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Boeren M, de Vrij N, Ha MK, Valkiers S, Souquette A, Gielis S, Kuznetsova M, Schippers J, Bartholomeus E, Van den Bergh J, Michels N, Aerts O, Leysen J, Bervoets A, Lambert J, Leuridan E, Wens J, Peeters K, Emonds MP, Elias G, Vandamme N, Jansens H, Adriaensen W, Suls A, Vanhee S, Hens N, Smits E, Van Damme P, Thomas PG, Beutels P, Ponsaerts P, Van Tendeloo V, Delputte P, Laukens K, Meysman P, Ogunjimi B. Lack of functional TCR-epitope interaction is associated with herpes zoster through reduced downstream T cell activation. Cell Rep 2024; 43:114062. [PMID: 38588339 DOI: 10.1016/j.celrep.2024.114062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
The role of T cell receptor (TCR) diversity in infectious disease susceptibility is not well understood. We use a systems immunology approach on three cohorts of herpes zoster (HZ) patients and controls to investigate whether TCR diversity against varicella-zoster virus (VZV) influences the risk of HZ. We show that CD4+ T cell TCR diversity against VZV glycoprotein E (gE) and immediate early 63 protein (IE63) after 1-week culture is more restricted in HZ patients. Single-cell RNA and TCR sequencing of VZV-specific T cells shows that T cell activation pathways are significantly decreased after stimulation with VZV peptides in convalescent HZ patients. TCR clustering indicates that TCRs from HZ patients co-cluster more often together than TCRs from controls. Collectively, our results suggest that not only lower VZV-specific TCR diversity but also reduced functional TCR affinity for VZV-specific proteins in HZ patients leads to lower T cell activation and consequently affects the susceptibility for viral reactivation.
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Affiliation(s)
- Marlies Boeren
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium; Laboratory of Experimental Hematology (LEH), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Nicky de Vrij
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium; Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - My K Ha
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Sebastiaan Valkiers
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Aisha Souquette
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sofie Gielis
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Maria Kuznetsova
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jolien Schippers
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Esther Bartholomeus
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Johan Van den Bergh
- Laboratory of Experimental Hematology (LEH), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Nele Michels
- Department of Family Medicine and Population Health (FAMPOP), Center for General Practice/Family Medicine, University of Antwerp, Antwerp, Belgium
| | - Olivier Aerts
- Department of Dermatology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Julie Leysen
- Department of Dermatology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - An Bervoets
- Department of Dermatology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Julien Lambert
- Department of Dermatology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination (CEV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Johan Wens
- Department of Family Medicine and Population Health (FAMPOP), Center for General Practice/Family Medicine, University of Antwerp, Antwerp, Belgium
| | - Karin Peeters
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetic Laboratory, Rode Kruis-Vlaanderen, Mechelen, Belgium
| | - George Elias
- Laboratory of Experimental Hematology (LEH), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Niels Vandamme
- Data Mining and Modeling for Biomedicine Group, VIB-UGent Center for Inflammation Research, 9052 Ghent, Belgium; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Hilde Jansens
- Department of Clinical Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Wim Adriaensen
- Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Arvid Suls
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Stijn Vanhee
- Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Niel Hens
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Evelien Smits
- Laboratory of Experimental Hematology (LEH), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium
| | - Pierre Van Damme
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for the Evaluation of Vaccination (CEV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Philippe Beutels
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Peter Ponsaerts
- Laboratory of Experimental Hematology (LEH), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Viggo Van Tendeloo
- Laboratory of Experimental Hematology (LEH), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium
| | - Peter Delputte
- Laboratory of Microbiology, Parasitology and Hygiene (LMPH), University of Antwerp, Antwerp, Belgium
| | - Kris Laukens
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Pieter Meysman
- Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Benson Ogunjimi
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium.
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Kovacevic J, Samia AM, Shah A, Motaparthi K. Herpes zoster ophthalmicus. Clin Dermatol 2024:S0738-081X(24)00007-5. [PMID: 38281688 DOI: 10.1016/j.clindermatol.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.
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Affiliation(s)
- Jasmina Kovacevic
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Arthur Mark Samia
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ankit Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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3
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Sturmlechner I, Jain A, Mu Y, Weyand CM, Goronzy JJ. T cell fate decisions during memory cell generation with aging. Semin Immunol 2023; 69:101800. [PMID: 37494738 PMCID: PMC10528238 DOI: 10.1016/j.smim.2023.101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The defense against infectious diseases, either through natural immunity or after vaccinations, relies on the generation and maintenance of protective T cell memory. Naïve T cells are at the center of memory T cell generation during primary responses. Upon activation, they undergo a complex, highly regulated differentiation process towards different functional states. Naïve T cells maintained into older age have undergone epigenetic adaptations that influence their fate decisions during differentiation. We review age-sensitive, molecular pathways and gene regulatory networks that bias naïve T cell differentiation towards effector cell generation at the expense of memory and Tfh cells. As a result, T cell differentiation in older adults is associated with release of bioactive waste products into the microenvironment, higher stress sensitivity as well as skewing towards pro-inflammatory signatures and shorter life spans. These maladaptations not only contribute to poor vaccine responses in older adults but also fuel a more inflammatory state.
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Affiliation(s)
- Ines Sturmlechner
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Abhinav Jain
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Yunmei Mu
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Cornelia M Weyand
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Jörg J Goronzy
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; Robert and Arlene Kogod Center on Aging, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA.
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van Gent M, Ouwendijk WJD, Campbell VL, Laing KJ, Verjans GMGM, Koelle DM. Varicella-zoster virus proteome-wide T-cell screening demonstrates low prevalence of virus-specific CD8 T-cells in latently infected human trigeminal ganglia. J Neuroinflammation 2023; 20:141. [PMID: 37308917 PMCID: PMC10259006 DOI: 10.1186/s12974-023-02820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Trigeminal ganglia (TG) neurons are an important site of lifelong latent varicella-zoster virus (VZV) infection. Although VZV-specific T-cells are considered pivotal to control virus reactivation, their protective role at the site of latency remains uncharacterized. METHODS Paired blood and TG specimens were obtained from ten latent VZV-infected adults, of which nine were co-infected with herpes simplex virus type 1 (HSV-1). Short-term TG-derived T-cell lines (TG-TCL), generated by mitogenic stimulation of TG-derived T-cells, were probed for HSV-1- and VZV-specific T-cells using flow cytometry. We also performed VZV proteome-wide screening of TG-TCL to determine the fine antigenic specificity of VZV reactive T-cells. Finally, the relationship between T-cells and latent HSV-1 and VZV infections in TG was analyzed by reverse transcription quantitative PCR (RT-qPCR) and in situ analysis for T-cell proteins and latent viral transcripts. RESULTS VZV proteome-wide analysis of ten TG-TCL identified two VZV antigens recognized by CD8 T-cells in two separate subjects. The first was an HSV-1/VZV cross-reactive CD8 T-cell epitope, whereas the second TG harbored CD8 T-cells reactive with VZV specifically and not the homologous peptide in HSV-1. In silico analysis showed that HSV-1/VZV cross reactivity of TG-derived CD8 T-cells reactive with ten previously identified HSV-1 epitopes was unlikely, suggesting that HSV-1/VZV cross-reactive T-cells are not a common feature in dually infected TG. Finally, no association was detected between T-cell infiltration and VZV latency transcript abundance in TG by RT-qPCR or in situ analyses. CONCLUSIONS The low presence of VZV- compared to HSV-1-specific CD8 T-cells in human TG suggests that VZV reactive CD8 T-cells play a limited role in maintaining VZV latency.
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Affiliation(s)
- Michiel van Gent
- HerpesLabNL, Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Werner J. D. Ouwendijk
- HerpesLabNL, Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - Kerry J. Laing
- Department of Medicine, University of Washington, Seattle, WA 98195 USA
| | - Georges M. G. M. Verjans
- HerpesLabNL, Department of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - David M. Koelle
- Department of Medicine, University of Washington, Seattle, WA 98195 USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195 USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA 98109 USA
- Department of Global Health, University of Washington, Seattle, WA 98195 USA
- Department of Translational Research, Benaroya Research Institute, Seattle, WA 98101 USA
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Matsumoto K, Ohfuji S, Inohara K, Akechi M, Kumashiro H, Ishibashi M, Irie S, Hirota Y. Effectiveness of Live Attenuated Varicella-Zoster Vaccine in Adults Older than 50 Years in Japan: A Retrospective Cohort Study. Vaccines (Basel) 2023; 11:vaccines11020259. [PMID: 36851138 PMCID: PMC9958742 DOI: 10.3390/vaccines11020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Background: In Japan, freeze-dried live attenuated varicella-zoster vaccine BIKEN is available for adults aged ≥50 years to prevent herpes zoster (HZ). A prospective cohort study of 1200 healthy adults and 300 patients with underlying illness confirmed vaccine safety between 2016 and 2017. However, evidence of vaccine effectiveness (VE) is limited. Methods: VE against HZ and postherpetic neuralgia (PHN) was evaluated in the vaccinated cohort of the previous safety study in a follow-up study between 2021 and 2022 and compared with unvaccinated family members. Self-administered questionnaires determined retrospective experiences of HZ and PHN diagnosis. Logistic regression estimated the VE by calculating the outcome odds ratio (OR) in vaccinated vs. unvaccinated groups: VE = (1 - OR) × 100(%). Results: Overall, 1098 vaccinated and 518 unvaccinated subjects were analysed. Between 2016 and 2022, 26 vaccinated (2.4%) and 22 unvaccinated (4.2%) subjects reported HZ diagnosis, and 3 vaccinated (0.3%) and 2 unvaccinated (0.4%) subjects reported PHN. Adjusted VE against a clinical diagnosis was 41% for HZ [-6% to 67%], with marginal significance, and 16% [-408% to 86%] for PHN. Stratification by age, sex, or comorbidities had an adjusted VE against HZ of ~40%, which was similar between strata. Conclusion: Freeze-dried live attenuated varicella-zoster vaccine reduces the risk of HZ regardless of age, sex, or comorbidities.
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Affiliation(s)
- Kazuhiro Matsumoto
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kana Inohara
- The Research Foundation for Microbial Diseases of Osaka University, Osaka 565-0871, Japan
| | - Masateru Akechi
- The Research Foundation for Microbial Diseases of Osaka University, Osaka 565-0871, Japan
| | | | | | - Shin Irie
- SOUSEIKAI Medical Group, Fukuoka 813-0017, Japan
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Cersosimo A, Riccardi M, Amore L, Cimino G, Arabia G, Metra M, Vizzardi E. Varicella zoster virus and cardiovascular diseases. Monaldi Arch Chest Dis 2022; 93. [PMID: 36128930 DOI: 10.4081/monaldi.2022.2414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/03/2022] [Indexed: 01/20/2023] Open
Abstract
Varicella zoster virus (VZV) is a Herpesviridae family double-stranded DNA virus that only affects humans. The first clinical manifestation appears to be varicella, typical of childhood. VZV, on the other hand, becomes latent in ganglion neurons throughout the neuroaxis after primary infection. The VZV reactivates and travels along peripheral nerve fibers in the elderly and immunocompromised individuals, resulting in Zoster. It can, however, spread centrally and infect cerebral and extracranial arteries, resulting in vasculopathy, which can lead to transient ischemic attacks, strokes, aneurysms, cavernous sinus thrombosis, giant cell arteritis, and granulomatous aortitis. Although the mechanisms of virus-induced pathological vascular remodeling are not fully understood, recent research indicates that inflammation and dysregulation of ligand-1 programmed death play a significant role. Few studies, on the other hand, have looked into the role of VZV in cardiovascular disease. As a result, the purpose of this review is to examine the relationship between VZV and cardiovascular disease, the efficacy of the vaccine as a protective mechanism, and the target population of heart disease patients who could benefit from vaccination.
