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

[Sullivan, Kathleen]

There are two published studies and a new one that confirms the first two from the CDC.  It is really important to use the data.  HIV is not DiGeorge and can I just make one more plug for using the genetic descriptor where appropriate?


On Apr 2, 2013, at 10:46 AM, Kumar, Ashish wrote:


> For what it’s worth, I have used these 2 criteria for several DiGeorge patients and given them live-attenuated vaccines without any trouble – CD4 count > 200 (as recommended by ACIP for HIV patients, although I’ve gone as low as 100), and  response to killed vaccines.

> Ashish

>  

> Ashish Kumar, MD, PhD

> Cancer and Blood Diseases Institute

> Division of Bone Marrow Transplantation and Immune Deficiency

> Cincinnati Children’s Hospital Medical Center

> http://www.cincinnatichildrens.org/bio/k/ashish-kumar/

> http://www.cincinnatichildrens.org/research/divisions/b/bone-marrow/labs/kumar/default/

>  

> From: Javier Chinen [mailto:chinej20 at hotmail.com] 

> Sent: Tuesday, April 02, 2013 10:12 AM

> To: CIS-PIDD

> Subject: : [cis-pidd] current opinions on live vaccines and DiGeorge Syndrome

>  

> Joyce, 

> It would be informative to have lymphocyte proliferation to specific antigens and if he had cardiac surgery and was thymectomized. Also if his CD4 cells are mostly of naive phenotype. I believe the low number of cases due to immunization reported has made it difficult to establish a cut-off for absolute T cell number, although a reference for immunodeficiency could be the CD4 ranges used for HIV infection.

> Optimally you would expect to have all pneumococcal serotypes antibody titers that are in PCV13 at protective levels. 

> I would include in your decision whether the naive T cell compartment and proliferation to specific antigen are preserved, whether the family is willing to accept the risk and how good is vaccination coverage in the child's community.

>  

> Javier

>  

> 

> > 

> > 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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Kate Sullivan, MD PhD
Professor of Pediatrics
ARC 1216 Immunology CHOP
3615 Civic Center Blvd.
Philadelphia, PA 19104
(p) 215-590-1697
(f) 267-426-0363



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