Age: 38.0
Sex: F
Vaccine: VARCEL
Symptoms: Exposure to communicable disease, Herpes zoster, Herpes zoster, Pruritus, Varicella zoster serology negative
Clinical narrative: Information has been received from a pt with a history of allergies, no known immunosupression and no document history of natural chicken pox who in approximately 1997 was vaccinated with a dose of varicella vaccine. Concomitant medications include Nexium, Flonase, Acupril and Zantac. The pt is a nurse who used to work in a neonatal intensive care unit. Approximately 4 years ago (1997) there was an outbreak of varicella in the unit and as she never had chicken pox the pt was administered a dose of varicella vaccine in the arm after her exposure. She completed the two dose series as indicated. Subsequently she has had titers drawn over the past few years, which have always been negative. The pt is now a nurse in a pediatrician's office where she has had a number of exposures to children with varicella. The pt reports that ever since she received varicella vaccine, that each time she is exposed to someone with chickenpox, she developed herpes zoster on her lower right buttocks cheek. She states that this has been physician diagnosed and that the zoster always occurs in the same location. She also indicated that these outbreaks of herpes zoster occur several time a year. It was noted at the time of the memo she does not have any evidence of herpes zoster. Unspecified medical attention was sought.  This is in follow-up to report(s) previously submitted on 5/15/2002: Information has been received from a 41 year old female registered nurse with no pertinent medical history, seasonal allergies, no known immunosuppression and no document history of natural chickenpox who in 1995 (also reported as 1996, and also reported on 21-JUL-2001 as "four years ago") was vaccinated with a "two dose regimen" of VARIVAX (site unknown). The patient is a nurse who used to work in a neonatal intensive care unit. On 12-JUL-2001, it was reported that "four years ago" there was an outbreak of varicella in the unit and as she never had chicken pox the pt was administered a dose of varicella vaccine in the arm after her exposure. She completed the two dose series as indicated. Subsequently she has had titers drawn over the past few years, which have always been negative. On 12-JUL-2001, it was reported that the pt is now a nurse in a pediatrician's office where she has had a number of exposures to children with varicella. The pt reports that ever since she received varicella vaccine, that each time she is exposed to someone with chickenpox, she developed herpes zoster on her lower right buttocks cheek. She states that this has been physician diagnosed and that the zoster always occurs in the same location. She also indicated that these outbreaks of herpes zoster occur several time a year. It was noted on 12-JUL-2001 she does not have any evidence of herpes zoster. Unspecified medical attention was sought. On 06-MAR-2003 follow-up information from the patient, now 43 year old, was received. She reported that "in 1996, (she) developed shingles below her right buttocks." In addition, she has had repeated cases of shingles, for which she has seen her physician a number of times. On 06-MAR-2003, it was reported that, "this month, she received two doses of steroids for bronchitis/pneumonia. This week, she broke out with chicken pox: 60-100 lesions spread through the body. She currently also has a shingles outbreak as well." On 06-MAR-2003 the patient reported that her physician thought she might have both chicken pox and shingles. The patient reported that her physician would like to refer her to an infectious disease specialist, she did not have any medical problems or immunosuppression." Follow up information has been received from a 41 year old female registered nurse with no pertinent medical history, seasonal allergies and hypersensitivity to acyclovir, valacyclovir hydrochloride (headache) and silver nitrate who reported that she had a negative VZV titer following multiple vaccination with VARIVAX, and then developed zoster. The nurse reports she was exposed to chicken pox at work and tested negative for immunity to VZV ("this took place when VARIVAX came out"). The nurse reported having received multiple doses of VARIVAX, and still had a negative VZV titer (date not specified). The nurse developed shingles within two months of completion of the VARIVAX series. The shingles were located on her right hip or right buttock. At the time of reporting the shingles clear and then reappear, at two to four month intervals, leaving scars (continuing this up to the present). The shingles are itchy and are preceded by nerve pain the day before a shingles outbreak. The shingles are treated with " VALTREX and acyclovir" when they reoccur (also reported to have a hypersensitivity to both medications). The patient reported the following concomitant therapy hydrochlorothiazide, lisinopril, NEURONTIN, LEXAPRO, CLARITIN, aspirin, vitamins (unspecified0, calcium (unspecified0 and vitamin B (unspecified). It was also noted that a couple years ago (date unspecified), the patient had an episode of shingles, and then developed chickenpox with over 60 lesions. At the time of reporting the patient had "recurring zoster". Additional information is not expected.