[CIS PIDD] [cis-pidd] DiGeorge and live virus vaccines

[Laura Hoyt]

Besides checking lymph functions, one option would be to give a Varivax first, since that could be treated if vaccine-associated disease occurs. Then if the patient does well, give the MMR later.  Many HIV-infected children with these CD3 counts have done fine with the vaccines, even without being on antiretroviral therapy, but they usually have CD4< CD8.

Laura Hoyt MD
Infectious Disease and Immunology
Children's Hospitals and Clinics of Minnesota


>>> "Haines, Kathleen M.D." <KHaines at HackensackUMC.org> 8/9/13 13:01 PM >>>

I have a 2yo girl w/DiGeorge due/overdue for live virus vaccines.  She is in good health.  However her lymphocyte subsets are as follows:  WBC 2500; CD3 707; CD4 483; CD8 217; CD 56/16 178.  She has made good antibodies to tetanus and responded to 5/7 pneumococcal subtypes in Prevnar.   Overall Igs: IgG 615 mg/dL; IgA 18 mg/dL; IgM 35 mg/dL.  I haven't done any lymphocyte functions.

I'm usually happy to give the live vaccines when the CD8 is close to 300 without any functional tests.  Should I go ahead and vaccinate w/ MMRV or hold off?  Opinions?

Kathleen A. Haines, MD
Section Chief, Pediatric Immunology
Section of Pediatric Rheumatology & Immunology
Hackensack UMC
30 Prospect Ave.
Hackensack, NJ 07601

Tel: 551-996-5306
Fax: 201-996-9815
khaines at HackensackUMC.org 

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