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Signoriello E, Bonavita S, Sinisi L, Russo CV, Maniscalco GT, Casertano S, Saccà F, Lanzillo R, Morra VB, Lus G. Is antibody titer useful to verify the immunization after VZV Vaccine in MS patients treated with Fingolimod? A case series. Mult Scler Relat Disord 2020; 40:101963. [PMID: 31986424 DOI: 10.1016/j.msard.2020.101963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 01/12/2020] [Accepted: 01/19/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fingolimod (FTY720, Gilenya) is a second line therapy to treat relapsing MS not responding to first-line treatments and/or with a high disease activity (according to Italian Regulatory authorities). Before starting Fingolimod, patients' immunity to varicella zoster virus (VZV) needs to be assessed and seronegative patients vaccinated. To test susceptibility and response, IgG antibodies are tested after immunization. Since Fingolimod determines a reduction of circulating B lymphocytes and immunoglobulins, we aimed at describing the trend of VZV antibodies in seronegative vaccinated patients with MS before and after treatment. METHODS A total of 23 patients vaccinated for VZV before starting Fingolimod treatment, were recruited in this observational retrospective study involving five MS Centers in Campania (Italy). Of these, 12 patients were excluded for missing data. Patients received two doses of Varivax® Vaccine. After vaccination patients were re-tested and were all positive for IgG-VZV. We re-tested IgG-VZV in the same laboratory after a mean time of 2.42 years from Fingolimod therapy start. RESULTS During Fingolimod therapy we observed a global reduction of antibody titer and a disappearance in 7/11 patients. Titer disappearance was more probable in patients with lower post-vaccination titer. Of the 7 patients with vanishing IgG-VZV, three suspended Fingolimod for adverse event. In two of them, we observed a reappearance of antibody titer after treatment cessation. In one patient chickenpox infection occurred one year later. DISCUSSION AND CONCLUSIONS Our observational study shows that Fingolimod could influence antibody titer probably through its effect on B lymphocytes, but the efficacy of the vaccination should be verified. In conclusion, it is necessary to pay attention to therapies acting on B lymphocytes as they could influence the antibody titer and efficacy of vaccination making the search for other markers of vaccine efficacy desirable such as cell-mediated immunity with proliferation and induction of memory T lymphocytes in response to viral glycoproteins.
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Affiliation(s)
- E Signoriello
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy.
| | - S Bonavita
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - L Sinisi
- Multiple Sclerosis Center, Division of Neurology, San Paolo Hospital, ASL Napoli 1 Centro
| | - C V Russo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Italy
| | - G T Maniscalco
- Multiple Sclerosis Center, Department of Neurology and Stroke Unit and o "AORN A.Cardarelli", Naples, Italy
| | - S Casertano
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - F Saccà
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Italy
| | - R Lanzillo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Italy
| | - V Brescia Morra
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Italy
| | - G Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Italy
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De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World J Virol 2016; 5:97-124. [PMID: 27563537 PMCID: PMC4981827 DOI: 10.5501/wjv.v5.i3.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/08/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.
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Mitra M, Faridi M, Ghosh A, Shah N, Shah R, Chaterjee S, Narang M, Bhattacharya N, Bhat G, Choudhury H, Kadhe G, Mane A, Roy S. Safety and immunogenicity of single dose live attenuated varicella vaccine (VR 795 Oka strain) in healthy Indian children: a randomized controlled study. Hum Vaccin Immunother 2015; 11:443-9. [PMID: 25692656 PMCID: PMC4514385 DOI: 10.1080/21645515.2014.1004031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Varicella, an acute viral systemic infection that may cause lifelong latent infection with the potential for causing clinical reactivation, may be prevented by immunization. The present study was an open label, randomized, controlled, phase III, multicentre trial, conducted to evaluate and compare the safety, tolerability and immunogenicity of a freeze dried live attenuated Oka strain Varicella Vaccine (VR 795 Oka strain) with Varilrix (Oka-RIT strain) in children. A total of 268 healthy Indian children aged 12 months to 12 y with baseline VZV IgG antibody (<100 mIU/ mL) were enrolled, and 256 children completed the study. The extent of rise of VZV IgG antibody titer assessed as 3-fold and 4-fold rise from baseline was found to be significantly higher (89.1% and 85.2%) in the test group as compared to control group (73.4% and 61.7%). The post-vaccination GMT of the test group was significantly higher (112.5 mIU/mL) as compared with the control group (67.8 mIU/mL) (P < 0.001). The seroconversion rate considering the 5 gp ELISA units/ml equivalent to 10mIU/ml were similar in the control (96.5%) and the test (98.3%) groups. The adverse events were not different in the control and test groups (P > 0.05). The test live attenuated vaccine was found to be highly immunogenic, safe and comparable to Varilrix used in control arm.
