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

[CIS-PIDD]

To Lisa's point, several years ago there was an epidemic at Indiana
University investigated by CDC. There were a significant number of
seronegative students who developed high IgG anti-varicella titers several
weeks into the epidemic with no IgM anti-varicella and no symptoms. Clearly
they were protected and had an anamnestic response.
Richard Wasserman

On Sat, Apr 21, 2018 at 8:31 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> There are two issues - one is that antibodies to varicella wane (even
> after natural infection) however, this isn't always predictive of
> susceptibility to infection/shingles, the other is that the serologic test
> for varicella antibodies varies considerably in its ability to detect low
> levels of antibody.
>
> How firm is the diagnosis of chicken pox?  We certainly see many children
> who get a few spots after the vaccine and one can find varicella virus in
> the lesions. So few people get wild type varicella that many pediatricians
> do not have a lot of experience diagnosing it, so if the rash was atypical
> and they don't have confirmation of the presence of the virus, it is
> possible that the child did not actually have chickenpox.
>
> We have had a few patients with recurrent zoster and little/no antibodies,
> we did repeat the varicella vaccine and most of them did have some
> seroconversion.  Whether or not it reduced their zoster episodes is hard to
> say.
>
>
> Lisa
>
>
> Lisa Kobrynski, MD, MPH
> Associate Professor of Pediatrics
> Marcus Professor of Immunology
> Section, Allergy/Immunology
> ------------------------------
> *From:* cis-pidd at lyris.dundee.net <cis-pidd at lyris.dundee.net> on behalf
> of CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
> *Sent:* Friday, April 20, 2018 3:44:13 PM
> *To:* CIS-PIDD
> *Subject:* [cis-pidd] Varicella non-responders
>
>
>
> 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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-- 
Richard L. Wasserman, MD, PHD
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Telephone (972) 5666-7788
Telefacsimile (972) 566-8837
Cell (214) 697-7211
www.allergypartners.com/northtexas/
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drrichwasserman at gmail.com

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