Loss of Varicella Zoster Virus Antibodies Despite Detectable Cell Mediated Immunity after Vaccination

Infection Brief ReportLoss of Varicella Zoster Virus Antibodies Despite

Detectable Cell Mediated Immunity after VaccinationB. Ludwig, F.B. Kraus, R. Allwinn, S. Keim, H.W. Doerr, S. BuxbaumAbstractBackground: Vaccination of children against VZV has

been included in the recommendations of the permanent

committee of vaccination (STIKO; Stndige Impfkommission

of the Robert Koch Institute, Berlin, Germany) in July 2004.

Due to this recommendation the medical practitioner and

the laboratories will be confronted with the problem of

serologic non-responders or loss of humoral immunity more

frequently.Patients and Methods: Here we report the case of a

Varicella Zoster Virus (VZV) vaccinee, who lost detectable

VZV antibodies although she had a persisting VZV specific

CD4 cellular immune response. We compare these parameters

to the VZV specific CD4 T cell responses of VZV seronegative

and seropositive healthy persons, as well as patients with

VZV disease. Results: VZV specific CD4 frequencies of VZV antibody

seronegative persons remained on the average below 0.1%

(median 0.04%, SD 0.03, range 0.010.08%) and were

significantly lower than VZV specific frequencies of seropositive healthy persons (median 0.3%, SD 0.24, range 0.060.81%; Mann-Whitney U-test p = 0.001). The samples

of patients with VZV associated disease showed an even

higher median level of VZV specific CD4 cell response than

the VZV seropositive healthy persons (median 1.04%, SD 1.06, range 0.512.92%, Mann-Whitney U-test p = 0.008).

The VZV specific immune response of the health care worker

directly after vaccination was comparable to the VZV specific

immunity in VZV seropositive healthy adults. Despite

serological reconversion 1.5 years later the VZV specific CD4

response still remained measurable and positive.

Conclusion: The new general VZV vaccination recommendation for children in Germany will probably increase the

number of persons that will be seronegative after vaccination. To gain more information concerning the absence of

seroconversion or the loss of immunity, it will be necessary

to focus future post-VZV vaccination immunity studies not

only on serologic testing but also on the measuring of the

cell mediated immunity.Infection 2006; 34: 222226

DOI 10.1007/s15010-006-5616-9IntroductionThe varicella zoster virus (VZV) is the etiological agent of

varicella (chickenpox) and herpes zoster (shingles). Chickenpox is the primary infection with VZV and one of the

most frequent vaccination-preventable virus diseases in

childhood with annual disease rates of over 750,000 cases

in Germany alone [1]....