Inherited IFNAR1 deficiency in otherwise healthy patients with adverse reaction to measles and yellow fever live vaccines

N Hernandez, G Bucciol, L Moens, J Le Pen… - Journal of Experimental …, 2019 - rupress.org
N Hernandez, G Bucciol, L Moens, J Le Pen, M Shahrooei, E Goudouris, A Shirkani
Journal of Experimental Medicine, 2019rupress.org
Vaccination against measles, mumps, and rubella (MMR) and yellow fever (YF) with live
attenuated viruses can rarely cause life-threatening disease. Severe illness by MMR
vaccines can be caused by inborn errors of type I and/or III interferon (IFN) immunity
(mutations in IFNAR2, STAT1, or STAT2). Adverse reactions to the YF vaccine have
remained unexplained. We report two otherwise healthy patients, a 9-yr-old boy in Iran with
severe measles vaccine disease at 1 yr and a 14-yr-old girl in Brazil with viscerotropic …
Vaccination against measles, mumps, and rubella (MMR) and yellow fever (YF) with live attenuated viruses can rarely cause life-threatening disease. Severe illness by MMR vaccines can be caused by inborn errors of type I and/or III interferon (IFN) immunity (mutations in IFNAR2, STAT1, or STAT2). Adverse reactions to the YF vaccine have remained unexplained. We report two otherwise healthy patients, a 9-yr-old boy in Iran with severe measles vaccine disease at 1 yr and a 14-yr-old girl in Brazil with viscerotropic disease caused by the YF vaccine at 12 yr. The Iranian patient is homozygous and the Brazilian patient compound heterozygous for loss-of-function IFNAR1 variations. Patient-derived fibroblasts are susceptible to viruses, including the YF and measles virus vaccine strains, in the absence or presence of exogenous type I IFN. The patients’ fibroblast phenotypes are rescued with WT IFNAR1. Autosomal recessive, complete IFNAR1 deficiency can result in life-threatening complications of vaccination with live attenuated measles and YF viruses in previously healthy individuals.
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