Ludmila Perelygina1, David Buchbinder2, Morna J Dorsey3, Marc Eloit4, Fabian Hauck5, Timo Hautala6, Despina Moshous7,8, Ignacio Uriarte9, Elena Deripapa10, Joseph Icenogle1, Kathleen E Sullivan11. 1. Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA. 2. Division of Hematology, CHOC Children's Hospital, Orange, CA, USA. 3. Department of Pediatrics, Division of Allergy, Immunology, and Blood and Marrow Transplant, Benioff Children's Hospital, University of California, San Francisco, 1975 4th Street, San Francisco, CA, 94158, USA. 4. Institut Pasteur, Laboratory of Pathogen Discovery, Biology of Infection Unit, Inserm U1117, Paris, France. 5. Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany. 6. Research Unit of Internal Medicine, University of Oulu and Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland. 7. Department of Pediatric Immunology, Hematology and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker Children's Hospital, Paris, France. 8. Laboratory "Genome Dynamics in The Immune System," INSERM UMR1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Paris, France. 9. Immunology Unit, The Child's and Mother Hospital, Vitorio Tetamanti, High School of Medicine, Mar del Plata National University, Castelli 2450 Mar del Plata, 7600, Buenos Aires, Argentina. 10. Department of Immunology, Center for Pediatric Hematology, Oncology, Immunology, Moscow, Russia. 11. Division of Allergy Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA. sullivank@email.chop.edu.
Abstract
PURPOSE: Nitazoxanide was recently reported as having in vitro effectiveness against the rubella virus. Immunodeficiency-related vaccine-derived rubella occurs in some patients who have an inherited immunodeficiency and who received the MMR vaccine. This study investigated the in vivo effectiveness of nitazoxanide therapy. METHODS: This is a retrospective analysis of seven patients treated with nitazoxanide as salvage therapy for immunodeficiency-related vaccine-derived rubella infection. The patients were recruited from an ongoing rubella detection surveillance project. RESULTS: Seven patients with persistent rubella were treated with nitazoxanide and one demonstrated significant clinical improvement. Two additional patients exhibited diminished viral capsid production with one patient having transient slowing of progression. The cohort overall generally had low T cell counts and had a high burden of comorbidities. There were three deaths. Two deaths were from PML and one was related to hematopoietic stem cell transplantation. CONCLUSIONS: Nitazoxanide has limited in vivo anti-viral effects for immunodeficiency-related vaccine-derived rubella. Most patients did not exhibit clinical improvement.
PURPOSE:Nitazoxanide was recently reported as having in vitro effectiveness against the rubella virus. Immunodeficiency-related vaccine-derived rubella occurs in some patients who have an inherited immunodeficiency and who received the MMR vaccine. This study investigated the in vivo effectiveness of nitazoxanide therapy. METHODS: This is a retrospective analysis of seven patients treated with nitazoxanide as salvage therapy for immunodeficiency-related vaccine-derived rubella infection. The patients were recruited from an ongoing rubella detection surveillance project. RESULTS: Seven patients with persistent rubella were treated with nitazoxanide and one demonstrated significant clinical improvement. Two additional patients exhibited diminished viral capsid production with one patient having transient slowing of progression. The cohort overall generally had low T cell counts and had a high burden of comorbidities. There were three deaths. Two deaths were from PML and one was related to hematopoietic stem cell transplantation. CONCLUSIONS:Nitazoxanide has limited in vivo anti-viral effects for immunodeficiency-related vaccine-derived rubella. Most patients did not exhibit clinical improvement.
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