Abstract
Corticosteroids, when given in high dosages, have long been recognized as a risk factor for severe infection with wild-type varicella-zoster virus in both children and adults. The goal of this review is to assess the degree to which both low-dosage and high-dosage corticosteroids contribute to serious adverse events (SAEs) following live varicella vaccination and live zoster vaccination. To this end, we examined multiple published reports of SAEs following varicella vaccination (VarivaxTM) and zoster vaccination (ZostavaxTM). We observed that five of eight viral SAEs following varicella vaccination, including two deaths, occurred in children receiving corticosteroids, while one of three fatal viral SAEs following live zoster vaccination occurred in an adult being treated with low-dosage prednisone. The latter death after live zoster vaccination occurred in a 70 year-old man with rheumatoid arthritis, being treated with prednisone 10 mg daily. Thus, corticosteroids contributed to more severe infectious complications in subjects immunized with each of the two live virus vaccines. Further, when we surveyed the rheumatology literature as well as individual case reports, we documented examples where daily dosages of 7.5–20 mg prednisone were associated with increased rates of severe wild-type varicella-zoster virus infections in children and adults.
Highlights
Accepted: 1 January 2021In this review, we propose that corticosteroids, even when prescribed at what are considered low dosages, increase the risk of a serious adverse event (SAE) in an individual immunized with either live varicella vaccine or live zoster vaccine
We propose that corticosteroids, even when prescribed at what are considered low dosages, increase the risk of a serious adverse event (SAE) in an individual immunized with either live varicella vaccine or live zoster vaccine
Thebecause three cases foundGermany, one longer report a 16-month-old boy who was admitted of fever an with SAEs after the live zoster vaccine occurred in three different countries
Summary
We propose that corticosteroids, even when prescribed at what are considered low dosages, increase the risk of a serious adverse event (SAE) in an individual immunized with either live varicella vaccine or live zoster vaccine. Takahashi notes that he was motivated to develop a live attenuated varicella vaccine because of severe cases of varicella that he had seen in hospitalized children. We decided prednisone 4 weeks before her boutnumber of herpes zoster Because of this case, we decided to to review a selected of the most detailed published reports of SAEs following review a selected number of the most detailed published reports of SAEs following either either live varicella vaccination or live zoster vaccination, to determine how many of these live varicella vaccination livereceived zoster vaccination, to determine many of these pa- did have a patients hadoralso corticosteroids. & Company did not distinguish SAEs in children taking corticosteroids from those not taking corticosteroids [14]
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