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

Sun Apr 22 09:51:49 EDT 2018

I don't have access to Powerchart at home and also have other things I need to get done. Let's just stick with Tuesday.

Francisco A. Bonilla, M.D., Ph.D.
Boston Children's Hospital
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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: Saturday, April 21, 2018 9:20 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Varicella non-responders [EXTERNAL]

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<mailto: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
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From: cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net> <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>> on behalf of CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto: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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