[CIS PIDD] [cis-pidd] live vaccines in Digeorge population

[Kobrynski, Lisa]

I agree with Ken.  If the T cell numbers are normal we usually don't get the proliferation studies, since we have never seen a child with immune dysfunction with normal T cell #.

The abnormal proliferation to tetanus and candida is not at all surprising in such a young child.

Proliferation to candida is frequently absent in prepubertal children and many males even after puberty.



Lisa



Lisa Kobrynski, MD, MPH
Associate Professor of Pediatrics
Marcus Professor of Immunology
Section, Allergy/Immunology
________________________________
From: Elisabeth Förster-Waldl [elisabeth.foerster-waldl at meduniwien.ac.at]
Sent: Friday, April 24, 2015 5:41 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] live vaccines in Digeorge population

… answer from my side, considering the info you sent, is the same than from others: yes.
And furthermore, I have a question which answer might help decision making: did the child have rotavirus vaccine? and was it well tolerated?
We recently observed a Di George syndrome patient who had not been evaluated for ID before rotavirus vaccination and developed prolonged diarrhea after having received the oral live vaccine.
In the meanwhile we know that this patient is severe lymphopenic, thus, we got an explanation for the vaccine related side effect, and thus, his features are different from the patient you describe.
Still, you might feel to be even more ‘on the safe side’ if you know that he already has tolerated an attenuated live vaccine.

kind regards
Elisabeth Förster-Waldl


___________________________________________________________

a.o. Univ. Prof. Dr. Elisabeth Förster-Waldl
Medical University of Vienna
Dept. of Pediatrics & Adolescent Medicine
Center for Congenital Immunodeficiencies, http://ccid.meduniwien.ac.at<http://ccid.meduniwien.ac.at/>
& Jeffrey Modell Center Vienna, http://www.jmf-vienna.at
Währinger Gürtel 18-20
A-1090 Wien
elisabeth.foerster-waldl at meduniwien.ac.at<mailto:elisabeth.foerster-waldl at meduniwien.ac.at>

On 23 Apr 2015, at 21:57, Anastasiya Ashurova <ana.ashurova at gmail.com<mailto:ana.ashurova at gmail.com>> wrote:

Hi
We are following a 15 month old DiGeorge baby found to have a 22q11 deletion at birth.  We are in the process of clearing her for the MMR vaccine.  Workup has shown normal T/B/NK flow cytometry, protective titers to Tetanus (1.86), Hib (2.39) with 13 of 13 protective pneumococcal titers.  She had a normal proliferative response to PHA, PW, and Con A but did not proliferate to tetanus and although she had a response to candida, it was not robust.   Would you vaccinate this patient with a live vaccines?


Thank you,
Anastasiya Kleva
Fellow, Division of Allergy and Immunology
Cohen’s Children’s Medical Center

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