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Affiliation(s)
- Monjori Mitra
- Institute of Child Health; Kolkata, India
- Correspondence to: Monjori Mitra;
| | - Mma Faridi
- Department of Pediatrics; University College of Medical Sciences; GTB Hospital Dilshad Garden, Delhi, India
| | | | - Nitin Shah
- Department of Pediatrics; Lion's Tarachand Bapa Hospital Sion West; Mumbai, India
| | - Raju Shah
- Ankur Children's Hospital; Ahmedabad, India
| | - Suparna Chaterjee
- Department of Pharmacology; Institute of Postgraduate Medical Education & Research; Kolkata, India
| | - Manish Narang
- Department of Pediatrics; University College of Medical Sciences; GTB Hospital Dilshad Garden, Delhi, India
| | | | - Gandhali Bhat
- Department of Pediatrics; Lion's Tarachand Bapa Hospital Sion West; Mumbai, India
| | | | | | - Amey Mane
- Medical Affairs Wockhardt; East Mumbai, India
| | - Sucheta Roy
- Medical Affairs Wockhardt; East Mumbai, India
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Macartney K, Heywood A, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev 2014; 2014:CD001833. [PMID: 24954057 PMCID: PMC7061782 DOI: 10.1002/14651858.cd001833.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevention of varicella (chickenpox) using live attenuated varicella vaccines has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States and Australia. Many countries do not routinely immunise children against varicella and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP). OBJECTIVES To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to March week 1, 2014), EMBASE (January 1990 to March 2014) and LILACS (1982 to March 2014). We searched for unpublished trials registered on the clinicaltrials.gov and WHO ICTRP websites. SELECTION CRITERIA RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse events following vaccination. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and analysed data using Review Manager software. MAIN RESULTS We identified three trials involving 110 healthy children who were siblings of household contacts. The included trials varied in study quality, vaccine used, length of follow-up and outcomes measured and, as such, were not suitable for meta-analysis. We identified high or unclear risk of bias in two of the three included studies. Overall, 13 out of 56 vaccine recipients (23%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with fewer than 50 skin lesions). In the three trials, most participants received PEP within three days following exposure; too few participants were vaccinated four to five days post-exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included trial reported on adverse events following immunisation. AUTHORS' CONCLUSIONS These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. We identified no RCTs for adolescents or adults. Safety was not adequately addressed.
