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Nonfebrile seizures after mumps, measles, rubella, and varicella-zoster virus combination vaccination with detection of measles virus RNA in serum, throat, and urine.

"We report the case of a child presenting with nonfebrile seizures 6 and 13 days after the first vaccination with a measles, mumps, rubella, and varicella (MMRV) combination vaccine. Measles virus RNA was detected in the patient's serum, throat, and urine. Genotyping revealed the Schwarz vaccine virus strain.....

An 11-month-old boy was presented to the pediatric unit after experiencing three seizures in the morning of the same day. The seizures were initiated by a sharp outcry with symmetric tonic-clonic movement of the arms and legs. During the seizures, the child was not reacting to his mother and had cyanotic lips. Seizures stopped spontaneously, without the administration of anticonvulsants, after approximately 1 to 2 min. Immediately after the seizures, body temperature, as measured by the mother as well as by the emergency physician, was not elevated (37.3°C). Upon admission, the child was sleepy but conscious and without signs of meningitis. The child had a slight rash on his trunk and pale skin color; otherwise, the clinical examination was unremarkable.....

There was no history of seizures before or any other known medical conditions. Six days before the seizure, the first vaccination with the regular measles, mumps, rubella, and varicella (MMRV) vaccine (Priorix-Tetra; GlaxoSmithKline) was performed. In the meantime, there were no signs of infection or fever.....

Viral concentration was low in serum and urine but remarkably higher in the throat swab."
"Even though live attenuated measles vaccines have been used for more than 40 years, data are scarce on the extent to which vaccine virus replicates in or is shed by vaccinees (5). Isolation of infectious vaccine virus from the blood and pharynx of vaccinated children by propagation on canine renal cell culture was successfully performed in early studies with the Edmonston strain (9), from experimentally vaccinated Cynomolgus monkeys after vaccination with the Schwarz vaccine strain (10), and in a study evaluating fever and rash appearing 3 to 9 days after measles vaccination (11)." 2013

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697452/

 

"We describe a death in a 15-mo-old girl who developed a varicella-like rash 20 d after varicella vaccination that lasted for 2 mo despite acyclovir treatment. The rash was confirmed to be due to vaccine-strain varicella-zoster virus (VZV). This is the first case of fatal varicella due to vaccine-strain VZV reported from the United States. The patient developed severe respiratory complications that worsened with each new crop of varicella lesions; vaccine-strain VZV was detected in the bronchial lavage specimen. Sepsis and multi-organ failure led to death.

The patient did not have a previously diagnosed primary immune deficiency, but her failure to thrive and repeated hospitalizations early in life (starting at 5 mo) for presumed infections and respiratory compromise treated with corticosteroids were suggestive of a primary or acquired immune deficiency. Providers should monitor for adverse reactions after varicella vaccination. If severe adverse events develop, acyclovir should be
administered as soon as possible. The possibility of acyclovir resistance and use of foscarnet should be considered if lesions do not improve
after 10 d of treatment (or if they become atypical [e.g., verrucous])." 2014


http://www.ncbi.nlm.nih.gov/pubmed/23982221


"We report the occurrence of one fatal case of the encephalitis associated with measles-rubella (MR) vaccine during an immunization campaign in São Paulo, Brazil. A 31 year-old-man, previously in good health, was admitted at emergency room, with confusion, agitation, inability to stand and hold his head up. Ten days prior to admission, he was vaccinated with combined MR vaccine (Serum Institute of India) and three days later he developed 'flu-like' illness with fever, myalgia and headache. Results of clinical and laboratory exams were consistent with a pattern of viral encephalitis. During hospitalization, his condition deteriorated rapidly with tetraplegia and progression to coma. On the 3rd day of hospitalization he died. Histopathology confirmed encephalitis and immunohistochemistry was positive for RV on brain tissue. RV was also detected by qPCR and virus isolation in cerebrospinal fluid, brain and other clinical samples. The sequence obtained from the isolated virus was identical to that of the RA 27/3 vaccine strain." DEC 2013

http://www.ncbi.nlm.nih.gov/pubmed/24216323

 

"We report the first laboratory-documented case of herpes zoster caused by the attenuated varicella zoster virus (VZV) contained in Zostavax in a 68-year-old immunocompetent adult with strong evidence of prior wild-type VZV infection." APR 2014

http://www.ncbi.nlm.nih.gov/pubmed/24470276


"we describe a previously immunized child who developed herpes zoster with meningitis. Vaccine strain of VZV was recovered from a skin swab and the cerebrospinal fluid. Reactivation of the vaccine strain of VZV should be recognized as a potential cause of meningitis in children." 2011

http://www.ncbi.nlm.nih.gov/pubmed/20844461



"More than 8 years after varicella vaccination, a healthy 16 year-old boy presented with keratouveitis, severe inflammatory glaucoma in his left eye, and Hutchinson's sign. He was treated with systemic acyclovir, topical steroids, cycloplegics, and glaucoma medications for a full recovery two months after presentation. It is unclear whether the source of herpes zoster which reactivated in this patient represents wild type virus or his previous vaccine strain. Herpes zoster ophthalmicus is very rare in the pediatric population after varicella vaccination but can cause severe inflammatory glaucoma that requires aggressive therapy."

