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01-06-2018 | Original Article

Co-appearance of OPV and BCG vaccine-derived complications in two infants with severe combined immunodeficiency

Authors: Sophia Heiman, Merav Weil, Lester M. Shulman, Amos J. Simon, Atar Lev, Raz Somech, Tali Stauber

Published in: Immunologic Research | Issue 3/2018

Abstract

Infants with severe combined immunodeficiency (SCID) are at risk of developing severe life-threatening infections if they are inadvertently given attenuated live vaccines. Concomitant appearance of two live vaccine-associated complications in one person is rarely reported. In this study, we present two SCID infants, who received BCG and oral polio vaccines according to their local immunization schedule early in life, before the diagnosis of immunodeficiency was made. Their clinical presentation, extensive immunological workup, genetic tests, and clinical disease course are presented. Both patients developed localized and disseminated infections originating from the BCG vaccine (BCGitis and BCGiosis, respectively) and in addition suffered from diarrhea and chronic fecal secretion of vaccine-derived poliovirus. Alarmingly, in case 2, the poliovirus was a type 2 vaccine-derived poliovirus in which both neurovirulence attenuation sites reverted to the neurovirulent genotype. These cases highlight the importance of early recognition of SCID by neonatal screening or thorough family anamnesis, and the need to further defer the timing of administration of attenuated live vaccines.

Costa-Carvalho BT, Grumach AS, Franco JL, Espinosa-Rosales FJ, Leiva LE, King A, et al. Attending to warning signs of primary immunodeficiency diseases across the range of clinical practice. J Clin Immunol. 2014;34(1):10–22. https://doi.org/10.1007/s10875-013-9954-6.CrossRefPubMed

Sarmiento JD, Villada F, Orrego JC, Franco JL, Trujillo-Vargas CM. Adverse events following immunization in patients with primary immunodeficiencies. Vaccine. 2016;34(13):1611–6. https://doi.org/10.1016/j.vaccine.2016.01.047.CrossRefPubMed

Shearer WT, Fleisher TA, Buckley RH, Ballas Z, Ballow M, Blaese RM, et al. Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts. J Allergy Clin Immunol. 2014;133(4):961–6. https://doi.org/10.1016/j.jaci.2013.11.043.CrossRefPubMedPubMedCentral

van der Burg M, Gennery AR. Educational paper. The expanding clinical and immunological spectrum of severe combined immunodeficiency. Eur J Pediatr. 2011;170(5):561–71. https://doi.org/10.1007/s00431-011-1452-3. CrossRefPubMedPubMedCentral

Gaspar HB, Gilmour KC, Jones AM. Severe combined immunodeficiency—molecular pathogenesis and diagnosis. Arch Dis Child. 2001;84(2):169–73.CrossRefPubMedPubMedCentral

Kwan A, Abraham RS, Currier R, Brower A, Andruszewski K, Abbott JK, et al. Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States. JAMA. 2014;312(7):729–38. https://doi.org/10.1001/jama.2014.9132.CrossRefPubMedPubMedCentral

Cross C. Ontario newborns now screened for SCID. CMAJ. 2013;185(13):E616. https://doi.org/10.1503/cmaj.109-4580.CrossRefPubMedPubMedCentral

Kwan A, Puck JM. History and current status of newborn screening for severe combined immunodeficiency. Semin Perinatol. 2015;39(3):194–205. https://doi.org/10.1053/j.semperi.2015.03.004.CrossRefPubMedPubMedCentral

Al-Saud B, Al-Mousa H, Al Gazlan S, Al-Ghonaium A, Arnaout R, Al-Seraihy A, et al. Primary immunodeficiency diseases in Saudi Arabia: a tertiary care hospital experience over a period of three years (2010–2013). J Clin Immunol. 2015;35(7):651–60. https://doi.org/10.1007/s10875-015-0197-6.CrossRefPubMed

10.

Rechavi E, Lev A, Simon AJ, Stauber T, Daas S, Saraf-Levy T, et al. First year of Israeli newborn screening for severe combined immunodeficiency—clinical achievements and insights. Front Immunol. 2017;8:1448. https://doi.org/10.3389/fimmu.2017.01448.CrossRefPubMedPubMedCentral

11.

Amariglio N, Lev A, Simon A, Rosenthal E, Spirer Z, Efrati O, et al. Molecular assessment of thymus capabilities in the evaluation of T-cell immunodeficiency. Pediatr Res. 2010;67(2):211–6. https://doi.org/10.1203/PDR.0b013e3181c6e554.CrossRefPubMed

12.

WHO. Polio laboratory manual. WHO. 2004.

13.