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Affiliation(s)
- Kristine Macartney
- Children's Hospital at Westmead and University of SydneyNational Centre for Immunisation Research and Surveillance of Vaccine Preventable DiseasesLocked Bag 4001WestmeadSydneyNSWAustralia2145
| | - Anita Heywood
- University of New South WalesSchool of Public Health and Community MedicineLevel 2, Samuels BuildingGate 11, Botany StreetKensingtonNSWAustralia2052
| | - Peter McIntyre
- Children's Hospital at Westmead and University of SydneyNational Centre for Immunisation Research and Surveillance of Vaccine Preventable DiseasesLocked Bag 4001WestmeadSydneyNSWAustralia2145
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Kim YH, Hwang JY, Shim HM, Lee E, Park S, Park H. Evaluation of a commercial glycoprotein enzyme-linked immunosorbent assay for measuring vaccine immunity to varicella. Yonsei Med J 2014; 55:459-66. [PMID: 24532518 PMCID: PMC3936636 DOI: 10.3349/ymj.2014.55.2.459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate a recently marketed commercial glycoprotein enzyme-linked immunosorbent assay (gpEIA) kit, the VaccZyme™ VZV gpEIA, for measuring the immunity of varicella-vaccinated children. MATERIALS AND METHODS We investigated the accuracy and reproducibility of the VaccZyme™ VZV gpEIA kit for the detection of antibodies to VZV. We also examined the sensitivity, specificity, and correlation between antibody titers calculated with gpEIA versus fluorescent antibody to membrane antigen (FAMA) by using sera of 349 children, ranging from 1 to 6 years old. RESULTS VaccZyme™ VZV gpEIA gave precise and reproducible intra- and inter-assay results. FAMA and gpEIA titers showed a linear correlation (Pearson correlation coefficient=0.987). The sensitivity and specificity of the VaccZyme™ gpEIA was 31.4% and 100%, respectively, when the guidelines of the gpEIA (<100 mIU/mL) and FAMA 1:4 were adopted as cutoff values. However, the maximum sensitivity and specificity were 88.9% and 95.1%, respectively, with the highest correlation (κ=0.840), if the cutoff values were set with gpEIA at 49.7 mIU/mL and FAMA 1:16. CONCLUSION These results demonstrate that the VaccZyme™ VZV gpEIA kit gave precise and reproducible data for measuring antibody titer after varicella vaccination. The results also showed that the antibody titer calculated with the VaccZyme™ gpEIA kit strongly correlated with the FAMA titer. However, cutoff values should be re-optimized for the evaluation of vaccine immunity.
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Affiliation(s)
- Yun Hwa Kim
- Department of Microbiology, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea.
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Watson B. Varicella-zoster vaccine in the USA: success for control of disease severity, but what next? Expert Rev Anti Infect Ther 2014; 3:105-15. [PMID: 15757461 DOI: 10.1586/14787210.3.1.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the period from 1990 to 1994, before the introduction of a varicella vaccine to the USA, approximately 100 deaths in otherwise healthy individuals, children and adolescents under 20 years of age, were attributable to varicella complications. The administration of a single-dose vaccine has now been widespread in the USA for nearly 10 years; however, since the effectiveness of a single dose in children under 13 years of age in an outbreak situation is approximately 80%, consideration of a second booster dose is in progress although not yet recommended. Licensure of a measles-mumps-rubella-varicella vaccine may hasten the recommendation.
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Affiliation(s)
- Barbara Watson
- Jefferson Medical College, Medical Specialist, Immunization Program, Division of Disease Control, The Philadelphia Department of Public Health, 500S Broad Street, Philadelphia, PA 19146, USA.
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Human anti-varicella-zoster virus (VZV) recombinant monoclonal antibody produced after Zostavax immunization recognizes the gH/gL complex and neutralizes VZV infection. J Virol 2012; 87:415-21. [PMID: 23077312 DOI: 10.1128/jvi.02561-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Varicella-zoster virus (VZV) is a ubiquitous, highly cell-associated, and exclusively human neurotropic alphaherpesvirus. VZV infection is initiated by membrane fusion, an event dependent in part on VZV glycoproteins gH and gL. Consistent with its location on the virus envelope, the gH/gL complex is a target of neutralizing antibodies produced after virus infection. One week after immunizing a 59-year-old VZV-seropositive man with Zostavax, we sorted his circulating blood plasma blasts and amplified expressed immunoglobulin variable domain sequences by single-cell PCR. Sequence analysis identified two plasma blast clones, one of which was used to construct a recombinant monoclonal antibody (rec-RC IgG). The rec-RC IgG colocalized with VZV gE on the membranes of VZV-infected cells and neutralized VZV infection in tissue culture. Mass spectrometric analysis of proteins immunoprecipitated by rec-RC IgG identified both VZV gH and gL. Transfection experiments showed that rec-RC IgG recognized a VZV gH/gL protein complex but not individual gH or gL proteins. Overall, our recombinant monoclonal anti-VZV antibody effectively neutralizes VZV and recognizes a conformational epitope within the VZV gH/L protein complex. An unlimited supply of this antibody provides the opportunity to analyze membrane fusion events that follow virus attachment and to identify multiple epitopes on VZV-specific proteins.
