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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Veröffentlicht in:Bone marrow transplantation (Basingstoke) 2010-11, Vol.45 (11), p.1602-1606
Hauptverfasser: Kussmaul, S C, Horn, B N, Dvorak, C C, Abramovitz, L, Cowan, M J, Weintrub, P S
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container_end_page 1606
container_issue 11
container_start_page 1602
container_title Bone marrow transplantation (Basingstoke)
container_volume 45
creator Kussmaul, S C
Horn, B N
Dvorak, C C
Abramovitz, L
Cowan, M J
Weintrub, P S
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 &amp; 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 &amp; 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. 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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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