796. Severe Complications of Varicella in Persons Vaccinated with Varicella Vaccine (Breakthrough Varicella): a Systematic Literature Review
Session: Poster Abstract Session: Vaccines: Safety and Adverse Events
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Varicella Severe BT Poster_2016 IDSA_FINAL.pdf (219.6 kB)
  • Background: Live, attenuated varicella vaccines introduced during the 1990s are safe and effective with >140 million doses distributed in the United States alone. Varicella may occur among vaccinated persons (breakthrough varicella). Breakthrough varicella is generally mild, but severe cases have been reported. Understanding the clinical presentations of breakthrough varicella (i.e., vaccine failure) is important for evaluating the vaccination program.

    Methods: Systematic review of articles published during 1977-2015 using specific search terms. Breakthrough varicella is defined as varicella ≥42 days after varicella vaccination. We defined severe breakthrough as varicella that resulted in 1) disseminated varicella-zoster virus (VZV) infection to other organs besides skin, 2) any hospitalization in addition to cases that met the first criterion, and 3) death.

    Results: Of the 877 articles identified, 34 were included: 25 described breakthrough varicella with disseminated VZV infection to other organs besides skin and 11 described hospitalized breakthrough varicella without internal organ involvement. The severe complications, not mutually exclusive, described in the articles included: neurologic (11 articles), hematologic (9), secondary infection with bacteremia or sepsis (7), pneumonia (5), ocular (5), hepatic (4) and renal (2). No articles indicated severe breakthrough varicella with disseminated VZV infection to other organs besides skin in persons who received 2 doses of varicella vaccine. Two articles reported hospitalized breakthrough varicella cases without other organ involvement in 4 patients who received 2 doses of varicella vaccine. There were 6 reports of fatal breakthrough varicella, all among 1-dose vaccine recipients; 5 occurred in persons with altered immunocompetence.

    Conclusion: Severe complications with organ involvement besides skin among breakthrough varicella cases do occur but appear rare. Most common severe complications involving disseminated VZV among vaccinated persons were similar to those seen in unvaccinated persons. No severe complications involving disseminated VZV infection were reported among 2-dose vaccine recipients.

    Jessica Leung, MPH, Epidemiology Branch, Division of Viral Diseases, National Center Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Karen Broder, MD, Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA and Mona Marin, MD, Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    J. Leung, None

    K. Broder, None

    M. Marin, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.