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Abstract
Varicella vaccination of children has decreased varicella disease incidence, but introduced the occurrence of herpes zoster (HZ) from vaccine-type virus. We identified 14 vaccinated children with suspected HZ and confirmed varicella virus by polymerase chain reaction in 6 cases. Two cases were due to vaccine-type virus. Serum varicella IgM and IgG were not useful for diagnosis of HZ among vaccinated children.
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Sauerbrei A, Stefanski J, Gruhn B, Wutzler P. Immune response of varicella vaccinees to different varicella-zoster virus genotypes. Vaccine 2011; 29:3873-7. [DOI: 10.1016/j.vaccine.2011.03.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 02/01/2023]
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Barton M, Wasfy S, Melbourne T, Hébert D, Moore D, Robinson J, Marchese RD, Allen UD. Sustainability of humoral responses to varicella vaccine in pediatric transplant recipients following a pretransplantation immunization strategy. Pediatr Transplant 2009; 13:1007-13. [PMID: 19207222 DOI: 10.1111/j.1399-3046.2008.01113.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Varicella infections pose serious challenges for organ transplant recipients. To determine the safety and immunogenicity of the OMVV and determine the maintenance of OMVV responses in transplanted subjects at varying periods of immunosuppression within the first two yr following transplantation. Eligible subjects given a two-dose OMVV pretransplantation were monitored for AE. Antibody levels were assessed at baseline, six wk post-OMVV, pretransplantation and up to 24 months post-transplantation. Seroprotection was defined as >or=5 gpEU. Twenty-one seronegative children were vaccinated. Following 42 doses, no vaccine-related serious AE occurred. Mab_titer were 17.8 (5.7-910.2) and 183.5 EU (18.8-8116.4) at six and 12 wk, respectively (p < 0.0001). Fourteen (66.7%) participants were transplanted at a median of 16 months (1.5-56) following OMVV and had Mab_titer of 27.2 EU (9.0-236.2) just prior to transplantation. Of 11 who had post-transplantation serology, seroprotection was sustained at three, six and 12 months post-transplantation in 10/11, 12/12 and 8/10 subjects. In five of six subjects with two-yr follow-up, antibody levels remained seroprotective. No breakthrough varicella infections occurred. The receipt of OMVV prior to transplantation induced humoral responses which persisted in the early months following transplantation and up to two yr post-transplantation and was not associated with any serious adverse consequences.
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Affiliation(s)
- Michelle Barton
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Mustafa MB, Arduino PG, Porter SR. Varicella zoster virus: review of its management. J Oral Pathol Med 2009; 38:673-88. [DOI: 10.1111/j.1600-0714.2009.00802.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Macartney K, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev 2008:CD001833. [PMID: 18646079 DOI: 10.1002/14651858.cd001833.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Live attenuated varicella vaccines for the prevention of varicella (chickenpox) has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States. However, many countries do not routinely immunise children against varicella, and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP). OBJECTIVES To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, Issue 1); MEDLINE (1966 to February 2008); and EMBASE (January 1990 to February 2008). SELECTION CRITERIA RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse effects following vaccination. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and analysed data using Review Manager software. MAIN RESULTS Three studies involving 110 healthy children who were siblings of household contacts were identified as suitable for inclusion. The studies varied in quality, study design, vaccine used, and outcomes measured and, as such, were not suitable for meta-analysis. Overall, 13 out of 56 vaccine recipients (18%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with less than 50 skin lesions). In the three studies, most subjects received PEP within three days following exposure; too few subjects were vaccinated four to five days post exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included studies reported on adverse events following immunisation. AUTHORS' CONCLUSIONS These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. No RCTs for adolescents or adults were identified. However safety was not adequately addressed.
