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Humoral and cellular response after varicella vaccination in VZV IgG seronegative kidney transplant candidates

Kho, Marcia M.L., Zuijderwijk, Joke M., van der Eijk, Annemiek A., de Kuiper, Ronella, Boer-Verschragen, Marieken J., Weimar, Willem, van Besouw, Nicole M.
Vaccine 2017 v.35 no.1 pp. 71-76
CD4-positive T-lymphocytes, CD8-positive T-lymphocytes, disease course, immunoglobulin G, kidney diseases, kidney transplant, patients, subunit vaccines, vaccination
In immunocompromised patients, primary infection with VZV may have a disastrous clinical course. Vaccination of VZV-seronegative patients on the waiting list for renal transplantation may prevent severe disease. However, the immunologic response of end-stage renal disease patients to peptide vaccines is far from optimal. Our question was whether end-stage renal disease patients with undetectable VZV-IgG levels were able to mount an adequate humoral and cellular response to a live attenuated varicella vaccine.Kidney transplant candidates with undetectable VZV levels were vaccinated twice with a live attenuated varicella vaccine at an interval of 6weeks. VZV IgG levels were analysed till 2years after vaccination. The VZV-specific T-cell reactivity was determined prior to vaccination and after transplantation.Seventy-seven percent (40/52) of the vaccinees reached positive VZV-IgG levels after vaccination (responders). Eighty-two percent (9/11) showed an increase in VZV-specific CD4+ memory T-cells (both central and effector memory cells). The percentage VZV-specific CD8+ memory T-cells did not increase. None of the non-responders suffered from primary VZV after transplantation. No severe vaccine-related adverse events were reported, only spontaneously resolving local skin irritation.The live attenuated varicella vaccine evokes positive VZV IgG-levels and VZV-specific memory T-cells in VZV-seronegative potential kidney transplant candidates.