Varicella vaccine strain infection in a non-immunocompromised patient. A case report and review of literature

Figures & data

Figure 1. Distinguishing of vaccine type virus isolate from wild type was done by PCR amplification of two vaccine specific SNPs sites (106262 and 108111), followed by sequencing of the amplicons using standard laboratory methods. Shown is partial DNA sequencing of wild type VZV (the 1^st 2 rows), vaccine type VZV (middle rows) and the virus type isolated from the patient (the final rows). Note that the patient isolate is similar to the vaccine strain VZV at the 108111 position (black highlight); not shown is the rest of the sequence which is similar between the 3 types

Figure 2. The sequence of events and therapies throughout the timeline

Table 1. A summary of all cases of varicella from vaccine strain which ended with death.

Age, Sex	Medical background	Clinical presentation	Timing of symptoms	Site of sample	PCR analysis of VZV	Cause of death	Timing of Death
13 mo, F^Citation5	Underlying primary immunodeficiency	Disseminated varicella (rash, hepatic and renal failure)	21 d PV	Skin lesion+ CSF	Vaccine strain	Multi-organ failure associated with disseminated varicella	7 weeks PV
15 mo, F^Citation5	Steroid treatment; possible underlying immunodeficiency	Disseminated rash and pneumonitis)	20 d PV	Skin lesion + bronchial lavage	Vaccine strain	Multi-organ failure associated with disseminated varicella	7 weeks PV
48 mo, F^Citation7	ALL	Rash, pneumonitis, hepatitis and CNS symptoms	32 d PV	Blood sample	Vaccine strain	Multi-organ failure associated with disseminated varicella	42 d PV
12 mo, F*	Asplenia, Congenital heart disease	Disseminated rash	25 d PV	Skin lesion	Vaccine strain	General deterioration	38 d PV

mo, months; F, Female; ALL, Acute lymphoblastic leukemia; CNS, central nervous system; CSF, Cerebrospinal fluid; PCR, Polymerase chain reaction; VZV, Varicella zoster virus; PV, Post Vaccination.

*The case described in the manuscript

Woodward M, Marko A, Galea S, Eagel B, Straus W. Varicella virus vaccine live: A 22-year review of postmarketing safety data. Open Forum Infect Dis. 2019;6(8):1–13. doi:10.1093/ofid/ofz295.

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Schrauder A, Henke-Gendo C, Seidemann K, Sasse M, Cario G, Moericke A, Schrappe M, Heim A, Wessel A. Varicella vaccination in a child with acute lymphoblastic leukaemia. Lancet. 2007;369(9568):1232. doi:10.1016/S0140-6736(07)60567-4.

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