Dear Editor,
Horizontal transmission has been rarely reported with of many live attenuated vaccines. Different mumps vaccines have shown rarely such transmission.1–5 A study in US reported evidence of the transmission of rubella vaccine virus from vaccinees to two susceptible contacts.6
With live varicella vaccines, there are at least three reports. The brother of a 3-y-old vaccinated girl developed fever and a rash; horizontal transmission of vaccine virus was later confirmed.7 A pregnant mother contracted the vaccine virus after her 12-mo-old boy received varicella vaccine.8 Horizontal transmission was reported in 15 (17%) susceptible healthy siblings after varicella vaccination of 156 children with leukemia.9 The package insert of live varicella vaccine (Varivax, Merck) states that “Post-marketing experience suggests that transmission of vaccine virus may occur rarely between healthy vaccinees who develop a varicella-like rash and healthy susceptible contacts. Transmission of vaccine virus from vaccinees who do not develop a varicella-like rash has also been reported.”10
There are two reports with rotavirus vaccines. A randomized, double-blind study on human rotavirus vaccine (Rotarix™, Glaxo) in 100 pairs of healthy twins found that the transmission rate among placebo recipients was 18.8%.11 In another case, rotavirus vaccine (RotaTeq, Merck) transmission was reported from a vaccinated infant to an older, unvaccinated sibling, resulting in symptomatic rotavirus gastroenteritis.12
A study on live attenuated influenza vaccine (FluMist, MedImmune) in a Finnish day care showed that one child in the placebo group had transiently detectable vaccine virus, indicating transmission from a vaccinated child; the child remained asymptomatic.13
Despite these reports, these live vaccines are used in millions of doses across the world. Clearly, the benefit of vaccination outweighs the very low risk of vaccine virus transmission.
Conflict of Interest
All three authors are employed by Serum Institute of India Ltd.
Footnotes
Previously published online: www.landesbioscience.com/journals/vaccines/article/22132
References
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