Age: 1.0
Sex: F
Vaccine: VARCEL
Symptoms: Abnormal behaviour, Headache, Meningitis, Pain, Paraesthesia
Clinical narrative: Information has been received on 11/21/02 from a doctor of philosophy (microbiologist) concerning a 6 year old female *with asthma* who at one year of age was vaccinated with a dose of varicella virus vaccine live *in the right thigh. The PT's MD noted that the PT was a "normal healthy child w/out any medical history" and to his knowledge was not receiving any medication at the time of vax.* On approximately 11/13/02 the patient developed pain and tingling in her right thigh. Several days later the child had developed a rash on the right thigh. *Several days later the child had developed a rash on the right thigh. The PT's MD stated that "there was a positive correlation btwn the site of injection and the site of herpes zoster."* The symptoms progressed to high fever, neck pain, headache, and behavioral changes. On 11/19/02 the patient presented to the ER, and was hospitalized with aseptic meningitis and shingles. *A spinal tap was done and a CSF specimen was sent for PCR analysis. It was also noted that the PT had no recent exposure to natural chicken pox. It was also noted that the PT had no recent exposure to natural chicken pox. It was reported that* the patient was given acyclovir treatment *and recovered*. A spinal tap was done and a CSF specimen was sent for PCR analysis. It was noted that the patient had no recent exposure to natural chicken pox. *F/UP report on 12/13/02: F/UP info received on 11/25/02 from the reported stated that she would be submitting CSF, obtained during the PT's acute illness and a vesicular lesion scraping.* *F/UP report on 12/30/02: F/up info received on 11/25/02 from the reporter stated that she would be submitting CSF, obtained during the PT's acute illness and a vesicular lesion scraping. The swab specimen from the herpes zoster in this case was - VZV and PCR identified the presence of Oka vax VIV. The CSF specimen results of the PCR analysis showed that it was an adequate specimen and that it was negative for both the wild-type varicella zoster virus and the vax strain virus. The CSF was reported to be genecleaned negative. On 12/10/02 the child presented w/recurrent herpes zoster again on the right thigh. The child did not have any SXs of meningitis. The reporter wanted to have a CSF examined for enterovirus. He stated that at the time of the viral meningitis the child did not have any SXs of enterovirus and that is why they looked for HSV and VZV both having been negative.* Additional information has been requested. Additional information was received from a literature article as stated above (initial reporter included as an author) concerning an 80 month old female with asthma treated with albuterol, flucticiamone, and slametrol aerosols on an as needed basis, who complained of right thigh pain six days prior to admission. Four days prior to admission she developed low-grade fever and right thigh swelling with 2 pathces of pink lesions. Herpes zoster was diagnosed and she was treated with oral acyclovir. One day prior to admission she had increased right thigh pain/swelling, worsening rash, headach, sleepiness, neck stiffness, and confusion. On admission she had right L2-L3 shingles with vesicles only, fever (39.2C( mild neck stiffness, but no disorientation. Non-contrast CT scan of the head was normal. CSF showed WBC 354 (N205, L 38%, M 42%), RBC 15, glucose 51, and protein 38. CSF bacterial cultures as well as PCR assays for enterovirus, herpes, simplex (HSV), Epstein-Barr virus and varicella-zoster virus (VZV) were negative. Culture of lesions scraping was negative for HSV and VZV. VZV IGM was undetectable but IgG was high (6.2 units; positive if > 1.1). She was treated with IV acyclovir for one week with complete recovery. CSF and lesion specimens wre submited for testing. PCR analysisi revealed the oka strain in lesions but not in CSF: wild-type VZV was not detected. (Varicella virus vaccine live) had been administered in the right thigh on her first birthday. Immune evaluation revealed normal lymphocyte subese numbers and distribution, and normal concerntraions of IgG, IgA, and IgM, and IgE. VZV IgM was still negative and IgG was positive (7.84 EIA units) six weeks later. She had another reactivation in her right thigh without dissemination 2 weeks after the first outbreak, this time in association with upper respiratory tract infection. It was reported that although CSP VZV PCR was negative, the time course of this child's illness, the lack of another focus of infection, and the negative studies for other common causes of aseptice meningitis suggest that she had reactivation of Oka strain herpes zoster with subsequent dissemination to the central nervous system 68 months after vaccination with (varicella virus vaccine live). Information received on 07 April 2004 contained the following adverse event: upper respiratory tract infection (Dec 2002). No further information is available.