Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list
Abstract Background The goal of this study was to apply the varicella zoster virus (VZV) vaccine to patients with pediatric rheumatic diseases (PRD) at risk for severe chickenpox, without interrupting their current immunosuppression, including biological agents, using an immunological-based pre-vacc...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-03-01
|
| Series: | Pediatric Rheumatology Online Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12969-018-0231-3 |
| _version_ | 1819075316876836864 |
|---|---|
| author | Fabian Speth Claas H. Hinze Susanne Andel Thomas Mertens Johannes-Peter Haas |
| author_facet | Fabian Speth Claas H. Hinze Susanne Andel Thomas Mertens Johannes-Peter Haas |
| author_sort | Fabian Speth |
| collection | DOAJ |
| description | Abstract Background The goal of this study was to apply the varicella zoster virus (VZV) vaccine to patients with pediatric rheumatic diseases (PRD) at risk for severe chickenpox, without interrupting their current immunosuppression, including biological agents, using an immunological-based pre-vaccination checklist to assure safety. A pre-vaccination checklist was implemented to ensure adequate immune competence prior to immunization. Methods This prospective study included seronegative patients (VZV-IgG ≤200 mIU/ml) and patients who had previously received only a single dose of VZV vaccine. All vaccinees demonstrated clinically inactive PRD. Patients were categorized according to their actual treatment in low-intensity IS (LIIS) and high-intensity IS (HIIS) including biological therapy. The pre-vaccination checklist defined thresholds for the following basic laboratory tests: white blood cell count ≥3000/mm3, lymphocytes ≥1200/mm3, serum IgG ≥500 mg/dl, IgM ≥20 mg/dl, tetanus toxoid antibody ≥0.1 IU/ml. In case of HIIS additional specifications included a CD4+ lymphocyte count ≥200/mm3 and a positive T-cell function (via analyzable positive control of a standard tuberculosis interferon-gamma-release-assay (TB-IGRA) indicating mitogen-induced T cell proliferation). Patients who met the criteria of the pre-vaccination checklist received the first and/or second VZV vaccination. Immunologic response and side effects were monitored. Results Twenty-three patients were recruited of whom nine had already received one VZV immunization before initiating IS. All patients met the pre-vaccination checklist criteria despite ongoing IS. There was no overall difference in VZV-IgG levels when comparing the LIIS (n=9) and HIIS (n=14) groups. In total, 21 patients (91%) showed a positive vaccination response, after the first immunization the median VZV-IgG across all patients was 224 (59-1219) mIU/ml (median (range)), after booster immunization it increased to 882 (30-4685) mIU/ml. Two patients in the HIIS group failed to raise positive VZV-IgG, despite booster immunization. All nine patients receiving only the second immunization on IS reached high titers of VZV-IgG >500 mIU/ml (1117 (513-4685) mIU/ml). There were no cases of rash or other vaccine-induced varicella disease symptoms and no evidence of PRD flare. Conclusions VZV vaccination is safe and largely immunogenic in children with ongoing IS fulfilling an immunological based pre-vaccination checklist. This new approach is based on immunologic function rather than on type of medications. Trial registration number ISRCRTN trial registration number 21654693, date of registration February 12, 2018, retrospectively registered. |
| first_indexed | 2024-12-21T18:23:29Z |
| format | Article |
| id | doaj.art-cf63e488048646ac96affe41aa897b31 |
| institution | Directory Open Access Journal |
| issn | 1546-0096 |
| language | English |
| last_indexed | 2024-12-21T18:23:29Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Pediatric Rheumatology Online Journal |
