role in educating patients and general practitioners regarding live vaccines. By reviewing a patient's vaccination history and following immunization guidelines prior to initiating immunosuppressive therapies, physicians can mitigate morbidity and mortality from vaccine-preventable diseases.
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Affiliation(s)
- Divya M Shan
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Andrew Fultz
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - John W Sanders
- Department of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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2
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Siegfried EC, Wine Lee L, Spergel JM, Prescilla R, Uppal S, Coleman A, Bansal A, Cyr SL, Shumel B. A case series of live attenuated vaccine administration in dupilumab-treated children with atopic dermatitis. Pediatr Dermatol 2024; 41:204-209. [PMID: 38308453 DOI: 10.1111/pde.15518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/16/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Current regulatory labeling recommends avoiding live vaccine use in dupilumab-treated patients. Clinical data are not available to support more specific guidance for live or live attenuated vaccines administration in dupilumab-treated patients. METHODS Children (6 months-5 years old) with moderate-to-severe atopic dermatitis (AD) enrolled in a phase 2/3 clinical trial of dupilumab (LIBERTY AD PRESCHOOL Part A/B; NCT03346434) and subsequently participated in the LIBERTY AD PED-OLE (NCT02612454). During these studies, protocol deviations occurred in nine children who received measles, mumps, rubella (MMR) vaccine with or without varicella vaccine; five with a ≤12-week gap between dupilumab administration and vaccination and four with a >12-week gap after discontinuing dupilumab. RESULTS Nine children (1 female; 8 male) had severe AD at baseline (8-56 months old). Of the nine children, five had a ≤12-week gap ranged 1-7 weeks between dupilumab administration and vaccination who received MMR vaccine (n = 2) or MMR and varicella vaccines (n = 3); among these, one resumed dupilumab treatment as early as 2 days and four resumed treatment 18-43 days after vaccination. No treatment-emergent adverse events, including serious adverse events and infections, were reported within the 4-week post-vaccination period in any children. CONCLUSIONS In this case series of dupilumab-treated children with severe AD who received MMR vaccine with or without varicella vaccine, no adverse effects (including vaccine-related infection) were reported within 4 weeks after vaccination. Further studies are warranted to evaluate the safety, tolerability, and immune response to live attenuated vaccines in dupilumab-treated patients.
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Affiliation(s)
- Elaine C Siegfried
- Department of Dermatology and Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatric Dermatology, Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan M Spergel
- Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Sumeet Uppal
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | - Ashish Bansal
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Sonya L Cyr
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Brad Shumel
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
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Huang L, Chen Z, Song Y, Tan J, Jia N, You W, Yuan H, Feng G, Li C, Luan C, Quan Y, Wang Y. Immunogenicity and safety of a live-attenuated varicella vaccine in a healthy population aged 13 years and older: A randomized, double-blind, controlled study. Vaccine 2024; 42:396-401. [PMID: 38057208 DOI: 10.1016/j.vaccine.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/27/2023] [Accepted: 10/13/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES Vaccines for prevention against varicella are important for adolescents and adults, who have an increased risk of severe varicella. This study aimed to evaluate the immunogenicity and safety of a two-dose immunization schedule of a live-attenuated varicella vaccine (VarV) manufactured by Sinovac (Dalian) in healthy adolescents and adults. METHODS A randomized, double-blind, controlled clinical trial was conducted in healthy population aged ≥ 13 years old in China. Participants in block 1 were randomly assigned (1:1) to receive two doses of either the test vaccine or an active control vaccine, administered 4, 6 or 8 weeks apart. Participants in block 2 were randomly assigned (2:1) to receive two doses of test vaccine or placebo, administered 10 weeks apart. The primary immunogenicity endpoint was the seroconversion rates and GMTs of varicella zoster virus (VZV) antibodies measured by fluorescent-antibody-to-membrane-antigen (FAMA) 4 weeks post-immunization. The primary safety endpoint was the incidence of adverse reactions within 4 weeks after each dose. RESULTS A total of 2398 participants were enrolled. The seroconversion rates of VZV antibodies were 79.55 % in the test group and 76.41 % in the active control group respectively 4 weeks after two doses of pooled schedule, with the difference of 3.14 % (95 %CI: -0.69 %, 6.97 %). The GMTs were 1:162.07 and 1:160.04 respectively, with the ratio of 1.013 (95 %CI: 0.910, 1.127). Both the seroconversion rates and GMTs reached the prespecified non-inferiority criteria. Two-dose schedule with an interval of 10 weeks could also induce high immune responses, with a seroconversion rate of 83.22 % and a GMT of 1:160.38 in the test group. Safety profiles were similar among the test group, active control group and placebo group. CONCLUSION VarV, manufactured by Sinovac (Dalian), demonstrated higher immune response and better flexibility in the immunization schedule among heathy population aged 13 years and older, without increased safety risk.
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Affiliation(s)
- Lili Huang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Zhen Chen
- National Institutes for Food and Drug Control, Beijing, China
| | - Yufei Song
- Sinovac Biotech Co., Ltd., Beijing, China
| | - Jiebing Tan
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | | | - Wangyang You
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Hongxue Yuan
- Sinovac (Dalian) Vaccine Technology Co., Ltd., Dalian, China
| | - Guangwei Feng
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Changgui Li
- National Institutes for Food and Drug Control, Beijing, China
| | - Chunfang Luan
- Sinovac (Dalian) Vaccine Technology Co., Ltd., Dalian, China.
| | - Yaru Quan
- National Institutes for Food and Drug Control, Beijing, China.
| | - Yanxia Wang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China.
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Jordan Z, Rowland E. Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review. Vaccine 2024; 42:75-83. [PMID: 38129287 DOI: 10.1016/j.vaccine.2023.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness. OBJECTIVE To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns. DESIGN Qualitative systematic review and thematic analysis. METHODS Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes. RESULTS 22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision. CONCLUSIONS Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule. REGISTRATION The review was registered on PROSPERO, registration ID CRD42021236120.
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Affiliation(s)
- Zoe Jordan
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK; University Hospitals Bristol and Weston NHS Foundation Trust, UK.
| | - Emma Rowland
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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5
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Miller C, Taylor-Salmon E, Emuren L, Landry M, Gershon A, Miller G. Progressive shingles in a toddler due to reactivation of Varicella Zoster vaccine virus four days after infection with SARS-CoV-2; a case report. BMC Infect Dis 2023; 23:854. [PMID: 38057696 PMCID: PMC10698951 DOI: 10.1186/s12879-023-08809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) is the clinical syndrome associated with reactivation of latent varicella-zoster virus (VZV). Several factors have been implicated to promote VZV reactivation; these include immunosuppression, older age, mechanical trauma, physiologic stress, lymphopenia, and more recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Recent reports suggest an increase in the number of HZ cases in the general population during the global COVID-19 pandemic. However, it is unknown what proportion of HZ during the pandemic is due to reactivation of wild-type or vaccine-strain VZV. CASE Here we report the first known case of HZ concomitant with SARS-CoV2 infection in a 20-month-old female who was treated with a single dose of dexamethasone, due to reactivation of the vaccine-type strain of VZV after presenting with a worsening vesicular rash. CONCLUSION In this case, we were able to show vaccine-strain VZV reactivation in the context of a mild acute symptomatic COVID-19 infection in a toddler. Being able to recognize HZ quickly and effectively in a pediatric patient can help stave off the significant morbidity and mortality associated with disease process.
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Affiliation(s)
- Christine Miller
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA
| | - Emma Taylor-Salmon
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA
| | - Leonard Emuren
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA
| | - Marie Landry
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Anne Gershon
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - George Miller
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA.
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Piché-Renaud PP, Yue Lee E, Ji C, Qing Huang JY, Uleryk E, Teoh CW, Morris SK, Top KA, Upton JEM, Vyas MV, Allen UD. Safety and immunogenicity of the live-attenuated varicella vaccine in pediatric solid organ transplant recipients: A systematic review and meta-analysis. Am J Transplant 2023; 23:1757-1770. [PMID: 37321454 DOI: 10.1016/j.ajt.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
This study aimed to synthesize the available evidence on the immunogenicity, safety, and effectiveness of live-attenuated varicella vaccine in solid organ transplant recipients. Medline and EMBASE were searched using predefined search terms to identify relevant studies. The included articles reported varicella vaccine administration in the posttransplant period in children and adults. A pooled proportion of transplant recipients who seroconverted and who developed vaccine-strain varicella and varicella disease was generated. Eighteen articles (14 observational studies and 4 case reports) were included, reporting on 711 transplant recipients who received the varicella vaccine. The pooled proportion was 88.2% (95% confidence interval 78.0%-96.0%, 13 studies) for vaccinees who seroconverted, 0% (0%-1.2%, 13 studies) for vaccine-strain varicella, and 0.8% (0%-4.9%, 9 studies) for varicella disease. Most studies followed clinical guidelines for administering live-attenuated vaccines, with criteria that could include being at least 1 year posttransplant, 2 months postrejection episode, and on low-dose immunosuppressive medications. Varicella vaccination in transplant recipients was overall safe in the included studies, with few cases of vaccine-strain-induced varicella or vaccine failure, and although it was immunogenic, the proportion of recipients who seroconverted was lower than that seen in the general population. Our data support varicella vaccination in select pediatric solid organ transplant recipients.
