Age: 13.0
Sex: F
Vaccine: VARCEL
Symptoms: Encephalitis herpes, Gastrooesophageal reflux disease, HIV antibody negative, Measles antibody positive, Mumps antibody test positive
Clinical narrative: Information has been received from a public health professional concerning a 13 year old female with a concurrent condition of presumed perinatal HSV encephalitis (she continues to experience recurrent lesions on her cheek, HIV negative and a medical history of a mild varicella case in 1993 who lived in the same facility with a 16 year old that was vaccinated on 28Jan2004 with a dose of varicella virus vaccine live. It was noted that the child was not on any immunosuppressive medications, though she may be on anticonvulsant medications. On 02Mar2004 (also reported as twelve days later the onset of the 16 year old pt's varicella rash), varicella was transferred to the 13 year old who had not been vaccinated. Subsequently the pt developed a mild fever and generalized rash with 15 vesicular lesions which had scabbed and the illness resolved. It was noted that there was no information as to the severity of this case. Diagnostic laboratory data included PCR testing of one vesicular lesion that was positive for Oka strain of VZV; there was a single point significantly from the high likelihood that she contacted the Oka strain from the index case. Unspecified medical attention was sought. The reporter also mentioned two other pt's who were residents of the same long term care facility: a female pt who was vaccinated in 1995 with varicella virus vaccine live and developed varicella in 1999 an on 04Mar2004 developed a rash (WAES0403USA01680) and a 16 year old who was vaccinated with varicella virus vaccine live and developed a varicella rash (WAES0403USA01096).   Follow up to report previously submitted on 05/14/2004 information has been received from a physician concerning a 13 year old female who resides in a pediatric long term care facility with profound mental retardation due to presumptive herpes encephalitis as a newborn, spastic quadriplegia, a seizure disorder, gastroesophageal reflux disease, and a history of mild varicella 1993, status post gastrostomy tub insertion and Nissen fundoplication. It was noted that the patient was non ambulatory and dependent on caregivers for all activities of daily living. The patients medications include phenobarbital, valproic acid, melatonin and senna. It was noted that the patient was not on any immunosuppressive medications ore routine steroids. It was noted that the patient lived in the same facility with a 16 year old that was vaccinated on 01/28/2004 with a dose of varicella virus vaccine live. On 2/16/2004, varicella was transferred to the 13 year old who had not been vaccinated. Subsequently, the patient developed a vesicular eruption (less than 15 vesicular lesions) with two days of mild fever. Unspecified medical attention was sought and the patient was treated with acyclovir in five days. An immune work up was normal including serum quantitative IgG, diphtheria antitoxoid antibody, negative HIV, mumps IgG postiive, rubella IgG positive and rubeola IgG positive. PCR testing of one vesicular lesion was positive for OKA strain on VIV (there was a single point mutation VS the index case strain, however, it was believed that this does not detract significantly from the high likelihood that she contracted the OKA strain from the index case. The lesions scabbed and the patient recovered without complication. Published information indicated that the patient was diaabled due to neonatal HSV 1 was exposed to the index, 18 days later she developed mild 15 lesions varicella. Secondary transmisison was noted Analysis of material from this secondary case indicated that it was also OKA vaccine strain, which occurred despite a previous history of wild type varicella. There was no evidence of immunosuppression by clinical history or immunologic testing, and the patient was not taking immunosuppresive medications. No further information is available.