A booster administration of the OKA/SK strain causes fatal disseminated varicella in an immunocompetent child

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.

Erratum of the “A booster administration of the OKA/SK strain causes fatal disseminated VZV infection in an immunocompetent child”

“…The article 1 to which this Erratum refers was published in Journal of Medical Virology 95(9):e29108 (https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.29108).…”

A booster administration of the OKA/SK strain causes fatal disseminated varicella in an immunocompetent child

“…The article identifies the virus as possessing genetic markers consistent with a varicella-strain vaccine (OKA/SK) administered 12 days before the onset of illness. 1 However, the available epidemiologic data accumulated with this vaccine strongly argues against the conclusion that the genotype of the vaccine administered: "correlates with attenuation failure leading to enhanced virulence of the vaccine-type VZV …". If this were the case, other recipients of this same vaccine would have suffered disseminated infection.…”