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Varicella immunity: persistent serologic non-response to immunization.

R K Katial1, S Ratto-Kim, K V Sitz

  • 1Department of Allergy and Immunology, Walter Reed Army Medical Center, Washington, DC 20307, USA.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|June 3, 1999
PubMed
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Healthcare workers may show non-responsiveness to varicella-zoster virus (VZV) vaccines. Sensitive assays and repeat immunization can confirm protection when standard antibody titers are low.

Area of Science:

  • Immunology
  • Vaccinology
  • Occupational Health

Background:

  • Varicella-zoster virus (VZV) infection poses an occupational risk to healthcare workers.
  • Assessing VZV immunity typically relies on positive antibody titers, considered the gold standard.

Observation:

  • A 29-year-old immunocompetent resident exhibited persistent serologic non-responsiveness to VZV vaccination despite three doses.
  • Standard ELISA assays failed to detect VZV antibodies, leading to repeated removal from clinical duties.
  • The patient remained asymptomatic after three direct exposures to VZV-infected children.

Findings:

  • Lymphocyte proliferation assays revealed adequate cell-mediated immunity to VZV antigens (SI=46.5).
  • More sensitive assays (fluorescent antibody to membrane antigen, latex agglutination) detected low-level VZV-specific IgG (titer 1:8).

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  • Commercial ELISA assays may be insufficiently sensitive for detecting vaccine-induced antibody titers.

    • Implications:

    • A subgroup of individuals may have low antibody responses to VZV vaccines despite intact cell-mediated immunity.
    • Current ELISA screening may underestimate VZV protection in vaccinated healthcare workers.
    • Recommendations include considering repeat immunizations and utilizing more sensitive IgG assays for accurate VZV immunity assessment in healthcare settings.