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Affiliation(s)
- Pierre-Philippe Piché-Renaud
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Erika Yue Lee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Clinical Immunology and Allergy, St. Michael's Hospital, Toronto, Ontario, Canada; Eliot Phillipson Clinician Scientist Training Program, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Ji
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Jenny Yu Qing Huang
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Chia Wei Teoh
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Global Child Health, the Hospital for Sick Children, Toronto, Ontario, Canada; Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karina A Top
- Departments of Pediatrics and Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia E M Upton
- Division of Immunology and Allergy, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manav V Vyas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton D Allen
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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7
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Berman MA, Rupp RE. Disseminated vaccine-induced varicella infection in a kidney transplant recipient. Am J Transplant 2023; 23:1806-1810. [PMID: 37286085 DOI: 10.1016/j.ajt.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
A 33-year-old kidney transplant (KT) recipient presented with a disseminated pruritic, painful, vesicular rash and hepatitis 3 weeks after receiving a varicella vaccine (VAR). A skin lesion biopsy sent to the Centers for Disease Control and Prevention for genotyping confirmed vaccine-strain varicella-zoster virus (VZV) (Oka strain; vOka). The patient was successfully treated with intravenous acyclovir during a prolonged hospital stay. This case supports the contraindication of VAR in adult KT recipients and highlights the potential for severe illness when used in this population. Optimally, VZV-seronegative KT candidates should receive VAR before starting immunosuppressive medications. If this opportunity is missed, the recombinant varicella-zoster vaccine might be considered following transplantation as it is already recommended to prevent herpes zoster in VZV-seropositive immunocompromised adults. Further study is needed as data are limited on the safety and efficacy of recombinant varicella-zoster vaccine for primary varicella prevention in VZV-seronegative immunocompromised adults.
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Affiliation(s)
- Megan A Berman
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA; Sealy Institute of Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA.
| | - Richard E Rupp
- Sealy Institute of Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA; Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
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8
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Feldman AG, Beaty BL, Ferrolino JA, Maron G, Weidner HK, Ali SA, Bitterfeld L, Boulware MA, Campbell KM, Carr E, Chapman S, Chang YC, Cunningham R, Dallas RH, Dantuluri KL, Domenick BN, Ebel NH, Elisofon S, Fawaz R, Foca M, Gans HA, Gopalareddy VV, Gu C, Gupta NA, Harmann K, Hollenbeck J, Huppler AR, Jaramillo C, Kasi N, Kerkar N, Lerret S, Lobritto SJ, Lopez MJ, Marini E, Mavis A, Mehra S, Moats L, Mohandas S, Munoz FM, Mysore KR, Onsan C, Ovchinsky N, Perkins K, Postma S, Pratscher L, Rand EB, Rowe RK, Schultz D, Sear K, Sell ML, Sharma T, Stoll J, Vang M, Villarin D, Weaver C, Wood P, Woodford-Berry O, Yanni G, Danziger-Isakov LA. Safety and Immunogenicity of Live Viral Vaccines in a Multicenter Cohort of Pediatric Transplant Recipients. JAMA Netw Open 2023; 6:e2337602. [PMID: 37824141 PMCID: PMC10570873 DOI: 10.1001/jamanetworkopen.2023.37602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Live vaccines (measles-mumps-rubella [MMR] and varicella-zoster virus [VZV]) have not been recommended after solid organ transplant due to concern for inciting vaccine strain infection in an immunocompromised host. However, the rates of measles, mumps, and varicella are rising nationally and internationally, leaving susceptible immunocompromised children at risk for life-threating conditions. Objective To determine the safety and immunogenicity of live vaccines in pediatric liver and kidney transplant recipients. Design, Setting, and Participants This cohort study included select pediatric liver and kidney transplant recipients who had not completed their primary MMR and VZV vaccine series and/or who displayed nonprotective serum antibody levels at enrollment between January 1, 2002, and February 28, 2023. Eligibility for live vaccine was determined by individual US pediatric solid organ transplant center protocols. Exposures Exposure was defined as receipt of a posttransplant live vaccine. Transplant recipients received 1 to 3 doses of MMR vaccine and/or 1 to 3 doses of VZV vaccine. Main Outcome and Measure Safety data were collected following each vaccination, and antibody levels were obtained at 0 to 3 months and 1 year following vaccination. Comparisons were performed using Mann-Whitney U test, and factors associated with development of postvaccination protective antibodies were explored using univariate analysis. Results The cohort included 281 children (270 [96%] liver, 9 [3%] kidney, 2 [1%] liver-kidney recipients) from 18 centers. The median time from transplant to enrollment was 6.3 years (IQR, 3.4-11.1 years). The median age at first posttransplant vaccine was 8.9 years (IQR, 4.7-13.8 years). A total of 202 of 275 (73%) children were receiving low-level monotherapy immunosuppression at the time of vaccination. The majority of children developed protective antibodies following vaccination (107 of 149 [72%] varicella, 130 of 152 [86%] measles, 100 of 120 [83%] mumps, and 124 of 125 [99%] rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 [77%] varicella, 45 of 49 [92%] measles, 35 of 42 [83%] mumps, 51 of 54 [94%] rubella). Five children developed clinical varicella, all of which resolved within 1 week. There were no cases of measles or rubella and no episodes of graft rejection within 1 month of vaccination. There was no association between antibody response and immunosuppression level at the time of vaccination. Conclusions and Relevance The findings suggest that live vaccinations may be safe and immunogenic after solid organ transplant in select pediatric recipients and can offer protection against circulating measles, mumps, and varicella.
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Affiliation(s)
- Amy G. Feldman
- Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado and Children’s Hospital Colorado, Aurora
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children’s Hospital Colorado, Aurora
| | - Brenda L. Beaty
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children’s Hospital Colorado, Aurora
| | - Jose A. Ferrolino
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gabriela Maron
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Hillary K. Weidner
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Saira A. Ali
- Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Kathleen M. Campbell
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | - Shelley Chapman
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | | | - Ronald H. Dallas
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | | | - Noelle H. Ebel
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | | | | | - Marc Foca
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York
| | - Hayley A. Gans
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | | | - Cindy Gu
- Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Nitika A. Gupta
- Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Katherine Harmann
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | | | - Anna R. Huppler
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | - Nagraj Kasi
- Medical University of South Carolina Shawn Jenkins Children’s Hospital, Charleston
| | - Nanda Kerkar
- Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Stacee Lerret
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Steven J. Lobritto
- Children’s Hospital of New York, NewYork-Presbyterian Hospital, New York
| | | | | | - Alisha Mavis
- Levine Children’s Hospital at Atrium Health, Charlotte, North Carolina
| | - Sonia Mehra
- Intermountain Primary Children’s Hospital, Salt Lake City, Utah
| | | | | | - Flor M. Munoz
- Texan Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Krupa R. Mysore
- Texan Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Ceren Onsan
- C.S. Mott Children’s Hospital, Michigan Medicine, Ann Arbor
| | | | - Kerrigan Perkins
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Stacy Postma
- Washington University School of Medicine, St Louis, Missouri
| | - Lauren Pratscher
- Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado and Children’s Hospital Colorado, Aurora
| | | | - Regina K. Rowe
- Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | | | - Katherine Sear
- Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
| | - Megan L. Sell
- Medical University of South Carolina Shawn Jenkins Children’s Hospital, Charleston
| | - Tanvi Sharma
- Boston Children’s Hospital, Boston, Massachusetts
| | - Janis Stoll
- Washington University School of Medicine, St Louis, Missouri
| | - Mychoua Vang
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | - Carly Weaver
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Phoebe Wood
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - George Yanni
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Lara A. Danziger-Isakov
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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Coralie R, Ziad C, Christian R, Pierre T, Chantal B, Bruce T, Philippe O. Varicella vaccine meningoencephalitis in a child receiving autologous bone marrow transplantation. Pediatr Transplant 2023; 27:e14562. [PMID: 37395442 DOI: 10.1111/petr.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Varicella vaccine, a live-attenuated Oka-strain of varicella zoster virus (VZV), is a recommended childhood vaccine by many countries. As with wild varicella strain, after primary infection, the live-attenuated virus can establish latency in sensory ganglia and reactivate causing vaccine-strain illnesses: herpes zoster (HZ), visceral or peripheral and central nervous system dissemination. We report a case of early reactivation of live-attenuated virus-HZ and meningoencephalitis-in an immunocompromised child. METHODS This is a retrospective descriptive report of a case, in a tertiary pediatric hospital, CHU Sainte-Justine (Montréal, Canada). RESULTS An 18 month-year old girl diagnosed with a primitive neuro-ectodermal tumor (PNET) received the day prior to diagnosis, a first varicella vaccine (MMRV). She received chemotherapy 20 days post MMRV vaccine and autologous bone marrow transplantation 3 months post vaccination. She was considered not eligible, to acyclovir prophylaxis prior transplantation (positive for VZV IgG and negative for herpes simplex virus IgG by ELISA). At day 1 post transplantation, she developed dermatomal HZ and meningoencephalitis. Oka-strain varicella was isolated, she was treated with acyclovir and foscarnet. Neurologic status improved in 5 days. Control of VZV viral load in cerebrospinal fluid showed a slow decrease to from 5.24 log 10 copies/mL to 2.14 log 10 copies/mL in 6 weeks. No relapse was observed. She recovered without neurological sequelae. CONCLUSIONS Our experience highlights the importance of conducting a thorough medical history regarding vaccination and serological status of newly immunocompromised patients. Intensive chemotherapy succeeding live vaccine administration <4 weeks could have influenced early and severe viral reactivation. Early initiation of prophylactic antiviral treatment is questioned in such circumstances.
