Age: 16.0
Sex: M
Vaccine: VARCEL, VARCEL
Symptoms: Blood immunoglobulin G, Blood immunoglobulin G normal, Blood immunoglobulin M, Dermatitis bullous, Diphtheria toxin antibody absent
Clinical narrative: This is in follow-up to report(s) previously submitted on 5/14/2004. Information has been received from a physician concerning a 16 year-old male who resides in a pediatric long-term care facility with profound mental retardation secondary to near drowning in childhood, apastic quadriplegia, a seizure disorder, recurrent aspiration pneumonia ("frequnet bouts of pneumonia that were greater in number than might be expected for such a profoundly disabled child"), gastroesophageal reflux disease (GERD), and a history of status-post gastrostomy tube insertion, Nissen fundoplication, pyloroplasty and tracheostomy. The patient was noted to be non-ambulatory and dependent on caregivers for all activites of daily living. It was also noted that the patient had no problem with any other infectious conditions, no evidence of any specific immunosuppression" and had no history of varicella. On 28-Jan-2004, the patient was vaccinated SC with the first dose (0.5 ml)  of varicella virus vaccine live (lot #640071/1317L). Concomitant medication included inhaled budesonide, albuterol (+) ipratropium bromide, baclofen, clonazapam (Klonopin), divalproex Na (Depakote), guaifenesin (Guiatuss), lamotrigine (Lamictal), oxygen, phenobarbital, polyethylene gylcol 1350 (Miralax), tobramycin and valproic acid. The patient was on no routine steroids. On 12-Feb-2004,  the patient developed a fever and less than 15 vesicular lesions (also described as a disseminated rash consistent with chickenpox). Unspecified medical attention was sought. VZV IgG testing on 18-Feb-2004 was negative. On 02-Mar-2004, this patient developed greater than 500 varicella lesions and his fever went up to 103 F and persisted 8 days and then resolved without sequelae. There was no treatment required. VZV IgG testing on 18-Feb-2004 was negative. The patient was treated empirically with clindamycin and ceftriaxone. An immune work-up was normal including serum quantitative IgG, diphtheria antitoxoid antibody, negative HIV, normal CD 3/4/8/19 and natural killer counts, mumps IgG negative, rubella IgG positive and rubeola IgG positive. Additional lab testing included a normal lymphocyte profile. PCR testing of approximately 5  scabs from the patient were positve for Oka strain ov VZV. The patient subsequently recovered without complication. A varicelle IgG following the illness was positive. Published information from the Infectious Diseases Society of America's annual meeting indicated that the patient was disabled as a result of a drowning accident in early childhood. At the time of admission to the pediatric extended care facility, he tested VZV seronegtive and was vaccinated. Fifteen days later, her developed severe (>500 lesions), febrile varicella, VZV PCR and sequence analysis revealed the Oka vaccine the cause. The physician also reported that two other patients who were residents of the same long-term care facility developed varicella and a rash after being vaccinated with varicella virus vaccine live (WAES#0403USA01680), and developed varicella through secondary transmission (WAES#0403USA01097). No further information is available.