335. Disseminated Varicella infection due to Oka -vaccine (vOka) strain of varicella-zoster virus (VZV) in an adult
Session: Poster Abstract Session: Challenges in Vaccinology and Vaccine Exploration
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Varicella vaccine (Varivax [Oka/Merck]; Merck), is a live attenuated vaccine appropriate for healthy individuals >12 months of age. This vaccine is widely used and is generally safe and well tolerated, although there are very rare case reports (<10) of vaccine-associated infections noted in immunized children with immunosuppression.

Methods: 

We report an adult who developed recurrent herpes zoster and subsequent disseminated VZV infection from a vaccination post stem cell transplant (SCT) with analysis of the strain type.

Results: 

A 67 year old male with history of non-Hodgkin lymphoma (NHL) who had received an autologous peripheral blood stem cell transplant in 2006, with relapse of disease in 2009 with no further treatment. He had previous varicella, IgG positive prior to transplant who was vaccinated with Varivax, in addition to MMR, HBV and HAV in March 2010.   Three months after vaccination, he developed herpes zoster and three recurrences with dissemination of the infection over a course of five months. In November 2010, he presented with lesions on his face, forearm, and back and associated hemphagocytic syndrome with ferritin of >15,000, pancytopenia and elevated transaminases. His CD 4 count on arrival was 56 and he was HIV negative.  Bone marrow and liver biopsies showed granulomas and skin biopsy culture grew VZV, while on valacyclovir.  We obtained assistance from the Varicella Zoster Virus Identification Program (VZVIP), which analyzes VZV DNA to distinguish the vOka from wild-type VZV.  The patient’s VZV infection was identified to be due to the vOka strain, (adverse event reported to the FDA #1011USA03734).  The patient developed multi-organ dysfunction from which he was unable to recover and died at home on hospice.

Conclusion: 

We describe the first adult case of disseminated infection due to the vOka strain of VZV, with a granulomatous reaction which has not previously been reported with dissemination in children. In adults with previous immunocompromising conditions, caution and thorough review of patient’s medical history should be undertaken, prior to revaccination with the varicella live attenuated vaccine.


Subject Category: I. Adult and Pediatric Vaccines

Preeti Bhalla, DO, Infectious Disease, Oregon Health & Science University, Portland, OR, Anne Gershon, MD, FIDSA, Columbia University College Physicians, New York, NY, Jason Chen, Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York, NY, Philip LaRussa, MD, Columbia University, New York, NY, Sharon Steinberg, BS, Columbia University College of Physicians & Surgeons, NY, NY and Graeme Forrest, MBBS, Portland VA Medical Center, Portland, OR

Disclosures:

P. Bhalla, None

A. Gershon, Merck: Grant Investigator, Grant recipient
GlaxoSmithKline: Consultant, Consulting fee

J. Chen, None

P. LaRussa, None

S. Steinberg, None

G. Forrest, Cubist: Investigator, Research support
Astellas: Investigator, Research support

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.