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Affiliation(s)
- Raad Coralie
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
| | - Chebel Ziad
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
| | - Renaud Christian
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
- Microbiology Division, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
| | - Teira Pierre
- Hematology and Oncology Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
| | - Buteau Chantal
- Infectious Diseases Division, Department of Pediatrics, CHUQ-Université Laval, Québec, Canada
| | - Tapiéro Bruce
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
| | - Ovetchkine Philippe
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal (QC), Montréal, Canada
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Paybast S, Sahraian MA, Nahayati MA, Habibi MA, Shahmohammadi S, Navardi S. Investigation of the safety of live attenuated varicella-zoster virus vaccination in patients with relapse-remitting multiple sclerosis treated with natalizumab: A case series and review of the literature. Mult Scler Relat Disord 2023; 77:104793. [PMID: 37413854 DOI: 10.1016/j.msard.2023.104793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/26/2023] [Accepted: 06/01/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION It is generally recommended to avoid live attenuated vaccines in patients treated with high efficacy disease-modifying treatment (DMT). However, a delay in starting DMT in highly active or aggressive multiple sclerosis (MS) might lead to a significant disability. OBJECTIVE We aimed to report a case series of 16 highly active RRMS patients who received the live-attenuated varicella-zoster virus (VZV) vaccine during treatment with natalizumab. METHODS This retrospective case series was conducted between September 2015 and February 2022 at the MS Research Center of Sina and Qaem hospital, Tehran, Mashhad, Iran, to identify the outcome of highly active MS patients who received the live-attenuated VZV vaccine on natalizumab. RESULTS Two males and 14 females were included in this study, with a mean age of 25.5 ± 8.4-year-old. 10 patients were naïve cases of highly active MS, and six were escalated to natalizumab. The patients received two doses of live attenuated VZV vaccine after a mean of 6.72 cycles of natalizumab treatment. Except for the one who experienced mild chickenpox infection, no serious adverse event or disease activity was evident after vaccination. CONCLUSION While our data do not confirm the safety of the live attenuated VZV vaccine in natalizumab recipients, it highlights the importance of case-by-case decision-making in MS management based on the risk-benefit assessment.
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Affiliation(s)
- Sepideh Paybast
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - Mohammad Ali Nahayati
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashahd, Iran
| | - Mohammad Amin Habibi
- Iranian Tissue Bank and Research Center, Gene, Cell and Tissue Institute, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Sareh Shahmohammadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - Samira Navardi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran.
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11
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Kang HM, Kang KR, Kim YJ, Kang JH, Lee SY. A booster administration of the OKA/SK strain causes fatal disseminated varicella in an immunocompetent child. J Med Virol 2023; 95:e29108. [PMID: 37715715 DOI: 10.1002/jmv.29108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
Live varicella vaccines are known to provide robust immunity against varicella zoster virus (VZV) infections. However, problems with viral attenuation have led to pathogenic VZV vaccine strains causing varicella-like rash and herpes zoster in immunocompetent children after immunization. We report the first fatal case of VZV infection caused by OKA/SK strain contained in the vaccine administrated as a booster shot in an immunocompetent child, which has been independently developed from any currently available varicella vaccines that are OKA strain or MAV/06 strain based. The patient died due to sudden pulmonary alveolar hemorrhage as a secondary complication of VZV pneumonitis. Sequencing of the four SNPs unique to the OKA/SK strain (SNP loci 14 035T; 32 626C; 58 777G; 70 319G) enabled discrimination of the strain responsible for the disseminated infection. OKA/SK strain does not have any SNPs in ORF62 postulated to be responsible for the attenuation of varicella vaccines which have been safely and effectively used world-wide or locally, and exclusively enriches a virulent factor in ORF31 identified in parental OKA strain, thus possibly resulting in disseminated VZV infection leading to mortality. Therefore, actions need to be taken to prevent vaccine related morbidity and mortality in children.
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Affiliation(s)
- Hyun Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Ri Kang
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ye Ji Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Casabona G, Berton O, Singh T, Knuf M, Bonanni P. Combined measles-mumps-rubella-varicella vaccine and febrile convulsions: the risk considered in the broad context. Expert Rev Vaccines 2023; 22:764-776. [PMID: 37642012 DOI: 10.1080/14760584.2023.2252065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/01/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Studies on quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccines have indicated a twofold increased relative risk of febrile convulsion (FC) after the first dose compared to MMR and V administered at the same medical visit (MMR+V). AREAS COVERED This narrative review contextualizes FC occurrence after the first MMRV vaccine dose from a clinical perspective and outlines approaches to attenuate FC occurrence post-vaccination. EXPERT OPINION While the relative FC risk increases after the first dose of MMRV compared to MMR+V vaccine in measles-naïve infants, the attributable risk is low versus the overall FC risk in the pediatric population triggered by other causes, like natural exposure to pathogens or routine vaccination. No increased risk of FC has been reported after MMRV co-administration with other routine vaccines compared to MMRV alone. Based on our findings and considering the MMRV vaccination benefits (fewer injections, higher coverage, better vaccination compliance), the overall benefit-risk profile of MMRV vaccine is considered to remain positive. Potential occurrence of FC in predisposed children (e.g. with personal/family history of FC) may be attenuated if they receive MMR+V instead of MMRV as the first dose. It is also important to monitor vaccinees for fever during the first 2 weeks post-vaccination.
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Affiliation(s)
| | | | | | - Markus Knuf
- Department for Pediatric and Adolescent Medicine, General Hospital Worms, General Hospital Worms, Worms, Germany
- Pediatric Infectious Diseases, University Medicine, Mainz, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
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13
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Wang W, Pan D, Cheng T, Zhu H. Rational Design of a Skin- and Neuro-Attenuated Live Varicella Vaccine: A Review and Future Perspectives. Viruses 2022; 14:848. [PMID: 35632591 PMCID: PMC9144592 DOI: 10.3390/v14050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Primary varicella-zoster virus (VZV) infection causes varicella, which remains a prominent public health concern in children. Current varicella vaccines adopt the live-attenuated Oka strain, vOka, which retains the ability to infect neurons, establish latency and reactivate, leading to vaccine-associated zoster in some vaccinees. Therefore, it is necessary to develop a safer next-generation varicella vaccine to help reduce vaccine hesitancy. This paper reviews the discovery and identification of the skin- and neuro-tropic factor, the open reading frame 7 (ORF7) of VZV, as well as the development of a skin- and neuro-attenuated live varicella vaccine comprising an ORF7-deficient mutant, v7D. This work could provide insights into the research of novel virus vaccines based on functional genomics and reverse genetics.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361102, China; (W.W.); (D.P.)
| | - Dequan Pan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361102, China; (W.W.); (D.P.)