| spelling | doaj.art-cf63e488048646ac96affe41aa897b312022-12-21T18:54:30ZengBMCPediatric Rheumatology Online Journal1546-00962018-03-0116111010.1186/s12969-018-0231-3Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check listFabian Speth0Claas H. Hinze1Susanne Andel2Thomas Mertens3Johannes-Peter Haas4German Center for Pediatric and Adolescent RheumatologyDepartment of Pediatric Rheumatology and Immunology, University Hospital MünsterGerman Center for Pediatric and Adolescent RheumatologyInstitute of Virology, Ulm University Medical CenterGerman Center for Pediatric and Adolescent RheumatologyAbstract Background The goal of this study was to apply the varicella zoster virus (VZV) vaccine to patients with pediatric rheumatic diseases (PRD) at risk for severe chickenpox, without interrupting their current immunosuppression, including biological agents, using an immunological-based pre-vaccination checklist to assure safety. A pre-vaccination checklist was implemented to ensure adequate immune competence prior to immunization. Methods This prospective study included seronegative patients (VZV-IgG ≤200 mIU/ml) and patients who had previously received only a single dose of VZV vaccine. All vaccinees demonstrated clinically inactive PRD. Patients were categorized according to their actual treatment in low-intensity IS (LIIS) and high-intensity IS (HIIS) including biological therapy. The pre-vaccination checklist defined thresholds for the following basic laboratory tests: white blood cell count ≥3000/mm3, lymphocytes ≥1200/mm3, serum IgG ≥500 mg/dl, IgM ≥20 mg/dl, tetanus toxoid antibody ≥0.1 IU/ml. In case of HIIS additional specifications included a CD4+ lymphocyte count ≥200/mm3 and a positive T-cell function (via analyzable positive control of a standard tuberculosis interferon-gamma-release-assay (TB-IGRA) indicating mitogen-induced T cell proliferation). Patients who met the criteria of the pre-vaccination checklist received the first and/or second VZV vaccination. Immunologic response and side effects were monitored. Results Twenty-three patients were recruited of whom nine had already received one VZV immunization before initiating IS. All patients met the pre-vaccination checklist criteria despite ongoing IS. There was no overall difference in VZV-IgG levels when comparing the LIIS (n=9) and HIIS (n=14) groups. In total, 21 patients (91%) showed a positive vaccination response, after the first immunization the median VZV-IgG across all patients was 224 (59-1219) mIU/ml (median (range)), after booster immunization it increased to 882 (30-4685) mIU/ml. Two patients in the HIIS group failed to raise positive VZV-IgG, despite booster immunization. All nine patients receiving only the second immunization on IS reached high titers of VZV-IgG >500 mIU/ml (1117 (513-4685) mIU/ml). There were no cases of rash or other vaccine-induced varicella disease symptoms and no evidence of PRD flare. Conclusions VZV vaccination is safe and largely immunogenic in children with ongoing IS fulfilling an immunological based pre-vaccination checklist. This new approach is based on immunologic function rather than on type of medications. Trial registration number ISRCRTN trial registration number 21654693, date of registration February 12, 2018, retrospectively registered.http://link.springer.com/article/10.1186/s12969-018-0231-3Biologic agentsDMARDsImmunologic testsJuvenile chronic arthritisPediatric rheumatic diseasesVaricella zoster virus |
| spellingShingle | Fabian Speth Claas H. Hinze Susanne Andel Thomas Mertens Johannes-Peter Haas Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list Pediatric Rheumatology Online Journal Biologic agents DMARDs Immunologic tests Juvenile chronic arthritis Pediatric rheumatic diseases Varicella zoster virus |
| title | Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list |
| title_full | Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list |
| title_fullStr | Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list |
| title_full_unstemmed | Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list |
| title_short | Varicella-zoster-virus vaccination in immunosuppressed children with rheumatic diseases using a pre-vaccination check list |
| title_sort | varicella zoster virus vaccination in immunosuppressed children with rheumatic diseases using a pre vaccination check list |
| topic | Biologic agents DMARDs Immunologic tests Juvenile chronic arthritis Pediatric rheumatic diseases Varicella zoster virus |
| url | http://link.springer.com/article/10.1186/s12969-018-0231-3 |
| work_keys_str_mv | AT fabianspeth varicellazostervirusvaccinationinimmunosuppressedchildrenwithrheumaticdiseasesusingaprevaccinationchecklist AT claashhinze varicellazostervirusvaccinationinimmunosuppressedchildrenwithrheumaticdiseasesusingaprevaccinationchecklist AT susanneandel varicellazostervirusvaccinationinimmunosuppressedchildrenwithrheumaticdiseasesusingaprevaccinationchecklist AT thomasmertens varicellazostervirusvaccinationinimmunosuppressedchildrenwithrheumaticdiseasesusingaprevaccinationchecklist AT johannespeterhaas varicellazostervirusvaccinationinimmunosuppressedchildrenwithrheumaticdiseasesusingaprevaccinationchecklist |