[CIS PIDD] [cis-pidd] Yellow Fever Vaccine in sIgAD

[Routes, John]

I disagree with the CDC recommendation and do not believe your patient has IgA deficiency




John M. Routes, MD
Chief, Section of Allergy and Clinical Immunology
Professor of Pediatrics, Medicine, Microbiology and Molecular Genetics
Department of Pediatrics
Children's Hospital of Wisconsin
Medical College of Wisconsin
9000 W. Wisconsin Ave.
Milwaukee, WI  53226-4874
Phone: Office 414-266-6840
Fax: 414-456-6487 (Clinical)
Fax: 414-456-6323 (Laboratory)
Email: jroutes at mcw.edu<mailto:jroutes at mcw.edu>





On Jul 2, 2013, at 6:21 PM, Yeşim Yılmaz Demirdağ <dryesimyilmaz at gmail.com<mailto:dryesimyilmaz at gmail.com>> wrote:

Dear all,

I would like to bring the "Yellow Fever vaccine and IgA deficiency" topic back to the group discussion. Last discussion concluded that YF vaccine is not contraindicated in IgA deficiency.

I received an e-mail today from a colleague. His patient, a 25 yo woman with history of Grave's disease, is planning to visit Ghana and she needs Yellow Fever vaccination. She had slightly low IgA and IgM 3 years ago (checked during Grave's work-up). She does not have recurrent infections and she is otherwise healthy. She and her father contacted CDC and were told that YF vaccine is contraindicated in selective IgA deficiency and they were given this reference  http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf  (Table 13 on page 48). I was not aware of this publication, so I wanted to let you all know about it and ask your opinion.

Back to the patient: Her recent IgA level is 49 mg/dl (70-312), IgM is 43 mg/dl (56-352) and IgG is 913 mg/dl (639-1349).  I am not impressed by these values. But the family is reluctant. What would you recommend for this patient? Does she have selective IgA deficiency? What about slightly low IgM? Do you think this combination should be a contraindication for the vaccine?

Dewton, you mentioned that YF vaccine is widely used in inland Brazil. Do you have any data on the frequency of IgA deficiency in patients who developed severe reaction to this vaccine?

Thank you,

Yesim



Yesim Yilmaz Demirdag, MD
Assistant Professor of Pediatrics
Division of Allergy and Immunology
Columbia University Medical Center
New York








On Wed, Jun 19, 2013 at 1:13 PM, Church, Joseph <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>> wrote:
Colleagues:

A 20+ year old patient is traveling to Africa and is recommended to receive Yellow Fever Vaccine.

She has selective IgA deficiency.  Assuming she does not have an antibody deficiency is there a contraindication to giving  her the YF vaccine?

Joe Church
Children’s hospital Los Angeles

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