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361102, China; (W.W.); (D.P.)
| | - Hua Zhu
- Department of Microbiology and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 070101, USA
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14
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Nichani P, Micieli JA. Granuloma Annulare, Scalp Necrosis, and Ischemic Optic Neuropathy From Giant Cell Arteritis After Varicella-Zoster Virus Vaccination. J Neuroophthalmol 2021; 41:e145-e148. [PMID: 32235218 DOI: 10.1097/wno.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Prem Nichani
- Faculty of Medicine (PN), University of Toronto, Toronto, Canada ; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada ; and Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Canada
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15
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Freij BJ, Hanrath AT, Chen R, Hambleton S, Duncan CJA. Life-Threatening Influenza, Hemophagocytic Lymphohistiocytosis and Probable Vaccine-Strain Varicella in a Novel Case of Homozygous STAT2 Deficiency. Front Immunol 2021; 11:624415. [PMID: 33679716 PMCID: PMC7930908 DOI: 10.3389/fimmu.2020.624415] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/29/2020] [Indexed: 01/15/2023] Open
Abstract
STAT2 is a transcription factor that plays an essential role in antiviral immunity by mediating the activity of type I and III interferons (IFN-I and IFN-III). It also has a recently established function in the negative regulation of IFN-I signaling. Homozygous STAT2 deficiency is an ultra-rare inborn error of immunity which provides unique insight into the pathologic consequence of STAT2 dysfunction. We report here a novel genetic cause of homozygous STAT2 deficiency with several notable clinical features. The proband presented aged 12 months with hemophagocytic lymphohistiocytosis (HLH) closely followed by clinical varicella, both occurring within three weeks of measles, mumps, and rubella (MMR) and varicella vaccinations. There was a history of life-threatening influenza A virus (IAV) disease 2 months previously. Genetic investigation uncovered homozygosity for a novel nonsense variant in STAT2 (c. 1999C>T, p. Arg667Ter) that abrogated STAT2 protein expression. Compatible with STAT2 deficiency, dermal fibroblasts from the child demonstrated a defect of interferon-stimulated gene expression and a failure to mount an antiviral state in response to treatment with IFN-I, a phenotype that was rescued by lentiviral complementation by wild type STAT2. This case significantly expands the phenotypic spectrum of STAT2 deficiency. The occurrence of life-threatening influenza, which has not previously been reported in this condition, adds STAT2 to the list of monogenetic causes of this phenotype and underscores the critical importance of IFN-I and IFN-III to influenza immunity. The development of probable vaccine-strain varicella is also a novel occurrence in STAT2 deficiency, implying a role for IFN-I/III immunity in control of attenuated varicella zoster virus in vivo and reinforcing the susceptibility to pathologic effects of live-attenuated viral vaccines in disorders of IFN-I immunity. Finally, the occurrence of HLH in this case reinforces emerging links to hyperinflammation in patients with STAT2 deficiency and other related defects of IFN-I signaling-highlighting an important avenue for further scientific enquiry.
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Affiliation(s)
- Bishara J. Freij
- Pediatric Department, Beaumont Children's Hospital, Royal Oak, MI, United States
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Aidan T. Hanrath
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Rui Chen
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Sophie Hambleton
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Christopher J. A. Duncan
- Immunity and Inflammation Theme, Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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16
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Affiliation(s)
- Si Hyun Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Se Hoon Lee
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Ramachandran V, Elliott SC, Rogers KL, Cohrs RJ, Weinberger M, Jackson W, Carpenter JE, Grose C, Bonthius DJ. Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents. J Child Neurol 2020; 35:889-895. [PMID: 32677551 PMCID: PMC7549284 DOI: 10.1177/0883073820938597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.
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Affiliation(s)
- Veena Ramachandran
- Division of Infectious Diseases, Blank Children’s Hospital, Des Moines, IA, USA
| | - Stephen C. Elliott
- Division of Hematology-Oncology, Blank Children’s Hospital, Des Moines, IA, USA
| | - Kathie L. Rogers
- Clinical Microbiology Laboratory, Blank Children’s Hospital, Des Moines, IA, USA
| | - Randall J. Cohrs
- Department of Neurology, University of Colorado Anschutz Medical
Campus, Aurora, CO, USA
| | - Miles Weinberger
- Division of Pulmonary Diseases, University of Iowa Children’s
Hospital, University of Iowa, Iowa City, IA, USA
| | - Wallen Jackson
- Division of Infectious Diseases/Virology, University of Iowa
Children’s Hospital, University of Iowa, Iowa City, IA, USA
| | - John E. Carpenter
- Division of Infectious Diseases/Virology, University of Iowa
Children’s Hospital, University of Iowa, Iowa City, IA, USA
| | - Charles Grose
- Division of Infectious Diseases/Virology, University of Iowa
Children’s Hospital, University of Iowa, Iowa City, IA, USA
- Charles Grose, MD, Division of Infectious
Diseases/Virology, University of Iowa Hospital, room BT2001, 200 Hawkins Drive,
Iowa City, IA 52242, USA.
| | - Daniel J. Bonthius
- Division of Child Neurology, University of Iowa Children’s Hospital, University of Iowa, Iowa City, IA, USA
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18
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Heusel EH, Grose C. Twelve Children with Varicella Vaccine Meningitis: Neuropathogenesis of Reactivated Live Attenuated Varicella Vaccine Virus. Viruses 2020; 12:v12101078. [PMID: 32992805 PMCID: PMC7599892 DOI: 10.3390/v12101078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
Varicella vaccine is a live attenuated varicella-zoster virus (VZV). Like its parental strain called VZV pOka, the vaccine virus vOka retains some neurotropic properties. To better understand vOka neuropathogenesis, we reassessed 12 published cases of vOka meningitis that occurred in once-immunized and twice-immunized children, all of whom had bouts of herpes zoster preceding the central nervous system infection. Eight of the 12 meningitis cases occurred in children who had received only one immunization. There was no pattern to the time interval between varicella vaccination and the onset of herpes zoster with meningitis. Four of the meningitis cases occurred in children who had received two immunizations. Since all four children were 14 years old when meningitis was diagnosed, there was a strong pattern to the interval between the first vaccination at age 1 year and onset of meningitis, namely, 13 years. Knowledge of pathogenesis requires knowledge of the location of herpes zoster; the majority of dermatomal rashes occurred at sites of primary immunization on the arm or thigh, while herpes zoster ophthalmicus was uncommon. Based on this literature review, currently there is no consensus as to the cause of varicella vaccine meningitis in twice-immunized children.
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19
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Stefanizzi P, De Nitto S, Patano F, Bianchi FP, Ferorelli D, Stella P, Ancona D, Bavaro V, Tafuri S. Post-marketing surveillance of adverse events following measles, mumps, rubella and varicella (MMRV) vaccine: retrospecive study in apulia region (ITALY), 2009-2017. Hum Vaccin Immunother 2020; 16:1875-1883. [PMID: 32040350 PMCID: PMC7482746 DOI: 10.1080/21645515.2019.1704124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/20/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022] Open
Abstract
Since 2006, some Italian Regions introduced the active offer of measles, mumps, rubella, and varicella (MMRV) vaccine for all newborns during the second years of life. In 2011, Italian Drug Authority (AIFA) recommended the discontinuation of the MMRV use for an increased risk of febrile seizures following vaccination; furthermore, some Regions (such as Apulia, that introduced MMRV offer in 2009) chose to continue the use of MMRV and Ministry of Health recommended to guarantee supplemental monitoring of safety of the vaccine. In Italy, the surveillance of Adverse Events following immunization (AEFIs) is currently carried out by AIFA and Regional Health Authorities; this paper aims to summarize the results of MMRV-vaccine surveillance of AEFIs program carried out in Apulia. From the AIFA database, we selected MMRV AEFIs that occurred in Apulia (about 4,000,000 inhabitants) from 2009 to 2017. For serious AEFIs, we applied the WHO causality assessment algorithm, using for cases hospitalized information from individual medical records. In the 8 years of observation, 155 MMRV-AEFIs (reporting rate: 37.9×100,000 doses) occurred of which 26 were classified as serious (6.3×100,000 doses) and 22 led to hospitalization. Performing causality assessment, for 10 the classification was "consistent causal association to immunization" (reporting rate: 2.4×100000 doses), for 2 indeterminate, for 13 "inconsistent causal association to immunization" and for 1 not-classifiable. No case of febrile seizure resulted consistent to vaccination. All consistent serious AEFIs were completely resolved at subsequent follow-up.
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Affiliation(s)
- Pasquale Stefanizzi
- Biomedical Science and Human Oncology, Universita degli Studi di Bari Aldo Moro, Bari, Italy
| | - Sara De Nitto
- Biomedical Science and Human Oncology, Universita degli Studi di Bari Aldo Moro, Bari, Italy
| | - Francesco Patano
- Biomedical Science and Human Oncology, Universita degli Studi di Bari Aldo Moro, Bari, Italy
| | - Francesco Paolo Bianchi
- Biomedical Science and Human Oncology, Universita degli Studi di Bari Aldo Moro, Bari, Italy
| | - Davide Ferorelli
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | | | | | - Vito Bavaro
- Biomedical Science and Human Oncology, Universita degli Studi di Bari Aldo Moro, Bari, Italy
| | - Silvio Tafuri
- Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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20
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Grose C, Enquist LW. The round trip model for severe herpes zoster caused by live attenuated varicella vaccine virus. J Med Virol 2020; 92:938-940. [PMID: 31943220 PMCID: PMC7354881 DOI: 10.1002/jmv.25664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
Varicella vaccine is a live attenuated varicella‐zoster virus. Varicella vaccine can enter latency and later reactivate as herpes zoster. Pseudorabies virus is another herpesvirus closely related to varicella‐zoster virus. The round trip model for pseudorabies virus explains pathogenesis of herpes zoster from vaccine virus.
