Safety and Immunogenicity of Varicella-Zoster Virus Vaccine in Pediatric Liver and Intestine Transplant Recipients

Abstract

Primary varicella-zoster virus (VZV) infections following organ transplantation may cause significant morbidity. We examined the safety and immunogenicity of Varivax® after transplantation as a potential prophylactic tool. Pediatric liver and intestine transplant recipients without history of chickenpox received one dose of Varivax ® . VZV humoral and cellular immunity were assessed before and ≥12 weeks after vaccination. Adverse events (AE) and management of exposure to wild type VZV were monitored. Sixteen VZVnaïve subjects, 13-76 months of age, at 257-2045 days after transplantation were immunized. Five children developed mild local AE of short duration. Four subjects developed fever and four developed non-injection site rashes, three of whom received acyclovir. Liver enzymes did not increase during the month after vaccination. Eighty-seven percent and 86% of children developed humoral and cellular immunity, respectively. There were five reported exposures to varicella in four children, none of which resulted in chickenpox. One subject received VZV-immunoglobulin and another subject with liver enzyme elevations after exposure received acyclovir; all remained asymptomatic. Varivax ® was safe and immunogenic in pediatric liver and intestine transplant recipients. Larger studies are needed to establish the efficacy and role of varicella vaccination after transplantation.

Herpes Simplex and Varicella Zoster Viruses: Forgotten but Not Gone

“…Such dissemination occurred in an adult seronegative cardiac transplant recipient who was vaccinated 2 years posttransplant and required hospitalization and intravenous acyclovir (68). In contrast, two studies in pediatric liver recipients described minimal adverse events with immunization, predominantly a small number of vesicles at sites distant from the vaccination site (69,70). Zostavax ® , a live attenuated high dose Oka strain vaccine, is approved for prevention of shingles in immunocompetent adults 60 years and older.…”

“…Seronegative patients are at risk for severe primary disease. Limited data in children with transplants suggests that vaccination with Oka strain attenuated vaccines is relatively safe (69,70,72) but similar data in adults are lacking. If seronegative patients are vaccinated following transplantation, they should be informed of the potential risks of dissemination (68) and early treatment with acyclovir be made available.…”

Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature

“…A live attenuated vaccine is recommended with 2 doses given 4 weeks apart. Although the vaccine is efficacious, 21,22 seronegative adults should be checked for immunity against varicella with varicella serology after 1 dose, and if they remain seronegative, the vaccine dose should be repeated. The Centers for Disease Control and Prevention recommends varicella vaccination to all children between 12 and 15 months of age, with a second dose to be given between 4 to 6 years of age.…”

Aciclovir and Varicella-zoster-immunoglobulin in solid-organ transplant recipients

“…VZV-specific effector T cells can be detected by their interferon-γ production after stimulation with VZV-specific antigens in vitro [13,14]. Unfortunately, experience with assessment of cellular immunity against VZV in solid-organ transplant recipients is poor [15].…”