Safety of the live, attenuated varicella vaccine in pediatric recipients of hematopoietic SCTs
VZV is an important cause of morbidity and mortality among patients after hematopoietic SCT (HSCT). There is controversy surrounding the use of the live attenuated varicella vaccine (LAVV) in this population due to concerns that the immunization may cause VZ-related disease. The Blood and Marrow Tra...
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description | VZV is an important cause of morbidity and mortality among patients after hematopoietic SCT (HSCT). There is controversy surrounding the use of the live attenuated varicella vaccine (LAVV) in this population due to concerns that the immunization may cause VZ-related disease. The Blood and Marrow Transplant (BMT) group at the University of California, San Francisco (UCSF) Children's Hospital has been recommending the LAVV for immunocompetent HSCT patients since 1995. We retrospectively examined the incidence of post-immunization complications attributable to the LAVV in pediatric patients after HSCT. We also reported seroconversion rates when possible. Among 68 recipients of the LAVV after HSCT, 3 (4.4%; 95% confidence interval (CI)=1.0–12.7%) experienced mild-to-moderate symptoms potentially attributable to vaccination, and there were no severe reactions. Among 28 patients analyzed for seroconversion, 18 (64.3%; 95% CI=45.8–79.4%) seroconverted, 3 (10.7%; 95% CI 2.9–28.0%) possibly seroconverted and 7 (25.0%; 95% CI=12.4–43.6%) failed to seroconvert. It appears safe to administer the LAVV to immunocompetent patients after HSCT. Prospective studies are needed to more accurately determine rates of vaccine complications, efficacy and immunologic responses to vaccination. |
doi_str_mv | 10.1038/bmt.2010.31 |
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There is controversy surrounding the use of the live attenuated varicella vaccine (LAVV) in this population due to concerns that the immunization may cause VZ-related disease. The Blood and Marrow Transplant (BMT) group at the University of California, San Francisco (UCSF) Children's Hospital has been recommending the LAVV for immunocompetent HSCT patients since 1995. We retrospectively examined the incidence of post-immunization complications attributable to the LAVV in pediatric patients after HSCT. We also reported seroconversion rates when possible. Among 68 recipients of the LAVV after HSCT, 3 (4.4%; 95% confidence interval (CI)=1.0–12.7%) experienced mild-to-moderate symptoms potentially attributable to vaccination, and there were no severe reactions. Among 28 patients analyzed for seroconversion, 18 (64.3%; 95% CI=45.8–79.4%) seroconverted, 3 (10.7%; 95% CI 2.9–28.0%) possibly seroconverted and 7 (25.0%; 95% CI=12.4–43.6%) failed to seroconvert. It appears safe to administer the LAVV to immunocompetent patients after HSCT. Prospective studies are needed to more accurately determine rates of vaccine complications, efficacy and immunologic responses to vaccination.</description><identifier>ISSN: 0268-3369</identifier><identifier>EISSN: 1476-5365</identifier><identifier>DOI: 10.1038/bmt.2010.31</identifier><identifier>PMID: 20190839</identifier><identifier>CODEN: BMTRE9</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/250/2152 ; 631/250/590/1867 ; 692/700/565/545/576/1955 ; Adolescent ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bone marrow ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Care and treatment ; Causes of ; Cell Biology ; Chicken pox ; Chickenpox ; Chickenpox vaccine ; Chickenpox Vaccine - administration & dosage ; Chickenpox Vaccine - adverse effects ; Chickenpox Vaccine - immunology ; Child ; Child, Preschool ; Complications ; Confidence intervals ; Female ; Health aspects ; Hematology ; Hematopoietic Stem Cell Transplantation ; Hematopoietic stem cells ; Human viral diseases ; Humans ; Immunization ; Immunocompetence ; Infant ; Infant, Newborn ; Infectious diseases ; Internal Medicine ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Morbidity ; original-article ; Patients ; Pediatrics ; Prevention ; Public Health ; Retrospective Studies ; Seroconversion ; Signs and symptoms ; Stem cell transplantation ; Stem Cells ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Vaccination ; Vaccines ; Vaccines, Attenuated - administration & dosage ; Vaccines, Attenuated - adverse effects ; Vaccines, Attenuated - immunology ; Varicella ; Varicella-zoster virus ; Viral diseases ; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><ispartof>Bone marrow transplantation (Basingstoke), 2010-11, Vol.45 (11), p.1602-1606</ispartof><rights>Macmillan Publishers Limited 2010</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2010 Nature Publishing Group</rights><rights>Macmillan Publishers Limited 2010.