[PAGID] Cellular Immunodeficiency and Rotateq

[Brian Vickery]

Dear Colleagues:

An anecdotal clinical question to pose to the group: Do you recommend that
all infants with suspected/confirmed cellular immune deficiency avoid live
oral rotavirus vaccine (Rotateq)? It seems that perhaps the obvious answer
is yes, although the Red Book/CDC/etc. as usual point out that there
are insufficient data to support a recommendation in this population. Have
any of you seen a patient who has suffered an adverse outcome as a result of
Rotateq administration?

I saw a new patient this morning in clinic who is 3 months old and likely
has incomplete DiGeorge Syndrome. He had received his 2 month oral dose of
Rotateq already with apparent impunity. While his workup is pending we are
advising against future doses of live vaccines...but the clinical scenario
gave me pause.

Historically, introduction of live viral vaccines such as MMR and Varicella
didn't occur until after the first birthday, which provided a long period of
time to study T cell function. Because this oral live virus vaccine has been
recently added to the schedule at 2, 4, and 6 months for all US children, I
wonder if it is being inadvertantly administered to some children with
impairment in cellular immunity, and if any of you has had experience with
this situation.

I welcome your thoughts.

Best regards,
Brian

Brian Vickery
Postdoctoral Fellow
Section of Allergy & Clinical Immunology
Yale University School of Medicine
New Haven, CT USA
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