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

[Joyce Yu]

Thanks to everyone for their comments and suggestions! Joyce


On Tue, Apr 2, 2013 at 11:00 AM, Sullivan, Kathleen <
sullivak at mail.med.upenn.edu> wrote:


> 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

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