Persistent rubella infection after erroneous vaccination in an immunocompromised patient with acute lymphoblastic leukemia in remission.
A 16-year-old male patient with acute lymphoblastic leukemia in complete remission and on maintenance treatment with weekly oral methotrexate and daily oral 6-mercaptopurine for 3 months was immunized in error with the WI-RA 27/3-HDC live attenuated rubella vaccine. Increasing rubella HAI antibodies were noted from 3 to 7 months post-vaccination as well as high levels of IgM antibody up to 8 months in three different tests. High HAI antibody titers persisted for 12-18 months after vaccination. Persisting rubella virus was indicated by PCR detection of rubella-specific nucleic acid in whole blood, non-stimulated and stimulated mononuclear cells 8 months following vaccination. Further attempts to detect rubella virus RNA in two subsequent blood samples were negative. Since acute arthritis and arthralgia occurred in the second month (days 51-63) after vaccination, antileukemic chemotherapy had to be interrupted. Evidence of higher risk for chronic or relapsing rubella-associated arthropathy in immunologically compromised patients and the need to interrupt antileukemic chemotherapy should warrant immunoprophylaxis with polyvalent immune globulin in rubella-susceptible patients who are immunocompromised.
Geiger
R
R
Department of Pediatrics, School of Medicine, University of Innsbruck, Austria.
Fink
F M
FM
Sölder
B
B
Sailer
M
M
Enders
G
G
D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D004279:DNA, Viral; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology* / Q000821:virology; D012074:Remission Induction; D012409:Rubella / Q000209:etiology*; D012411:Rubella Vaccine / Q000009:adverse effects*; D012412:Rubella virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D014611:Vaccination / Q000009:adverse effects*; D014613:Vaccines, Attenuated / Q000009:adverse effects; D014759:Viral Envelope Proteins / Q000235:genetics
D000914:Antibodies, Viral; D004279:DNA, Viral; D012411:Rubella Vaccine; D014613:Vaccines, Attenuated; D014759:Viral Envelope Proteins; C061827:E2 envelope protein, Rubella virus