Severe Herpes Zoster Following Varicella Vaccination in Immunocompetent Young Children

Amaran Moodley; Jack Swanson; Charles Grose; Daniel J Bonthius

doi:10.1177/0883073818821498

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Severe Herpes Zoster Following Varicella Vaccination in Immunocompetent Young Children

Journal article

Open access

Peer reviewed

Severe Herpes Zoster Following Varicella Vaccination in Immunocompetent Young Children

Amaran Moodley, Jack Swanson, Charles Grose and Daniel J Bonthius

Journal of child neurology, Vol.34(4), pp.184-188

03/2019

DOI: 10.1177/0883073818821498

PMCID: PMC6376897

PMID: 30628536

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Abstract

Varicella vaccination is now virtually universal in North America, as well as in some European and Asian countries. Since varicella vaccine is a live attenuated virus, the virus replicates in the skin after administration and can travel via sensory nerves or viremia to become latent in the dorsal root ganglia. In some immunized children, virus reactivates within a few months to a few years to cause the dermatomal exanthem known as herpes zoster (shingles). Herpes zoster caused by vaccine virus often reactivates within the same dermatome as the site of the original varicella vaccine injection. We present evidence that occasional cases of herpes zoster following varicella vaccination in immunocompetent children can be as severe as herpes zoster following wild-type varicella. Analysis of the virus in one case disclosed that the vaccine virus causing herpes zoster was a wild-type variant with a mutation in ORF0. With regard to dermatomal localization of the viral eruption, we predict that herpes zoster of the lumbar dermatomes in children is likely to be caused by vaccine virus, because herpes zoster in those dermatomes is rare in children after wild-type varicella. One of the children with herpes zoster subsequently developed asthma, a known risk factor for herpes zoster, but none of the children had an autoimmune disease. Although postherpetic neuralgia is exceedingly rare, children who develop herpes zoster following varicella vaccination are at risk (albeit low) of developing meningoencephalitis and should be carefully observed for a few weeks.

Chickenpox Vaccine - adverse effects

Herpes Zoster - etiology

Humans

Child, Preschool

Infant

Male

Asthma - etiology

Vaccination - adverse effects

Chickenpox - prevention & control

Chickenpox Vaccine - therapeutic use

Details

Title: Subtitle: Severe Herpes Zoster Following Varicella Vaccination in Immunocompetent Young Children
Creators: Amaran Moodley - Division of Infectious Diseases, Blank Children's Hospital, Des Moines, IA, USA
Jack Swanson - Department of Pediatrics, McFarland Clinic, Ames, IA, USA
Charles Grose - Division of Infectious Diseases/Virology, Children's Hospital, University of Iowa, Iowa City, IA, USA
Daniel J Bonthius - Division of Child Neurology, Children's Hospital, University of Iowa, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Journal of child neurology, Vol.34(4), pp.184-188
DOI: 10.1177/0883073818821498
PMID: 30628536
PMCID: PMC6376897
NLM abbreviation: J Child Neurol
ISSN: 0883-0738
eISSN: 1708-8283
Grant note: R01 HL126667 / NHLBI NIH HHS R01 AI089716 / NIAID NIH HHS
Language: English
Date published: 03/2019
Academic Unit: Stead Family Department of Pediatrics; Infectious Disease (Pediatrics)
Record Identifier: 9984093503302771

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