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Pediatrics. 2019 Dec;144(6). pii: e20191522. doi: 10.1542/peds.2019-1522.

Vaccine Oka Varicella Meningitis in Two Adolescents.

Author information

Seattle Children's Hospital, Seattle, Washington;
Department of Pediatrics, University of Washington, Seattle, Washington.
Randall Children's Hospital at Legacy Emanuel, Portland, Oregon.
Seattle Children's Hospital, Seattle, Washington.
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Pediatrics, Vagelos School of Physicians and Surgeons, Columbia University, New York, New York; and.
Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.


The live-attenuated varicella vaccine, a routine immunization in the United States since 1995, is both safe and effective. Like wild-type varicella-zoster virus, however, vaccine Oka (vOka) varicella can establish latency and reactivate as herpes zoster, rarely leading to serious disease, particularly among immunocompromised hosts. Previous cases of reactivated vOka resulting in meningitis have been described in young children who received a single dose of varicella vaccine; less is known about vOka reactivation in older children after the 2-dose vaccine series. We present 2 adolescents with reactivated vOka meningitis, 1 immunocompetent and 1 immunocompromised, both of whom received 2 doses of varicella vaccine many years before as children. Pediatricians should be aware of the potential of vOka varicella to reactivate and cause clinically significant central nervous system disease in vaccinated children and adolescents.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Gershon has National Institutes of Health funding to study varicella-zoster virus and a service laboratory contract with Merck for study of the safety of varicella-zoster virus vaccines. Dr Englund has received research support from Merck and GlaxoSmithKline. The other authors have indicated they have no potential conflicts of interest to disclose. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Diseases Control and Prevention.

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