PDF(Pubmed)
Abstract：
A young man with X-linked severe combined immunodeficiency developed a persistent vaccine-derived rubella virus (VDRV) infection, with the emergence of cutaneous granulomas more than fifteen years after receipt of two doses of measles-mumps-rubella (MMR) vaccine. Following nasopharyngeal swab (NP) collection, VDRV was detected by real-time polymerase chain reaction (RT-qPCR) and sequencing, and live, replication-competent VDRV was isolated in cell culture. To assess duration and intensity of viral shedding, sequential respiratory samples, one cerebrospinal fluid sample, and two urine samples were collected over 15 months, and VDRV RNA was detected in all samples by RT-qPCR. Live VDRV was cultured from nine of the eleven respiratory specimens and from one urine specimen. To our knowledge, this was the first reported instance of VDRV cultured from respiratory specimens or from urine. To assess potential transmission to close contacts, NP specimens and sera were collected from all household contacts, all of whom were immunocompetent and previously vaccinated with MMR. VDRV RNA was not detected in any NP swabs from the contacts, nor did serologic investigations suggest VDRV transmission to any contacts. This report highlights the need to understand the prevalence and duration of VDRV shedding in granuloma patients and to estimate the risk of VDRV transmission to immune and non-immune contacts.
摘要：
一名患有X连锁严重联合免疫缺陷的年轻人发展出持续的疫苗衍生风疹病毒（VDRV）感染，在接受两剂麻疹-腮腺炎-风疹（MMR）疫苗超过15年后出现皮肤肉芽肿。收集鼻咽拭子（NP）后，通过实时聚合酶链反应(RT-qPCR)和测序检测VDRV,和生活，在细胞培养物中分离有复制能力的VDRV。为了评估病毒脱落的持续时间和强度，顺序呼吸样本，一份脑脊液样本,在15个月内收集了两份尿液样本，通过RT-qPCR检测所有样品中的VDRVRNA。从11个呼吸道标本中的9个和一个尿液标本中培养活VDRV。据我们所知,这是从呼吸道标本或尿液培养的VDRV首次报道.为了评估向密切接触者的潜在传播，从所有家庭接触者收集NP标本和血清，所有这些人都有免疫能力，并且以前接种过MMR。在接触者的任何NP拭子中均未检测到VDRVRNA，血清学检查也没有提示VDRV传播给任何接触者.本报告强调需要了解肉芽肿患者中VDRV脱落的患病率和持续时间，并估计VDRV传播给免疫和非免疫接触者的风险。