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7
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Th1 regulatory events by infectious pathogens, herpes zoster and herpes simplex viruses: prospects for therapeutic options for atopic eczema. Postepy Dermatol Alergol 2022; 39:662-667. [PMID: 36090727 PMCID: PMC9454353 DOI: 10.5114/ada.2022.118920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Infections caused by viral and bacterial pathogens are typically perceived as harmful, such as in cases of herpes zoster and herpes simplex virus infections. However, clinical observation of an improvement in atopic skin lesions upon herpes virus infection has been noted, particularly at the site of varicella and Kaposi’s varicelliform eruption. Th1 immune cells and cytokines, mobilized and induced for protection against infectious pathogens, are expected to improve Th2 dominant atopic symptoms. This study focuses on Th1 immunoregulatory events mediated by infectious pathogens, particularly herpes viruses. Immunoregulatory events induced by herpes viruses may have a potential therapeutic value for treating atopic eczema.
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Jeong S, Choi S, Park SM, Kim J, Ghang B, Lee EY. Incident and recurrent herpes zoster for first-line bDMARD and tsDMARD users in seropositive rheumatoid arthritis patients: a nationwide cohort study. Arthritis Res Ther 2022; 24:180. [PMID: 35902964 PMCID: PMC9330646 DOI: 10.1186/s13075-022-02871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited information regarding disease-modifying antirheumatic drug (DMARD)-dependent risks of overall, incident, and recurrent herpes zoster (HZ) during first-line biologic DMARD (bDMARD) or targeted synthetic DMARD (tsDMARD) treatment among patients with seropositive rheumatoid arthritis (RA) in terms of HZ risk. METHODS A total of 11,720 patients with seropositive RA who were prescribed bDMARD or tofacitinib between January 2011 and January 2019 from the Korean Health Insurance Review & Assessment Service database were studied. A multivariate Cox proportional hazards regression model was adopted to evaluate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the risk of HZ dependent on the choice of first-line bDMARDs or tsDMARD, including etanercept, infliximab, adalimumab, golimumab, tocilizumab, rituximab, tofacitinib, and abatacept. RESULTS During the 34,702 person-years of follow-up, 1686 cases (14.4%) of HZ were identified, including 1372 (11.7%) incident and 314 (2.7%) recurrent HZs. Compared with that of the abatacept group, tofacitinib increased the overall risk (aHR, 2.46; 95% CI, 1.61-3.76; P<0.001), incidence (aHR, 1.99; 95% CI, 1.18-3.37; P=0.011), and recurrence (aHR, 3.69; 95% CI, 1.77-7.69; P<0.001) of HZ. Infliximab (aHR, 1.36; 95% CI, 1.06-1.74; P=0.017) and adalimumab (aHR, 1.29; 95% CI, 1.02-1.64; P=0.032) also increased the overall HZ risk. Moreover, a history of HZ was found to be an independent risk factor for HZ (aHR, 1.54; 95% CI, 1.33-1.78; P<0.001). CONCLUSIONS HZ risk is significantly increased in RA patients with a history of HZ after the initiation of bDMARDs or tsDMARD. The risk of incident and recurrent HZ was higher after tofacitinib treatment in patients with RA than that after treatment with bDMARDs. Individualized characteristics and history of HZ should be considered when selecting bDMARDs or tsDMARD for RA patients considering HZ risks.
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Affiliation(s)
- Seogsong Jeong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, South Korea
| | - Seulggie Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jinseok Kim
- Division of Rheumatology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea
| | - Byeongzu Ghang
- Division of Rheumatology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, South Korea.
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea. .,Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea.
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Boccard M, Conrad A, Mouton W, Valour F, Roure-Sobas C, Frobert E, Rohmer B, Alcazer V, Labussière-Wallet H, Ghesquières H, Venet F, Brengel-Pesce K, Trouillet-Assant S, Ader F. A Simple-to-Perform ifn-γ mRNA Gene Expression Assay on Whole Blood Accurately Appraises Varicella Zoster Virus-Specific Cell-Mediated Immunity After Allogeneic Hematopoietic Stem Cell Transplantation. Front Immunol 2022; 13:919806. [PMID: 35967359 PMCID: PMC9363621 DOI: 10.3389/fimmu.2022.919806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
Herpes zoster, which is due to the reactivation of Varicella zoster virus (VZV), is a leading cause of morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). While cell-mediated immunity (CMI) is critical to inhibiting VZV reactivation, CMI is not routinely assessed due to a lack of reliable tests. In this study, we aimed to evaluate VZV-specific CMI among allo-HSCT recipients (n = 60) and healthy individuals (HI, n = 17) through a panel of three immune functional assays after ex vivo stimulation by VZV antigen: quantification of (i) IFN-γ release in the supernatants, (ii) T-cell proliferation after a 7-day stimulation of peripheral blood mononuclear cells (PBMC), and (iii) measurement of the ifn-γ mRNA gene expression level after 24 h of stimulation of a whole-blood sample. VZV responsiveness was defined according to IFN-γ release from VZV-stimulated PBMC. Upon VZV stimulation, we found that allo-HSCT recipients at a median time of 6 [5-8] months post-transplant had lower IFN-γ release (median [IQR], 0.34 [0.12–8.56] vs. 409.5 [143.9–910.2] pg/ml, P <.0001) and fewer proliferating T cells (0.05 [0.01–0.57] % vs. 8.74 [3.12–15.05] %, P <.0001) than HI. A subset of allo-HSCT recipients (VZV-responders, n = 15/57, 26%) distinguished themselves from VZV-non-responders (n = 42/57, 74%; missing data, n = 3) by higher IFN-γ release (80.45 [54.3–312.8] vs. 0.22 [0.12–0.42] pg/ml, P <.0001) and T-cell proliferation (2.22 [1.18–7.56] % vs. 0.002 [0.001–0.11] %, P <.0001), suggesting recovery of VZV-specific CMI. Interestingly, VZV responders had a significant fold increase in ifn-γ gene expression, whereas ifn-γ mRNA was not detected in whole blood of VZV-non-responders (P <.0001). This study is the first to suggest that measurement of ifn-γ gene expression in 24-h-stimulated whole blood could be an accurate test of VZV-specific CMI. The routine use of this immune functional assay to guide antiviral prophylaxis at an individual level remains to be evaluated.
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Affiliation(s)
- Mathilde Boccard
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Anne Conrad
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - William Mouton
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Laboratoire de Recherche Commun (LCR), Hospices Civils de Lyon/BioMérieux, Pierre-Bénite, France
| | - Florent Valour
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Chantal Roure-Sobas
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Emilie Frobert
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Barbara Rohmer
- Service d’Hépatologie Gastro-Entérologie et Nutrition Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Vincent Alcazer
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Département d’Hématologie clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hélène Labussière-Wallet
- Département d’Hématologie clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Ghesquières
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Département d’Hématologie clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Fabienne Venet
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Laboratoire de Recherche Commun (LCR), Hospices Civils de Lyon/BioMérieux, Pierre-Bénite, France
- Laboratoire d’Immunologie, Hospices Civils de Lyon, Lyon, France
- EA7426 UCBL1-HCL-bioMérieux Pathophysiology of Injury-induced Immunosuppression, Lyon, France
| | - Karen Brengel-Pesce
- Laboratoire de Recherche Commun (LCR), Hospices Civils de Lyon/BioMérieux, Pierre-Bénite, France
| | - Sophie Trouillet-Assant
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Laboratoire de Recherche Commun (LCR), Hospices Civils de Lyon/BioMérieux, Pierre-Bénite, France
| | - Florence Ader
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- *Correspondence: Florence Ader,
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Chiu HY, Hung YT, Huang SW, Huang YH. Comparative risk of herpes zoster in patients with psoriatic disease on systemic treatments: a systematic review and network meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221091188. [PMID: 35519434 PMCID: PMC9066628 DOI: 10.1177/20406223221091188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Numerous previous studies have examined risk of herpes zoster (HZ) in psoriatic disease; however, the results of these studies are conflicting and the relative risks associated with different treatments remain largely unknown. In this meta-analysis, we examined the relative risk of HZ associated with systemic treatments for psoriatic disease. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched to identify relevant English-language studies published up to April 2021. Data were extracted using a standardized data extraction form. Network meta-analyses (NMA) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We examined the differences in HZ risk (incidence rate ratio; IRR) between treatments using a random-effects model for direct pairwise comparisons and NMA. The surface under the cumulative ranking area was calculated to rank the HZ risk for each treatment condition. Results: This study analyzed 13 studies including 19 treatment arms involving a total of 443,104 patients with psoriatic disease. Corticosteroids (CS) [IRR, 2.56; 95% confidence interval (CI), 1.59–4.13], a Janus kinase inhibitor (JAKi; tofacitinib) (IRR, 2.34; 95% CI, 1.03–5.32), infliximab (IRR, 2.32; 95% CI, 1.27–4.21), conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) + CS (IRR, 2.26; 95% CI, 1.23–4.17), anti-tumor necrosis factor-α (anti-TNF-α) + csDMARDs and/or CS (IRR, 2.13; 95% CI, 1.38–3.31), csDMARDs (IRR, 1.62; 95% CI, 1.18–2.22), and anti-TNF-α except infliximab (IRR, 1.61; 95% CI, 1.13–2.30) were all associated with a significantly higher HZ risk compared to controls. CS treatment possessed the highest HZ risk, followed by infliximab and JAKi (tofacitinib). Phosphodiesterase-4 inhibitor, anti-interleukin-17, -23 or -12/23, phototherapy, and acitretin showed a risk similar to controls without significant differences. Conclusion: The NMA demonstrated CS, infliximab, and JAKi (tofacitinib), and several combination treatments were associated with higher HZ risk in patients with psoriasis and psoriatic arthritis. Differences in HZ risk should be taken into consideration when considering optimal psoriasis treatment.
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Affiliation(s)
- Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
- Department of Dermatology, National Taiwan University Hospital, Taipei
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Yi-Teng Hung
- Department of Dermatology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan
| | - Shi-Wei Huang
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Douliu
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 333
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
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11
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Nakamura-Nishimura Y, Shinkuma S, Miyagawa F, Haredy A, Gomi Y, Yamanishi K, Asada H. Immunogenicity of varicella-zoster virus vaccine by different routes of administration: comparable vaccination efficacy of one-fifth dose intradermal vaccination to conventional subcutaneous vaccination. J Dermatol Sci 2022; 106:86-92. [DOI: 10.1016/j.jdermsci.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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12
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Bell MR, Kutzler MA. An old problem with new solutions: Strategies to improve vaccine efficacy in the elderly. Adv Drug Deliv Rev 2022; 183:114175. [PMID: 35202770 DOI: 10.1016/j.addr.2022.114175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
Vaccination is the most effective measure to protect against infections. However, with increasing age, there is a progressive decline in the ability of the immune system to both protect against infection and develop protective immunity from vaccination. This age-related decline of the immune system is due to age-related changes in both the innate and adaptive immune systems. With an aging world population and increased risk of pandemics, there is a need to continue to develop strategies to increase vaccine responses in the elderly. Here, the major age-related changes that occur in both the innate and adaptive immune responses that impair the response to vaccination in the elderly will be highlighted. Existing and future strategies to improve vaccine efficacy in the elderly will then be discussed, including adjuvants, delivery methods, and formulation. These strategies provide mechanisms to improve the efficacy of existing vaccines and develop novel vaccines for the elderly.
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Kumar NP, Padmapriyadarsini C, Rajamanickam A, Bhavani PK, Nancy A, Jayadeepa B, Selvaraj N, Asokan D, Renji RM, Venkataramani V, Tripathy S, Babu S. BCG vaccination induces enhanced frequencies of memory T cells and altered plasma levels of common γc cytokines in elderly individuals. PLoS One 2021; 16:e0258743. [PMID: 34758029 PMCID: PMC8580239 DOI: 10.1371/journal.pone.0258743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/26/2021] [Indexed: 12/03/2022] Open
Abstract
BCG vaccination is known to induce innate immune memory, which confers protection against heterologous infections. However, the effect of BCG vaccination on the conventional adaptive immune cells subsets is not well characterized. We investigated the impact of BCG vaccination on the frequencies of T cell subsets and common gamma c (γc) cytokines in a group of healthy elderly individuals (age 60–80 years) at one month post vaccination as part of our clinical study to examine the effect of BCG on COVID-19. Our results demonstrate that BCG vaccination induced enhanced frequencies of central (p<0.0001) and effector memory (p<0.0001) CD4+ T cells and diminished frequencies of naïve (p<0.0001), transitional memory (p<0.0001), stem cell memory (p = 0.0001) CD4+ T cells and regulatory T cells. In addition, BCG vaccination induced enhanced frequencies of central (p = 0.0008), effector (p<0.0001) and terminal effector memory (p<0.0001) CD8+ T cells and diminished frequencies of naïve (p<0.0001), transitional memory (p<0.0001) and stem cell memory (p = 0.0034) CD8+T cells. BCG vaccination also induced enhanced plasma levels of IL-7 (p<0.0001) and IL-15 (p = 0.0020) but diminished levels of IL-2 (p = 0.0033) and IL-21 (p = 0.0020). Thus, BCG vaccination was associated with enhanced memory T cell subsets as well as memory enhancing γc cytokines in elderly individuals, suggesting its ability to induce non-specific adaptive immune responses.
