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Scientific article
Open access
English

Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling

Published inViruses, vol. 13, no. 11, 2286
Publication date2021-11-16
First online date2021-11-16
Abstract

Varicella vaccine meningitis is an uncommon delayed adverse event of vaccination. Varicella vaccine meningitis has been diagnosed in 12 children, of whom 3 were immunocompromised. We now report two additional cases of vaccine meningitis in twice-immunized immunocompetent children and we perform further testing on a prior third case. We used three methods to diagnose or investigate cases of varicella vaccine meningitis, none of which have been used previously on this disease. These include metagenomic next-generation sequencing and cytokine multiplex profiling of cerebrospinal fluid and immunology exome analysis of white blood cells. In one new case, the diagnosis was confirmed by metagenomic next-generation sequencing of cerebrospinal fluid. Both varicella vaccine virus and human herpesvirus 7 DNA were detected. We performed cytokine multiplex profiling on the cerebrospinal fluid of two cases and found ten elevated biomarkers: interferon gamma, interleukins IL-1RA, IL-6, IL-8, IL-10, IL-17F, chemokines CXCL-9, CXCL-10, CCL-2, and G-CSF. In a second new case, we performed immunology exome sequencing on a panel of 356 genes, but no errors were found. After a review of all 14 cases, we concluded that (i) there is no common explanation for this adverse event, but (ii) ingestion of an oral corticosteroid burst 3-4 weeks before onset of vaccine meningitis may be a risk factor in some cases.

eng
Keywords
  • IL-10
  • IL-6
  • Oka strain
  • Corticosteroids
  • Herpes zoster
  • Human herpesvirus 6
  • Human herpesvirus 7
  • Innate immunity
  • Serious adverse event
  • Varicella-zoster virus
Funding
  • NINDS NIH HHS - [NS096117]
  • NIAID NIH HHS - [AI153817]
  • American Academy of Neurology - [P0534134]
Citation (ISO format)
RAMACHANDRAN, Prashanth S et al. Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling. In: Viruses, 2021, vol. 13, n° 11, p. 2286. doi: 10.3390/v13112286
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Identifiers
ISSN of the journal1999-4915
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