</rights><rights>Copyright Nature Publishing Group Nov 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c667t-28b14410aaceec396d75dbd4f562683e5c02ab46692a2ded2838baa19255b9283</citedby><cites>FETCH-LOGICAL-c667t-28b14410aaceec396d75dbd4f562683e5c02ab46692a2ded2838baa19255b9283</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/bmt.2010.31$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/bmt.2010.31$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27911,27912,41475,42544,51306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23503428$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20190839$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kussmaul, S C</creatorcontrib><creatorcontrib>Horn, B N</creatorcontrib><creatorcontrib>Dvorak, C C</creatorcontrib><creatorcontrib>Abramovitz, L</creatorcontrib><creatorcontrib>Cowan, M J</creatorcontrib><creatorcontrib>Weintrub, P S</creatorcontrib><title>Safety of the live, attenuated varicella vaccine in pediatric recipients of hematopoietic SCTs</title><title>Bone marrow transplantation (Basingstoke)</title><addtitle>Bone Marrow Transplant</addtitle><addtitle>Bone Marrow Transplant</addtitle><description>VZV is an important cause of morbidity and mortality among patients after hematopoietic SCT (HSCT). There is controversy surrounding the use of the live attenuated varicella vaccine (LAVV) in this population due to concerns that the immunization may cause VZ-related disease. The Blood and Marrow Transplant (BMT) group at the University of California, San Francisco (UCSF) Children's Hospital has been recommending the LAVV for immunocompetent HSCT patients since 1995. We retrospectively examined the incidence of post-immunization complications attributable to the LAVV in pediatric patients after HSCT. We also reported seroconversion rates when possible. Among 68 recipients of the LAVV after HSCT, 3 (4.4%; 95% confidence interval (CI)=1.0–12.7%) experienced mild-to-moderate symptoms potentially attributable to vaccination, and there were no severe reactions. Among 28 patients analyzed for seroconversion, 18 (64.3%; 95% CI=45.8–79.4%) seroconverted, 3 (10.7%; 95% CI 2.9–28.0%) possibly seroconverted and 7 (25.0%; 95% CI=12.4–43.6%) failed to seroconvert. It appears safe to administer the LAVV to immunocompetent patients after HSCT. Prospective studies are needed to more accurately determine rates of vaccine complications, efficacy and immunologic responses to vaccination.</description><subject>631/250/2152</subject><subject>631/250/590/1867</subject><subject>692/700/565/545/576/1955</subject><subject>Adolescent</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bone marrow</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Care and treatment</subject><subject>Causes of</subject><subject>Cell Biology</subject><subject>Chicken pox</subject><subject>Chickenpox</subject><subject>Chickenpox vaccine</subject><subject>Chickenpox Vaccine - administration & dosage</subject><subject>Chickenpox Vaccine - adverse effects</subject><subject>Chickenpox Vaccine - immunology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Complications</subject><subject>Confidence intervals</subject><subject>Female</subject><subject>Health aspects</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation</subject><subject>Hematopoietic stem cells</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunization</subject><subject>Immunocompetence</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>original-article</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Prevention</subject><subject>Public Health</subject><subject>Retrospective Studies</subject><subject>Seroconversion</subject><subject>Signs and symptoms</subject><subject>Stem cell transplantation</subject><subject>Stem Cells</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><subject>Transplantation</subject><subject>Vaccination</subject><subject>Vaccines</subject><subject>Vaccines, Attenuated - administration & dosage</subject><subject>Vaccines, Attenuated - adverse effects</subject><subject>Vaccines, Attenuated - immunology</subject><subject>Varicella</subject><subject>Varicella-zoster virus</subject><subject>Viral diseases</subject><subject>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><issn>0268-3369</issn><issn>1476-5365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqF0ktv1DAQAOAIgWgpnLhDBAIOdBe_4iTHasVLqsSh5Uo0cSZdV4m92E6l_nsm3aVLURHKIXH8eTxjT5Y952zJmaw-tGNaCkYjyR9kh1yVelFIXTzMDpnQ1UJKXR9kT2K8ZIwrxYrH2QHxmlWyPsx-nEGP6Tr3fZ7WmA_2Co9zSAndBAm7_AqCNTgMQF_GWIe5dfkGOwuJJvKAxm4suhTnCGscIfmNt5ho7mx1Hp9mj3oYIj7bvY-y758-nq--LE6_ff66OjldGK3LtBBVS6lxBmAQjax1VxZd26m-0FSCxMIwAa3SuhYgOuxEJasWgNeiKNqaRkfZu23cTfA_J4ypGW28yduhn2JTlYpXjJfsv7LUUpV0fIrkq7_kpZ-CozJmpDWrtCD0-l9IaCV4oehm9uoCBmys630KYOaNmxOhhCwps5rU8h5FT4ejNd5hb-n_nQVv_1iwRhjSOvphSta7eBe-30ITfIwB-2YT7AjhuuGsmZuooSZq5iZqJCf9YlfT1I7Y3drfXUPgzQ5ANDD0AZyxce9kwaS6uZXjrYs05S4w7A_n_n1fbrmDNAW8jUdmJiR-Acw_4-g</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>Kussmaul, S C</creator><creator>Horn, B N</creator><creator>Dvorak, C C</creator><creator>Abramovitz, L</creator><creator>Cowan, M J</creator><creator>Weintrub, P S</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20101101</creationdate><title>Safety of the live, attenuated varicella vaccine in pediatric recipients of hematopoietic SCTs</title><author>Kussmaul, S C ; Horn, B N ; Dvorak, C C ; Abramovitz, L ; Cowan, M J ; Weintrub, P S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c667t-28b14410aaceec396d75dbd4f562683e5c02ab46692a2ded2838baa19255b9283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>631/250/2152</topic><topic>631/250/590/1867</topic><topic>692/700/565/545/576/1955</topic><topic>Adolescent</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Bone