Kilpatrick DR, Iber JC, Chen Q, Ching K, Yang SJ, De L, et al. Poliovirus serotype-specific VP1 sequencing primers. J Virol Methods. 2011;174(1–2):128–30. https://doi.org/10.1016/j.jviromet.2011.03.020.CrossRefPubMed

14.

Yang CF, Naguib T, Yang SJ, Nasr E, Jorba J, Ahmed N, et al. Circulation of endemic type 2 vaccine-derived poliovirus in Egypt from 1983 to 1993. J Virol. 2003;77(15):8366–77.CrossRefPubMedPubMedCentral

15.

Diop OM, Burns CC, Sutter RW, Wassilak SG, Kew OM. Update on vaccine-derived polioviruses—worldwide, January 2014–March 2015. MMWR Morb Mortal Wkly Rep. 2015;64(23):640–6.PubMedPubMedCentral

16.

Kew OM, Sutter RW, de Gourville EM, Dowdle WR, Pallansch MA. Vaccine-derived polioviruses and the endgame strategy for global polio eradication. Annu Rev Microbiol. 2005;59:587–635. https://doi.org/10.1146/annurev.micro.58.030603.123625.CrossRefPubMed

17.

Pariyaprasert W, Pacharn P, Visitsunthorn N, Chokephaibulkit K, Sanpakit K, Viprakasit V, et al. Successful treatment of disseminated BCG infection in a SCID patient with granulocyte colony stimulating factor. Asian Pac J Allergy Immunol. 2008;26(1):71–5.PubMed

18.

Weil M, Shulman LM, Heiman S, Stauber T, Alfandari J, Weiss L, et al. Prolonged excretion of type-2 poliovirus from a primary immune deficient patient during the transition to a type-2 poliovirus-free world, Israel, 2016. Euro Surveill. 2016;21(47) https://doi.org/10.2807/1560-7917.ES.2016.21.47.30408.

19.

Canessa C, Romano F, Lippi F, Bianchi L, Kashef S, Rezaei N, et al. Bcgitis and vaccine-derived poliovirus infection in a patient with a novel deletion in RAG1 binding site. Int J Immunopathol Pharmacol. 2013;26(2):511–5.CrossRefPubMed

20.

Trimble R, Atkins J, Quigg TC, Burns CC, Wallace GS, Thomas M, et al. Vaccine-associated paralytic poliomyelitis and BCG-osis in an immigrant child with severe combined immunodeficiency syndrome—Texas, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(33):721–4.PubMedPubMedCentral

21.

Bakare N, Menschik D, Tiernan R, Hua W, Martin D. Severe combined immunodeficiency (SCID) and rotavirus vaccination: reports to the Vaccine Adverse Events Reporting System (VAERS). Vaccine. 2010;28(40):6609–12. https://doi.org/10.1016/j.vaccine.2010.07.039.CrossRefPubMed

22.

Dutmer CM, Asturias EJ, Smith C, Dishop MK, Schmid DS, Bellini WJ, et al. Late onset hypomorphic RAG2 deficiency presentation with fatal vaccine-strain VZV infection. J Clin Immunol. 2015;35(8):754–60. https://doi.org/10.1007/s10875-015-0207-8.CrossRefPubMedPubMedCentral

23.

Schuil J, van de Putte EM, Zwaan CM, Koole FD, Meire FM. Retinopathy following measles, mumps, and rubella vaccination in an immuno-incompetent girl. Int Ophthalmol. 1998;22(6):345–7.CrossRefPubMed

24.

Bitnun A, Shannon P, Durward A, Rota PA, Bellini WJ, Graham C, et al. Measles inclusion-body encephalitis caused by the vaccine strain of measles virus. Clin Infect Dis. 1999;29(4):855–61. https://doi.org/10.1086/520449.CrossRefPubMed

25.

Bayer DK, Martinez CA, Sorte HS, Forbes LR, Demmler-Harrison GJ, Hanson IC, et al. Vaccine-associated varicella and rubella infections in severe combined immunodeficiency with isolated CD4 lymphocytopenia and mutations in IL7R detected by tandem whole exome sequencing and chromosomal microarray. Clin Exp Immunol. 2014;178(3):459–69. https://doi.org/10.1111/cei.12421.CrossRefPubMedPubMedCentral

26.

Shrot S, Barkai G, Ben-Shlush A, Soudack M. BCGitis and BCGosis in children with primary immunodeficiency—imaging characteristics. Pediatr Radiol. 2016;46(2):237–45. https://doi.org/10.1007/s00247-015-3464-z.CrossRefPubMed

27.