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Affiliation(s)
- Nathella Pavan Kumar
- ICMR-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- * E-mail: (NPK); (SB)
| | | | | | - Perumal Kannabiran Bhavani
- ICMR-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Arul Nancy
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Bharathi Jayadeepa
- ICMR-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Nandhini Selvaraj
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Dinesh Asokan
- ICMR-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | | | | | - Srikanth Tripathy
- ICMR-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- Dr D Y Patil Medical College, Hospital and Research Centre, Pune, India
| | - Subash Babu
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
- * E-mail: (NPK); (SB)
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14
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Andreoni M, Sticchi L, Nozza S, Sarmati L, Gori A, Tavio M. Recommendations of the Italian society for infectious and tropical diseases (SIMIT) for adult vaccinations. Hum Vaccin Immunother 2021; 17:4265-4282. [PMID: 34524945 PMCID: PMC8828129 DOI: 10.1080/21645515.2021.1971473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 12/14/2022] Open
Abstract
Vaccination prevents 2-3 million deaths worldwide every year. Nevertheless, vaccine-preventable diseases (VPDs) still cause a considerable number of deaths especially in subjects belonging to "risk groups." These are represented by older adults, immunocompromised individuals and all subjects with underlying chronic medical conditions (cardiovascular, pulmonary, renal and liver chronic diseases, diabetes, immunodeficiency disorders). They have a weaker immune system and, if infected, are more likely to develop severe complications of their condition or of the preventable-infectious disease. This document summarizes the recommendations for vaccination of the main Global Institutional Organizations and analyses the risks of comorbidities associated with infectious disease and the benefits of vaccination for each specific group. The document provides a clear, practical and authoritative guide to adult vaccination.
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Affiliation(s)
- Massimo Andreoni
- UOC Infectious diseases Tor Vergata Polyclinic, University Hospital Viale, Rome, Italy
| | - Laura Sticchi
- Hygiene Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Silvia Nozza
- Medical Director, San Raffaele Hospital, Milan, Italy
| | - Loredana Sarmati
- UOC Infectious diseases Tor Vergata Polyclinic, University Hospital Viale, Rome, Italy
| | - Andrea Gori
- UOC Infectious Diseases, Irccs Ca’Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Marcello Tavio
- UOC Division of Emerging Infectious Diseases and Immunosuppressed, AOU Ospedali Riuniti of Ancona, Ancona, Italy
| | - Society for Infectious and Tropical Diseases (SIMIT)
- UOC Infectious diseases Tor Vergata Polyclinic, University Hospital Viale, Rome, Italy
- Hygiene Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Medical Director, San Raffaele Hospital, Milan, Italy
- UOC Infectious Diseases, Irccs Ca’Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
- UOC Division of Emerging Infectious Diseases and Immunosuppressed, AOU Ospedali Riuniti of Ancona, Ancona, Italy
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15
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Curtis JR, Cofield SS, Bridges SL, Bassler J, Deodhar A, Ford TL, Huffstutter J, Jankeel A, Kivitz A, Kamal S, Lindsey S, Messaoudi I, Mendoza N, Michaud K, Mikuls TR, Ridley D, Shergy W, Siegel SAR, Winthrop KL. The Safety and Immunologic Effectiveness of the Live Varicella-Zoster Vaccine in Patients Receiving Tumor Necrosis Factor Inhibitor Therapy : A Randomized Controlled Trial. Ann Intern Med 2021; 174:1510-1518. [PMID: 34570596 DOI: 10.7326/m20-6928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The safety and effectiveness of live virus vaccines, such as the varicella-zoster vaccine, are unknown in patients with inflammatory diseases receiving immunomodulatory therapy such as tumor necrosis factor inhibitors (TNFis). OBJECTIVE To evaluate the safety and immunogenicity of the live attenuated zoster vaccine (ZVL) in patients receiving TNFis. DESIGN Randomized, blinded, placebo-controlled trial. (ClinicalTrials.gov: NCT02538341). SETTING Academic and community-based rheumatology, gastroenterology, and dermatology practices. PATIENTS Adults aged 50 years or older receiving TNFis for any indication. INTERVENTION Random assignment to ZVL versus placebo. MEASUREMENTS Glycoprotein enzyme-linked immunosorbent assay (gpELISA) and enzyme-linked immunosorbent spot (ELISpot) from serum and peripheral blood mononuclear cells measured at baseline and 6 weeks after vaccination. Suspected varicella infection or herpes zoster was clinically assessed using digital photographs and polymerase chain reaction on vesicular fluid. RESULTS Between March 2015 and December 2018, 617 participants were randomly assigned in a 1:1 ratio to receive ZVL (n = 310) or placebo (n = 307) at 33 centers. Mean age was 62.7 years (SD, 7.5); 66.1% of participants were female, 90% were White, 8.2% were Black, and 5.9% were Hispanic. The most common TNFi indications were rheumatoid arthritis (57.6%) and psoriatic arthritis (24.1%); TNFi medications were adalimumab (32.7%), infliximab (31.3%), etanercept (21.2%), golimumab (9.1%), and certolizumab (5.7%). Concomitant therapies included methotrexate (48.0%) and oral glucocorticoids (10.5%). Through week 6, no cases of confirmed varicella infection were found; cumulative incidence of varicella infection or shingles was 0.0% (95% CI, 0.0% to 1.2%). At 6 weeks, compared with baseline, the mean increases in geometric mean fold rise as measured by gpELISA and ELISpot were 1.33 percentage points (CI, 1.17 to 1.51 percentage points) and 1.39 percentage points (CI, 1.07 to 1.82 percentage points), respectively. LIMITATION Potentially limited generalizability to patients receiving other types of immunomodulators. CONCLUSION This trial informs safety concerns related to use of live virus vaccines in patients receiving biologics. PRIMARY FUNDING SOURCE The National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American College of Rheumatology.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama (J.R.C., S.K.)
| | - Stacey S Cofield
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama (S.S.C., J.B.)
| | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (S.L.B.)
| | - John Bassler
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama (S.S.C., J.B.)
| | - Atul Deodhar
- Oregon Health & Science University, Portland, Oregon (A.D., S.A.S., K.L.W.)
| | - Theresa L Ford
- North Georgia Rheumatology Group, Lawrenceville, Georgia (T.L.F.)
| | | | - Allen Jankeel
- University of California, Irvine, Irvine, California (A.J., I.M., N.M.)
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania (A.K.)
| | - Shaila Kamal
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama (J.R.C., S.K.)
| | | | - Ilhem Messaoudi
- University of California, Irvine, Irvine, California (A.J., I.M., N.M.)
| | - Norma Mendoza
- University of California, Irvine, Irvine, California (A.J., I.M., N.M.)
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and FORWARD-The National Databank for Rheumatic Diseases, Wichita, Kansas (K.M.)
| | - Ted R Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska (T.R.M.)
| | - David Ridley
- St. Paul Rheumatology, P.A., Eagan, Minnesota (D.R.)
| | - William Shergy
- RANA - Rheumatology Associates of North Alabama, Huntsville, Alabama (W.S.)
| | - Sarah A R Siegel
- Oregon Health & Science University, Portland, Oregon (A.D., S.A.S., K.L.W.)
| | - Kevin L Winthrop
- Oregon Health & Science University, Portland, Oregon (A.D., S.A.S., K.L.W.)
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16
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Characterization of Varicella-Zoster (VZV) Specific T Cell Response in Healthy Subjects and Transplanted Patients by Using Enzyme Linked Immunospot (ELISpot) Assays. Vaccines (Basel) 2021; 9:vaccines9080875. [PMID: 34451999 PMCID: PMC8402512 DOI: 10.3390/vaccines9080875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Solid organ transplant recipients, due to the administration of post-transplant immunosuppressive therapies, are at greater risk of viral reactivation episodes, mainly from herpes viruses, including varicella-zoster virus (VZV). The aim of this pilot study was to develop functional immunological assays (VZV-ELISpot) for the quantification and characterization of the VZV-specific effector-memory and central-memory responses in healthy subjects and transplanted patients. Glycoprotein gE and immediate-early 63 (IE-63) were used as antigens for in vitro stimulation. VZV-seropositive healthy subjects showed higher responses in respect to seronegative subjects. Even if differences were observed between VZV-seropositive healthy subjects and transplanted subjects at pre-transplant, the VZV-specific T-cell response was reduced at 60 days after transplant, mainly for the high level of immunosuppression. Phenotypical characterization revealed that response against VZV was mainly mediated by CD4 T cells. The results obtained in this study might be useful for the definition of personalized follow-up of the transplanted patients, providing useful information on the status of the patient potentially at risk of viral reactivation or other opportunistic infections.
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17
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Association between Neutrophil-Lymphocyte Ratio and Herpes Zoster Infection in 1688 Living Donor Liver Transplantation Recipients at a Large Single Center. Biomedicines 2021; 9:biomedicines9080963. [PMID: 34440167 PMCID: PMC8391531 DOI: 10.3390/biomedicines9080963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 12/05/2022] Open
Abstract
Liver transplantation (LT) is closely associated with decreased immune function, a contributor to herpes zoster (HZ). However, risk factors for HZ in living donor LT (LDLT) remain unknown. Neutrophil-lymphocyte ratio (NLR) and immune system function are reportedly correlated. This study investigated the association between NLR and HZ in 1688 patients who underwent LDLT between January 2010 and July 2020 and evaluated risk factors for HZ and postherpetic neuralgia (PHN). The predictive power of NLR was assessed through the concordance index and an integrated discrimination improvement (IDI) analysis. Of the total cohort, 138 (8.2%) had HZ. The incidence of HZ after LT was 11.2 per 1000 person-years and 0.1%, 1.3%, 2.9%, and 13.5% at 1, 3, 5, and 10 years, respectively. In the Cox regression analysis, preoperative NLR was significantly associated with HZ (adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–1.09; p = 0.005) and PHN (HR, 1.08; 95% CI, 1.03–1.13; p = 0.001). Age, sex, mycophenolate mofetil use, and hepatitis B virus infection were risk factors for HZ versus age and sex for PHN. In the IDI analysis, NLR was discriminative for HZ and PHN (p = 0.020 and p = 0.047, respectively). Preoperative NLR might predict HZ and PHN in LDLT recipients.
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18
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Widasmara D, Firdausiya F. Disseminated Herpes Zoster on a Child with Systemic Lupus Erythematosus and Lupus Nephritis. Infect Drug Resist 2021; 14:2777-2785. [PMID: 34321894 PMCID: PMC8313509 DOI: 10.2147/idr.s314220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Disseminated herpes zoster (DHZ) is a complication of herpes zoster (HZ) associated with an immunocompromised state. Immunocompromised conditions in systemic lupus erythematosus (SLE) and lupus nephritis increase the incidence of DHZ. Case A 14-year-old girl was consulted with a complaint of painful reddish blisters for the previous 4 days. At first, blisters only appeared on the right leg, then multiplied and spread throughout the body. The patient had been diagnosed with SLE since 3 months and 2 months later also diagnosed with lupus nephritis. The patient received methylprednisolone pulse dose 1 g for 3 days, then maintenance dose 1×80 mg every 2 days for 2 weeks before blisters appeared. Dermatological examination of the facial region, anterior and posterior trunk, gluteus, superior limb dextra and sinistra, dorsum manus, cruris dextra, femur dextra lateral and plantar pedis presented vesicles with an erythematous base, and some other confluent vesicles became bullae, well defined, with an irregular border, varied in size and shape. An investigation by Tzanck smears in bullae and vesicles showed polymorphonuclear cells (PMN) and multinucleated giant cells (MGC). Laboratory tests showed anemia, neutrophilia, and lymphopenia. The patient was diagnosed as HZD. The patient received oral acyclovir 5×800mg for 10 days and obtained clinical improvement. Conclusion Although the onset of HZ in children is less common, it may occur in children with SLE comorbidity. Complications of DHZ in SLE patients may be due to immunological abnormalities, lymphopenia conditions, and immunosuppression therapy with high-dose glucocorticoids (GC). In addition, the incidence of both HZ and DHZ increases in lupus nephritis patients compared with SLE.
