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Immunogenicity and Safety Assessments After One and Two Doses of a Refrigerator-Stable Tetravalent Measles-Mumps-Rubella-Varicella Vaccine in Healthy Children During the Second Year of Life

Schuster, Volker MD*; Otto, Walter MD†; Maurer, Lothar MD†; Tcherepnine, Patricia MD†; Pfletschinger, Ulrich MD†; Kindler, Klaus MD†; Soemantri, Peter MD†; Walther, Uta MD†; Macholdt, Ute MD†; Douha, Martine MSc‡; Pierson, Patrice MSc‡; Willems, Paul MD‡


In the article on page 724 in volume 27, issue 8, there is an error in the Discussion section text. The second sentence in the fourth paragraph of the Discussion should read

“The incidence of fever of any intensity (rectal temperature ≥38.0°C/axillary temperature ≥37.5°C) was higher in the MMRV group during the 15 days after administration of the first dose, but most cases of fever reported during this study were high grade (rectal temperature ≥39.5°C/axillary temperature ≥39.0°C), with no statistically significant differences in the frequency of higher fever (>39.5°C) seen between groups after administration of either dose.” The text has been changed from “low grade” to “high grade” in the middle of the sentence.

The Pediatric Infectious Disease Journal. 32(4):e163, April 2013.

To the Editors:

Cor pulmonale is rare in children, especially when it is associated with pulmonary tuberculosis. An 8-year-old male child was admitted in our hospital with a history of fever and cough for 3 months, dyspnea for 2 months and progressive generalized body swelling for 1 month. He had 1 episode of hematemesis 6 months earlier for which the child was investigated and found out to have duodenal ulcers on upper gastrointestinal endoscopy. There was a family history of tuberculosis (grandmother). On examination, child had respiratory distress, cyanosis and edema. Tachycardia was present along with raised jugular venous pressure and hepatomegaly. Blood pressure was normal, and a grade 2 systolic murmur was present. There were coarse crepitations in the lung bases. Cardiomegaly was present on chest radiograph, and the electrocardiogram showed right-sided hypertrophy. By echocardiography there was a dilated right atrium, right ventricle and pulmonary veins along with severe pulmonary arterial hypertension and severe tricuspid regurgitation was noted. No congenital heart disease was noted. Hemoglobin was 11.9 gm %, and the platelet count was 190,000.

Contrast enhanced computed tomography of the chest revealed diffuse consolidation changes in both lung fields and 4 × 3 cm cavity in the left lower lobe segment with calcification in the wall of the cavity and bronchiectatic changes. The tuberculin test reaction with 5 tuberculin units was 35 mm. The gastric aspirate was positive for acid fast bacilli, and a polymerase chain reaction for Mycobacterium tuberculosis was positive. The enzyme-linked immunosorbent assay test for HIV infections was nonreactive. Sweat chloride test was negative. Child was discharged to receive antitubercular treatment.

Cor pulmonale as a manifestation of pulmonary tuberculosis in children was reported in 2 children in 1964.1 Vyslouzil et al2 stated that hypoxia along with restriction of the pulmonary blood bed and decrease of functional parenchyma represents are the major factors responsible for limitation of pulmonary diffusion and cor pulmonale. Ershov et al3 found that irreversible injuries to the vessels are because of both sclerotic changes and specific circulating immune complexes. Circulating immune complexes influence the central hemodynamics, decreasing cardiac output and circulating blood volume by 30%–40%, thus resulting in deficiency of blood inflow to the right compartments of the heart so that the atrium functions at a higher load like a suction pump which leads to cardiac hypertrophy.

Navreet Sharda, MB BS, MD

Department of Pediatrics

VMMC and Safdarjung Hospital

New Delhi, India

The Pediatric Infectious Disease Journal. 32(4):424, April 2013.

Pediatric Infectious Disease Journal: August 2008 - Volume 27 - Issue 8 - pp 724-730
doi: 10.1097/INF.0b013e318170bb22
Original Studies

Background: Measles, mumps, and rubella (MMR) and varicella (V) vaccines are often coadministered at 1 clinic visit. This study (104389/NCT00127023) was undertaken to assess the immunogenicity and safety of a new refrigerator-stable tetravalent MMRV vaccine after 1 dose and after 2 doses administered during the second year of life.

Methods: Nine hundred seventy healthy children aged 10–21 months received 2 doses of MMRV vaccine (Priorix-Tetra; GlaxoSmithKline Biologicals, Rixensart, Belgium) 42 days apart (MMRV group; N = 732) or 1 dose of MMR vaccine (Priorix) coadministered with varicella vaccine (Varilrix) followed by a second dose of only MMR vaccine 42 days later (MMR + V group; N = 238).

Results: Observed seroconversion rates for measles, mumps, rubella, and varicella antibodies 42 days postdose 1 were 94.5%, 96.1%, 99.7%, 95.5% in the MMRV group and 93.4%, 93.6%, 98.1%, 95.6% in the MMR + V group. Respective seroconversion rates postdose 2 were 98.3%, 99.4%, 99.7%, 99.7% in the MMRV group and 97.6%, 99.5%, 100%, 97.5% in the MMR + V group. Observed antimeasles and antimumps geometric mean titers (GMTs) were higher after each dose in the MMRV group than in the MMR + V group. Antivaricella GMT increased 21-fold in the MMRV group postdose 2, and was markedly higher than in the MMR + V group who did not receive a second dose of varicella (1903.3 and 80.3 dilution−1, respectively). Both vaccine regimens were generally well-tolerated in terms of local reactions, fever >39.5°C, and vaccine-related rashes.

Conclusions: Both after 1 dose and after 2 doses, the MMRV vaccine was at least as immunogenic as concomitant MMR and varicella vaccination suggesting that it could be suitable for use according to current vaccination schedules.

From the *Hospital for Children and Adolescents, University of Leipzig, Leipzig; †Pediatric offices in Fulda, Frankenthal, Roding, Stuttgart, Trier, Kleve-Materborn, Berlin, Neuhaus am Rennweg, Germany; and ‡GlaxoSmithKline Biologicals, Rixensart, Belgium.

Accepted for publication February 26, 2008.

The study was funded by GlaxoSmithKline Biologicals, which also provided assistance with study design and data acquisition.

U.P. has been investigator for GlaxoSmithKline, Chiron-Behring, MSD, und Aventis-Pasteur-Merieux in the past.

V.S. has been involved as investigator in several other vaccine studies sponsored by GlaxoSmithKline.

M.D., P.P., and P.W. are employees of GlaxoSmithKline Biologicals.

Address for correspondence: Prof. Volker Schuster, Hospital for Children and Adolescents, University of Leipzig, Liebigstrasse 20a, 04103 Leipzig, Germany. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.