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Case Reports
. 2010 Jan 28;362(4):314-9.
doi: 10.1056/NEJMoa0904485.

Vaccine-acquired rotavirus in infants with severe combined immunodeficiency

Niraj C Patel  1 , Paula M Hertel, Mary K Estes, Maite de la Morena, Ann M Petru, Lenora M Noroski, Paula A Revell, I Celine Hanson, Mary E Paul, Howard M Rosenblatt, Stuart L Abramson
Affiliations
Case Reports

Vaccine-acquired rotavirus in infants with severe combined immunodeficiency

Niraj C Patel et al. N Engl J Med. .

Abstract

Live pentavalent human-bovine reassortant rotavirus vaccine is recommended in the United States for routine immunization of infants. We describe three infants, two with failure to thrive, who had dehydration and diarrhea within 1 month after their first or second rotavirus immunization and subsequently received a diagnosis of severe combined immunodeficiency. Rotavirus was detected, by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay, in stool specimens obtained from all three infants, and gene-sequence analysis revealed the presence of vaccine rotavirus. These infections raise concerns regarding the safety of rotavirus vaccine in severely immunocompromised patients.

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Conflict of interest statement

No other potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1. DNA Amplicons of Rotavirus Gene 6 Isolated from Stool Specimens Obtained from the Three Case Patients
The amplicon size is 888 bp; for comparison, an 800-bp marker is shown (asterisk). The negative control was double-distilled water, and the positive control, rotavirus vaccine.
Figure 2
Figure 2. Sequences of Rotavirus Gene 6 in DNA Isolated from Stool Specimens Obtained from the Three Case Patients
Representative sequences are shown for the rotavirus vaccine RV5 and for specimens obtained from Patients 1, 2, and 3. The sequences were identical between the two lots of vaccine, among each patient’s multiple stool specimens, and between the vaccine and the specimens from each patient, with the exception of the single nucleotide difference shown for Patients 1 and 2. Amplicons were isolated with the use of a reverse-transcriptase–polymerase-chain-reaction assay. The “nt” denotes nucleotides.
See this image and copyright information in PMC

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