http://www.ncbi.nlm.nih.gov/pubmed/19294571



"A five-year-old girl, vaccinated against varicella-zoster virus (VZV) presented with clinical symptoms of herpes zoster in the 6th cervical dermatome. A VZV direct immune-fluorescence assay was negative three times but additional genotypical analysis showed a VZV strain genotype 2 (Oka vaccine strain). Therefore the diagnosis of a breakthrough varicella disease with the vaccine strain was established. An immunodeficiency was ruled out and the patient responded well to the initiated therapy. This case demonstrates that a negative VZV direct immunofluorescence assay does not exclude an infection with the vaccine strain." 2013

http://www.ncbi.nlm.nih.gov/pubmed/23358727


"A 23-year-old teacher presented to hospital with a mild case of varicella. VZV vaccine strain vOka that resembles Varilrix but not Varivax or Biken strains was isolated from the skin lesion of the patient and was identified by single nucleotide polymorphism (SNP) analysis. The teacher denied having varicella vaccine before. Retrospective analysis suggests the transmission came from a pupil who developed zoster 13 months after varicella vaccine Varilrix."

http://www.ncbi.nlm.nih.gov/pubmed/21134454


"A 25-day-old infant developed varicella 22 days after her mother received varicella vaccine postpartum. Infection with vaccine-strain varicella-zoster virus was confirmed by genetic analysis. The mother had no postvaccination rash nor did other contacts have rash or recent vaccination." 2012

http://www.ncbi.nlm.nih.gov/pubmed/22572750



"A 12-year-old boy developed a skin rash following administration of MMR varicella zoster virus vaccine [route, dosage and outcome not stated].

The boy's medical history included DiGeorge syndrome and juvenile idiopathic arthritis, which was treated with etanercept. He inadvertently received the MMR varicella zoster virus vaccine during a well-child visit. Ten days later, he was hospitalised with a 2-day history of fever, conjunctivitis, rash and sore throat. His mother held further doses of etanercept. Upon admission, physical examination revealed a blanching morbilliform rash on his face, ears, neck, chest, back and limbs. He also had mild conjunctivitis, palatal petechiae with posterior pharyngeal erythema and mild post auricular cervical lymphadenopathy.

The boy began receiving aciclovir. Urine and skin samples were positive for measles virus, and were phylogenetically clustered as genotype A with Edmonston reference strain. He was diagnosed with vaccine-associated disease." 2014


-Pediatric Infectious Disease Journal 33: 117, No. 1, Jan 2014 - USA
http://link.springer.com/article/10.1007/s40278-014-0119-z
  

"Varicella vaccination is less effective than the natural immunity that existed in prevaccine communities. Universal varicella vaccination has not proven to be cost-effective as increased HZ (shingles) morbidity has disproportionately offset cost savings associated with reductions in varicella disease. Universal varicella vaccination has failed to provide long-term protection from VZV disease."            

http://www.ncbi.nlm.nih.gov/pubmed/2265944

 

Stroke after varicella vaccination.

Two children presented with acute hemiparesis 5 days and 3 weeks following varicella vaccination. Both showed unilateral infarction of the basal ganglia and internal capsule, a distribution consistent with varicella angiopathy. Both children had small patent foramen ovale (PFO), and one child also had severe iron-deficiency anemia, which may have predisposed the patient to this adverse effect.

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http://www.ncbi.nlm.nih.gov/pubmed/15580216/

"Analysis of 36 individuals over age 60 years who were immunized with  Zostavax revealed varicella zoster virus DNA in swabs of skin inoculation sites obtained immediately after immunization in 18 (50%) of 36 subjects  and in saliva collected over 28 days in 21 (58%) of 36 subjects. Genotypic analysis of DNA extracted from 9 random saliva samples identified vaccine virus in ALL instances. In some immunized individuals over age 60, vaccine virus DNA is shed in saliva up to 4 weeks."

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"Zostavax contains live attenuated VZV, and the package insert warns newly vaccinated individuals to avoid contact for an unspecified time with newborn infants, immunosuppressed individuals, and pregnant women who have not had chicken pox or have not been immunized for chicken pox. Because VZV DNA is present in saliva of zoster patients for at least 2 weeks [5] and VZV in saliva can also be infectious [6], we examined the inoculation site and saliva of Zostavax-vaccinated subjects for the presence of VZV DNA for 4 weeks after immunization"

FULL TEXT   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096786/

 

"Healthcare workers born after 1980 were 20 times (95% CI: 11.0 to 37.2) more likely to be susceptible to measles, and 2 times (95% CI: 1.2 to 3.2) more likely to be susceptible to varicella than those those born before 1965.

CONCLUSIONS:The susceptibility to measles in healthcare workers in our centre is higher in younger cohorts, with values higher than expected in a community with high vaccination coverage against measles, mumps, rubella vaccine (MMR) in the paediatric population for many years." 2012

http://www.ncbi.nlm.nih.gov/pubmed/22137370