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Varicella-associated death likely resulted from immunosuppression
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The fifth US death of a child who received one dose of varicella vaccine occurred on May 7, 2012, according to recent data published in MMWR.
The 4-year-old girl had acute lymphoblastic leukemia (ALL) and was exposed to her mildly ill cousin on April 10, 2012. Her cousin developed a varicella rash 2 days after the visit. The patient’s oncologist was made aware of the contact 13 days afterward. Oral acyclovir was prescribed for 7 days and the patient continued her scheduled chemotherapy, including a 5-day course of dexamethasone.
The patient was taken to the ED for fever and abdominal pain 22 days after varicella exposure. Chemotherapy was discontinued and the patient’s parents were instructed to follow-up with her oncologist. The patient returned to the ED 2 days later with a generalized rash; she was treated with acyclovir and antibiotics. The patient developed multiple organ failure and died on May 7. PCR confirmed varicella and no other diagnoses were reported.
The first dose of varicella vaccine (Varivax, Merck) was given to the patient in March 2009 and she was diagnosed with ALL in March 2011. At the time of her diagnosis, she was immunoglobulin G-positive for varicella-zoster virus.
“Varicella vaccination has led to significant declines in varicella disease in the United States,” the researchers wrote. “Eligible persons without evidence of immunity to varicella should receive two doses of varicella vaccine. Live-attenuated varicella vaccine is contraindicated for immunocompromised persons, but the vaccination program offers protection to these vulnerable persons through herd effects. To provide more targeted herd protection for immunocompromised children, varicella vaccination of their household contacts in recommended.”
Disclosure: The researchers report no relevant financial disclosures.
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