Norouzi S, Aghamohammadi A, Mamishi S, Rosenzweig SD, Rezaei N. Bacillus Calmette-Guerin (BCG) complications associated with primary immunodeficiency diseases. J Infect. 2012;64(6):543–54. https://doi.org/10.1016/j.jinf.2012.03.012.CrossRefPubMedPubMedCentral

28.

Sharifi Asadi P, Aghamohammadi A, Mahmoudi S, Pourakbari B, Saboui F, Mamishi S. Clinical, laboratory and imaging findings of the patients with disseminated bacilli Calmette-Guerin disease. Allergol Immunopathol. 2015;43(3):254–8. https://doi.org/10.1016/j.aller.2014.01.003.CrossRef

29.

Marciano BE, Huang CY, Joshi G, Rezaei N, Carvalho BC, Allwood Z, et al. BCG vaccination in patients with severe combined immunodeficiency: complications, risks, and vaccination policies. J Allergy Clin Immunol. 2014;133(4):1134–41. https://doi.org/10.1016/j.jaci.2014.02.028.CrossRefPubMedPubMedCentral

30.

Conti F, Lugo-Reyes SO, Blancas Galicia L, He J, Aksu G, Borges de Oliveira E Jr, et al. Mycobacterial disease in patients with chronic granulomatous disease: a retrospective analysis of 71 cases. J Allergy Clin Immunol. 2016;138(1):241–8 e3. https://doi.org/10.1016/j.jaci.2015.11.041.CrossRefPubMed

31.

Jorba J, Campagnoli R, De L, Kew O. Calibration of multiple poliovirus molecular clocks covering an extended evolutionary range. J Virol. 2008;82(9):4429–40. https://doi.org/10.1128/JVI.02354-07.CrossRefPubMedPubMedCentral

32.

Burns CC, Diop OM, Sutter RW, Kew OM. Vaccine-derived polioviruses. J Infect Dis. 2014;210(Suppl 1):S283–93. https://doi.org/10.1093/infdis/jiu295. CrossRefPubMed

33.

Li L, Ivanova O, Driss N, Tiongco-Recto M, da Silva R, Shahmahmoodi S, et al. Poliovirus excretion among persons with primary immune deficiency disorders: summary of a seven-country study series. J Infect Dis. 2014;210(Suppl 1):S368–72. https://doi.org/10.1093/infdis/jiu065.CrossRefPubMed

34.

Collett MS, Hincks JR, Benschop K, Duizer E, van der Avoort H, Rhoden E, et al. Antiviral activity of pocapavir in a randomized, blinded, placebo-controlled human oral poliovirus vaccine challenge model. J Infect Dis. 2016; https://doi.org/10.1093/infdis/jiw542.

35.

Chen Z, Chumakov K, Dragunsky E, Kouiavskaia D, Makiya M, Neverov A, et al. Chimpanzee-human monoclonal antibodies for treatment of chronic poliovirus excretors and emergency postexposure prophylaxis. J Virol. 2011;85(9):4354–62. https://doi.org/10.1128/JVI.02553-10.CrossRefPubMedPubMedCentral

36.

Myers LA, Patel DD, Puck JM, Buckley RH. Hematopoietic stem cell transplantation for severe combined immunodeficiency in the neonatal period leads to superior thymic output and improved survival. Blood. 2002;99(3):872–8.CrossRefPubMed

37.

Rivers L, Gaspar HB. Severe combined immunodeficiency: recent developments and guidance on clinical management. Arch Dis Child. 2015;100(7):667–72. https://doi.org/10.1136/archdischild-2014-306425.CrossRefPubMed

38.

Baker MW, Laessig RH, Katcher ML, Routes JM, Grossman WJ, Verbsky J, et al. Implementing routine testing for severe combined immunodeficiency within Wisconsin’s newborn screening program. Public Health Rep. 2010;125(Suppl 2):88–95.CrossRefPubMedPubMedCentral

39.

Somech R, Lev A, Simon AJ, Korn D, Garty BZ, Amariglio N, et al. Newborn screening for severe T and B cell immunodeficiency in Israel: a pilot study. Isr Med Assoc J. 2013;15(8):404–9.PubMed

Title: Co-appearance of OPV and BCG vaccine-derived complications in two infants with severe combined immunodeficiency
Authors: Sophia Heiman
Merav Weil
Lester M. Shulman
Amos J. Simon
Atar Lev
Raz Somech
Tali Stauber
Publication date: 01-06-2018
Publisher: Springer US
Published in: Immunologic Research / Issue 3/2018
Print ISSN: 0257-277X
Electronic ISSN: 1559-0755
DOI: https://doi.org/10.1007/s12026-018-9007-6

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Co-appearance of OPV and BCG vaccine-derived complications in two infants with severe combined immunodeficiency

Abstract

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