Varicella Vaccination of Children With Leukemia Without Interruption of Maintenance Therapy: A Danish Experience

Lotte Møller Smedegaard; Anja Poulsen; Ines Ackerl Kristensen; Susanne Rosthøj; Kjeld Schmiegelow; Ulrikka Nygaard

doi:10.1097/INF.0000000000001279

Varicella Vaccination of Children With Leukemia Without Interruption of Maintenance Therapy: A Danish Experience

Lotte Møller Smedegaard, Anja Poulsen, Ines Ackerl Kristensen, Susanne Rosthøj, Kjeld Schmiegelow, Ulrikka Nygaard

3 Citations (Scopus)

Abstract

Background: Varicella-zoster virus (VZV) can be fatal or cause severe complications in children with acute lymphoblastic leukemia (ALL). This analysis set out to investigate the morbidity and mortality of VZV vaccination without interruption of maintenance therapy in children with ALL. Methods: Files of 73 seronegative children with ALL were examined for data regarding VZV vaccination and infection, and long-term seroconversion was measured. Criteria before VZV vaccination were (1) seronegative, (2) in complete remission, (3) age >= 1.0 year, (4) lymphocyte count >= 0.6 × 109/L at time of vaccination and (5) receiving maintenance therapy. Results: Forty-five children were vaccinated. No child died or experienced serious adverse events due to VZV vaccination. Nine children developed late chickenpox despite vaccination. Long-term protection was found in 86% of children not receiving acyclovir and 78% of the entire population. Long-term seroconversion was found in 52% of the children. There were no severe cases of varicella infection. Acyclovir prophylaxis postvaccination was associated with an increased risk of late chickenpox [hazard ratio = 5.40 (1.43, 20.41), P = 0.01]. In contrast, a vaccine-induced rash reduced the risk of late chickenpox [hazard ratio = 0.08 (0.01, 0.66), P = 0.02]. No child had interruption of maintenance therapy at the time of vaccination, but 33% experienced discontinuation of therapy due to vaccine-induced rash. Dexamethasone was associated with an increased risk of vaccine-induced rash [hazard ratio = 2.9 (1.21, 6.90), P = 0.02]. Conclusions: This analysis indicates that VZV vaccination is feasible and justified in seronegative children with ALL, in countries where VZV vaccination is not part of the national vaccination program.

Original language	English
Journal	The Pediatric Infectious Disease Journal
Volume	35
Issue number	11
Pages (from-to)	e348-e352
Number of pages	5
ISSN	0891-3668
DOIs	https://doi.org/10.1097/INF.0000000000001279
Publication status	Published - 1 Nov 2016

Keywords

varicella zoster virus
vaccination
pediatrics
acute lymphoblastic leukemia
childhood leukemia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/INF.0000000000001279

Cite this

@article{1b56532f91c54682847fa92e28cf3ce9,

title = "Varicella Vaccination of Children With Leukemia Without Interruption of Maintenance Therapy: A Danish Experience",

abstract = "Background: Varicella-zoster virus (VZV) can be fatal or cause severe complications in children with acute lymphoblastic leukemia (ALL). This analysis set out to investigate the morbidity and mortality of VZV vaccination without interruption of maintenance therapy in children with ALL. Methods: Files of 73 seronegative children with ALL were examined for data regarding VZV vaccination and infection, and long-term seroconversion was measured. Criteria before VZV vaccination were (1) seronegative, (2) in complete remission, (3) age >= 1.0 year, (4) lymphocyte count >= 0.6 × 109/L at time of vaccination and (5) receiving maintenance therapy. Results: Forty-five children were vaccinated. No child died or experienced serious adverse events due to VZV vaccination. Nine children developed late chickenpox despite vaccination. Long-term protection was found in 86% of children not receiving acyclovir and 78% of the entire population. Long-term seroconversion was found in 52% of the children. There were no severe cases of varicella infection. Acyclovir prophylaxis postvaccination was associated with an increased risk of late chickenpox [hazard ratio = 5.40 (1.43, 20.41), P = 0.01]. In contrast, a vaccine-induced rash reduced the risk of late chickenpox [hazard ratio = 0.08 (0.01, 0.66), P = 0.02]. No child had interruption of maintenance therapy at the time of vaccination, but 33% experienced discontinuation of therapy due to vaccine-induced rash. Dexamethasone was associated with an increased risk of vaccine-induced rash [hazard ratio = 2.9 (1.21, 6.90), P = 0.02]. Conclusions: This analysis indicates that VZV vaccination is feasible and justified in seronegative children with ALL, in countries where VZV vaccination is not part of the national vaccination program.",

