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

Tue Apr 24 13:57:01 EDT 2018

Her history of chickenpox was diagnosed clinically by the pediatrician and treated with acyclovir about 4-5 years after one dose of varicella vaccine. She received one more varicella vaccine after that episode.  Thank you all for the input regarding the clinical use and interpretation of the varicella vaccine titers, it is helpful to hear everyone’s experience.

- Jay

On Sat, 21 Apr 2018, CIS-PIDD wrote:

> 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
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