title: Fatal varicella due to the vaccine-strain varicella-zoster virus.
abstract: We describe a death in a 15-mo-old girl who developed a varicella-like rash 20 d after varicella vaccination that lasted for 2 mo despite acyclovir treatment. The rash was confirmed to be due to vaccine-strain varicella-zoster virus (VZV). This is the first case of fatal varicella due to vaccine-strain VZV reported from the United States. The patient developed severe respiratory complications that worsened with each new crop of varicella lesions; vaccine-strain VZV was detected in the bronchial lavage specimen. Sepsis and multi-organ failure led to death. The patient did not have a previously diagnosed primary immune deficiency, but her failure to thrive and repeated hospitalizations early in life (starting at 5 mo) for presumed infections and respiratory compromise treated with corticosteroids were suggestive of a primary or acquired immune deficiency. Providers should monitor for adverse reactions after varicella vaccination. If severe adverse events develop, acyclovir should be administered as soon as possible. The possibility of acyclovir resistance and use of foscarnet should be considered if lesions do not improve after 10 d of treatment (or if they become atypical [e.g., verrucous]). Experience with use of varicella vaccine indicates that the vaccine has an excellent safety profile and that serious adverse events are very rare and mostly described in immunocompromised patients. The benefit of vaccination in preventing severe disease and mortality outweigh the low risk of severe events occurring after vaccination.
authors: National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA.
authors: Jessica
authors: J
authors: Leung
authors: Department of Pediatrics; New York Medical College; New York, NY USA.
authors: Subhadra
authors: S
authors: Siegel
authors: National Center for Emerging and Zoonotic Infectious Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA.
authors: James F
authors: JF
authors: Jones
authors: Bureau of Immunization; New York State Health Department; Albany, NY USA.
authors: Cynthia
authors: C
authors: Schulte
authors: Bureau of Immunization; New York State Health Department; Albany, NY USA.
authors: Debra
authors: D
authors: Blog
authors: National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA.
authors: D Scott
authors: DS
authors: Schmid
authors: National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA.
authors: Stephanie R
authors: SR
authors: Bialek
authors: National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA.
authors: Mona
authors: M
authors: Marin
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002644:Chickenpox / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy; D019433:Chickenpox Vaccine / Q000008:administration & dosage* / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D009102:Multiple Organ Failure / Q000209:etiology / Q000473:pathology; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D017211:Treatment Failure; D014481:United States
chemical_list: D000998:Antiviral Agents; D019433:Chickenpox Vaccine; D000212:Acyclovir
keywords: VZV; acyclovir resistance; vaccine adverse event; vaccine-strain; varicella; varicella-zoster virus
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