University Medical Center Ulm, Department of Pediatrics and Adolescent Medicine, Ulm, Germany.
University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany.
Vaccine. 2020 Nov 25;38(50):8024-8031. doi: 10.1016/j.vaccine.2020.10.028. Epub 2020 Nov 5.
Children with inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH) receiving immunosuppressive treatment are at risk for severe varicella zoster virus (VZV)-induced disease. This study evaluated vaccination of susceptible patients with stable disease and documented immunoreactivity without interruption of their current immunosuppression (IS).
This prospective multicentre observational study used a prevaccination checklist to select patients with low-intensity and high-intensity IS for VZV vaccination. Tolerability and safety after immunization were assessed by questionnaire. The immune response was measured by the VZV-IgG concentration, relative avidity index (RAI), and specific lymphocyte proliferative response.
A total of 29 VZV vaccinations were performed in 17 seronegative patients aged 3-16 years (IBD n = 15, AIH n = 2). Eight patients received high-intensity immunosuppression, another six low-intensity immunosuppression, and three patients interrupted IS before VZV vaccination. All 29 vaccinations were well tolerated; only minor side effects such as fever and abdominal pain, were reported in two patients. One patient experienced a flare of Crohn's disease the day after vaccination. The VZV-IgG-concentration increased significantly (p = 0.018) after vaccination, and a specific lymphocyte response towards VZV in vitro was detected in all tested patients which correlated with the RAI (r = 0.489; p = 0.078).
VZV vaccination was well tolerated, safe and immunogenic in children receiving ongoing IS due to IBD and AIH. Ensuring immunoreactivity by clinical and laboratory parameters, rather than the type and dosage of IS, is a reasonable approach to decide on live-attenuated virus vaccinations in immunosuppressed children (German clinical trials DRKS00016357).
接受免疫抑制治疗的炎症性肠病（IBD）和自身免疫性肝炎（AIH）患儿有发生严重水痘带状疱疹病毒（VZV）感染的风险。本研究评估了在不中断现有免疫抑制（IS）的情况下，对处于疾病稳定期且免疫反应性得到充分证实的易感患者进行 VZV 疫苗接种的效果。
本前瞻性多中心观察性研究使用疫苗接种前检查表，选择低强度和高强度 IS 的患者进行 VZV 疫苗接种。通过问卷调查评估接种后的耐受性和安全性。通过 VZV-IgG 浓度、相对亲和力指数（RAI）和特异性淋巴细胞增殖反应来测量免疫反应。
共对 17 例 3-16 岁的血清阴性患者（IBD n=15，AIH n=2）进行了 29 次 VZV 疫苗接种。8 例患者接受高强度 IS，另有 6 例接受低强度 IS，3 例患者在 VZV 疫苗接种前中断 IS。所有 29 次疫苗接种均耐受良好；仅 2 例患者报告出现轻微副作用，如发热和腹痛。1 例克罗恩病患者在接种后第 1 天出现疾病发作。接种后 VZV-IgG 浓度显著升高（p=0.018），所有检测患者均在外周血淋巴细胞中检测到针对 VZV 的特异性反应，与 RAI 相关（r=0.489；p=0.078）。
在 IBD 和 AIH 患儿持续接受 IS 治疗的情况下，VZV 疫苗接种具有良好的耐受性、安全性和免疫原性。通过临床和实验室参数确保免疫反应性，而不是 IS 的类型和剂量，是决定免疫抑制儿童进行活病毒疫苗接种的合理方法（德国临床试验 DRKS00016357）。
