Prolonged varicella viraemia and streptococcal toxic shock syndrome following varicella vaccination of a health care worker

To the Editor: Italiano and colleagues described a 49-year-old woman with prolonged vaccine viraemia, associated with hepatitis, streptococcal toxic shock syndrome and poststreptococcal reactive arthritis following routine varicella vaccination.1 The woman, initially seronegative for varicella zoster virus (VZV), was stated to be immunocompetent, possibly because she was previously well and produced varicella IgG following vaccination. It is not clear whether other aspects of her immune status were investigated. Although VZV IgG was detected after vaccination, indicating appropriate adaptive immune activation, this does not necessarily exclude a defect in the innate immune system.