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Affiliation(s)
- Charles Grose
- Virology Laboratory, Children's Hospital, University of IowaIowaIowa
| | - Lynn W. Enquist
- Department of Molecular BiologyPrinceton UniversityPrincetonNew Jersey
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21
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Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
| | - Alessandro Rivetti
- ASL CN2 Alba Bra, Dipartimento di Prevenzione - S.Pre.S.A.L, Via Vida 10, Alba, Piemonte, Italy, 12051
| | - Pasquale Marchione
- Italian Medicine Agency - AIFA, Signal Management Unit, Post-Marketing Surveillance Department, Via del Tritone 181, Rome, Italy, 00187
| | | | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
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Pelekouda E, Papagiannis D, Tsiaousi I, Maltezou HC. Herpes zoster after vaccination with one dose varicella vaccine to a 4-year-old child. Infez Med 2019; 27:449-451. [PMID: 31846998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clinical observations from the international literature report that herpes zoster occurs after varicella vaccination in immunocompetent children. We present the case of a four-year-old immunocompetent girl who developed herpes zoster after she had received one dose of varicella-zoster virus live attenuated vaccine at the age of 15 months. Continued surveillance for herpes zoster among vaccinated persons is important to evaluate the varicella vaccination program and to detect any changes in the epidemiology of herpes zoster. Vaccinated children appear to have a lower risk of herpes zoster than people who were infected naturally with varicella zoster virus (chickenpox).
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Affiliation(s)
| | | | | | - Helena C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
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Ortiz-Brizuela E, Leal-Vega F, Cuellar-Rodríguez J, Bobadilla-Del-Valle M, Ponce-de-León A. Vaccine-derived varicella zoster infection in a kidney transplant recipient after zoster vaccine live administration. Vaccine 2019; 37:3576-3579. [PMID: 31109718 DOI: 10.1016/j.vaccine.2019.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
A 49-year-old kidney transplant recipient, presented with a skin rash, and interstitial infiltrates three weeks after receiving a live attenuated varicella-zoster vaccine. Varicella-zoster Oka-vaccine strain was detected in plasma by polymerase chain reaction and sequencing analysis targeting open reading frame 62 (ORF 62). She was treated successfully with intravenous acyclovir. Our case report supports the current contraindication of live attenuated varicella-zoster vaccine in the solid-organ transplant recipients. Recombinant subunit varicella-zoster vaccine may be the vaccine of choice in these patients; nevertheless, further information is required to establish its safety, efficacy, and optimal timing.
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Affiliation(s)
- Edgar Ortiz-Brizuela
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico
| | - Francisco Leal-Vega
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico
| | - Jennifer Cuellar-Rodríguez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico
| | - Miriam Bobadilla-Del-Valle
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico
| | - Alfredo Ponce-de-León
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, Mexico City 14080, Mexico.
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Farnaes L, Coufal NG, Spector SA. Vaccine Strain Varicella Infection in an Infant With Previously Undiagnosed Perinatal Human Immunodeficiency Type-1 Infection. Pediatr Infect Dis J 2019; 38:413-415. [PMID: 30882735 DOI: 10.1097/inf.0000000000002183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 15-month-old infant with a history of developmental delay and weight loss with multiple hospital admissions was diagnosed with a pustular lesion identified as vaccine strain varicella at the vaccination site. He was ultimately determined to be HIV infected following a protracted evaluation, which did not initially include HIV since his mother was confirmed HIV seronegative at 3 months gestation.
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Affiliation(s)
| | - Nicole G Coufal
- Pediatric Critical Care, Department of Pediatrics, University of California San Diego, La Jolla, CA and Rady Children's Hospital San Diego, La Jolla, CA
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25
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Abstract
Varicella vaccination is now virtually universal in North America, as well as in some European and Asian countries. Since varicella vaccine is a live attenuated virus, the virus replicates in the skin after administration and can travel via sensory nerves or viremia to become latent in the dorsal root ganglia. In some immunized children, virus reactivates within a few months to a few years to cause the dermatomal exanthem known as herpes zoster (shingles). Herpes zoster caused by vaccine virus often reactivates within the same dermatome as the site of the original varicella vaccine injection. We present evidence that occasional cases of herpes zoster following varicella vaccination in immunocompetent children can be as severe as herpes zoster following wild-type varicella. Analysis of the virus in one case disclosed that the vaccine virus causing herpes zoster was a wild-type variant with a mutation in ORF0. With regard to dermatomal localization of the viral eruption, we predict that herpes zoster of the lumbar dermatomes in children is likely to be caused by vaccine virus, because herpes zoster in those dermatomes is rare in children after wild-type varicella. One of the children with herpes zoster subsequently developed asthma, a known risk factor for herpes zoster, but none of the children had an autoimmune disease. Although postherpetic neuralgia is exceedingly rare, children who develop herpes zoster following varicella vaccination are at risk (albeit low) of developing meningoencephalitis and should be carefully observed for a few weeks.
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Affiliation(s)
- Amaran Moodley
- Division of Infectious Diseases, Blank Children’s Hospital, Des Moines, IA, USA
| | - Jack Swanson
- Department of Pediatrics, McFarland Clinic, Ames, IA, USA
| | - Charles Grose
- Division of Infectious Diseases/Virology, Children’s Hospital, University of Iowa, Iowa City, IA, USA
| | - Daniel J. Bonthius
- Division of Child Neurology, Children’s Hospital, University of Iowa, Iowa City, IA, USA
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Zoch-Lesniak B, Tolksdorf K, Siedler A. Trends in herpes zoster epidemiology in Germany based on primary care sentinel surveillance data, 2005-2016. Hum Vaccin Immunother 2018; 14:1807-1814. [PMID: 29498894 PMCID: PMC6067859 DOI: 10.1080/21645515.2018.1446718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/07/2018] [Accepted: 02/25/2018] [Indexed: 11/07/2022] Open
Abstract
Herpes zoster (HZ) is caused by reactivation of the varicella-zoster-virus (VZV). Childhood varicella vaccination, as recommended in Germany in 2004, may reduce the risk of HZ in vaccinated children but also virus circulation and thus the booster possibility of latent infected persons. In this context we analyzed age-specific trends in HZ epidemiology in Germany using data on HZ-associated outpatient consultations in participating sentinel sites and HZ-associated cases in all hospitals since 2005. We analyzed two separate time periods that differed in sentinel management and data integrity. For the period 2005-2010, we found a decrease in HZ-associated outpatient consultations in 1- to 4-year-olds (IRR = 0.72, 95%CI 0.63-0.81, p<0.001). For the period 2013-2016, we observed a decrease in HZ-associated outpatient consultations in 10- to 14-year-olds (IRR = 0.85, 95%CI 0.78-0.93, p<0.01). Moreover, we detected an increase in the age groups 20 years and older except for the group 30-39 years. HZ-associated hospitalizations showed similar trends for the second time period (here 2012-2015). The decrease in HZ-associated outpatient consultations and hospitalizations in children started and continued over cohorts eligible for varicella vaccination and could be a result of their reduced HZ-risk. Whether the observed steady increasing HZ incidences for adults are associated with the varicella vaccination in children remains unclear and could not be investigated with our data.
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Affiliation(s)
- Beate Zoch-Lesniak
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Immunization Unit, Berlin, Germany
| | - Kristin Tolksdorf
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
| | - Anette Siedler
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Immunization Unit, Berlin, Germany
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Abstract
Varicella zoster virus (VZV) is the cause of chickenpox (varicella) and shingles (zoster), and was once responsible for over 4 million infections in the United States annually. The development of a live attenuated VZV vaccine was initially viewed with extreme skepticism. Nonetheless, a VZV vaccine was developed in the 1970s by Takahashi and his colleagues in Japan and was eventually licensed in the US. It is now known to be one of the safest and most effective vaccines available and is administered worldwide. Here are described important factors that contributed to the successful research and licensure of the highly successful VZV vaccine.
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Affiliation(s)
- Jana Shaw
- Department of Pediatrics, Upstate Medical Center, Syracuse, New York
| | - Anne A. Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
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Dubey AP, Faridi MMA, Mitra M, Kaur IR, Dabas A, Choudhury J, Mukherjee M, Mishra D. Safety and immunogenicity of Bio Pox™, a live varicella vaccine (Oka strain) in Indian children: A comparative multicentric, randomized phase II/III clinical trial. Hum Vaccin Immunother 2017; 13:2032-2037. [PMID: 28509605 PMCID: PMC5612528 DOI: 10.1080/21645515.2017.1318236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Varicella or chickenpox is a highly contagious disease with a high secondary attack rate. Almost 30% of Indian adolescents lack protective antibodies against varicella, emphasizing the need of routine varicella immunization. The Oka VZV is a well-established, safe and efficacious vaccine strain that is highly immunogenic and produces lifelong protective immunity. The present multicentric, open label, randomized, controlled Phase II/III study, compared the Bio Pox™ (indigenous investigational vaccine) with a licensed vaccine, Varivax™ [a][a] Please note that this article refers to the product named VARIVAX as manufactured by Changchun Keygen Biological Products Ltd., China and marketed in India by VHB Life Sciences Limited, Mumbai, and not the product VARIVAX® owned by Merck Sharp & Dohme Corp., Rahway, New Jersey, USA. Merck Sharp & Dohme Corp. have asked us to make clear that the product manufactured by Changchun Keygen Biological Products Ltd. is unrelated to and is not sponsored, endorsed or otherwise authorised by Merck Sharp & Dohme Corp. , for its safety and immunogenicity profile in 252 healthy subjects in the age group of 1-12 y (cohort I: 6-12 years, II:1-6 years) in 3 tertiary medical institutions. Antibodies were measured by VZV Glycoprotein Enzyme Linked Immunoassay (IgG ELISA) kit. Seroconversion percentage in children having pre-vaccination anti VZV IgG titer <10 mIU/mL (< 5 gp ELISA units/mL) were 80% for Bio Pox™ and 77% for Varivax™ (p = 0.692). The seroconversion rate in the group receiving Bio Pox™ was non-inferior to the group that received Varivax™. There were mild local reactions for both the vaccines; none of the patient had fever or required hospitalization or medication. The Bio Pox™ was found to be safe and immunogenic in children against VZV infection.