keywords = "varicella zoster virus, vaccination, pediatrics, acute lymphoblastic leukemia, childhood leukemia",

author = "Smedegaard, {Lotte M{\o}ller} and Anja Poulsen and Kristensen, {Ines Ackerl} and Susanne Rosth{\o}j and Kjeld Schmiegelow and Ulrikka Nygaard",

year = "2016",

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doi = "10.1097/INF.0000000000001279",

language = "English",

volume = "35",

pages = "e348--e352",

journal = "Pediatric Infectious Disease Journal",

issn = "0891-3668",

publisher = "Lippincott Williams & Wilkins",

number = "11",

}

TY - JOUR

T1 - Varicella Vaccination of Children With Leukemia Without Interruption of Maintenance Therapy

T2 - A Danish Experience

AU - Smedegaard, Lotte Møller

AU - Poulsen, Anja

AU - Kristensen, Ines Ackerl

AU - Rosthøj, Susanne

AU - Schmiegelow, Kjeld

AU - Nygaard, Ulrikka

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: Varicella-zoster virus (VZV) can be fatal or cause severe complications in children with acute lymphoblastic leukemia (ALL). This analysis set out to investigate the morbidity and mortality of VZV vaccination without interruption of maintenance therapy in children with ALL. Methods: Files of 73 seronegative children with ALL were examined for data regarding VZV vaccination and infection, and long-term seroconversion was measured. Criteria before VZV vaccination were (1) seronegative, (2) in complete remission, (3) age >= 1.0 year, (4) lymphocyte count >= 0.6 × 109/L at time of vaccination and (5) receiving maintenance therapy. Results: Forty-five children were vaccinated. No child died or experienced serious adverse events due to VZV vaccination. Nine children developed late chickenpox despite vaccination. Long-term protection was found in 86% of children not receiving acyclovir and 78% of the entire population. Long-term seroconversion was found in 52% of the children. There were no severe cases of varicella infection. Acyclovir prophylaxis postvaccination was associated with an increased risk of late chickenpox [hazard ratio = 5.40 (1.43, 20.41), P = 0.01]. In contrast, a vaccine-induced rash reduced the risk of late chickenpox [hazard ratio = 0.08 (0.01, 0.66), P = 0.02]. No child had interruption of maintenance therapy at the time of vaccination, but 33% experienced discontinuation of therapy due to vaccine-induced rash. Dexamethasone was associated with an increased risk of vaccine-induced rash [hazard ratio = 2.9 (1.21, 6.90), P = 0.02]. Conclusions: This analysis indicates that VZV vaccination is feasible and justified in seronegative children with ALL, in countries where VZV vaccination is not part of the national vaccination program.

AB - Background: Varicella-zoster virus (VZV) can be fatal or cause severe complications in children with acute lymphoblastic leukemia (ALL). This analysis set out to investigate the morbidity and mortality of VZV vaccination without interruption of maintenance therapy in children with ALL. Methods: Files of 73 seronegative children with ALL were examined for data regarding VZV vaccination and infection, and long-term seroconversion was measured. Criteria before VZV vaccination were (1) seronegative, (2) in complete remission, (3) age >= 1.0 year, (4) lymphocyte count >= 0.6 × 109/L at time of vaccination and (5) receiving maintenance therapy. Results: Forty-five children were vaccinated. No child died or experienced serious adverse events due to VZV vaccination. Nine children developed late chickenpox despite vaccination. Long-term protection was found in 86% of children not receiving acyclovir and 78% of the entire population. Long-term seroconversion was found in 52% of the children. There were no severe cases of varicella infection. Acyclovir prophylaxis postvaccination was associated with an increased risk of late chickenpox [hazard ratio = 5.40 (1.43, 20.41), P = 0.01]. In contrast, a vaccine-induced rash reduced the risk of late chickenpox [hazard ratio = 0.08 (0.01, 0.66), P = 0.02]. No child had interruption of maintenance therapy at the time of vaccination, but 33% experienced discontinuation of therapy due to vaccine-induced rash. Dexamethasone was associated with an increased risk of vaccine-induced rash [hazard ratio = 2.9 (1.21, 6.90), P = 0.02]. Conclusions: This analysis indicates that VZV vaccination is feasible and justified in seronegative children with ALL, in countries where VZV vaccination is not part of the national vaccination program.

KW - varicella zoster virus

KW - vaccination

KW - pediatrics

KW - acute lymphoblastic leukemia

KW - childhood leukemia

U2 - 10.1097/INF.0000000000001279

DO - 10.1097/INF.0000000000001279

M3 - Journal article

SN - 0891-3668

VL - 35

SP - e348-e352

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

IS - 11

ER -