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Tilden MD (1851-1940), John

PEDIATRICS Vol. 106 No. 2 August 2000, p. e28

ELECTRONIC ARTICLE:
Chickenpox Attributable to a Vaccine Virus Contracted From a Vaccinee With Zoster

Philip Alfred Brunell, MS, MD and Takele Argaw, DVM From Ahmanson Pediatrics Department, Cedars Sinai Medical Center, Los Angeles, California; and the Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.       ABSTRACT

Five months after 2 siblings were immunized with varicella vaccine, 1
developed zoster. Two weeks later the second sibling got a mild case of
chicken pox. Virus isolated from the latter was found to be vaccine type.
Thus, the vaccine strain was transmitted from the vaccinee with zoster to
his sibling. Vaccinees who later develop zoster must be considered
contagious. varicella-zoster, zoster, vaccine, transmission, rash, PstI.
Varicella is the initial manifestation of varicella-zoster virus (VZV)
infection. After clinical recovery, as with other herpes viruses, VZV
persists in a latent form. The virus may become activated resulting in
zoster. This occurs most commonly in older individuals, but also is seen in
immunocompromised younger people, eg, those infected with human
immunodeficiency disease virus or transplant recipients. It also is known to
occur in normal varicella vaccine recipients.1

Exposure of susceptible individuals to zoster has been recognized for more
than a century to result in varicella.2 We now report the occurrence of
varicella in a child whose brother developed zoster after immunization with
varicella vaccine. It has been advised that vaccinees that develop a rash
soon after immunization avoid contact with persons at high risk for
complications of varicella.3 Similar precautions would be appropriate for
contact with vaccinees that develop zoster. Heretofore, transmission of
vaccine virus was recognized to occur primarily from vaccinees with leukemia
that developed rashes after immunization.4,5
Although far less common, vaccine virus also has spread from normal
vaccinees with,6,7 and possibly without, a rash.8

Full Text available at: http://www.pediatrics.org/cgi/content/full/106/2/e28
CDC death stats http://www.cdc.gov/nchs/fastats/chicken.htm

Outbreak of Invasive Group A Streptococcus Associated with
Varicella in a Childcare Center -- Boston, Massachusetts, 1997 http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00049535.htm

Brogan TV, et al.  Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients. Pediatr Infect Dis J. 1995 Jul;14(7):588-94. PMID: 7567287; UI: 96055604.
       

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