title: Immune response and tolerability of varicella vaccine in children and adolescents with systemic lupus erythematosus previously exposed to varicella-zoster virus.
abstract: OBJECTIVE
  The aim of the present paper is to evaluate the immune response and tolerability of varicella vaccine in children and adolescents with systemic lupus erythematosus previously exposed to varicella-zoster virus.
  
  
  METHODS
  We performed a prospective and controlled study on a group of 54 SLE patients that were chosen at random to be or not to be vaccinated (28 were vaccinated and 26 were not). Twenty-eight healthy controls, of matching age and sex were also vaccinated. All were submitted to a questionnaire, physical evaluation and laboratory assays: lymphocyte immune-phenotyping by flow cytometry, plasma varicella zoster virus (VZV) serology by ELISA and in vitro interferon gamma (IFNγ) production by T-cells after stimulus with VZV antigen. They were evaluated before vaccination and at 30, 45, 180 and 360 days afterwards.
  
  
  RESULTS
  We did not observe any differences in the frequency of adverse events in both vaccinated groups. At study entry, all individuals were seropositive for VZV antibodies. The serum VZV antibody titres similarly increased after vaccination. The frequency of flares and the SLEDAI score were also similar among the patients. Thirty days after vaccination the production of IFNγ specific to VZV was lower in the SLE group compared to healthy controls. In the follow-up we observed 4 cases of herpes zoster in the SLE unvaccinated group, but no zoster in the vaccinated group.
  
  
  CONCLUSIONS
  The varicella vaccine was well tolerated in SLE group, who had pre-existing immunity to varicella. The varicella vaccine immunogenicity measurement by serum antibody titres was appropriate. The incidence of HZ was lower in the vaccinated lupus group.
authors.affiliation: Department of Pediatrics, Universidade Federal de São Paulo, Brazil. cassiapassarelli@uol.com.br
authors.forename: Cassia M P L
authors.initials: CM
authors.lastname: Barbosa
authors.forename: Maria T R A
authors.initials: MT
authors.lastname: Terreri
authors.forename: Paula O
authors.initials: PO
authors.lastname: Rosário
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: de Moraes-Pinto
authors.forename: Clovis Artur A
authors.initials: CA
authors.lastname: Silva
authors.forename: Maria Odete E
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D019433:Chickenpox Vaccine / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006562:Herpes Zoster / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D016130:Immunophenotyping / Q000379:methods; D007371:Interferon-gamma / Q000097:blood; D059425:Interferon-gamma Release Tests; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000276:immunology*; D008297:Male; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000276:immunology / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000914:Antibodies, Viral; D015415:Biomarkers; D019433:Chickenpox Vaccine; D007371:Interferon-gamma