Immune response and tolerability of varicella vaccine in children and adolescents with systemic lupus erythematosus previously exposed to varicella-zoster virus

• Published in: Clinical and experimental rheumatology Vol. 30; no. 5; pp. 791 - 798
• Main Authors: BARBOSA, C. M. P. L, TERRERI, M. T. R. A, ROSARIO, P. O, DE MORAES-PINTO, M. I, SILVA, C. A. A, HILARIO, M. O. E
• Format: Journal Article
• Language: English
• Published: Pisa Clinical and Experimental Rheumatology 01.09.2012
• Subjects: Adolescent; Antibodies, Viral - blood; Biological and medical sciences; Biomarkers - blood; Brazil; Chickenpox Vaccine - adverse effects; Chickenpox Vaccine - immunology; Child; Child, Preschool; Diseases of the osteoarticular system; Enzyme-Linked Immunosorbent Assay; Female; Flow Cytometry; Herpes Zoster - immunology; Herpes Zoster - prevention & control; Herpes Zoster - virology; Herpesvirus 3, Human - immunology; Human viral diseases; Humans; Immunity, Cellular; Immunity, Humoral; Immunophenotyping - methods; Infectious diseases; Interferon-gamma - blood; Interferon-gamma Release Tests; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - immunology; Male; Medical sciences; Prospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; T-Lymphocytes - immunology; T-Lymphocytes - virology; Time Factors; Treatment Outcome; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Brazil; Skin disease; Alphaherpesvirinae; Autoimmune disease; Prevention; Systemic lupus erythematosus; Systemic disease; Varicella; Child; Human; Varicella zoster virus; Immunopathology; Connective tissue disease; Nervous system diseases; Herpes zoster; Immune response; Herpesviridae; Rheumatology; Immune deficiency; Infection; Virus; Immunoprophylaxis; vaccine; Viral disease; Adolescent; immunocompromised host
• ISSN: 0392-856X; 1593-098X

The aim of the present paper is to evaluate the immune response and tolerability of varicella vaccine in children and adolescents with systemic lupus erythematosus previously exposed to varicella-zoster virus. We performed a prospective and controlled study on a group of 54 SLE patients that were chosen at random to be or not to be vaccinated (28 were vaccinated and 26 were not). Twenty-eight healthy controls, of matching age and sex were also vaccinated. All were submitted to a questionnaire, physical evaluation and laboratory assays: lymphocyte immune-phenotyping by flow cytometry, plasma varicella zoster virus (VZV) serology by ELISA and in vitro interferon gamma (IFNγ) production by T-cells after stimulus with VZV antigen. They were evaluated before vaccination and at 30, 45, 180 and 360 days afterwards. We did not observe any differences in the frequency of adverse events in both vaccinated groups. At study entry, all individuals were seropositive for VZV antibodies. The serum VZV antibody titres similarly increased after vaccination. The frequency of flares and the SLEDAI score were also similar among the patients. Thirty days after vaccination the production of IFNγ specific to VZV was lower in the SLE group compared to healthy controls. In the follow-up we observed 4 cases of herpes zoster in the SLE unvaccinated group, but no zoster in the vaccinated group. The varicella vaccine was well tolerated in SLE group, who had pre-existing immunity to varicella. The varicella vaccine immunogenicity measurement by serum antibody titres was appropriate. The incidence of HZ was lower in the vaccinated lupus group.