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Affiliation(s)
- Kristine Macartney
- National Centre for Immunisation Research (NCIRS), Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, Australia, 2145.
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Breuer J, Schmid D, Gershon A. Use and Limitations of Varicella‐Zoster Virus–Specific Serological Testing to Evaluate Breakthrough Disease in Vaccinees and to Screen for Susceptibility to Varicella. J Infect Dis 2008; 197 Suppl 2:S147-51. [DOI: 10.1086/529448] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics 2007; 120:221-31. [PMID: 17606582 DOI: 10.1542/peds.2007-1089] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
National varicella immunization coverage using the current 1-dose immunization strategy has increased among vaccine-eligible children 19 through 35 months of age from 27% in 1997 to 88% by 2005. These high immunization rates have resulted in a 71% to 84% decrease in the reported number of varicella cases, an 88% decrease in varicella-related hospitalizations, a 59% decrease in varicella-related ambulatory care visits, and a 92% decrease in varicella-related deaths in 1- to 4-year-old children when compared with data from the prevaccine era. Despite this significant decrease, the number of reported cases of varicella has remained relatively constant during the past 5 to 6 years. Since vaccine effectiveness for prevention of disease of any severity has been 80% to 85%, a large number of cases of varicella continue to occur among people who already have received the vaccine (breakthrough varicella), and outbreaks of varicella have been reported among highly immunized populations of schoolchildren. The peak age-specific incidence has shifted from 3- to 6-year-old children in the prevaccine era to 9- to 11-year-old children in the postvaccine era for cases in both immunized and unimmunized children during these outbreaks. Outbreaks of varicella are likely to continue with the current 1-dose immunization strategy. After administration of 2 doses of varicella vaccine in children, the immune response is markedly enhanced, with > 99% of children achieving an antibody concentration (determined by glycoprotein enzyme-linked immunosorbent assay) of > or = 5 U/mL (an approximate correlate of protection) and a marked increase in geometric mean antibody titers after the second vaccine dose. The estimated vaccine efficacy over a 10-year observation period of 2 doses for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella, compared with those who are given 1 dose, during the first 10 years after immunization. To achieve greater levels of immunity with fewer serosusceptible people, greater protection against breakthrough varicella disease, and reduction in the number of outbreaks that occur nationwide among school-aged populations, a 2-dose varicella immunization strategy is now recommended for children > or = 12 months of age.
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Hammond O, Wang Y, Green T, Antonello J, Kuhn R, Motley C, Stump P, Rich B, Chirmule N, Marchese RD. The optimization and validation of the glycoprotein ELISA assay for quantitative varicella-zoster virus (VZV) antibody detection. J Med Virol 2007; 78:1679-87. [PMID: 17063506 DOI: 10.1002/jmv.20754] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Varicella is a highly contagious viral disease found throughout the world. A live-attenuated Varicella-Zoster virus (VZV) vaccine (Oka/Merck strain), VARIVAXtrade mark, was licensed in the United States (US) in 1995 and was made a part of the US recommended childhood vaccination schedule in 1996. The immune response to VZV-containing vaccines has been measured using an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to glycoproteins from VZV. A correlate for protective immunity has been established between anti-VZV glycoprotein antibody levels and protection against breakthrough varicella in children, and this correlate is used as the primary immunogenicity endpoint in clinical trials with VZV-containing vaccines. The performance of the "first generation" validated version of the assay was recently reevaluated in order to identify areas for improvement. Specific format and reagent changes were implemented, with the goal of improving assay consistency by maintaining tighter control over assay processes and reagents. An extensive validation of the "second generation" gpELISA was undertaken in order to characterize the updated assay. In this article, we describe the gpELISA method, detail the procedures used to evaluate assay performance, and present the operating characteristics of the second generation gpELISA.
