Age: 5.0
Sex: M
Vaccine: FLUX, VARCEL
Symptoms: Hypoxia, Infection, Pneumonia
Clinical narrative: pt recv vax during 2 week "break" from steroid tx for hx reactive airway; restarted steroids 1 1/2 weeks a/ sx occurred; 18d p/ vax, presented w/ lesions; hosp w/ VZV pneumonia, decompensated, intubated-on vent; required 3 blood transfusion. This is an follow-up to report(s) previously submitted on 5/14/1999. Information has been received from a health care professional concerning a 5-year-old male patient who in 1998 was vaccinated with one dose of VARIVAX. Approximately ten days following vaccination, the patient experienced a rash (time frame unknown) and was eventually hospitalized with VZV pneumonia. At the time of the report, the patient was on a ventilator in the PICU. It was reported that in approximately 17-NOV-1998, DFA analysis of endotracheal secretions was done for CMV, HSV, flu A and B and RSV, all of which were negative; however, DFA for VZV was "strongly positive." In addition, specimens were "negative for sycoplasm IgM." Additional information received indicated that in approximately 17-NOV-1998, results of PCR analysis from an endotracheal specimen were positive for vaccine strain varicella zoster virus. It was also reported that the patient recovered and was discharged. The patient had a history of reactive airway disease and the physician believed the patient had been on a course of steroids 10 days prior to vaccination. The patient "did have a rash on admission however, it was not severe. However, the patient did decompensate quickly from a respiratory perspective and required intubation with ventilator assist. The patient required ventilatory support for approximately 6 weeks. The physician did not know if the patient acquired a noseomial infection while on the ventilator which would have complicated the patient's course." Further additional information indicated that the child has "severe cerebral palsy (due to an abruption at birth)." The child is competely homebound and requires total care. Also, his concomitant therapy at the time of vaccination included Tegretol, Clonopine, Rhinocort and albuterol. It was reported that the patient "has a long term history of intermitent steroid use due to his severe reactive airway disease, but he was not actually on steroids at the time of vaccination. "As of of 08-OCT-1998 the patient was in the middle of a steroid taper, which was completed on approximately 15-OCT-1998. On 22-OCT-1998 the child "had been off steroids for a week and was vaccinated with VARIVAX. " He started again on steroids on 29-OCT-1998 and on 09-NOV-1998 he presented to the doctor's office with lesions and subsequently was hospitalized due to VZV pneumonia. Follow-up information from a physician reported that on 22-OCT-1998, the patient was vaccinated with a dose of Influenza virus vaccine. In addition, it was reported that the patient was hospitalized from 09-NOV-1998 through 02-JAN-1999. While hospitalized, the patient received three transfusions. Subsequently, the patient recovered. Additional follow-up information from a physician reported that the patient's usual dose of steroid was 1-2 mg/kg/day (2 tsps BID) of Pediapred. On 29-OCT-1998, the patient was again started on 1-2 mg/kg/day (2 tsps) of Pediapred twice daily for 5 days. Subsequently in October 2003, the patient's experience was also reported in a published literature article. The article also mentioned three other patient's (WAES # 96031140, 98101671 and 00120881) with similar experiences following exposure to VARIVAX. No further information is available.