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Chronic Infection with Rotavirus Vaccine Strains in UK Children with Severe Combined Immunodeficiency

Morillo-Gutierrez, Beatriz FRCPCH; Worth, Austen PhD; Valappil, Manoj FRCPath; Gaspar, H. Bobby MRCPCH, PhD; Gennery, Andrew R. MD

The Pediatric Infectious Disease Journal: September 2015 - Volume 34 - Issue 9 - p 1040–1041
doi: 10.1097/INF.0000000000000788
Letters to the Editor
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Department of Paediatric Immunology Newcastle upon Tyne Hospital NHS Foundation Trust Newcastle upon Tyne, United Kingdom

Department of Paediatric Immunology Great Ormond Street Hospital London, United Kingdom

Department of Laboratory Medicine Newcastle upon Tyne Hospital NHS Foundation Trust. Newcastle upon Tyne, United Kingdom

Molecular and Cellular Immunology section UCL Institute of Child Health London, United Kingdom

Department of Paediatric Immunology Institute of Cellular Medicine Newcastle University Newcastle upon Tyne Hospital NHS Foundation Trust Newcastle upon Tyne, United Kingdom

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Beatriz Morillo-Gutierrez, FRCPCH; E-mail: bmorillog@gmail.com.

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To the Editors:

Following the recent publication of Klinkenberg et al1 in Germany of a case of a severe combined immunodeficiency (SCID) patient infected with rotavirus vaccine strain, we would like to report 7 cases in the UK with similar characteristics. These cases have been diagnosed since July 2013, when the rotavirus live vaccine was included in the UK routine childhood vaccination schedule for infants 2 and 3 months of age.2 SCID is one of the contraindications to receiving this vaccine.3,4

We describe 7 infants born in UK with different ethnic backgrounds, all diagnosed with SCID but who received oral rotavirus vaccine before the immunologic diagnosis, and were found subsequently to be infected with rotavirus vaccine strain. This represents 100% of exposed SCID diagnoses presenting to the 2 UK national referral centers since the introduction of rotavirus vaccination. Five presented with chronic diarrhea and 2 with severe failure to thrive. Six required parenteral nutrition at some stage during their admission, and 3 developed significant gastrointestinal complications following corrective therapy, which have prolonged inpatient hospital stay, increased the costs and risk of treatment, and increased the risk of cross-infection to other immunodeficient patients treated on the same wards. Further details of the patients are presented (Table 1).

Table

Table

We believe these are the first patients to be reported in the UK experiencing chronic rotavirus vaccine strain infection. A high penetrance of symptomatic rotavirus infection in SCID patients was predictable, because it was described in the USA following introduction of the vaccine in the routine childhood vaccination schedule in 2006.5 The requirement to establish a newborn screening program for SCID was therefore reinforced and successfully introduced in many US states from May 2010.6

As in many European countries, newborn screening for SCID has not yet been approved in UK; until this happens, it is likely that infants with SCID will continue to be immunized with live vaccines, thus complicating and increasing their hospital stay and treatment costs.

Beatriz Morillo-Gutierrez, FRCPCH

Department of Paediatric Immunology Newcastle upon Tyne Hospital NHS Foundation Trust Newcastle upon Tyne, United Kingdom

Austen Worth, PhD

Department of Paediatric Immunology Great Ormond Street Hospital London, United Kingdom

Manoj Valappil, FRCPath

Department of Laboratory Medicine Newcastle upon Tyne Hospital NHS Foundation Trust. Newcastle upon Tyne, United Kingdom

H. Bobby Gaspar, MRCPCH, PhD

Molecular and Cellular Immunology section UCL Institute of Child Health London, United Kingdom

Andrew R. Gennery, MD

Department of Paediatric Immunology Institute of Cellular Medicine Newcastle University Newcastle upon Tyne Hospital NHS Foundation Trust Newcastle upon Tyne, United Kingdom

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REFERENCES

1. Klinkenberg D, Blohm M, Hoehne M, et al. Risk of rotavirus vaccination for children with SCID. Pediatr Infect Dis J. 2015;34:114–115
2. Iturriza-Gómara M, Cunliffe N. Rotavirus vaccine: a welcome addition to the immunisation schedule in the UK. BMJ. 2013;346:f2347
3. Centers for Disease Control and Prevention (CDC). . Addition of severe combined immunodeficiency as a contraindication for administration of rotavirus vaccine. MMWR Morb Mortal Wkly Rep. 2010;59:687–688
4. Bakare N, Menschik D, Tiernan R, et al. Severe combined immunodeficiency (SCID) and rotavirus vaccination: reports to the vaccine adverse events reporting system (VAERS). Vaccine. 2010;28:6609–6612
5. Patel NC, Hertel PM, Estes MK, et al. Vaccine-acquired rotavirus in infants with severe combined immunodeficiency. N Engl J Med. 2010;362:314–319
6. Kwan A, Abraham RS, Currier R, et al. Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States. JAMA. 2014;312:729–738
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