[PAGID] Cellular Immunodeficiency and Rotateq

[Kathleen E. Sullivan]

Only a couple of SCID patients have had problems.  The virus is  
attenuated in an unusual way and although there is little data-  
innate responses seem to limit spread.

Kate
Kathleen E. Sullivan MD PhD
Chief, Division of Allergy and Immunology
Professor of Pediatrics
The Children's Hospital of Philadelphia
(p) 215-590-1697
(f) 267-426-0363


On May 16, 2008, at 1:04 PM, Brian Vickery wrote:


>

> 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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