Abstract
Varicella vaccine is a live attenuated varicella-zoster virus (VZV). Like its parental strain called VZV pOka, the vaccine virus vOka retains some neurotropic properties. To better understand vOka neuropathogenesis, we reassessed 12 published cases of vOka meningitis that occurred in once-immunized and twice-immunized children, all of whom had bouts of herpes zoster preceding the central nervous system infection. Eight of the 12 meningitis cases occurred in children who had received only one immunization. There was no pattern to the time interval between varicella vaccination and the onset of herpes zoster with meningitis. Four of the meningitis cases occurred in children who had received two immunizations. Since all four children were 14 years old when meningitis was diagnosed, there was a strong pattern to the interval between the first vaccination at age 1 year and onset of meningitis, namely, 13 years. Knowledge of pathogenesis requires knowledge of the location of herpes zoster; the majority of dermatomal rashes occurred at sites of primary immunization on the arm or thigh, while herpes zoster ophthalmicus was uncommon. Based on this literature review, currently there is no consensus as to the cause of varicella vaccine meningitis in twice-immunized children.
Highlights
Four cases of varicella vaccine meningitis in twice immunized adolescents have been reported in the United States since 2017 [1]
The most serious complication in healthy children is probably central nervous system infection, which is caused by reactivation of the vaccine virus from the dorsal root ganglia (DRG), usually years after the first varicella vaccination
The goal of this review is to present an overview of varicella vaccine meningitis in children immunized with the live attenuated varicella vaccine
Summary
Four cases of varicella vaccine meningitis in twice immunized adolescents have been reported in the United States since 2017 [1]. In 2012, there were seven known cases of varicella vaccine meningitis, all of which had occurred in children who had received only one varicella vaccination. There was a belief that complications such as varicella vaccine meningitis would not occur in children who had received two varicella vaccinations. We review the literature on varicella meningitis we caused undertaken a second of varicella vaccinethese meningitis, in order to include reactivation of wild type investigation varicella in children, because wild-type cases providechildren insight who into the have received either one or two varicella vaccinations. Vaccine Meningitis after Herpes Zoster in Once-Immunized Children because these wild-type cases provide insight into the pathogenesis of varicella vaccine meningitis. All children had received one varicella vaccination, after which they later developed herpes zoster meningitis.
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