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Affiliation(s)
- Dhelya Widasmara
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Brawijaya/ Dr. Saiful Anwar Regional Hospital, Malang, Indonesia
| | - Fitri Firdausiya
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Brawijaya/ Dr. Saiful Anwar Regional Hospital, Malang, Indonesia
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Parks CG, Hofmann JN, Beane Freeman LE, Sandler DP. Agricultural Pesticides and Shingles Risk in a Prospective Cohort of Licensed Pesticide Applicators. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:77005. [PMID: 34319145 PMCID: PMC8317610 DOI: 10.1289/ehp7797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Some pesticides are immunotoxic and have been associated with an increased risk of immune-mediated diseases. The risk of shingles, the clinical reactivation of varicella-zoster virus, increases with aging and immunosuppression; little is known about its associations with pesticides. OBJECTIVE We examined the use of agricultural pesticides in relation to incident shingles in a prospective cohort of licensed pesticide applicators. METHODS The study sample included 12,820 (97% male) farmers (enrolled in 1993-1997 in North Carolina and Iowa), who were followed for a median of 12 y (interquartile range: 11-13). Shingles was self-reported at enrollment and at follow-up. We evaluated ever-use of 48 agricultural pesticides reported at study enrollment in relation to shingles risk and considered exposure-response for intensity-weighted lifetime days (IWLDs) of use. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models, adjusting for state, and allowing estimates to vary by median attained age (60 y). RESULTS Incident shingles was reported by 590 participants. Associations were positive (HRs>1.2) for ever- vs. never-use of eight insecticides, three fumigants, two fungicides, and five herbicides, and exposure-response trends were seen across increasing quartiles (Q3 and Q4>Q1) or tertiles (T3 and T2>T1) of IWLDs for four insecticides [permethrin (crops), coumaphos, malathion, and lindane], two fumigants (carbon tetrachloride/carbon disulfide and methyl bromide), and three herbicides [alachlor, trifluralin (<60 years of age) and 2,4-dichlorophenoxyacetic acid]. Shingles was not associated with total years or days per year mixed or applied any pesticides, but in older participants, shingles was associated with a history of a high pesticide exposure event [HR=1.89 (95% CI: 1.45, 2.45)]. CONCLUSIONS Several specific pesticides were associated with increased risk of shingles in farmers, especially at higher levels of cumulative use. These novel findings, if replicated in other populations, could have broader implications for the potential effects of pesticides on vaccine efficacy and susceptibility to other infections. https://doi.org/10.1289/EHP7797.
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Affiliation(s)
- Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Jonathan N. Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
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20
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Rutstein BH, Gmuca S, Gerber JS, Lim T, Argraves M, Ogdie A. Validation of coding algorithms for the identification of herpes zoster among children. Pharmacoepidemiol Drug Saf 2021; 30:1162-1167. [PMID: 33960541 DOI: 10.1002/pds.5264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To examine the validity of International Classification of Diseases, 10th Revision, (ICD-10) code-based algorithms for herpes zoster (HZ) in the electronic medical record (EMR) of a large, integrated pediatric healthcare network and to examine baseline demographics and chronic comorbidities associated with HZ in a representative pediatric population. METHODS We reviewed the electronic charts of all patients with a single ICD-10 for HZ (B02.xx) as their primary or secondary diagnosis in the EMR of the Children's Hospital of Philadelphia (CHOP) healthcare network from January 2010-March 2019. The positive predictive value (PPV) for a single code for HZ was calculated and alternative algorithms were examined to determine which method resulted in the highest PPV. RESULTS The PPV for a single ICD-10 code was 91.7% (95% CI 80.8-95.4) for definitive and/or probable cases of HZ and 63.9% (95% CI 53.4%-75.5%) for definitive cases alone. Adding a prescription for an antiviral did not improve the PPV. However, adding a new code for rash entered within 1 week of the HZ code increased the PPV to 100% for definitive and/or probable cases but with substantial loss of sensitivity. A high proportion of children with HZ who required inpatient hospitalization had chronic disease (70%) and were on systemic immunomodulatory therapy (50%). CONCLUSIONS HZ can be identified with a high PPV in electronic medical records of children using ICD-10 code alone. These findings lay the foundation for future pharmacoepidemiologic research to better understand risk factors for HZ infection.
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Affiliation(s)
- Beth H Rutstein
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tristan Lim
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa Argraves
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexis Ogdie
- Department of Medicine, Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Picard E, Bowdish DME, McElhaney JE, Pawelec G, Loeb M, Verschoor CP. The frequency of interleukin-1β-producing monocytes is significantly associated with varicella-zoster responses of nursing home residents. Clin Exp Immunol 2021; 205:63-74. [PMID: 33714219 DOI: 10.1111/cei.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022] Open
Abstract
Previous studies have demonstrated that the status of the T cell compartment and inflammation-related factors are associated with the immunogenicity of the varicella-zoster virus (VZV) vaccine in older adults; however, little is known about the roles of other immune cell subsets known to influence the generation and maintenance of immunological memory. Responses to a live-attenuated VZV vaccine were studied in relation to peripheral blood mononuclear cell (PBMC) composition and function in a sample of 30 nursing home residents (aged 80-99 years). Interferon-gamma enzyme-linked immunospot (ELISPOT) was used to measure VZV responses at baseline and 6 weeks following vaccination, and associations were sought with the frequencies of monocytes and T, B and natural killer (NK) cells and the production and secretion of cytokines following their ex-vivo stimulation with different agents. While only the frequency of interleukin (IL)-6+ CD14+ monocytes was inversely associated with post-vaccination VZV response, amounts of IL-1β, IL-10, IL-17A and tumour necrosis factor (TNF) secreted by PBMCs and the frequency of IL-1β+ CD14+ monocytes was positively correlated with pre-vaccination VZV response. Furthermore, both bivariate correlation and causal mediation analyses supported the notion that IL-1β+ CD14+ monocytes were significant mediators of the associations between IL-1β and TNF secretion by PBMCs and pre-vaccination VZV responses. Our findings implicate a strong cytokine response mediated by inflammatory IL-1β+ monocytes in coordinating responses of long-lived VZV-reactive memory T cells, but with an opposing effect of IL-6+ CD14+ monocytes. Whether monocyte status promotes or inhibits the induction and/or maintenance of these memory T cells later in life has yet to be determined.
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Affiliation(s)
- E Picard
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - D M E Bowdish
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - J E McElhaney
- Health Sciences North Research Institute, Sudbury, ON, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - G Pawelec
- Health Sciences North Research Institute, Sudbury, ON, Canada.,Department of Immunology, University of Tübingen, Tübingen, Germany
| | - M Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - C P Verschoor
- Health Sciences North Research Institute, Sudbury, ON, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
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22
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Humoral Immunity to Varicella Zoster Virus in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis Compared to Healthy Controls. Vaccines (Basel) 2021; 9:vaccines9040325. [PMID: 33915820 PMCID: PMC8067210 DOI: 10.3390/vaccines9040325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Background: The prevalence of herpes zoster (HZ) is high in patients with rheumatic diseases. Systemic lupus erythematosus (SLE) doubles the risk for developing HZ. However, little is known about natural humoral immunity against varicella zoster virus (VZV) in patients with SLE. Hence, we compared VZV IgG antibody concentrations in a group of SLE patients with healthy controls and patients with rheumatoid arthritis (RA). Methods: n = 56 patients with SLE, n = 54 patients with RA, and n = 56 healthy controls were included in this study. The VZV IgG antibody concentration was measured using an enzyme-linked immunosorbent assay (ELISA). The antibody concentrations were compared between the groups. Results: Overall IgG antibody titers for VZV in SLE patients were comparable to healthy controls but higher when compared to patients with rheumatoid arthritis (p = 0.0012). In consequence, antibody levels in controls were higher than in RA patients (p = 0.0097). Stratification by age revealed highest titers among SLE patients in the fourth life decade (p = 0.03 for controls, p = 0.0008 for RA patients) whereas RA patients in their sixth decade had the lowest antibody concentration (p = 0.03 for controls, p = 0.04 for SLE patients). Regarding the individual HZ history, antibody levels of SLE patients with a positive history exceeded all other groups. Conclusions: Although humoral VZV immunity in SLE patients is comparable to healthy controls it seems to be pronounced in young SLE patients between 30 and 39. The lowest VZV IgG levels were found in RA patients. HZ seems to induce antibody production, particularly in patients with SLE. Immunological processes might contribute to VZV antibody levels in SLE patients, but further investigations are needed to substantiate this hypothesis. Even though the increased HZ prevalence seems to be independent of humoral immunity in SLE patients, reduced humoral immunity might contribute to HZ in RA patients. The available HZ subunit vaccination might be an appropriate way to reduce the HZ risk in patients with rheumatic diseases.
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23
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Soysal A, Gönüllü E, Yıldız İ, Karaböcüoğlu M. Incidence of varicella and herpes zoster after inclusion of varicella vaccine in national immunization schedule in Turkey: time trend study. Hum Vaccin Immunother 2021; 17:731-737. [PMID: 32703071 PMCID: PMC7993137 DOI: 10.1080/21645515.2020.1788861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022] Open
Abstract
The aim of the study was to investigate changes in the incidences of Varicella and Herpes Zoster (HZ) following introduction of single dose Varicella vaccine (VV) in Turkey. Changes in the incidences of varicella and HZ per 100,000 population were compared with pre (2011-2012) and post-VV period (2018-2019) throughout years between years 2011 and 2019 both for children and adults. In children ≤5 years of age, the annual incidences of varicella significantly decreased from 290 per 100000 children in 2011 to 24 per 100000 children in 2019 [p = .0001]. Also, for children ≤5 years the mean annual incidence of varicella decreased significantly [326/100000 ±51/100000 vs 23/100000 ± 1/100000; p = .014] between pre- and post-VV period. Moreover, the annual incidences of varicella significantly decreased from 43 per 100000 children in 2011 to 26 per 100000 children in 2019 in children age between 6 and 17 years. On the other hand, incidence of varicella in adult population (age >17 years) did not change significantly. Besides, the annual incidences of Herpes Zoster did not change significantly in children age stratas but significant increment observed in adult population. This increment was significant in adult age strata of 18-44 years, but non-significant in age strata of 45-64 years and >64 years. Thus, our study showed a significant reduction in the incidences of Varicella in children age stratas whereas significant increment in the incidence of HZ in adult population after the implementation of VV into the NIP of Turkey.
