Twenty-two patients with steroid sensitive nephrotic syndrome (SSNS) and 20 controls (not age matched but average age similar) were studied by investigators in Istanbul, Turkey, in order to examine the efficacy and safety of varicella vaccine in SSNS. All SSNS patients were steroid responsive and were in remission or had already stopped steroid therapy at least 6 weeks before vaccination. The patients were followed for 8 weeks for clinical changes after vaccination. Varicella serum antibodies were determined pre-vaccine, 8 weeks after vaccine and 2 years after vaccine. All SSNS and control children had no history of varicella or any detectable antibody to varicellazoster virus (VZV) before vaccination. Eighty-five percent of SSNS patients and 86% of normal children seroconverted at 8 weeks. Varicella IgG antibodies were found at similar rates in both groups after 2 years. One child with SSNS relapsed 3 weeks after vaccination. Modified chickenpox (very mild cases) occurred in 3 other patients with SSNS. Two of the 3 had zero seroconversion at 8 weeks. One child from the control group developed a rash (not varicella). This report demonstrates the efficacy and safety of varicella vaccination for SSNS patients when vaccinated during remission.
This study addresses important questions regarding immunization with varicella vaccine, a live virus, in children with nephrotic syndrome1: 1) Safety—what is the risk of severe varicella infection or relapse of SSNS? 2) Efficacy—will children with SSNS respond to varicella vaccine? This limited study suggests vaccinating SSNS patients in remission may be both safe and effective. The study did not state how much immunosuppression patients received or were still receiving and, therefore, limits the interpretation of the seroconversion data. The safety question is an important finding and should be useful when considering live virus vaccines in children with nephrotic syndrome.
Although the sample size is small, the results suggest that giving this live viral vaccine to this immunosuppressed population may not be the rash decision we once thought.