Abstract 135: Effectiveness Of Live Vaccines Following Intravenous Immune Globulin Therapy During The Convalescent Phase Of Kawasaki Disease Using The Schedule Recommended In Japan

Background: There are differences between Japan and the United States regarding recommended timing of live virus vaccinations after treatment of Kawasaki disease patients with intravenous immune globulin (IVIG): 6 months in Japan and 11 months in the U.S. The prevalence of antibodies to these vaccines using either vaccination schedule remains undetermined. Objective: The present study aimed to evaluate the effectiveness of the live virus vaccination schedule for Kawasaki disease recommended in Japan. Methods: This was a prospective observational study. Kawasaki disease patients aged 6 months and older without past history of or vaccination against measles, rubella, varicella-zoster (VZ), or mumps were enrolled. The children were vaccinated against measles, rubella, VZ, and mumps 6 months after IVIG. Serologic tests for IgG-class specific antibodies to each vaccine virus were performed prior to IVIG; 2 days, 3 months, and 6 months after IVIG, and 3 months after vaccination. The primary outcome was seroprevalence of positive antibodies, which was defined as serum concentration more than 4 IU/mL. Results: A total of 24 children (mean month age 16.8 ± 2.7 at vaccinations, 70.8% male) were enrolled. The rate of measles, rubella, VZ, and mumps seropositivity was 12.5% (3/24), 0% (0/24), 12.5% (3/24), and 0% (0/24), respectively, just before vaccination. The rate increased to 91.7% (22/24), 87.5% (21/24), 20.8% (5/24), and 8.3% (2/24), respectively, 3 months after vaccination. There were no serious adverse events. Conclusions: Use of the Japanese vaccination schedule led to extremely low seroprevalence of VZ and mumps antibodies but acceptable seroprevalence of measles and rubella antibodies. This study is ongoing and more cases (up to 30, the target sample size) are needed before the appropriateness of the timing of vaccination in Japan can be discussed.

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

Journal of Child Neurology ◽

10.1177/0883073820938597 ◽

2020 ◽

Vol 35 (13) ◽

pp. 889-895 ◽

Cited By ~ 2

Author(s):

Veena Ramachandran ◽

Stephen C. Elliott ◽

Kathie L. Rogers ◽

Randall J. Cohrs ◽

Miles Weinberger ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Herpes Zoster ◽

Varicella Zoster Virus ◽

Varicella Vaccine ◽

The United States ◽

Vaccine Virus ◽

Virus Reactivation ◽

Wild Type ◽

Varicella Zoster ◽

Intravenous Acyclovir

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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