Hum Vaccin Immunother. 2014 Jan;10(1):146-9. doi: 10.4161/hv.26200. Epub 2013 Aug 27.

Fatal varicella due to the vaccine-strain varicella-zoster virus.

Leung J1, Siegel S2, Jones JF3, Schulte C4, Blog D4, Schmid DS1, Bialek SR1, Marin M1.

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 ... serious adverse events are ... mostly described in immunocompromised patients.

KEYWORDS:

VZV; acyclovir resistance; vaccine adverse event; vaccine-strain; varicella; varicella-zoster virus

PMID:  23982221