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Novel criteria can be used to verify safety of varicella vaccination in immunosuppressed children
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Researchers have developed a prescreening checklist of common blood test levels to identify children with rheumatic diseases under immunosuppression who may be suitable candidates to receive the varicella vaccine, according to research presented at the European League Against Rheumatism Annual European Congress of Rheumatology.
Twenty-one varicella zoster virus (VZV)-susceptible patients with clinically inactive pediatric rheumatic diseases who received methotrexate and/or prednisone, leflunomide, mycophenolate motefil or an immunosuppressant biologic disease-modifying rheumatic drug (DMARD) were recruited for the study. Patients were between the ages of 2 years and 18 years and were screened based on a checklist for levels of white blood cell counts above 3,000 l, an absolute lymphocyte count greater than 1,200 µl, an immunoglobulin (Ig) G above 500 mg/dl, and the presence of IgM or tetanus toxin-IgG. Patients who received a stronger course of immunosuppression were screened for CD4 above 200 µl among children older than 5 years or a CD4 above 500 l in children between the ages of 1 year and 5 years, as well as for positive T cell reactivity to mitogen or antigen.
Nine patients on low-intensity immunosuppression and 12 patients who received high-intensity immunosuppression passed all of the checklist criteria. Eight patients received the varicella vaccine (VV) prior to the study and received a booster dose only, and seven patients received a second dose during the study period. Thirteen patients received their first dose of VZV within the study period.
In 11 of 13 patients, VZV-IgG levels above 150 IU/mL were present, and five of seven who received a second dose showed levels above 500 IU/µl. No evidence of VV-induced varicella or complications was seen, and none of the patients had a disease flare, according to the researchers.
“Although chickenpox is a common and often mild childhood illness, it can be life-threatening in children with a suppressed immune system, such as those being treated for rheumatic disease.
While a vaccine is available, its safety in children receiving immunosuppression has long been debated,” study investigator, Fabian Speth, MD, of the German Center for Pediatric and Adolescent Rheumatology, Germany, said in a press release. “By prescreening children using easy-to-obtain immunological criteria, we were able to safely and effectively vaccinate a major group of immunocompromised children, without having to stop their treatment. This is a significant development in preventing a persisting, and sometimes fatal, virus.” – by Shirley Pulawski
Reference:
Speth F, et al. Paper #OP0069. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology; June 10-13, 2015; Rome.
Disclosure: The researchers report no relevant financial disclosures.