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Affiliation(s)
- Ahmet Soysal
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - Erdem Gönüllü
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - İsmail Yıldız
- Clinic of Pediatrics, Şişli Memorial Hospital, Istanbul, Turkey
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24
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Soysal A, Gönüllü E, Yıldız İ, Karaböcüoğlu M. Incidence of varicella and herpes zoster after inclusion of varicella vaccine in national immunization schedule in Turkey: time trend study. Hum Vaccin Immunother 2021. [PMID: 32703071 DOI: 10.1080/21645515.2020.1788861)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to investigate changes in the incidences of Varicella and Herpes Zoster (HZ) following introduction of single dose Varicella vaccine (VV) in Turkey. Changes in the incidences of varicella and HZ per 100,000 population were compared with pre (2011-2012) and post-VV period (2018-2019) throughout years between years 2011 and 2019 both for children and adults. In children ≤5 years of age, the annual incidences of varicella significantly decreased from 290 per 100000 children in 2011 to 24 per 100000 children in 2019 [p = .0001]. Also, for children ≤5 years the mean annual incidence of varicella decreased significantly [326/100000 ±51/100000 vs 23/100000 ± 1/100000; p = .014] between pre- and post-VV period. Moreover, the annual incidences of varicella significantly decreased from 43 per 100000 children in 2011 to 26 per 100000 children in 2019 in children age between 6 and 17 years. On the other hand, incidence of varicella in adult population (age >17 years) did not change significantly. Besides, the annual incidences of Herpes Zoster did not change significantly in children age stratas but significant increment observed in adult population. This increment was significant in adult age strata of 18-44 years, but non-significant in age strata of 45-64 years and >64 years. Thus, our study showed a significant reduction in the incidences of Varicella in children age stratas whereas significant increment in the incidence of HZ in adult population after the implementation of VV into the NIP of Turkey.
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Affiliation(s)
- Ahmet Soysal
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - Erdem Gönüllü
- Clinic of Pediatrics, Ataşehir Memorial Hospital, Istanbul, Turkey
| | - İsmail Yıldız
- Clinic of Pediatrics, Şişli Memorial Hospital, Istanbul, Turkey
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25
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Gustafson CE, Kim C, Weyand CM, Goronzy JJ. Influence of immune aging on vaccine responses. J Allergy Clin Immunol 2021; 145:1309-1321. [PMID: 32386655 PMCID: PMC7198995 DOI: 10.1016/j.jaci.2020.03.017] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
Impaired vaccine responses in older individuals are associated with alterations in both the quantity and quality of the T-cell compartment with age. As reviewed herein, the T-cell response to vaccination requires a fine balance between the generation of inflammatory effector T cells versus follicular helper T (TFH) cells that mediate high-affinity antibody production in tandem with the induction of long-lived memory cells for effective recall immunity. During aging, we find that this balance is tipped where T cells favor short-lived effector but not memory or TFH responses. Consistently, vaccine-induced antibodies commonly display a lower protective capacity. Mechanistically, multiple, potentially targetable, changes in T cells have been identified that contribute to these age-related defects, including posttranscription regulation, T-cell receptor signaling, and metabolic function. Although research into the induction of tissue-specific immunity by vaccines and with age is still limited, current mechanistic insights provide a framework for improved design of age-specific vaccination strategies that require further evaluation in a clinical setting.
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Affiliation(s)
- Claire E Gustafson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Department of Medicine, Veterans Administration Healthcare System, Palo Alto, Calif
| | - Chulwoo Kim
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Department of Medicine, Veterans Administration Healthcare System, Palo Alto, Calif
| | - Cornelia M Weyand
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Department of Medicine, Veterans Administration Healthcare System, Palo Alto, Calif
| | - Jörg J Goronzy
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Department of Medicine, Veterans Administration Healthcare System, Palo Alto, Calif.
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26
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Chen RI, Deaner JD, Srivastava SK, Lowder CY. Acute retinal necrosis following recombinant subunit varicella-zoster virus vaccine. Am J Ophthalmol Case Rep 2020; 20:100962. [PMID: 33163688 PMCID: PMC7599389 DOI: 10.1016/j.ajoc.2020.100962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/07/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Previously, secondary prevention of herpes zoster required live-attenuated vaccination, which is contraindicated in immunocompromised populations. More recently, a recombinant subunit vaccine (Shingrix, GlaxoSmithKline, Research Triangle Park, North Carolina) was approved by the Food and Drug Administration. Iatrogenic varicella-zoster virus (VZV) infection is theoretically impossible as it does not contain a live virus. We present a case of acute retinal necrosis (ARN) and disseminated zoster after receiving the recombinant subunit vaccine. Observations A 65-year-old woman with past medical history of multiple myeloma treated with a previous autologous hematopoietic stem cell transplant and now with daratumumab and pomalidomide developed disseminated zoster and subsequently acute retinal necrosis weeks after receiving the zoster subunit vaccine. Molecular testing confirmed the presence of VZV, and the absence of herpes simplex virus, cytomegalovirus, and toxoplasmosis. The VZV was found to be genotypically wildtype and not related to the Oka strain used in the live-attenuated zoster vaccine. She was treated with systemic valacyclovir and intravitreal foscarnet. Conclusions and importance This is the first report of VZV infection following the zoster subunit vaccine. The Advisory Committee on Immunization Practices (ACIP) has recommended the recombinant subunit vaccine over the live-attenuated vaccine due to its superior efficacy. The off-label use of the subunit vaccine in immunocompromised populations has been supported up to this point by studies demonstrating its relative safety. Though post-vaccination VZV infection or reactivation appears to be rare, clinicians should be aware of this potential complication to the recombinant subunit vaccine.
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Affiliation(s)
- Rebecca I Chen
- Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue i-32 Cleveland, OH, 44195, USA
| | - Jordan D Deaner
- Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue i-32 Cleveland, OH, 44195, USA
| | - Sunil K Srivastava
- Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue i-32 Cleveland, OH, 44195, USA
| | - Careen Y Lowder
- Cleveland Clinic Cole Eye Institute, 9500 Euclid Avenue i-32 Cleveland, OH, 44195, USA
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27
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Wang L, Verschuuren EAM, Paap D, Rondaan C, Raveling-Eelsing E, Westra J, Bos NA. Prophylactic vaccination with a live-attenuated herpes zoster vaccine in lung transplant candidates. J Heart Lung Transplant 2020; 39:1445-1454. [PMID: 33071180 DOI: 10.1016/j.healun.2020.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/25/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) is caused by the reactivation of varicella-zoster virus (VZV). Patients with lung transplants are at high risk for HZ owing to their immunocompromised status and the need for lifelong immunosuppression. In this study, patients on the waiting list for lung transplantation were vaccinated by a live-attenuated HZ vaccine (Zostavax, Merck Sharp & Dohme), and the safety and immunogenicity of this vaccine were studied. METHODS In total, 105 patients with end-stage pulmonary disease (ESPD) were enrolled (68 participants received 1 dose of Zostavax and 37 participants were enrolled as unvaccinated controls). Among them, 43 patients underwent lung transplantation and were followed up for further analysis. VZV immunoglobulin G antibody titers and VZV-specific cell-mediated immunity (CMI) on multiple time points before and after vaccination and before and after transplantation were measured. RESULTS Immune response to Zostavax was higher in younger patients, highest within 3 months after vaccination, and not influenced by gender or type of ESPD. Age, cytomegalovirus serostatus, and immunity to VZV at baseline impacted the subsequent immune response to the vaccine. Short-term immunosuppressant treatment had strong effects on VZV CMI levels, which returned to a high level at 6 months after transplantation in vaccinated patients. Zostavax did not impact infection or rejection rate after transplantation. CONCLUSIONS Zostavax was safe and induced a robust humoral and cellular response for patients awaiting lung transplantation regardless of the type of ESPD. Patients younger than the recommended vaccination age of over 50 years showed a strong response and could also benefit from pre-transplant immunization.
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Affiliation(s)
- Lei Wang
- Department of Rheumatology and Clinical Immunology
| | | | - Davy Paap
- Department of Rheumatology and Clinical Immunology; Department of Rehabilitation Medicine
| | - Christien Rondaan
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Chakraborty U, Chandra A, Sil A, Biswas SK. Elderly immunocompetent man presenting with disseminated cutaneous herpes zoster. BMJ Case Rep 2020; 13:13/8/e237480. [PMID: 32843392 DOI: 10.1136/bcr-2020-237480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Uddalak Chakraborty
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Abheek Sil
- Dermatology, Venereology, Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Surajit Kumar Biswas
- Dermatology, Venereology, Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Granier C, Gey A, Roncelin S, Weiss L, Paillaud E, Tartour E. Immunotherapy in older patients with cancer. Biomed J 2020; 44:260-271. [PMID: 33041248 PMCID: PMC8358190 DOI: 10.1016/j.bj.2020.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 12/19/2022] Open
Abstract
Ageing implicates a remodeling of our immune system, which is a consequence of the physiological senescence of our cells and tissues coupled with environmental factors and chronic antigen exposure. An immune system that senesces includes more differentiated cells with accumulation of highly differentiated CD4 and CD8 T cells. The pool of naive T cells decreases with the exponential thymic involution induced by age. Differentiated T cells have similar, if not higher, functional capacities but scarce studies are looking at the impact of senescence among specific T cells. After a stimulation, other immune cells (monocytes, dendritic cells and NK) are functionally altered during ageing. It is as if the immune system was more efficient at the basal level, but less efficient after a stimulation in the old compared to young people, likely due to less reserve. Concerning the clinical impact, older people are more prone to certain pathogens and their clinical manifestations differ from the younger people. Severe flu and VZV reactivation are more frequent with an altered cellular response to vaccination. Vaccination failure can have detrimental consequences in people presenting frailty criteria. Old people frailty is majored by their comorbidities and diseases like cancer. Thus, chemotherapies are employed with circumspection in older patients. The use of anti-PD-1/PD-L1 immunotherapies is therefore attractive, because of less side effects with a better response compared to chemotherapy. Old persons inclusion is lacking in current studies and clinical trials. Some subgroups or pooled analyses confirm the gain in response without increased toxicities in older patients but their inclusion criteria differ from the real-life practice. Specific studies focusing on this population are needed because of the increasing cancer incidence with age and the overall ageing of the population.
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Affiliation(s)
- C Granier
- Biological Immunology Department, APHP, Georges Pompidou European Hospital, Paris, France; University of Paris, PARCC, INSERM, APHP, Paris, France; Ligue Contre le Cancer Labeled Team, France.
| | - A Gey
- Biological Immunology Department, APHP, Georges Pompidou European Hospital, Paris, France; University of Paris, PARCC, INSERM, APHP, Paris, France; Ligue Contre le Cancer Labeled Team, France
| | - S Roncelin
- Biological Immunology Department, APHP, Georges Pompidou European Hospital, Paris, France
| | - L Weiss
- Clinical Immunology Department, APHP, Paris, France; INSERM U976 HIPI, Paris, France; Paris Descartes Medical School, University of Paris, Paris, France
| | - E Paillaud
- Department of Geriatric, APHP, Paris Cancer Institute CARPEM, Europeen Georges Pompidou Hospital, Paris, France; Paris Est Creteil University, INSERM, IMRB, Creteil, France
| | - E Tartour
- Biological Immunology Department, APHP, Georges Pompidou European Hospital, Paris, France; University of Paris, PARCC, INSERM, APHP, Paris, France; Ligue Contre le Cancer Labeled Team, France
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Risk of recurrent herpes zoster in a population-based cohort study of older adults. J Am Acad Dermatol 2020; 85:611-618. [PMID: 32622890 DOI: 10.1016/j.jaad.2020.06.1013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There are limited data on zoster recurrence. OBJECTIVE To examine in detail zoster recurrence in a population-based cohort. METHODS Using data from a large cohort (The 45 and Up Study) with linked medical data (2004-2015), the incidences of first and recurrent zoster were examined by using survival analysis methods. RESULTS Over 1,846,572 person-years of follow-up, of 17,413 participants who had a first zoster episode (incidence, 9.43 per 1000 person-years; 95% confidence interval, 9.29-9.57), 675 (3.9%) experienced a recurrence. The mean time between first and recurrent zoster was 2 years for those aged 45-54 years and 3 years for those aged 55 years and older. Among those with a first zoster, the incidence of recurrence was 11.05 (95% confidence interval, 10.24-11.91) per 1000 person-years, and higher recurrence incidence occurred in women compared to men, in younger compared to older participants, and in immunosuppressed compared to nonimmunosuppressed participants. Recurrence appeared lower in the 12 months after zoster onset but then remained consistent at approximately 12.00 per 1000 person-years in the following 8 years. LIMITATIONS Recurrence may be underestimated because of the use of administrative data for case ascertainment. Potential misclassification of nonimmunosuppressed participants. CONCLUSIONS Our results support the vaccination of people who have already experienced zoster and underpin the need for additional studies on immunogenicity and vaccine efficacy in these populations.