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Affiliation(s)
- Olivia Hammond
- Vaccine and Biologics Research, Merck Research Laboratories, Wayne, Pennsylvania, USA
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Emir S, Büyükpamukçu M, Köseoğlu V, Hasçelik G, Akyüz C, Kutluk T, Varan A. Varicella vaccination in children with lymphoma and solid tumours. Postgrad Med J 2006; 82:760-2. [PMID: 17099098 PMCID: PMC2660507 DOI: 10.1136/pmj.2005.041293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Varicella infection can be a severe disease, especially in immunosuppressed patients. Here, experience with live varicella vaccine to prevent varicella infection is reported in children who were undergoing treatment for lymphoma and solid tumours. METHODS 40 children, aged between 12 months and 15 years with no clinical history of varicella, were vaccinated with live varicella vaccine. All received two doses of the vaccine subcutaneously 4 weeks apart. Serum samples were taken before the first dose and 6 weeks after the second dose of vaccine. RESULTS Before vaccination, 32 patients were seronegative for varicella and eight were seropositive. Seroconversion was observed 6 weeks after the second dose in 24 of the 32 (75%) seronegative children. In 4 of 8 previously seropositive patients, antibody titres increased after immunisation. Zoster infection occurred 5 weeks after the second dose of vaccine in only one previously seronegative child. 7 children, who had responded to the vaccine, have been exposed to varicella in their families or in school without contracting clinical disease. CONCLUSION Although the small number of patients in our group prevents us from drawing definitive conclusions, the varicella vaccine seems to be well tolerated and can be administered to children with lymphoma and solid tumours undergoing treatment.
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Affiliation(s)
- S Emir
- Department of Pediatric Oncology, SB Ankara Dişkapi Children's Training and Research Hospital, Ankara, Turkey.
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20
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Huang DB, Wu JJ, Tyring SK. A review of licensed viral vaccines, some of their safety concerns, and the advances in the development of investigational viral vaccines. J Infect 2004; 49:179-209. [PMID: 15337336 PMCID: PMC7126106 DOI: 10.1016/j.jinf.2004.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2004] [Indexed: 02/03/2023]
Abstract
Viral vaccines could be considered among the most important medical achievements of the 20th century. They have prevented much suffering and saved many lives. Although some curative antiviral drugs exist, we desperately depend on efforts by academic, governmental and industrial scientists in the advancement of viral vaccines in the prevention and control of infectious diseases. In the next decade, we hope to see advancement in the development of current and investigational viral vaccines against childhood and adult infections. In this article, we will review the licensed viral vaccines, some of their safety concerns, and the advances in the development of investigational viral vaccines.
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Affiliation(s)
- David B Huang
- Division of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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21
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Abstract
The disease burden of chickenpox to children has been described, and a lower force of neutralising antibody to varicella-zoster virus (VZV) than against measles, either after natural infection or after vaccination, has been reported. In the case of VZV, strong cell-mediated immunity may work efficiently to prevent the spread of the virus. The lower force of humoral antibody to VZV might be related to the occurrence of "breakthrough" varicella cases in a small portion of the vaccine recipients. Safety and high effectiveness of the varicella vaccine--approximately 85% effective for all diseases and 95-100% effective for moderate-to-severe diseases--have been reported. Vaccine-induced immunity persists for 10-20 years. However, concerns have been raised that universal immunisation in children may shift the susceptibility from children to adults, whose symptoms are usually moderate-to-severe. In addition, other concerns have been expressed that, due to lack of exposure to varicella in children, the elderly may develop zoster infections more frequently than before. A clear answer is difficult to give at present, although, for several reasons, such situations may be unlikely to occur.
