Geiger R, Fink F M, Sölder B, Sailer M, Enders G
Department of Pediatrics, School of Medicine, University of Innsbruck, Austria.
J Med Virol. 1995 Dec;47(4):442-4. doi: 10.1002/jmv.1890470425.
A 16-year-old male patient with acute lymphoblastic leukemia in complete remission and on maintenance treatment with weekly oral methotrexate and daily oral 6-mercaptopurine for 3 months was immunized in error with the WI-RA 27/3-HDC live attenuated rubella vaccine. Increasing rubella HAI antibodies were noted from 3 to 7 months post-vaccination as well as high levels of IgM antibody up to 8 months in three different tests. High HAI antibody titers persisted for 12-18 months after vaccination. Persisting rubella virus was indicated by PCR detection of rubella-specific nucleic acid in whole blood, non-stimulated and stimulated mononuclear cells 8 months following vaccination. Further attempts to detect rubella virus RNA in two subsequent blood samples were negative. Since acute arthritis and arthralgia occurred in the second month (days 51-63) after vaccination, antileukemic chemotherapy had to be interrupted. Evidence of higher risk for chronic or relapsing rubella-associated arthropathy in immunologically compromised patients and the need to interrupt antileukemic chemotherapy should warrant immunoprophylaxis with polyvalent immune globulin in rubella-susceptible patients who are immunocompromised.
一名16岁男性急性淋巴细胞白血病患者处于完全缓解期，正在接受维持治疗，每周口服甲氨蝶呤，每日口服6-巯基嘌呤，持续3个月。该患者被错误地接种了WI-RA 27/3-HDC风疹减毒活疫苗。接种疫苗后3至7个月，风疹血凝抑制（HAI）抗体水平上升，在三次不同检测中，IgM抗体水平在8个月内一直较高。接种疫苗后，高HAI抗体滴度持续了12至18个月。接种疫苗8个月后，通过聚合酶链反应（PCR）检测全血、未刺激和刺激的单核细胞中的风疹特异性核酸，表明风疹病毒持续存在。随后对两份后续血样检测风疹病毒RNA的进一步尝试均为阴性。由于接种疫苗后第二个月（第51至63天）出现急性关节炎和关节痛，抗白血病化疗不得不中断。免疫功能低下患者发生慢性或复发性风疹相关关节病的风险较高，以及中断抗白血病化疗的必要性，这表明对于风疹易感的免疫功能低下患者，应使用多价免疫球蛋白进行免疫预防。
