Varicella vaccination after fingolimod: A case report
1Department of Neurology, University of Kentucky College of Medicine, Kentucky Clinic L-445, 740 S. Limestone St., Lexington, KY 40536-0284, USA.
Multiple Sclerosis and Related Disorders
|April 17, 2015
Summary
This case report highlights potential risks of fingolimod (Gilenya) and varicella zoster virus (VZV) vaccination. It suggests fingolimod may increase VZV shedding and reduce vaccine effectiveness, necessitating careful patient management.
Area of Science:
- Immunology
- Virology
- Neurology
Background:
- Fingolimod (Gilenya) is an immunomodulatory drug used for relapsing remitting multiple sclerosis.
- Varicella zoster virus (VZV) seronegative status requires caution with VZV-related vaccines.
- Vaccination with attenuated VZV vaccine (Zostavax) in an immunocompromised state carries potential risks.
Purpose of the Study:
- To report a case of potential VZV reactivation and reduced vaccine efficacy following fingolimod treatment and subsequent VZV vaccination.
- To investigate the interaction between fingolimod's immunomodulatory effects and VZV vaccination in a multiple sclerosis patient.
Main Methods:
- Case report detailing a 36-year-old female with multiple sclerosis.
- Administration of fingolimod, followed by discontinuation due to VZV seronegativity.
- Subsequent vaccination with attenuated VZV vaccine despite medical advice.
- Monitoring for VZV-related complications in both the patient and her child.
Main Results:
- The patient's 3-year-old daughter developed varicella 14 days post-vaccination.
- The patient experienced recurrent herpes zoster (shingles) 8 and 10.5 months after vaccination while on fingolimod.
- Both patient and daughter's conditions resolved with acyclovir therapy.
Conclusions:
- Fingolimod-induced immunomodulation may increase the risk of VZV shedding after attenuated VZV vaccination.
- Fingolimod may reduce the efficacy of the attenuated VZV vaccine.
- This case underscores the importance of VZV serological screening and careful timing of vaccinations in patients treated with immunomodulatory therapies like fingolimod.
Keywords:
FingolimodImmunosuppressionMultiple sclerosisShinglesVaricella zoster vaccineVaricella zoster virusMore Related Videos
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