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McElhaney JE, Verschoor C, Pawelec G. Zoster Vaccination in Older Adults: Efficacy and Public Health Implications. J Gerontol A Biol Sci Med Sci 2020; 74:1239-1243. [PMID: 30945744 DOI: 10.1093/gerona/glz085] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Indexed: 12/18/2022] Open
Abstract
Shingles and its most common disabling complication, post-herpetic neuralgia, represent a serious public health challenge in the older population. The decline in the T-cell-mediated immune response to varicella zoster virus after age 50 is clearly associated with increased risk of viral reactivation, causing an acutely painful zoster rash, which may have a severe prodrome of dermatomal pain and persist as seriously debilitating post-herpetic neuralgia well beyond the resolution of the rash. However, new vaccines and adjuvants are being developed and trialed and are now more effective in preventing shingles and the sequelae of post-herpetic neuralgia. Those vaccines that possess the ability to enhance antigen presentation and reverse memory T-cell exhaustion, as well as diminish the immune suppressive effects of regulatory T cells, are most likely to be effective in older adults.
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Affiliation(s)
| | - Chris Verschoor
- Health Sciences North Research Institute, Sudbury, Ontario.,McMaster University, Hamilton, Ontario, Canada
| | - Graham Pawelec
- Health Sciences North Research Institute, Sudbury, Ontario.,Department of Immunology, University of Tübingen, Tübingen, Germany
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The Tat Protein of HIV-1 Prevents the Loss of HSV-Specific Memory Adaptive Responses and Favors the Control of Viral Reactivation. Vaccines (Basel) 2020; 8:vaccines8020274. [PMID: 32512757 PMCID: PMC7349931 DOI: 10.3390/vaccines8020274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
The development of therapeutic strategies to control the reactivation of the Herpes Simplex Virus (HSV) is an unaddressed priority. In this study, we evaluated whether Tat, a HIV-1 protein displaying adjuvant functions, could improve previously established HSV-specific memory responses and prevent viral reactivation. To this aim, mice were infected with non-lethal doses of HSV-1 and, 44 days later, injected or not with Tat. Mice were then monitored to check their health status and measure memory HSV-specific cellular and humoral responses. The appearance of symptoms associated with HSV-reactivation was observed at significantly higher frequencies in the control group than in the Tat-treated mice. In addition, the control animals experienced a time-dependent decrease in HSV-specific Immunoglobulin G (IgG), while the Tat-treated mice maintained antibody titers over time. IgG levels were directly correlated with the number of HSV-specific CD8+ T cells, suggesting an effect of Tat on both arms of the adaptive immunity. Consistent with the maintenance of HSV-specific immune memory, Tat-treated mice showed a better control of HSV-1 re-infection. Although further studies are necessary to assess whether similar effects are observed in other models, these results indicate that Tat exerts a therapeutic effect against latent HSV-1 infection and re-infection by favoring the maintenance of adaptive immunity.
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Almanzar G, Kienle F, Schmalzing M, Maas A, Tony HP, Prelog M. Tofacitinib modulates the VZV-specific CD4+ T cell immune response in vitro in lymphocytes of patients with rheumatoid arthritis. Rheumatology (Oxford) 2020; 58:2051-2060. [PMID: 31106368 DOI: 10.1093/rheumatology/kez175] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/05/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE RA is a chronic inflammatory disease characterized by lymphocyte infiltration and release of inflammatory cytokines. Previous studies have shown that treatment with Janus kinase inhibitors, such as tofacitinib, increased the incidence rate of herpes zoster compared with conventional DMARDs. Therefore, this study aimed to investigate the effect of tofacitinib on the varicella-zoster-virus (VZV)-specific T cell immune response. METHODS The effect of tofacitinib on the VZV-specific T cell immune response was determined by evaluating the IFNγ production, the proliferative capacity, the VZV-induced differentiation into effector and memory T cells, the expression of activation marker CD69 and helper T cell type 1 (Th1)-characteristic chemokine receptors, such as CXCR3 and CCR5, as well as cytotoxic activity (perforin and granzyme B expression) of CD4+ T cells of patients with RA compared with healthy donors upon stimulation with VZV antigen in vitro. RESULTS Tofacitinib significantly reduced the IFNγ production, proliferation, activation, and CXCR3 expression of VZV-specific CD4+ T cells in a dose-dependent manner in short- and long-term lymphocyte culture. No effect on the distribution of naive, effectors or memory, or on the expression of perforin or granzyme B by VZV-specific CD4+ T cells was observed. CONCLUSION This study showed that tofacitinib significantly modulated the Th1 response to VZV. The poor VZV-specific cellular immune response in patients with RA may be considered in recommendations regarding appropriate vaccination strategies for enhancing the VZV-specific Th1 response.
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Affiliation(s)
- Giovanni Almanzar
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, Würzburg, Germany
| | - Felix Kienle
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, Würzburg, Germany
| | - Marc Schmalzing
- Department of Internal Medicine II, Rheumatology and Immunology, University Hospital Würzburg, Würzburg, Germany
| | - Anna Maas
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, Würzburg, Germany
| | - Hans-Peter Tony
- Department of Internal Medicine II, Rheumatology and Immunology, University Hospital Würzburg, Würzburg, Germany
| | - Martina Prelog
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, Würzburg, Germany
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Abstract
Vaccines are considered one of the most important advances in modern medicine and have greatly improved our quality of life by reducing or eliminating many serious infectious diseases. Successful vaccines have been developed against many of the most common human pathogens, and this success has not been dependent upon any one specific class of vaccine since subunit vaccines, non-replicating whole-virus or whole-bacteria vaccines, and attenuated live vaccines have all been effective for particular vaccine targets. After completing the initial immunization series, one common aspect of successful vaccines is that they induce long-term protective immunity. In contrast, several partially successful vaccines appear to induce protection that is relatively short-lived and it is likely that long-term protective immunity will be critical for making effective vaccines against our most challenging diseases such as AIDS and malaria.
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Affiliation(s)
- Ian J Amanna
- Najít Technologies, Inc, Beaverton, OR, 97006, USA
| | - Mark K Slifka
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA.
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Saadatian-Elahi M, Bauduceau B, Del-Signore C, Vanhems P. Diabetes as a risk factor for herpes zoster in adults: A synthetic literature review. Diabetes Res Clin Pract 2020; 159:107983. [PMID: 31846665 DOI: 10.1016/j.diabres.2019.107983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/26/2023]
Abstract
AIM The objective of this review was to evaluate the role of diabetes as a risk factor for herpes zoster (HZ) and to discuss implications of prevention by vaccination with available HZ vaccines. METHODS We reviewed studies that investigated the incidence rates of HZ in patients with diabetes. Papers in English or French published between January 2000 and December 2018 have been selected from PubMed and Google Scholarship by using appropriate key words. RESULTS The risk of HZ was significantly higher in patients with diabetes as compared to controls in 11 studies out of 16, although the magnitude of risk associated to diabetes varied across studies from 1.06 to 2.38 (p < 0.05). The incidence of HZ in patients with diabetes increased with age and was higher in women than in men. The incidence of the most common complication of HZ, i.e. post-herpetic neuralgia was also higher in patients with diabetes. CONCLUSIONS The presence of HZ adds supplementary complications to the pre-existing comorbidity in patients with diabetes. Investigating the impact of preventive measure by HZ vaccination is therefore of paramount importance in patients with diabetes.
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Affiliation(s)
- Mitra Saadatian-Elahi
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France.
| | | | - Corinne Del-Signore
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France
| | - Philippe Vanhems
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), CIC 1417, Paris, France
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Ischemia-modified albumin (IMA) and dynamic thiol-disulfide homeostasis in patients with postherpetic neuralgia. J LAB MED 2019. [DOI: 10.1515/labmed-2018-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Ischemia-modified albumin (IMA) is an isotype of albumin that increases under oxidative stress, and plasma thiols are main defense mechanisms against oxidative stress. The objective of this study was to investigate thiol-disulfide homeostasis and serum IMA levels in postherpetic neuralgia (PHN) patients.
Methods
A total of 29 PHN patients and 30 healthy controls were included in the study. Serum total and native thiol concentrations and serum disulfide concentration were measured using the method described by Erel and Neselioglu. The albumin cobalt binding test was used to measure serum IMA levels.
Results
Serum IMA levels were 1.21 ± 0.58 AU and 0.75 ± 0.09 AU in the PHN and control groups, respectively (p < 0.001). Serum total thiol concentrations were found to be 421.62 ± 90.28 μmol/L and 598.36 ± 73.63 μmol/L in the PHN and control groups, respectively (p < 0.001). Serum native thiol concentrations were found to be 365.75 ± 92.07 μmol/L and 531.90 ± 72.9 μmol/L in the PHN and control groups, respectively (p < 0.001). Serum disulfide concentrations were found to be 33.23 ± 5.33 μmol/L and 27.93 ± 7.81 μmol/L in the PHN and control groups, respectively (p = 0.003). The native thiol/total thiol ratio was significantly lower, and the disulfide/total thiol and disulfide/native thiol ratios were significantly higher in the PHN group compared to the controls.
Conclusions
IMA levels are high and dynamic thiol/disulfide homeostasis is disrupted in PHN patients.
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Abstract
T cell ageing has a pivotal role in rendering older individuals vulnerable to infections and cancer and in impairing the response to vaccination. Easy accessibility to peripheral human T cells as well as an expanding array of tools to examine T cell biology have provided opportunities to examine major ageing pathways and their consequences for T cell function. Here, we review emerging concepts of how the body attempts to maintain a functional T cell compartment with advancing age, focusing on three fundamental domains of the ageing process, namely self-renewal, control of cellular quiescence and cellular senescence. Understanding these critical elements in successful T cell ageing will allow the design of interventions to prevent or reverse ageing-related T cell failure.
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Affiliation(s)
- Jörg J Goronzy
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA.
- The Department of Medicine, Palo Alto Veteran Administration Health Care System, Palo Alto, CA, USA.
| | - Cornelia M Weyand
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
- The Department of Medicine, Palo Alto Veteran Administration Health Care System, Palo Alto, CA, USA
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Haredy AM, Takei M, Iwamoto SI, Ohno M, Kosaka M, Hirota K, Koketsu R, Okuno T, Ikuta K, Yamanishi K, Ebina H. Quantification of a cell-mediated immune response against varicella zoster virus by assessing responder CD4 high memory cell proliferation in activated whole blood cultures. Vaccine 2019; 37:5225-5232. [PMID: 31358406 DOI: 10.1016/j.vaccine.2019.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Herpes zoster (HZ) is caused by reactivation of a latent varicella zoster virus (VZV). The potential to develop HZ increases with age due to waning of memory cell-mediated immunity (CMI), mainly the CD4 response. Therefore, VZV-CD4-memory T cells (CD4-M) count in blood could serve as a barometer for HZ protection. However, direct quantification of these cells is known to be difficult because they are few in number in the blood. We thus developed a method to measure the proliferation level of CD4-M cells responding to VZV antigen in whole blood culture. METHODS Blood samples were collected from 32 children (2-15 years old) with or without a history of varicella infection, 18 young adults (28-45 years old), and 80 elderly (50-86 years old) with a history of varicella infection. The elderly group was vaccinated, and blood samples were taken 2 months and 1 year after VZV vaccination. Then, 1 mL of blood was mixed with VZV, diluted 1/10 in medium, and cultured. CD4-M cells were identified and measured by flow cytometry. RESULTS There was distinct proliferation of CD3+CD4highCD45RA-RO+ (CD4high-M) cells specific to VZV antigen at day 9. The majority of CD4high-M cells had the effector memory phenotype CCR7- and was granzyme B-positive. CD4high-M cells were detected in blood culture from varicella-immune but not varicella-non-immune children. Meanwhile, a higher level of CD4high-M proliferation was observed in young adults than in the elderly. The CD4high-M proliferation level was boosted 2 months after VZV vaccination and maintained for at least 1 year in the elderly. CONCLUSION Quantifying VZV responder CD4high -M cell proliferation is a convenient way to measure VZV CMI using small blood volumes. Our method can be applied to measure VZV vaccine-induced CMI in the elderly. Clinical study registry numbers: (www.clinicaltrials.jp) 173532 and 183985.
