PEDIATRICS Vol. 87 No. 2 February 1991, pp. 166-170
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Lack of Transmission of the Live Attenuated Varicella Vaccine Virus to Immunocompromised Children After Immunization of Their Siblings

Pamela S. Diaz MD1, Deborah Au RN1, Susan Smith 1, Michael Amylon MD1, Michael Link MD1, Stephen Smith MD1, and Ann M. Arvin MD1

1 From the Department of Pediatrics, the Divisions of Infectious Diseases and Hematology/Oncology, Stanford University School of Medicine, Stanford, California

The safety of administering the live attenuated Oka/Merck varicella vaccine to the well siblings of children with malignancy was evaluated as a strategy for reducing the risk of household exposure to varicella among immunocompromised children. Susceptible well children were eligible for vaccination if the child with malignancy had leukemia, lymphoma, or solid tumor in remission for 3 months or longer. No evidence of vaccine virus transmission was found among 30 children with malignancy whose 37 healthy susceptible siblings were immunized with varicella vaccine. Varicella-zoster virus was not isolated from the oropharyngeal secretions taken from 17 vaccinees or their 14 immunocompromised siblings. None of the 30 immunocompromised children had vaccine-related rashes or showed immunologic evidence of subclinical varicella-zoster virus infection based on testing for varicella-zoster virus IgG antibodies and Tlymphocyte proliferation to varicella-zoster virus. Four healthy vaccinees eventually had mild breakthrough cases of varicella, with transmission to the high-risk sibling in 3 cases. However, even in these families, the immunocompromised children had been protected from household exposure varicella for at least 20 months early in the course of their immunosuppressive treatment.

Key Words: varicella-zoster virus • vaccination • immunization • malignancy • virus transmission • immunocompromised children

Submitted on November 17, 1989
Accepted on January 24, 1990




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