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Affiliation(s)
| | - Mohammad Moonis Akbar Faridi
- University College of Medical Sciences, Delhi, India
- CONTACT Mohammad Moonis Akbar Faridi ; MD, DCH, MNAMS, FIAP, FNNF, Director Professor and Head, University College of Medical Sciences, E-9 GTB Hospital Campus, Delhi-110095, India
| | | | - Iqbal Rajinder Kaur
- Department of Microbiology University College of Medical Sciences, Delhi, India
| | - Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | | | | | - Devendra Mishra
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
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Abstract
Severe adverse events associated with varicella-zoster virus (VZV) vaccination are rare. The authors describe a 53-year-old woman with no known immunodeficiency who presented with diffuse pruritic rash 17 days after receiving the varicella virus vaccine live. She had a low level of white blood cells and received a diagnosis of thrombocytopenia with elevated aminotransferase levels. Punch biopsy demonstrated positive VZV immunostaining and viral culture positive for VZV. After treatment with acyclovir, her rash improved and her white blood cell and platelet counts returned to normal. Mild reactions to vaccines including localized rash are well recognized. Disseminated infections have been reported in patients with congenital and acquired immunodeficiency, but systemic postvaccination infections are rare in immunocompetent adults. This case highlights the importance of recognizing adverse events associated with vaccination.
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Spencer JP, Trondsen Pawlowski RH, Thomas S. Vaccine Adverse Events: Separating Myth from Reality. Am Fam Physician 2017; 95:786-794. [PMID: 28671426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Vaccines are one of the most successful medical advances in modern times. Most vaccine-preventable illnesses are unfamiliar to modern parents. Because of this, parents are increasingly questioning the necessity of immunizing their children, especially because no vaccine is completely free of adverse effects or the risk of complications. Family physicians should be aware of the risks and benefits of recommended immunizations. Thimerosal is currently used only in multidose vials of influenza vaccine, and exposure through vaccines is not associated with adverse neurologic outcomes. The measles, mumps, and rubella vaccine is not associated with autism. Vaccines are associated with local reactions, such as pain and erythema. The rotavirus vaccine minimally increases the rate of intussusception, whereas other vaccines minimally increase the risk of syncope. Although immunization with the human papillomavirus vaccine is recommended for all boys and girls, vaccination rates remain low. Physicians should guide parents to credible resources if they are considering vaccine refusal. If a recommended vaccine is refused, proper documentation is essential. The Vaccine Adverse Event Reporting System and National Vaccine Injury Compensation Program track adverse events and allow compensation for documented harms from vaccinations.
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31
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Guffey DJ, Koch SB, Bomar L, Huang WW. Herpes zoster following varicella vaccination in children. Cutis 2017; 99:207-211. [PMID: 28398421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Herpes zoster (HZ), or shingles, is commonly seen in older adults but does occur in children. Routine administration of the varicella vaccine started in 1995 in the United States; since then, the incidence of varicella and HZ has declined. We report a case of HZ in an otherwise healthy 19-month-old boy who had been vaccinated at 13 months of age and recovered fully after acyclovir treatment. We review previously reported cases of HZ in healthy vaccinated children.
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Affiliation(s)
- Darren J Guffey
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah B Koch
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Leonora Bomar
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - William W Huang
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Arnold N, Messaoudi I. Herpes zoster and the search for an effective vaccine. Clin Exp Immunol 2017; 187:82-92. [PMID: 27164323 PMCID: PMC5167054 DOI: 10.1111/cei.12809] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/26/2016] [Accepted: 05/05/2016] [Indexed: 12/30/2022] Open
Abstract
Primary infection with varicella zoster virus (VZV), an exclusively human neurotrophic alphaherpsesvirus, results in varicella, known more commonly as chickenpox. Like other alphaherpesviruses, VZV establishes latency in the sensory ganglia and can reactivate to cause herpes zoster (also known as shingles), a painful and debilitating disease, especially in elderly and immunocompromised individuals. The overall incidence of herpes zoster in Europe and the United States is three per 1000 people, but increases sharply after 60 years of age to 10 per 1000 people. Zostavax® is a vaccine approved by the Federal Drug Administration for the prevention of herpes zoster. Unfortunately, this vaccine reduces the incidence of disease by only 51% and the incidence of post-herpetic neuralgia by 66·5% when administered to those aged 60 and older. Moreover, it is contraindicated for individuals who are immunocompromised or receiving immunosuppressant treatments, although they are at higher risk for herpes zoster compared to immune-competent older individuals. This paper reviews VZV pathogenesis, host responses and current vaccines available to prevent herpes zoster.
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Affiliation(s)
- N Arnold
- Graduate Program in Microbiology, University of California-Riverside, Riverside, CA, USA
| | - I Messaoudi
- Graduate Program in Microbiology, University of California-Riverside, Riverside, CA, USA
- Division of Biomedical Sciences, School of Medicine, University of California-Riverside, Riverside, CA, USA
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Gabutti G, Franchi M, Maniscalco L, Stefanati A. Varicella-zoster virus: pathogenesis, incidence patterns and vaccination programs. Minerva Pediatr 2016; 68:213-225. [PMID: 27125440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Varicella or chickenpox is a common and highly contagious exanthematic disease caused by the varicella-zoster virus (VZV) that during primary infection has the ability to establish latency. VZV reactivation, even decades after primary infection, causes herpes zoster. In healthy immunocompetent subjects, children in particular, varicella results in mild to moderate illness and for this reason, regardless its high morbidity, it is not considered a public health priority. Varicella still represents the most widespread vaccine preventable childhood infectious disease in industrialized countries; due to its relevant burden on healthcare resources several countries has introduced varicella vaccination into the recommended routine childhood national immunization schedule. Nowadays, live attenuated monovalent and combined MMRV vaccines are licensed worldwide. The use of several millions of doses has demonstrated the excellent safety and efficacy level of varicella vaccines as well as of combined MMRV vaccines. Universal vaccination adopted in many countries with a two-dose strategy has allowed to significantly reducing morbidity and mortality of this infectious disease. Anyway, an ample international debate is ongoing on the time range to be used between the two doses, and on the safety issues related to the use as first-dose of MMRV vaccine. Taking into account the availability of a zoster vaccine in subjects older than 50 years of age, it will be relevant to clarify if an impact on exogenous boosters and on the epidemiology of herpes zoster can occur after the adoption of extensive varicella immunization.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
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Guzzetta G, Poletti P, Merler S, Manfredi P. The Epidemiology of Herpes Zoster After Varicella Immunization Under Different Biological Hypotheses: Perspectives From Mathematical Modeling. Am J Epidemiol 2016; 183:765-73. [PMID: 26994062 DOI: 10.1093/aje/kwv240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/04/2015] [Indexed: 11/13/2022] Open
Abstract
The impact of varicella vaccination on the epidemiology of herpes zoster (HZ) critically depends on the mechanism of immunological boosting, through which reexposures to varicella-zoster virus are thought to reduce the individual risk of HZ development. However, the qualitative and quantitative dynamics of this process are largely unknown. Consequently, mathematical models evaluating immunization strategies need to rely on theoretical assumptions. Available varicella-zoster virus models can be classified in 3 main families according to the postulated effect of exogenous boosting: 1) progressive accumulation of immunity following repeated reexposures; 2) partial protection that wanes over time; or 3) full but temporary immunity against HZ. In this work, we review and compare quantitative predictions from the 3 modeling approaches regarding the effect of varicella immunization on HZ. All models predict a qualitatively similar, but quantitatively heterogeneous, transient increase of HZ incidence. In particular, novel estimates from the progressive immunity model predict the largest increase in natural HZ and the largest incidence of HZ cases from reactivation of the vaccine strain, which in the long term will likely outnumber prevaccination numbers. Our results reinforce the idea that a better understanding of HZ pathogenesis is required before further mass varicella immunization programs are set out.
