title: Transcutaneous yellow fever vaccination of subjects with or without atopic dermatitis.
abstract: BACKGROUND
  Atopic dermatitis (AD) is a common inflammatory skin disease with a global prevalence ranging from 3% to 20%. Patients with AD have an increased risk for complications after viral infection (eg, herpes simplex virus), and vaccination of patients with AD with live vaccinia virus is contraindicated because of a heightened risk of eczema vaccinatum, a rare but potentially lethal complication associated with smallpox vaccination.
  
  
  OBJECTIVE
  We sought to develop a better understanding of immunity to cutaneous viral infection in patients with AD.
  
  
  METHODS
  In a double-blind randomized study we investigated the safety and immunogenicity of live attenuated yellow fever virus (YFV) vaccination of nonatopic subjects and patients with AD after standard subcutaneous inoculation or transcutaneous vaccination administered with a bifurcated needle. Viremia, neutralizing antibody, and antiviral T-cell responses were analyzed for up to 30 days after vaccination.
  
  
  RESULTS
  YFV vaccination administered through either route was well tolerated. Subcutaneous vaccination resulted in higher seroconversion rates than transcutaneous vaccination but elicited similar antiviral antibody levels and T-cell responses in both the nonatopic and AD groups. After transcutaneous vaccination, both groups mounted similar neutralizing antibody responses, but patients with AD demonstrated lower antiviral T-cell responses by 30 days after vaccination. Among transcutaneously vaccinated subjects, a significant inverse correlation between baseline IgE levels and the magnitude of antiviral antibody and CD4(+) T-cell responses was observed.
  
  
  CONCLUSIONS
  YFV vaccination of patients with AD through the transcutaneous route revealed that high baseline IgE levels provide a potential biomarker for predicting reduced virus-specific immune memory after transcutaneous infection with a live virus.
authors: Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Ore. Electronic address: slifkam@ohsu.edu.
authors: Mark K
authors: MK
authors: Slifka
authors: Department of Pediatrics, National Jewish Health, Denver, Colo.
authors: Donald Y M
authors: DY
authors: Leung
authors: Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Ore.
authors: Erika
authors: E
authors: Hammarlund
authors: Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Ore.
authors: Hans-Peter
authors: HP
authors: Raué
authors: Department of Dermatology, Oregon Health & Science University, Portland, Ore.
authors: Eric L
authors: EL
authors: Simpson
authors: Department of Dermatology, Oregon Health & Science University, Portland, Ore.
authors: Susan
authors: S
authors: Tofte
authors: Department of Dermatology, Oregon Health & Science University, Portland, Ore.
authors: Shahana
authors: S
authors: Baig-Lewis
authors: Rho, Inc, Chapel Hill, NC.
authors: Gloria
authors: G
authors: David
authors: Rho, Inc, Chapel Hill, NC.
authors: Henry
authors: H
authors: Lynn
authors: Rho, Inc, Chapel Hill, NC.
authors: Rob
authors: R
authors: Woolson
authors: Division of Dermatology, University of California San Diego, La Jolla, Calif.
authors: Tissa
authors: T
authors: Hata
authors: Department of Pediatrics, National Jewish Health, Denver, Colo.
authors: Henry
authors: H
authors: Milgrom
authors: Department of Dermatology, Oregon Health & Science University, Portland, Ore.
authors: Jon
authors: J
authors: Hanifin
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002478:Cells, Cultured; D003876:Dermatitis, Atopic / Q000097:blood / Q000276:immunology* / Q000821:virology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007963:Leukocytes, Mononuclear; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D013601:T-Lymphocytes / Q000276:immunology; D014611:Vaccination; D014766:Viremia; D015004:Yellow Fever / Q000517:prevention & control*; D022341:Yellow Fever Vaccine / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral; D022341:Yellow Fever Vaccine; D007073:Immunoglobulin E
keywords: AD; AE; Adverse event; Atopic dermatitis; IgE; LNI; Log neutralizing index; NT(50); Neutralizing titer 50; T-cell memory; YFV; Yellow fever virus; antibody; atopic dermatitis