Persistent rubella infection after erroneous vaccination in an immunocompromised patient with acute lymphoblastic leukemia in remission
✍ Scribed by Dr. R. Geiger; F. M. Fink; B. Sölder; M. Sailer; G. Enders
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 313 KB
- Volume
- 47
- Category
- Article
- ISSN
- 0146-6615
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
A 16‐year‐old male patient with acute lymphoblastic leukemia in complete remission and on maintenance treatment with weekly oral rnethotrexate 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 imrnunoprophylaxis with polyvalent immune globulin in rubella‐susceptible patients who are immunocompromised. © Wiley‐Liss, Inc.