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Gustafson CJ, Woodard M, Hanke CW. A Unique Case of Herpes Zoster Within One Week of Varicella Zoster Vaccination. J Drugs Dermatol 2016; 15:241-243. [PMID: 26885795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a unique case of herpes zoster that developed shortly after Varicella Zoster vaccination.
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Ortiz Salvador JM, Subiabre Ferrer DF, Vilata Corell JJ. [Post-vaccinal herpes zoster: Value of the Tzank cytodiagnostic test]. An Pediatr (Barc) 2015; 85:216-217. [PMID: 26549005 DOI: 10.1016/j.anpedi.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/04/2015] [Accepted: 09/26/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Juan José Vilata Corell
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España; Cátedra universitaria, Universidad de Valencia, Valencia, España
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Abstract
As part of an adult immunization program, the occupational and environmental health nurse should consider offering the shingles vaccine for employees aged 60 years and above.
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Mitra M, Faridi M, Ghosh A, Shah N, Shah R, Chaterjee S, Narang M, Bhattacharya N, Bhat G, Choudhury H, Kadhe G, Mane A, Roy S. Safety and immunogenicity of single dose live attenuated varicella vaccine (VR 795 Oka strain) in healthy Indian children: a randomized controlled study. Hum Vaccin Immunother 2015; 11:443-9. [PMID: 25692656 PMCID: PMC4514385 DOI: 10.1080/21645515.2014.1004031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Varicella, an acute viral systemic infection that may cause lifelong latent infection with the potential for causing clinical reactivation, may be prevented by immunization. The present study was an open label, randomized, controlled, phase III, multicentre trial, conducted to evaluate and compare the safety, tolerability and immunogenicity of a freeze dried live attenuated Oka strain Varicella Vaccine (VR 795 Oka strain) with Varilrix (Oka-RIT strain) in children. A total of 268 healthy Indian children aged 12 months to 12 y with baseline VZV IgG antibody (<100 mIU/ mL) were enrolled, and 256 children completed the study. The extent of rise of VZV IgG antibody titer assessed as 3-fold and 4-fold rise from baseline was found to be significantly higher (89.1% and 85.2%) in the test group as compared to control group (73.4% and 61.7%). The post-vaccination GMT of the test group was significantly higher (112.5 mIU/mL) as compared with the control group (67.8 mIU/mL) (P < 0.001). The seroconversion rate considering the 5 gp ELISA units/ml equivalent to 10mIU/ml were similar in the control (96.5%) and the test (98.3%) groups. The adverse events were not different in the control and test groups (P > 0.05). The test live attenuated vaccine was found to be highly immunogenic, safe and comparable to Varilrix used in control arm.
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Affiliation(s)
- Monjori Mitra
- Institute of Child Health; Kolkata, India
- Correspondence to: Monjori Mitra;
| | - Mma Faridi
- Department of Pediatrics; University College of Medical Sciences; GTB Hospital Dilshad Garden, Delhi, India
| | | | - Nitin Shah
- Department of Pediatrics; Lion's Tarachand Bapa Hospital Sion West; Mumbai, India
| | - Raju Shah
- Ankur Children's Hospital; Ahmedabad, India
| | - Suparna Chaterjee
- Department of Pharmacology; Institute of Postgraduate Medical Education & Research; Kolkata, India
| | - Manish Narang
- Department of Pediatrics; University College of Medical Sciences; GTB Hospital Dilshad Garden, Delhi, India
| | | | - Gandhali Bhat
- Department of Pediatrics; Lion's Tarachand Bapa Hospital Sion West; Mumbai, India
| | | | | | - Amey Mane
- Medical Affairs Wockhardt; East Mumbai, India
| | - Sucheta Roy
- Medical Affairs Wockhardt; East Mumbai, India
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Klopfer SO, Stek JE, Petrecz M, Reisinger KS, Black SB, Goveia MG, Nicholson O, Gardner JL, Grosso AD, Brown ML, Kuter BJ, Schödel FP. Analysis of safety data in children after receiving two doses of ProQuad® (MMRV). Vaccine 2014; 32:7154-60. [PMID: 25219563 DOI: 10.1016/j.vaccine.2014.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND In randomized clinical studies, over 11,800 children, 12 months to 6 years of age, were administered ProQuad(®), a combination measles, mumps, rubella, and varicella vaccine (MMRV). This paper describes the safety following a 2-dose regimen of MMRV administered to children in the second year of life. METHODS Safety data from five clinical studies were combined for all children who were scheduled to receive two doses of MMRV ∼3-6 months apart. All vaccinated children were followed for safety following each dose of MMRV. RESULTS Of 3112 children who received a first dose of MMRV, 2780 (89.3%) received a second dose of MMRV. Overall, 70.5% and 57.7% of children reported ≥1 adverse experiences following first and second doses of MMRV, respectively. Injection-site redness was statistically significantly higher postdose 2 than postdose 1, while injection-site pain/tenderness was statistically significantly higher postdose 1 compared to postdose 2. Rashes were statistically significantly lower postdose 2 compared to postdose 1. Ten febrile seizures (8 postdose 1, 2 postdose 2) were reported following MMRV vaccination. The incidence of febrile seizures postdose 1 of MMRV was 0.26% (8/3019) compared to 0.07% (2/2695) postdose 2 of MMRV. CONCLUSIONS Administration of two doses of MMRV has an acceptable safety profile in children 12 to 23 months of age. There is a small increase in the risk of febrile seizures following the first dose of MMRV as compared to the component vaccines, but the risk for any individual child is relatively low.
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Affiliation(s)
| | - Jon E Stek
- Merck & Co., Inc, Whitehouse Station, NJ, United States
| | - Maria Petrecz
- Merck & Co., Inc, Whitehouse Station, NJ, United States
| | | | - Steven B Black
- Cincinnati Children's Hospital, Cincinnati, OH, United States
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Kuter BJ, Brown MLH, Hartzel J, Williams WR, EvesiKaren A, Black S, Shinefield H, Reisinger KS, Marchant CD, Sullivan BJ, Thear M, Klopfer S, Xu J, Gress JO, Schödel F. Safety and Immunogenicity of a Combination: Measles, Mumps, Rubella and Varicella Vaccine (ProQuad®). Human Vaccines 2014; 2:205-14. [PMID: 17035730 DOI: 10.4161/hv.2.5.3246] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A combination measles, mumps, rubella, and varicella vaccine (ProQuad, Merck & Co., Inc, West Point, PA) was evaluated in five clinical trials. Use of ProQuad would result in fewer injections for children and would facilitate universal immunization against all four diseases. OBJECTIVE To describe the combined results obtained from the studies conducted during the clinical development program for ProQuad. METHODS A total of 5833 healthy children, 12-23 months of age, and 399 healthy children, 4-6 years of age, received 1 or 2 doses of ProQuad in five controlled clinical trials. M-M-R II and VARIVAX were used as the control for most studies. Safety was evaluated for six weeks postvaccination and immunogenicity was assessed six weeks after each dose by a sensitive assay (ELISA or gpELISA). RESULTS A single dose of ProQuad in 12- to 23-month-old children was shown to be as immunogenic as a single dose of M-M-R II and VARIVAX and was generally well tolerated. ProQuad can be used concomitantly with other vaccines (hepatitis B and Hoemophilus influenzoe b). A higher rate of fever was reported after 1 dose of ProQuad compared to M-M-R II and VARIVAX, but fever episodes were transient without long-term sequelae. Both a 2-dose regimen of ProQuad in 12- to 23-month-olds and use of ProQuad in place of M-M-R II at 4-6 years were shown to be immunogenic and well tolerated. The incidence of adverse experiences following a second dose of ProQuad was lower than that following the initial dose. CONCLUSIONS A single dose of ProQuad is as immunogenic as M-M-R II and VARIVAX and is well tolerated in a 1- or 2-dose schedule. ProQuad should easily fit into the routine immunization schedule.
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Affiliation(s)
- Barbara J Kuter
- Merck Research Laboratories, P 0. Box 4, West Point 19426, Pennsylvania, USA.
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Lepage P, Blumental S. [Is it necessary to vaccinate against varicella?]. Rev Med Brux 2014; 35:335-337. [PMID: 25675640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Varicella is a frequent viral disease, with a substantial medical and societal impact. For many years, various industrialized countries have adopted an universal mass vaccination against varicella, using a one-dose schedule. In these countries, the global incidence of varicella has decreased by about 90%. A significant reduction in hospitalizations, outpatient visits and medical costs due to varicella has also been observed. Recently, a 2-dose schedule has demonstrated an efficacy of about 98%, as well as herd immunity.
