[CIS PIDD] [cis-pidd] varicella vaccination in T cell lymphopenia

[CIS-PIDD]

Laia:

I think you have to balance the risk of exposure to a live but attenuated VZV versus the risk of the child getting wild-type varicella infection.  The latter is likely in Los Angeles.

Also, you have the availability of antiviral medication that you can give at the first sign of vaccine-related varicella.  In a similar situation I gave the my 2yo patient the vaccine and a prescription for valacyclovir.  The prescription was not needed.

Joe Church
Children's Hospital Los Angeles







-----Original Message-----
From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org] 
Sent: Tuesday, December 13, 2016 1:38 PM
To: CIS-PIDD
Subject: [cis-pidd] varicella vaccination in T cell lymphopenia

Dear all, 

I would very much appreciate ypur suggestions regarding this patient:

-5 yo caucasian male born to non-consanguineous parents, with severe T lymphopenia (ALC between 900-1200/mm3 over time) detected in the postoperative of cardiovascular surgery (congenital heart disease) at the age of 2 months. No severe infections previous to the first evaluation. Normal T cell counts at birth. No dysmorphic features. Normal IgG, IgA and IgM at diagnosis. Normal monocyte, neutrophil, eos and basophils. Normal Hb and platelets. No protein-lose enteropathy. Was started on IVIG and antibiotic prophylaxis, while completing the study. 

T cell subphenotyping shows: 
CD3+: 28%
CD4+: 16,2% (178/mm3)
CD8+: 9,5% (105/mm3)
CD19+: 55,2% (607/mm3)
CD16-56+: 15,9% (175/mm3)

CD3+ alpha/beta: 84,8% (264/mm3)
CD3 gamma/delta: 14% (43,6%)
CD3+CD45RA+: 33,6%
CD3+CD45RO+: 52,1%

with normal prolipherative responses to PHA. No deletion in 2q112 nor in 10q11. Truesight gene panel shows no mutations. 

Has been withdrawn of IVIG, and shows normal IgG, IgA, IgM and normal vaccine responses to inactivated vaccines. 

How would you manage the risk of varicella, since VVZ vaccine should not be administered? 



Thank you in advance, 



Laia Alsina, MD, PhD
Attending at the Allergy and Clinical Immunology Department Hospital Sant Joan de Déu, Barcelona Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic.
ORCID ID: http://orcid.org/0000-0002-3559-0018






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