[CIS PIDD] [cis-pidd] Varicella non-responders

[CIS-PIDD]

Hi Jay -
 
I get this consult question frequently in otherwise healthy adults. The
commercially available ELISA varicella antibody assays are known to have
sensitivity issues such that they may not reliably detect vaccine-induced
antibody. Due to these false negatives, the CDC doesn¹t recommend routine
post-vaccine serology be relied upon for evidence of immunity.
Documentation of age-appropriate immunization or of previous typical
varicella infection is sufficient.  If there are other clinical issues
suggesting immunodeficiency, then there may be additional testing to
consider, but I don¹t think we can rely on varicella titers as diagnostic
evidence of immunodeficiency.

Best,

Marc

Marc Riedl, MD, MS
Professor of Medicine
Clinical Director ­ US HAEA Angioedema Center
Division of Rheumatology, Allergy & Immunology
University of California, San Diego
8899 University Center Lane, Suite 230
San Diego, CA  92122
Tel  858.657.5350  Fax 858.657.5375




On 4/20/18, 12:44 PM, "cis-pidd at lyris.dundee.net on behalf of CIS-PIDD"
<cis-pidd at lyris.dundee.net on behalf of cis-pidd at lists.clinimmsoc.org>
wrote:

>
>
>I wanted to know if anyone has experience with patients who do not
>respond to varicella vaccine. I had a 16 year old patient with mildly low
>IgM and IgA who received varicella
>vaccine when he was 1 and 8 years old, history of chicken pox a few years
>after the first vaccine. Her varicella antibody titer was not protective.
>
>Her immune work-up is below:
>IgG 964, IgM 43, IgA 54
>Lymphocyte subsets: CD3: 2415, CD4: 1331, CD8: 1053, CD16: 186, CD56:
>155, CD19: 433
>T-cell proliferation to PHA: 92% of control
>Ab titers: Diphtheria and Tetanus protective, S. pneumoniae: 16/23
>serotypes protective
>
>
>
>Thank you for the input.
>- Jay
>
>Jay Patel, MD
>Fellow, Allergy and Immunology
>University of Washington
>
>
>
>
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