[CIS PIDD] [cis-pidd] Live Vaccines for AT babies diagnosed by SCID screen?

[CIS-PIDD]

Hey Jin:



I would not worry much about skipping the rotavirus vaccine.



MMR is the real conundrum with these infants.  If you give the MMR the child is likely protected at least for a while, but then you wait for the rubella component to cause problems.



If you withhold the vaccine, and the child gets wild-type measles you've got a major issue.  Perhaps a decision would depend in part on how big the vaccine denier population is that lives close to the patient.  This is a major issue in LA.



Perhaps a bit out of the box:  Immunoglobulin would protect the patient from most vaccine-preventable infections including MMR.  And you could probably get away with a lower dose or less frequent administration if measles protection is the primary target.  You could give a dose of IVIg and monitor measles antibody titers.  A neutralizing assay may be better a predictor of protection than the standard ELISA, but you can check with your ID folk.



Good Luck.



Joe Church

Children's Hospital Los Angeles



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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: Thursday, May 10, 2018 10:41 AM
To: CIS-PIDD
Subject: [cis-pidd] Live Vaccines for AT babies diagnosed by SCID screen? (EXTERNAL EMAIL)

Hello all,
Now that we are all diagnosing AT babies very early, is there a consensus on live vaccines?
Are people just doing it case by case based on CD4 and CD8 counts as well as proliferation?
Would people be willing to share what they do at their institution?

We just diagnosed a baby with AT who was picked up on NBS.  He is due for his 2 month vaccines.
CD4 count around 800, CD8 count count only 250, B cells very low around 80 cells/ul, normal NK cells,
Very decent proliferation with PHA and Pokeweed.
I want to say ok, but now with this concern about rubella positive granulomas in patients with AT linked with MMR, I am wondering if I should be more cautious.

Thank you for your thoughts,

Hey

Hey Jin Chong MD PhD
Division Director of Pediatric Allergy & Immunology
Assistant Professor of Pediatrics
Children's Hospital of Pittsburgh of UPMC
One Children's Hospital Drive
4401 Penn Avenue
Pittsburgh, PA 15224
tel 412-692-7885
fax 412-692-8499





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