Safety and immunogenicity of varicella vaccine in patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids.
OBJECTIVE
To evaluate the safety and immunogenicity of varicella vaccine (VV) in susceptible patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids.


METHODS
Twenty-five patients with juvenile rheumatic diseases (ages 2-19 years) and 18 healthy children and adolescents (ages 3-18 years) received a single dose of VV. All 25 patients were receiving methotrexate; 13 were also receiving prednisone and 5 were also receiving other disease-modifying antirheumatic drugs. None of the vaccinated patients or controls had a previous history of varicella. Anti-varicella-zoster virus IgG antibody (anti-VZV-IgG) titers were measured by enzyme-linked immunosorbent assay immediately before, 4-6 weeks after, and 1 year after vaccination. The patients were monitored prospectively for adverse reactions related to the vaccine, exposure, and occurrence of varicella. Disease activity was assessed 3 months before and 3 months after VV.


RESULTS
Twenty patients and all of the controls had negative preimmunization titers of VZV-IgG, and 5 patients had equivocal levels. Positive VZV-IgG titers were detected in 10 (50%) of 20 seronegative patients and 13 (72.2%) of 18 controls 4-6 weeks after VV (P = 0.2). One year after vaccination, 8 of 10 patients maintained positive VZV-IgG titers. No overt varicella episodes and no severe adverse reactions were observed during the followup period. No worsening of clinical parameters and no flares of juvenile rheumatic diseases or changes in doses of medications used were detected after vaccination. In fact, the number of active joints in patients with juvenile idiopathic arthritis was significantly lower after VV (P = 0.009).


CONCLUSIONS
VV appears to be safe in patients with juvenile rheumatic diseases receiving methotrexate, as long as continuous prospective vigilance for side effects is performed.
School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Gecilmara Salviato
GS
Pileggi
Cleonice Barbosa Sandoval
CB
de Souza
Virgínia Paes Leme
VP
Ferriani
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000276:immunology*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003882:Dermatomyositis / Q000188:drug therapy / Q000276:immunology; D018450:Disease Progression; D064420:Drug-Related Side Effects and Adverse Reactions / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007279:Injections, Subcutaneous; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D012595:Scleroderma, Systemic / Q000188:drug therapy / Q000276:immunology; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D019433:Chickenpox Vaccine; D007166:Immunosuppressive Agents; D014613:Vaccines, Attenuated; D008727:Methotrexate