[CIS PIDD] [cis-pidd] current opinions on live vaccines and DiGeorge Syndrome

[Hauck, Fabian Dr.med.]

Dear Joyce,

I think lymphocyte function is more important than absolute numbers (that are not so bad anyway).
Why not start with varicella? You could treat with ACV... When the vaccine is well tollerated you could continue with MMR.

Best wishes, Fabian

Fabian Hauck, MD
Assistant Doctor
Pediatric Hematology and Oncology - Stem cell transplantation
Immunological Service
Dr. von Haunersches Kinderspital
Lindwurmstraße 4
80337 München, Germany
Tel: +49-(0)89-5160-7940
Fax: +49-(0)89-5160-4742
Email: fabian.hauck at med.uni-muenchen.de<mailto:fabian.hauck at med.uni-muenchen.de>
________________________________________
Von: Junker, Anne [ajunker at cw.bc.ca]
Gesendet: Dienstag, 2. April 2013 04:20
An: CIS-PIDD
Betreff: Re: [cis-pidd] current opinions on live vaccines and DiGeorge Syndrome

Joyce - we have no problem recommending the live virus vaccines in this situation. Anne

From: Joyce Yu [mailto:jeyu74 at gmail.com]
Sent: Monday, April 01, 2013 06:29 PM Pacific Standard Time
To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Subject: [cis-pidd] current opinions on live vaccines and DiGeorge Syndrome

Hi all,

I'm taking care of a 1.5 yo boy with DiGeorge Syndrome and have been asked whether he can get the live vaccines.

He has otherwise been generally well (aside from his cardiac and feeding issues).

Most recent testing showed:
CD4 859 (1204 at prior testing)
CD8 721 (1921 prior)
NK 415 (757 prior)
CD19 2182 (3534 prior)

He has normal response to PHA, ConA, and slightly decreased response to PWM. He also has NL IgG, IgM, IgA and protective titers to diphtheria, tetanus, Hib, and pneumococcal (+ titers to 8 of 14)

Since he appears to have decent T and B cell function, I am thinking that he has little risk for receiving the MMR and varicella. However, his lymphocyte counts have decreased in the past year or so, so I am not sure whether I should take that into consideration. I was wondering whether anyone has looked further into the issue of cutoffs for lymphocyte counts, or could I make my decision based on functional studies despite decreasing absolute number of lymphocytes?

Thanks,

Joyce Yu
Weill Cornell Medical Center

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