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

Fri May 11 05:47:23 EDT 2018

At least based upon our cohort of about 500 A-T patients, there is no concern for varicella vaccine.  Many fewer have had rotavirus since the vaccine has not been around as long, but I am not aware of any complications of that vaccine in our population or in the rest of the world.

The jury is still out on the MMR vaccine.  The risk must be small because the majority of people with A-T received that vaccine, but do not have granulomas. However,  because the granulomas have sometimes become a terrible, terrible problem and because there is little wild type measles, mumps or rubella in the United States, i do not recommend the MMR vaccine.

IVIG certainly has plenty of antibodies to measles, mumps and rubella, and it could be given to an A-T patient if there was a known exposure or a local outbreak.  In the absence of a contact, the risk of contracting any of these illnesses is very small, so I would not consider this by itself to be an indication for IgG replacement therapy.

Howard Lederman
A-T Clinical Center at Johns Hopkins.

Sent from my Verizon 4G LTE Droid
On May 10, 2018 5:40 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org> wrote:

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

________________________________
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

---

You are currently subscribed to cis-pidd as: jchurch at chla.usc.edu<mailto:jchurch at chla.usc.edu>.

To unsubscribe click here: http://cts.dundee.net/u?id=96396658.df9245d5219d19fc82ac9f3bbf52c836&n=T&l=cis-pidd&o=4896667

(It may be necessary to cut and paste the above URL if the line is broken)

or send a blank email to leave-4896667-96396658.df9245d5219d19fc82ac9f3bbf52c836 at lyris.dundee.net<mailto:leave-4896667-96396658.df9245d5219d19fc82ac9f3bbf52c836 at lyris.dundee.net>

CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,
is for the sole use of the intended recipient(s) and may contain confidential
or legally privileged information. Any unauthorized review, use, disclosure
or distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of this original message.

---

You are currently subscribed to cis-pidd as: hlederm1 at jhmi.edu<mailto:hlederm1 at jhmi.edu>.

To unsubscribe click here: http://cts.dundee.net/u?id=96396623.fe33ca1fb90d0766aac0b19fec27e272&n=T&l=cis-pidd&o=4897259

(It may be necessary to cut and paste the above URL if the line is broken)

or send a blank email to leave-4897259-96396623.fe33ca1fb90d0766aac0b19fec27e272 at lyris.dundee.net<mailto:leave-4897259-96396623.fe33ca1fb90d0766aac0b19fec27e272 at lyris.dundee.net>

---
You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://cts.dundee.net/u?id=96396833.5a9591ccd1e327fe6bc4d1543298c482&n=T&l=cis-pidd&o=4897981
or send a blank email to leave-4897981-96396833.5a9591ccd1e327fe6bc4d1543298c482 at lyris.dundee.net
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://pairlist7.pair.net/pipermail/pagid/attachments/20180511/7f0cad01/attachment-0001.html>