marrow</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Care and treatment</topic><topic>Causes of</topic><topic>Cell Biology</topic><topic>Chicken pox</topic><topic>Chickenpox</topic><topic>Chickenpox vaccine</topic><topic>Chickenpox Vaccine - administration & dosage</topic><topic>Chickenpox Vaccine - adverse effects</topic><topic>Chickenpox Vaccine - immunology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Complications</topic><topic>Confidence intervals</topic><topic>Female</topic><topic>Health aspects</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation</topic><topic>Hematopoietic stem cells</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunization</topic><topic>Immunocompetence</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>original-article</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Prevention</topic><topic>Public Health</topic><topic>Retrospective Studies</topic><topic>Seroconversion</topic><topic>Signs and symptoms</topic><topic>Stem cell transplantation</topic><topic>Stem Cells</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Transplantation</topic><topic>Vaccination</topic><topic>Vaccines</topic><topic>Vaccines, Attenuated - administration & dosage</topic><topic>Vaccines, Attenuated - adverse effects</topic><topic>Vaccines, Attenuated - immunology</topic><topic>Varicella</topic><topic>Varicella-zoster virus</topic><topic>Viral diseases</topic><topic>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kussmaul, S C</creatorcontrib><creatorcontrib>Horn, B N</creatorcontrib><creatorcontrib>Dvorak, C C</creatorcontrib><creatorcontrib>Abramovitz, L</creatorcontrib><creatorcontrib>Cowan, M J</creatorcontrib><creatorcontrib>Weintrub, P S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Bone marrow transplantation (Basingstoke)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kussmaul, S C</au><au>Horn, B N</au><au>Dvorak, C C</au><au>Abramovitz, L</au><au>Cowan, M J</au><au>Weintrub, P S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety of the live, attenuated varicella vaccine in pediatric recipients of hematopoietic SCTs</atitle><jtitle>Bone marrow transplantation (Basingstoke)</jtitle><stitle>Bone Marrow Transplant</stitle><addtitle>Bone Marrow Transplant</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>45</volume><issue>11</issue><spage>1602</spage><epage>1606</epage><pages>1602-1606</pages><issn>0268-3369</issn><eissn>1476-5365</eissn><coden>BMTRE9</coden><abstract>VZV is an important cause of morbidity and mortality among patients after hematopoietic SCT (HSCT). There is controversy surrounding the use of the live attenuated varicella vaccine (LAVV) in this population due to concerns that the immunization may cause VZ-related disease. The Blood and Marrow Transplant (BMT) group at the University of California, San Francisco (UCSF) Children's Hospital has been recommending the LAVV for immunocompetent HSCT patients since 1995. We retrospectively examined the incidence of post-immunization complications attributable to the LAVV in pediatric patients after HSCT. We also reported seroconversion rates when possible. Among 68 recipients of the LAVV after HSCT, 3 (4.4%; 95% confidence interval (CI)=1.0–12.7%) experienced mild-to-moderate symptoms potentially attributable to vaccination, and there were no severe reactions. Among 28 patients analyzed for seroconversion, 18 (64.3%; 95% CI=45.8–79.4%) seroconverted, 3 (10.7%; 95% CI 2.9–28.0%) possibly seroconverted and 7 (25.0%; 95% CI=12.4–43.6%) failed to seroconvert. It appears safe to administer the LAVV to immunocompetent patients after HSCT. Prospective studies are needed to more accurately determine rates of vaccine complications, efficacy and immunologic responses to vaccination.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>20190839</pmid><doi>10.1038/bmt.2010.31</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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subjects | 631/250/2152 631/250/590/1867 692/700/565/545/576/1955 Adolescent Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction Care and treatment Causes of Cell Biology Chicken pox Chickenpox Chickenpox vaccine Chickenpox Vaccine - administration & dosage Chickenpox Vaccine - adverse effects Chickenpox Vaccine - immunology Child Child, Preschool Complications Confidence intervals Female Health aspects Hematology Hematopoietic Stem Cell Transplantation Hematopoietic stem cells Human viral diseases Humans Immunization Immunocompetence Infant Infant, Newborn Infectious diseases Internal Medicine Male Medical sciences Medicine Medicine & Public Health Morbidity original-article Patients Pediatrics Prevention Public Health Retrospective Studies Seroconversion Signs and symptoms Stem cell transplantation Stem Cells Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Vaccination Vaccines Vaccines, Attenuated - administration & dosage Vaccines, Attenuated - adverse effects Vaccines, Attenuated - immunology Varicella Varicella-zoster virus Viral diseases Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye |
title | Safety of the live, attenuated varicella vaccine in pediatric recipients of hematopoietic SCTs |
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