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MacDonald SE, Dover DC, Simmonds KA, Svenson LW. Risk of febrile seizures after first dose of measles-mumps-rubella-varicella vaccine: a population-based cohort study. CMAJ 2014; 186:824-9. [PMID: 24914115 PMCID: PMC4119141 DOI: 10.1503/cmaj.140078] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The combination measles-mumps-rubella-varicella (MMRV) vaccine currently used in Canada (Priorix-Tetra) may increase the risk of febrile seizures relative to the separate vaccines (MMR and varicella) previously administered. We determined the risk of febrile seizure after the first dose of MMRV, as well as any additional risk for children at high risk for seizures because of pre-existing medical conditions. METHODS In this retrospective, population-based cohort study, we compared the risk of seizures after the first dose of MMRV with the risk after same-day administration of separate MMR and varicella vaccines (MMR+V) in children 12 to 23 months of age in the province of Alberta. We deterministically linked vaccination data to health service utilization data for seizures. We used Poisson regression, with adjustment for age and calendar year, to determine the risk for the full cohort and for high-risk children. RESULTS The risk of seizures 7 to 10 days after vaccination was twice as high with MMRV as with MMR+V (relative risk [RR] 1.99, 95% confidence interval [CI] 1.30-3.05). The excess absolute risk of seizures was 3.52 seizures per 10 000 doses of MMRV relative to MMR+V. In high-risk children, the risk was not differentially higher for MMRV (RR 1.30, 95% CI 0.60-2.79). INTERPRETATION Despite an increased risk of febrile seizures following MMRV (compared with MMR+V), the absolute level of risk was small. Policy-makers need to balance these findings with the potential benefits of administering the combination vaccine or determine whether the choice of vaccine rests with clinicians and/or parents.
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Affiliation(s)
- Shannon E MacDonald
- Departments of Pediatrics (MacDonald) and Community Health Sciences (Simmonds, Svenson), University of Calgary, Calgary, Alta.; Faculty of Nursing (MacDonald) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; and Epidemiology and Surveillance Team (Dover, Simmonds, Svenson), Alberta Ministry of Health, Edmonton, Alta.
| | - Douglas C Dover
- Departments of Pediatrics (MacDonald) and Community Health Sciences (Simmonds, Svenson), University of Calgary, Calgary, Alta.; Faculty of Nursing (MacDonald) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; and Epidemiology and Surveillance Team (Dover, Simmonds, Svenson), Alberta Ministry of Health, Edmonton, Alta
| | - Kimberley A Simmonds
- Departments of Pediatrics (MacDonald) and Community Health Sciences (Simmonds, Svenson), University of Calgary, Calgary, Alta.; Faculty of Nursing (MacDonald) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; and Epidemiology and Surveillance Team (Dover, Simmonds, Svenson), Alberta Ministry of Health, Edmonton, Alta
| | - Lawrence W Svenson
- Departments of Pediatrics (MacDonald) and Community Health Sciences (Simmonds, Svenson), University of Calgary, Calgary, Alta.; Faculty of Nursing (MacDonald) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; and Epidemiology and Surveillance Team (Dover, Simmonds, Svenson), Alberta Ministry of Health, Edmonton, Alta
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El-Darouti MA, Hegazy RA, Abdel Hay RM, Rashed LA. Study of T helper (17) and T regulatory cells in psoriatic patients receiving live attenuated varicella vaccine therapy in a randomized controlled trial. Eur J Dermatol 2014; 24:464-9. [PMID: 25119950 DOI: 10.1684/ejd.2014.2377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
BACKGROUND The use of live attenuated varicella vaccine (Varilrix(®)) as an adjuvant treatment in severe cases of psoriasis has recently been postulated. Its efficacy raised questions regarding its possible mechanisms of action. OBJECTIVE To compare the efficacy and safety of combining Varilrix(®) and cyclosporine to cyclosporine alone in the treatment of severe psoriasis. Furthermore, to study the expression of T helper (Th)17 and T regulatory (Tregs) cells before and after therapy. MATERIALS AND METHODS This randomized controlled trial included 24 psoriatic patients, randomly divided into 2 groups (A and B). All patients received cyclosporine at a daily dose of 2.5 mg/kg/day. In addition, group A received 4 doses of Varilrix(®) once/3 weeks, and group B received 4 doses of subcutaneous saline. Skin biopsies were obtained from all patients before and after therapy and from all controls for estimation of interleukin (IL)-17, IL-22 and Forkhead boxP3 (FoxP3) using RT-PCR. RESULTS Group A patients showed a significantly higher % of clinical improvement (P = 0.011), which occurred earlier than group B. At baseline, levels of IL-17 and IL-22 were significantly higher while the level of FoxP3 was significantly lower in patients (P<0.001) compared to controls. After therapy, both groups showed significant reductions in both IL-17 and IL-22 levels, and significant elevation in FoxP3 (P<0.001). This change was significantly more evident in group A patients. CONCLUSION Live attenuated varicella vaccine could play a role in the treatment of psoriasis when combined with low dose cyclosporine through accentuating the influence on the Th17/Treg balance.
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Affiliation(s)
| | | | | | - Laila A Rashed
- Department of Clinical Biochemistry, Faculty of Medicine, Cairo University, 13th Abrag Othman, kornish El Maadi, Cairo 11431, Egypt
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Varicella and herpes zoster vaccines: WHO position paper, June 2014. Wkly Epidemiol Rec 2014; 89:265-87. [PMID: 24983077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Adult immunization. Treat Guidel Med Lett 2014; 12:39-48. [PMID: 24869519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Endres J, Graber MA, Dachs R. Evidence to guide measles immunization recommendations. Am Fam Physician 2014; 89:786-787. [PMID: 24866213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jill Endres
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mark A Graber
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Robert Dachs
- Ellis Hospital Family Medicine Residency Program, Schenectady, NY, USA
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Ulman CA, Trevino JJ, Gandhi RK. Herpes zoster in a 2-year-old vaccinated against varicella. Dermatol Online J 2014; 20:21259. [PMID: 24456962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 06/03/2023] Open
Abstract
Herpes zoster is uncommon in the pediatric population. We report a case of herpes zoster in a 2-year-old boy who received the live attenuated varicella zoster virus vaccination at his 12-month pediatric visit. The child was treated with acyclovir and recovered without complications.
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Abstract
The varicella zoster virus is associated with significant disease in those with chronic kidney disease, both pre- and postrenal transplantation. With the advent of the varicella vaccine, the opportunity to prevent significant morbidity and mortality exists. Despite the secondary immune defects associated with renal failure, the varicella vaccine has been demonstrated to be immunogenic, safe and efficacious in pediatric patients with kidney disease.
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Affiliation(s)
- Jeffrey J Fadrowski
- Division of Pediatric Nephrology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Park 335, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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Global Advisory Committee on Vaccine Safety,12–13 June 2013. Wkly Epidemiol Rec 2013; 88:301-12. [PMID: 23909011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Huang LM, Lee BW, Chan PC, Povey M, Henry O. Immunogenicity and safety of combined measles-mumps-rubella-varicella vaccine using new measles and rubella working seeds in healthy children in Taiwan and Singapore: a phase II, randomized, double-blind trial. Hum Vaccin Immunother 2013; 9:1308-15. [PMID: 23425607 PMCID: PMC3901822 DOI: 10.4161/hv.24035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/06/2013] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
AIM This study evaluated the immunogenicity and safety of tetravalent measles-mumps-rubella-varicella (MMRV) vaccine produced with measles and rubella monovalent bulks derived from a newly established working seed virus stock (MMRV(new WS)) compared with the combined MMRV vaccine derived from the current seed virus stock, in Taiwanese and Singaporean children (NCT00892775). METHODS Healthy children aged 11-22 mo were randomized to receive two doses of either the MMRV(new WS) vaccine or the MMRV vaccine. Antibody titers against measles, mumps and rubella were measured using ELISA and against varicella using an immunofluorescence assay. The primary objective was to demonstrate non-inferiority of MMRV(new WS) to MMRV in terms of post-dose-1 seroconversion rates, defined as a group difference with a lower limit of the 95% confidence interval greater than -10% for each antigen. Parents/guardians recorded symptoms in diary cards for 43 d after each vaccine dose. RESULTS Non-inferiority of MMRV(new WS) to MMRV was achieved for all vaccine antigens. The lower limits of the 95% confidence intervals for group differences (MMRV(new WS) group vs. MMRV) for measles (99.4% vs 100%), mumps (89.7% vs 90.4%), rubella (99.7% vs 100%) and varicella (97.6% vs 92.9%) seroconversion rates were greater than -10%. Mild symptoms including a peak in fever between days 5 and 12, post-dose-1, was observed in both groups. CONCLUSION The immune responses elicited by the MMRV(new WS) vaccine were non-inferior to that elicited by the MMRV vaccine for all antigens. Both vaccines exhibited an acceptable safety profile in Taiwanese and Singaporean children.
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Affiliation(s)
- Li-Min Huang
- Department of Pediatrics; National Taiwan University Hospital; Taipei, Taiwan
| | | | - Poh Chong Chan
- University Children’s Medical Institute; National University Hospital; Singapore
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