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Affiliation(s)
- Ahmad M Haredy
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan.
| | | | | | | | - Mitsuyo Kosaka
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan
| | - Kazue Hirota
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan
| | - Ritsuko Koketsu
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan
| | - Toshiomi Okuno
- Department of Microbiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuyoshi Ikuta
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan
| | - Koichi Yamanishi
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan
| | - Hirotaka Ebina
- Biken Center for Innovative Vaccine Research and Development, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Suita, Osaka, Japan
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Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, de Thurah A, Landewé RBM, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2019; 79:39-52. [DOI: 10.1136/annrheumdis-2019-215882] [Citation(s) in RCA: 357] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022]
Abstract
To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.
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Interferon Gamma Inhibits Varicella-Zoster Virus Replication in a Cell Line-Dependent Manner. J Virol 2019; 93:JVI.00257-19. [PMID: 30918075 DOI: 10.1128/jvi.00257-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/21/2019] [Indexed: 01/29/2023] Open
Abstract
The major immediate early 62 (IE62) protein of varicella-zoster virus (VZV) is delivered to newly infected cell nuclei, where it initiates VZV replication by transactivating viral immediate early (IE), early (E), and late (L) genes. Interferon gamma (IFN-γ) is a potent cytokine produced following primary VZV infection. Furthermore, VZV reactivation correlates with a decline in IFN-γ-producing immune cells. Our results showed that treatment with 20 ng/ml of IFN-γ completely reduced intracellular VZV yield in A549 lung epithelial cells, MRC-5 lung fibroblasts, and ARPE-19 retinal epithelial cells at 4 days post-VZV infection. However, IFN-γ reduced virus yield only 2-fold in MeWo melanoma cells compared to that of untreated cells. IFN-β significantly inhibited VZV replication in both ARPE-19 and MeWo cells. In luciferase assays with VZV open reading frame 61 (ORF61) promoter reporter plasmid, IFN-γ abrogated the transactivation activity of IE62 by 95%, 97%, and 89% in A549, ARPE-19, and MRC-5 cells, respectively. However, IFN-γ abrogated IE62's transactivation activity by 16% in MeWo cells, indicating that IFN-γ inhibits VZV replication as well as IE62-mediated transactivation in a cell line-dependent manner. The expression of VZV IE62 and ORF63 suppressed by IFN-γ was restored by JAK1 inhibitor treatment, indicating that the inhibition of VZV replication is mediated by JAK/STAT1 signaling. In the presence of IFN-γ, knockdown of interferon response factor 1 (IRF1) increased VZV replication. Ectopic expression of IRF1 reduced VZV yields 4,000-fold in MRC-5 and ARPE-19 cells but 3-fold in MeWo cells. These results suggest that IFN-γ blocks VZV replication by inhibiting IE62 function in a cell line-dependent manner.IMPORTANCE Our results showed that IFN-γ significantly inhibited VZV replication in a cell line-dependent manner. IFN-γ inhibited VZV gene expression after the immediate early stage of infection and abrogated IE62-mediated transactivation. These results suggest that IFN-γ blocks VZV replication by inhibiting IE62 function in a cell line-dependent manner. Understanding the mechanisms by which IFN-γ plays a role in VZV gene programming may be important in determining the tissue restriction of VZV.
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Deep Sequencing Identification of Differentially Expressed miRNAs in the Spinal Cord of Resiniferatoxin-Treated Rats in Response to Electroacupuncture. Neurotox Res 2019; 36:387-395. [PMID: 31124075 DOI: 10.1007/s12640-019-00052-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/29/2019] [Accepted: 04/23/2019] [Indexed: 01/26/2023]
Abstract
Electroacupuncture (EA) is an effective treatment to relieve pain in patients with postherpetic neuralgia. However, the mechanisms of EA involved therein are still unknown. We first injected resiniferatoxin (RTX) into Sprague Dawley rats to construct the neuralgia model. One week after injection, the rats were treated with EA at the "Huantiao" (GB30) and "Yanglingquan" (GB34) acupoints for 5 weeks. Nociceptive behavioral tests were performed to analyze the changes in thermal sensitivity and mechanical allodynia after RTX induction and EA treatment. Deep sequencing was performed to identify differentially expressed miRNAs in the spinal cord of RTX-induced rats in response to EA treatment. The nociceptive behavioral tests showed that EA at the left GB30 and GB34 acupoints significantly reduced RTX-induced tactile sensitivity and increased RTX-inhibited thermal sensitivity. The sequencing data indicated that RTX resulted in one upregulated and five downregulated miRNAs, and EA treatment resulted in two upregulated miRNAs. Furthermore, seven upregulated and two downregulated miRNAs were found between rats subjected to EA and sham operation. Functional analysis suggested that the targets of differentially expressed miRNAs were enriched in many nervous system-related pathways. The pathway-gene-miRNA net analysis showed that miR-7a-5p had the most target genes. Moreover, miR-233-3p was downregulated after RTX injection and upregulated by EA treatment. We speculated that the upregulation of miR-7a-5p and miR-233-3p is involved in the analgesic effects of EA. Our analysis on the EA-induced differential expression of miRNAs provides novel insights into the mechanisms of EA analgesia in postherpetic neuralgia.
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Zuin M, Rigatelli G, Adami A. Cerebrovascular events after herpes zoster infection: a risk that should be not underestimated. J Neurovirol 2019; 25:439-447. [PMID: 31069708 DOI: 10.1007/s13365-019-00748-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/21/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
The occurrence of a cerebrovascular event after a herpes zoster (HZ) infection represents a nightmare in clinical practice, especially in those patients with concomitant cardiovascular comorbidities/risk factors and disease related per se to a higher risk of zoster infection. Moreover, the absence of a consensus opinion regarding a specific and adequate prevention of cerebrovascular events in these patients further complicates the treatment. Accumulating evidences demonstrated that HZ and HZ ophtalmicus (HZO) increase the risk of cerebrovascular events in the short-and long-term periods. Moreover, patient's ages < 40 years old, despite having fewer traditional cardiovascular comorbidities, demonstrated a higher risk of cerebrovascular events after both HZ and HZO infection. Further prospective studies are needed to analyse the role of antiviral treatments and vaccination in these subjects to clarify if they could be able to reduce the risk of stroke after a zoster infection. In the meanwhile, physicians must be aware of a higher risk of cerebrovascular events, especially in younger patients, with few cardiovascular risk factors, after an HZ infection.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Via WA Mozart, 9, 37040 Legnago, Verona, Italy.
| | - Alessandro Adami
- Division of Neurology, Stroke Center, SacroCuore-Don Calabria Hospital, Negrar, Italy
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Krasselt M, Baerwald C, Liebert UG, Seifert O. Humoral immunity to varicella zoster virus is altered in patients with rheumatoid arthritis. Clin Rheumatol 2019; 38:2493-2500. [PMID: 31028550 DOI: 10.1007/s10067-019-04563-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The prevalence of herpes zoster (HZ) is high in patients with rheumatologic diseases. The incidence in patients with rheumatoid arthritis (RA) is at least twice as high as in healthy people. Nevertheless, little is known about humoral immunity against varicella zoster virus (VZV), in particular in patients with RA. We, therefore, aimed to retrospectively compare VZV antibody concentrations in a collective of patients with RA in a German outpatient clinic with age- and sex-matched controls without RA. METHODS We included n = 247 patients with RA from one single university centre as well as n = 250 age- and sex-matched controls from the in-house routine in this retrospective analysis. The concentration of VZV IgG antibody concentration was either available from the records or was measured using an enzyme-linked immunosorbent assay (ELISA). Additionally, avidity for specific IgG was analysed for some of the samples. The antibody concentrations have been compared between the two groups. Moreover, a consecutive subgroup analysis after stratification by age was performed. RESULTS A total of 68.4% (n = 169) of the included patients were treated with conventional synthetic DMARDs, either as monotherapy or in combination. Biological originator DMARDs were used in 45.8% (n = 113) of the patients, with the majority (85%, n = 96) of them being on tumour necrosis factor (TNF)-inhibiting agents. As the main result of this study, antibody titres for VZV were found to be significantly lower in RA patients compared with healthy controls (p < 0.0001). The observed difference was most pronounced for the older patients being in the sixth and seventh decade. Antibody avidity was high in both groups with a significantly higher avidity among the controls (p = 0.0006). CONCLUSIONS A possible explanation for the low VZV antibody concentration in RA patients might be premature immunosenescence, which most likely also effects the B cell compartment and humoral immunity. This thesis is emphasised by the significantly higher antibody avidity among the controls. The data also suggest that the increased HZ risk is a consequence of a poor humoral immunity. The available HZ vaccinations should contribute to decreasing the elevated HZ risk in RA patients. KEY POINTS • Humoral immunity to varicella zoster virus seems to be reduced in patients with RA. • This impaired immunity might contribute to the increased herpes zoster susceptibility in RA patients. • An accelerated immunosenescence in RA could be causative for this finding.
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Affiliation(s)
- Marco Krasselt
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Liebigstr. 20/22, 04103, Leipzig, Germany.
| | - Christoph Baerwald
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Liebigstr. 20/22, 04103, Leipzig, Germany
| | - Uwe G Liebert
- Institute for Virology, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Olga Seifert
- Division of Rheumatology, Medical Department III - Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig Medical Centre, Liebigstr. 20/22, 04103, Leipzig, Germany
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Ohfuji S, Ito K, Inoue M, Ishibashi M, Kumashiro H, Hirota Y, Kayano E, Ota N. Safety of live attenuated varicella-zoster vaccine in patients with underlying illnesses compared with healthy adults: a prospective cohort study. BMC Infect Dis 2019; 19:95. [PMID: 30691396 PMCID: PMC6350288 DOI: 10.1186/s12879-019-3719-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background In Japan, freeze-dried live attenuated varicella-zoster vaccine is available for adults aged ≥50 years to prevent herpes zoster. However, limited evidence has been accumulated regarding vaccine safety for patients with underlying illnesses, who have been considered as the high-risk group for herpes zoster. Methods A prospective cohort study of 1200 healthy adults and 300 patients with underlying illnesses such as malignancy, diabetes mellitus, autoimmune diseases, and renal diseases was conducted. All subjects were vaccinated and then their adverse events (AEs) were followed for 28 days after vaccination. Key safety measures included any AEs, severe AEs (SAEs), and vaccine-related AEs such as injection-site AEs and systemic AEs. The frequencies and 95% confidence intervals of AEs were calculated. Results During the follow-up period, 2 SAEs (bone fracture and acute cholecystitis) among healthy adults and 1 SAE (disseminated mycobacteriosis) among patients with underlying illnesses were reported, although none of them was diagnosed as vaccine-related. Vaccine-related AEs were reported in 42% of healthy adults and patients with underlying illnesses, and the proportions were similar between the groups. The most frequent AEs were injection-site AEs in both groups (i.e., 41 and 39%), and systemic AEs were observed in 4% of both groups. Only among healthy adults, those with a history of herpes zoster were more likely to report injection-site AEs than those without a history of herpes zoster (53% vs 39%). Conclusions The present study confirmed the safety of freeze-dried, live attenuated varicella-zoster vaccine even in patients with underlying illnesses. A history of herpes zoster might be related to development of injection-site AEs in healthy adults. Trial registration The study was prospectively registered on Japic-Clinical Trials Information as JapicCTI-163415 on October 31, 2016.
