Varicella vaccination after fingolimod: A case report

A 36 year old woman with relapsing remitting multiple sclerosis and a childhood history of varicella (chickenpox) received 5 days of fingolimod (Gilenya®) before the drug was stopped upon discovery that she was varicella zoster virus (VZV) seronegative. Despite medical advice to the contrary, she was vaccinated with attenuated zoster virus vaccine (Zostavax®) the day after discontinuing fingolimod. Although the vaccination was uncomplicated by rash or systemic illness, her 3 year old daughter developed varicella 14 days following the vaccination. The patient developed recurrent thoracic herpes zoster 8 and 10.5 months following the vaccination while receiving fingolimod. Both episodes resolved during acyclovir therapy. This case report suggests that the immunomodulation that attends the administration of fingolimod may increase the risk of viral shedding following vaccination with attenuated VZV and reduce the efficacy of vaccination.