Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

Veena Ramachandran; Stephen C. Elliott; Kathie L. Rogers; Randall J. Cohrs; Miles Weinberger; Wallen Jackson; John E. Carpenter; Charles Grose; Daniel J. Bonthius

doi:10.1177/0883073820938597

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Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

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Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

Veena Ramachandran, Stephen C. Elliott, Kathie L. Rogers, Randall J. Cohrs, Miles Weinberger, Wallen Jackson, John E. Carpenter, Charles Grose and Daniel J. Bonthius

Journal of child neurology, Vol.35(13), pp.889-895

07/17/2020

DOI: 10.1177/0883073820938597

PMCID: PMC7549284

PMID: 32677551

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Abstract

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

acyclovir

asthma

cerebrospinal fluid

Original

prednisone

vaccine

varicella

Details

Title: Subtitle: Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents
Creators: Veena Ramachandran - Iowa Lutheran Hospital
Stephen C. Elliott - Blank Children's Hospital
Kathie L. Rogers - Blank Children's Hospital
Randall J. Cohrs - University of Colorado Anschutz Medical Campus
Miles Weinberger - University of Iowa
Wallen Jackson - University of Iowa
John E. Carpenter - University of Iowa
Charles Grose - University of Iowa
Daniel J. Bonthius - University of Iowa
Resource Type: Journal article
Publication Details: Journal of child neurology, Vol.35(13), pp.889-895
DOI: 10.1177/0883073820938597
PMID: 32677551
PMCID: PMC7549284
NLM abbreviation: J Child Neurol
ISSN: 0883-0738
eISSN: 1708-8283
Publisher: SAGE Publications
Grant note: HL126667 / ;
Language: English
Date published: 07/17/2020
Academic Unit: Stead Family Department of Pediatrics; Infectious Disease (Pediatrics)
Record Identifier: 9984354008302771

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