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Affiliation(s)
- Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan. .,Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan.
| | - Kazuya Ito
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan.,Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Megumi Inoue
- PS Clinic, Medical Co. LTA, 6-18, Ten-ya-machi, Hakata-ku, Fukuoka-city, Fukuoka, 812-0025, Japan
| | - Motoki Ishibashi
- PS Clinic, Medical Co. LTA, 6-18, Ten-ya-machi, Hakata-ku, Fukuoka-city, Fukuoka, 812-0025, Japan
| | - Hiroko Kumashiro
- PS Clinic, Medical Co. LTA, 6-18, Ten-ya-machi, Hakata-ku, Fukuoka-city, Fukuoka, 812-0025, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, Medical Co. LTA, 3-6-1 Kashii-Teriha Higashi-ku, Fukuoka, 813-0017, Japan
| | - Eiji Kayano
- Kanonji Institute, Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Naoshi Ota
- Kanonji Institute, Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
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Baird NL, Zhu S, Pearce CM, Viejo-Borbolla A. Current In Vitro Models to Study Varicella Zoster Virus Latency and Reactivation. Viruses 2019; 11:v11020103. [PMID: 30691086 PMCID: PMC6409813 DOI: 10.3390/v11020103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/26/2022] Open
Abstract
Varicella zoster virus (VZV) is a highly prevalent human pathogen that causes varicella (chicken pox) during primary infection and establishes latency in peripheral neurons. Symptomatic reactivation often presents as zoster (shingles), but it has also been linked to life-threatening diseases such as encephalitis, vasculopathy and meningitis. Zoster may be followed by postherpetic neuralgia, neuropathic pain lasting after resolution of the rash. The mechanisms of varicella zoster virus (VZV) latency and reactivation are not well characterized. This is in part due to the human-specific nature of VZV that precludes the use of most animal and animal-derived neuronal models. Recently, in vitro models of VZV latency and reactivation using human neurons derived from stem cells have been established facilitating an understanding of the mechanisms leading to VZV latency and reactivation. From the models, c-Jun N-terminal kinase (JNK), phosphoinositide 3-kinase (PI3K) and nerve growth factor (NGF) have all been implicated as potential modulators of VZV latency/reactivation. Additionally, it was shown that the vaccine-strain of VZV is impaired for reactivation. These models may also aid in the generation of prophylactic and therapeutic strategies to treat VZV-associated pathologies. This review summarizes and analyzes the current human neuronal models used to study VZV latency and reactivation, and provides some strategies for their improvement.
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Affiliation(s)
- Nicholas L Baird
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Shuyong Zhu
- Institute of Virology, Hannover Medical School, 30625 Hannover, Germany.
| | - Catherine M Pearce
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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Reactivation of Simian Varicella Virus in Rhesus Macaques after CD4 T Cell Depletion. J Virol 2019; 93:JVI.01375-18. [PMID: 30404798 DOI: 10.1128/jvi.01375-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023] Open
Abstract
Rhesus macaques intrabronchially inoculated with simian varicella virus (SVV), the counterpart of human varicella-zoster virus (VZV), developed primary infection with viremia and rash, which resolved upon clearance of viremia, followed by the establishment of latency. To assess the role of CD4 T cell immunity in reactivation, monkeys were treated with a single 50-mg/kg dose of a humanized monoclonal anti-CD4 antibody; within 1 week, circulating CD4 T cells were reduced from 40 to 60% to 5 to 30% of the total T cell population and remained low for 2 months. Very low viremia was seen only in some of the treated monkeys. Zoster rash developed after 7 days in the monkey with the most extensive CD4 T cell depletion (5%) and in all other monkeys at 10 to 49 days posttreatment, with recurrent zoster in one treated monkey. SVV DNA was detected in the lung from two of five monkeys, in bronchial lymph nodes from one of the five monkeys, and in ganglia from at least two dermatomes in three of five monkeys. Immunofluorescence analysis of skin rash, lungs, lymph nodes, and ganglia revealed SVV ORF63 protein at the following sites: sweat glands in skin; type II cells in lung alveoli, macrophages, and dendritic cells in lymph nodes; and the neuronal cytoplasm of ganglia. Detection of SVV antigen in multiple tissues upon CD4 T cell depletion and virus reactivation suggests a critical role for CD4 T cell immunity in controlling varicella virus latency.IMPORTANCE Reactivation of latent VZV in humans can result in serious neurological complications. VZV-specific cell-mediated immunity is critical for the maintenance of latency. Similar to VZV in humans, SVV causes varicella in monkeys, establishes latency in ganglia, and reactivates to produce shingles. Here, we show that depletion of CD4 T cells in rhesus macaques results in SVV reactivation, with virus antigens found in zoster rash and SVV DNA and antigens found in lungs, lymph nodes, and ganglia. These results suggest the critical role of CD4 T cell immunity in controlling varicella virus latency.
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Yang P, Chen Z, Zhang J, Li W, Zhu C, Qiu P, Quan Y, Cui X, Yuan L, Jiang C. Evaluation of Varicella-zoster virus-specific cell-mediated immunity by interferon-γ Enzyme-Linked Immunosorbent Assay in adults ≥50 years of age administered a herpes zoster vaccine. J Med Virol 2019; 91:829-835. [PMID: 30613990 DOI: 10.1002/jmv.25391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/29/2018] [Indexed: 11/11/2022]
Abstract
Varicella-zoster virus (VZV)-specific cell-mediated immunity (CMI) is critical for preventing and controlling the onset of herpes zoster (HZ). To assess VZV CMI, an interferon-γ (IFN-γ) enzyme-linked immunosorbent assay (ELISA) was validated by examining the influence of VZV-specific antigen content, incubation time, and interval from whole blood collection on the assay. In phase II clinical trial, VZV-specific CMI in adults ≥50 years of age administered an HZ vaccine were evaluated by IFN-γ ELISA, as determined by measuring IFN-γ production in the whole blood in response to stimulation with ultraviolet light-inactivated VZV. The VZV-specific IFN-γ levels varied among individuals from prevaccination (baseline) to 6 weeks postvaccination. In most subjects, VZV-specific CMI was increased at 6 weeks postvaccination. The HZ vaccine elicited a significant increase in the VZV-specific CMI response as measured by ELISA; the geometric mean fold-rises from baseline to 6 weeks postvaccination were 3.50, 4.22, and 5.24 in the 4.3, 4.7, and 4.9 log plaque-forming unit vaccine groups, respectively, which was significantly higher than in the placebo group (P < 0.05). These results indicate that vaccination enhances the VZV-specific CMI responses in subjects; IFN-γ ELISA is an effective method for evaluating the CMI response and may be useful for identifying individuals at a high risk of HZ infection.
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Affiliation(s)
- Ping Yang
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Zhen Chen
- National Institutes for Food and Drug Control, Beijing, China
| | | | - Wei Li
- Changchun BCHT Biotechnology Company, Changchun, China
| | - Changlin Zhu
- Changchun BCHT Biotechnology Company, Changchun, China
| | - Ping Qiu
- National Institutes for Food and Drug Control, Beijing, China
| | - Yaru Quan
- National Institutes for Food and Drug Control, Beijing, China
| | - Xiaoyu Cui
- National Institutes for Food and Drug Control, Beijing, China
| | - Liyong Yuan
- National Institutes for Food and Drug Control, Beijing, China
| | - Chunlai Jiang
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China.,Key Laboratory for Molecular Enzymology & Engineering, Ministry of Education, Jilin University, Changchun, China
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Fulop T, Franceschi C, Hirokawa K, Pawelec G. Immunosenescence Modulation by Vaccination. HANDBOOK OF IMMUNOSENESCENCE 2019. [PMCID: PMC7121048 DOI: 10.1007/978-3-319-99375-1_71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A decline in immune function is a hallmark of aging that leads to complicated illness from a variety of infectious diseases, cancer and other immune-mediated disorders, and may limit the ability to appropriately respond to vaccination. How vaccines might alter the senescent immune response and what are the immune correlates of protection will be addressed from the perspective of (1) stimulating a previously primed response as in the case of vaccines for seasonal influenza and herpes zoster, (2) priming the response to novel antigens such as pandemic influenza or West Nile virus, (3) vaccination against bacterial pathogens such as pneumococcus and pertussis, (4) vaccines against bacterial toxins such as tetanus and Clostridium difficile, and (5) vaccine approaches to mitigate effects of cytomegalovirus on immune senescence. New or improved vaccines developed over recent years demonstrate the considerable opportunity to improve current vaccines and develop new vaccines as a preventive approach to a variety of diseases in older adults. Strategies for selecting appropriate immunologic targets for new vaccine development and evaluating how vaccines may alter the senescent immune response in terms of potential benefits and risks in the preclinical and clinical trial phases of vaccine development will be discussed.
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Affiliation(s)
- Tamas Fulop
- Division of Geriatrics Research Center on Aging, University of Sherbrooke Department of Medicine, Sherbrooke, QC Canada
| | - Claudio Franceschi
- Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | | | - Graham Pawelec
- Center for Medical Research, University of Tübingen, Tübingen, Germany
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Harder T, Siedler A. Systematic Review and Meta-analysis of Chickenpox Vaccination and Risk of Herpes Zoster: A Quantitative View on the “Exogenous Boosting Hypothesis”. Clin Infect Dis 2018; 69:1329-1338. [DOI: 10.1093/cid/ciy1099] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/21/2018] [Indexed: 11/14/2022] Open
Abstract
AbstractBackgroundThe “exogenous boosting hypothesis” postulates that reexposure to circulating varicella zoster virus (VZV) over the life span inhibits reactivation of VZV. Consequently, if circulation of VZV is suppressed by introduction of chickenpox vaccination, incidences of herpes zoster may rise.MethodsWe performed a systematic review and metaanalysis on impact of chickenpox vaccination on herpes zoster incidence and time trend, focusing on population-level effects by analyzing interrupted time-series (ITS) studies. We searched Medline and Embase for ITS reporting incidences of chickenpox and herpes zoster before and after implementation of chickenpox vaccination. Autoregressive integrated moving average models were calculated. Change in trend and incidence from studies were pooled.ResultsTwelve studies were included, of which 6 were eligible for metaanalysis. Metaanalysis revealed a significant increase in chickenpox cases prior to implementation of chickenpox vaccination and a reversed trend thereafter, particularly in individuals aged 1–4 years. The increase in age-adjusted herpes zoster incidence before implementation of chickenpox vaccination did not change thereafter. However, separate analysis of age groups revealed a net increase of hospitalized herpes zoster cases in individuals aged 10–49 years after implementation of chickenpox vaccination. This very small effect (fewer than 2 additional cases per 100 000 persons) did not occur in other age groups.ConclusionsTo date, no conclusive evidence exists that chickenpox vaccination has a substantial population-level impact on herpes zoster in nonvaccinated age groups. While exogenous boosting may exist, the effect size generated by chickenpox vaccination might be rather small on the population level.
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Affiliation(s)
- Thomas Harder
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Anette Siedler
- Immunization Unit, Robert Koch Institute, Berlin, Germany
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50
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Choi JY, Kang MG, Park KU, Park WB, Kim KI, Kim ES, Kim HB, Song KH, Kim CH. Immunogenicity of the Varicella-Zoster Vaccine in Community-Dwelling Non-robust Elderly Individuals Compared to Robust Elderly Individuals: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2018; 74:1225-1230. [DOI: 10.1093/gerona/gly287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract
To determine whether immunogenicity of the herpes zoster live-attenuated vaccine (ZVL) in elderly individuals is influenced by frailty status and cytokine levels, individuals aged at least 65 years were prospectively administered ZVL after their frailty status and cytokine levels were assessed. Humoral and cellular immunogenicity were assessed using enzyme-linked immunosorbent assays for the varicella-zoster virus–specific IgG antibody and varicella-zoster virus–specific enzyme-linked immunospot assays, before and 6 weeks after vaccination. We enrolled 69 participants (mean age, 74.3 years); 31 were non-robust. Thirty-seven participants had a greater than 2 geometric mean fold rise in IgG antibodies, 22 more participants had at least 10 spot-forming cells/106 peripheral blood mononuclear cells (from 35 to 57 participants), and 42 experienced a twofold geometric mean fold rise increase of spot-forming cells 6 weeks after vaccination. The geometric mean fold rises of the antibody titers were similar in the robust and non-robust groups; moreover, the baseline enzyme-linked immunospot assay geometric mean values were not significantly different before or 6 weeks after vaccination. We observed no significant correlations between baseline cytokine levels and immunogenicity. Approximately half of the community-dwelling elderly participants in this study experienced a twofold rise in antibodies and one-third more participants showed at least 10 spot-forming cells after ZVL administration, suggesting that the ZVL can boost immunity in non-robust (especially pre-frail) and robust elderly individuals.
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Affiliation(s)
- Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Min-gu Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Wan Beom Park
- Deparment of Internal Medicine, Seoul National University Hospital, Jongno-gu, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do
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