Vaccine Oka Varicella Meningitis in Two Adolescents

Harrington, Whitney E.; Mató, Sayonara; Burroughs, Lauri; Carpenter, Paul A.; Gershon, Anne A.; Schmid, Daniela; Englund, Janet A.

doi:10.1542/peds.2019-1522

Cited by 18 publications

(20 citation statements)

References 25 publications

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“…First, all 3 patients were aged 14 years. 15 , 16 Second, the 3 patients have likely had latent vaccine virus in their dorsal root ganglia for 13 years, since their first varicella vaccination. Third, 2 of the 3 patients had herpes zoster in their lower extremities.…”

Section: Resultsmentioning

confidence: 99%

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Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

et al. 2020

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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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Section: Resultsmentioning

confidence: 99%

“…We also review the 2 prior varicella vaccine meningitis cases in twice-immunocompetent adolescents, both of which are very similar to our case. 15 , 16 Altogether, these 3 cases elucidate risk factors for varicella vaccine meningitis in older children who have received 2 varicella vaccinations.…”

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confidence: 93%

Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

et al. 2020

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“…In addition, there were no reactivation of vaccine-strain VZV in our patients, possibly reflecting the effective cellular immunity against VZV. However, such a reactivation, occurring even years after primary immunization, and accompanied by central nervous system infection, has been described, both in immunocompetent and immunocompromised adolescents (28).…”

Section: Discussionmentioning

confidence: 99%

The Safety and Efficacy of Live Viral Vaccines in Patients With Cartilage-Hair Hypoplasia

et al. 2020

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Background: Live viral vaccines are generally contraindicated in patients with combined immunodeficiency including cartilage-hair hypoplasia (CHH); however, they may be tolerated in milder syndromes. We evaluated the safety and efficacy of live viral vaccines in patients with CHH. Methods: We analyzed hospital and immunization records of 104 patients with CHH and measured serum antibodies to measles, mumps, rubella, and varicella zoster virus (VZV) in all patients who agreed to blood sampling (n = 50). We conducted a clinical trial (ClinicalTrials.gov identifier: NCT02383797) of live VZV vaccine on five subjects with CHH who lacked varicella history, had no clinical symptoms of immunodeficiency, and were seronegative for VZV; humoral and cellular immunologic responses were assessed post-immunization. Results: A large proportion of patients have been immunized with live viral vaccines, including measles-mumps-rubella (MMR) (n = 40, 38%) and VZV (n = 10, 10%) vaccines, with no serious adverse events. Of the 50 patients tested for antibodies, previous immunization has been documented with MMR (n = 22), rubella (n = 2) and measles (n = 1) vaccines. Patients with CHH demonstrated seropositivity rates of 96%/75%/91% to measles, mumps and rubella, respectively, measured at a medium of 24 years postimmunization. Clinical trial participants developed humoral and cellular responses to VZV vaccine. One trial participant developed post-immunization rash and knee swelling, both resolved without treatment.

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“…All four children developed herpes zoster and meningitis 13 years after their first vaccination. Data from references [ 1 , 10 , 11 ]. Age of first varicella vaccination: light blue bar; age of second vaccination: dark blue bar; age of meningitis: red bar.…”

Section: Figurementioning

confidence: 99%

“…Since that assumption has proven not to be true, we have undertaken a second investigation of varicella vaccine meningitis, in order to include children who have received either one or two varicella vaccinations. Reports of the first four cases of varicella vaccine meningitis in twice-immunized adolescents were published in 2017, 2019 and 2020 [ 1 , 10 , 11 ]. We also review the literature on varicella meningitis caused by reactivation of wild type varicella in children, because these wild-type cases provide insight into the pathogenesis of varicella vaccine meningitis.…”

Section: Introductionmentioning

confidence: 99%

Twelve Children with Varicella Vaccine Meningitis: Neuropathogenesis of Reactivated Live Attenuated Varicella Vaccine Virus

Heusel

Grose

2020

Viruses

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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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Vaccine Oka Varicella Meningitis in Two Adolescents

Cited by 18 publications

References 25 publications

Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

The Safety and Efficacy of Live Viral Vaccines in Patients With Cartilage-Hair Hypoplasia

Twelve Children with Varicella Vaccine Meningitis: Neuropathogenesis of Reactivated Live Attenuated Varicella Vaccine Virus

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