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Affiliation(s)
- Michiaki Takahashi
- The Research Foundation for Microbial Diseases, Osaka University, Osaka, Japan
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22
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Wu JJ, Huang DB, Pang KR, Tyring SK. Vaccines and immunotherapies for the prevention of infectious diseases having cutaneous manifestations. J Am Acad Dermatol 2004; 50:495-528; quiz 529-32. [PMID: 15034501 DOI: 10.1016/j.jaad.2003.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the development of antimicrobial drugs has advanced rapidly in the past several years, such agents act against only certain groups of microbes and are associated with increasing rates of resistance. These limitations of treatment force physicians to continue to rely on prevention, which is more effective and cost-effective than therapy. From the use of the smallpox vaccine by Jenner in the 1700s to the current concerns about biologic warfare, the technology for vaccine development has seen numerous advances. The currently available vaccines for viral illnesses include Dryvax for smallpox; the combination measles, mumps, and rubella vaccine; inactivated vaccine for hepatitis A; plasma-derived vaccine for hepatitis B; and the live attenuated Oka strain vaccine for varicella zoster. Vaccines available against bacterial illnesses include those for anthrax, Haemophilus influenzae, and Neisseria meningitidis. Currently in development for both prophylactic and therapeutic purposes are vaccines for HIV, herpes simplex virus, and human papillomavirus. Other vaccines being investigated for prevention are those for cytomegalovirus, respiratory syncytial virus, parainfluenza virus, hepatitis C, and dengue fever, among many others. Fungal and protozoan diseases are also subjects of vaccine research. Among immunoglobulins approved for prophylactic and therapeutic use are those against cytomegalovirus, hepatitis A and B, measles, rabies, and tetanus. With this progress, it is hoped that effective vaccines soon will be developed for many more infectious diseases with cutaneous manifestations.
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Affiliation(s)
- Jashin J Wu
- Center for Clinical Studies, Houston, Texas, USA
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23
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Tugwell BD, Lee LE, Gillette H, Lorber EM, Hedberg K, Cieslak PR. Chickenpox outbreak in a highly vaccinated school population. Pediatrics 2004; 113:455-9. [PMID: 14993534 DOI: 10.1542/peds.113.3.455] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We investigated a chickenpox outbreak that started in an Oregon elementary school in October 2001, after public schools began phasing in a varicella vaccination requirement for enrollment. We sought to determine the rate of varicella vaccination and effectiveness and risk factors for breakthrough disease. METHODS A chickenpox case was defined as an acute maculopapulovesicular rash without other explanation occurring from October 30, 2001 through January 27, 2002 in a student without a prior history of chickenpox. We reviewed varicella vaccination records and history of prior chickenpox, and we calculated vaccine effectiveness. We evaluated the effects of age, gender, age at vaccination, and time since vaccination on risk of breakthrough disease (ie, chickenpox occurring >42 days after vaccination). RESULTS Of 422 students, 218 (52%) had no prior chickenpox. Of these, 211 (97%) had been vaccinated before the outbreak. Twenty-one cases occurred in 9 of 16 classrooms. In these 9 classrooms, 18 of 152 (12%) vaccinated students developed chickenpox, compared with 3 of 7 (43%) unvaccinated students. Vaccine effectiveness was 72% (95% confidence interval: 3%-87%). Students vaccinated >5 years before the outbreak were 6.7 times (95% confidence interval: 2.2-22.9) as likely to develop breakthrough disease as those vaccinated </=5 years before the outbreak (15 of 65 [23%] vs 3 of 87 [3%]). CONCLUSIONS A chickenpox outbreak occurred in a school in which 97% of students without a prior history of chickenpox were vaccinated. Students vaccinated >5 years before the outbreak were at risk for breakthrough disease. Booster vaccination may deserve additional consideration.
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Affiliation(s)
- Barna D Tugwell
- Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Chan ISF, Li S, Matthews H, Chan C, Vessey R, Sadoff J, Heyse J. Use of statistical models for evaluating antibody response as a correlate of protection against varicella. Stat Med 2002; 21:3411-30. [PMID: 12407681 DOI: 10.1002/sim.1268] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In vaccine clinical trials, humoral antibody responses are often used to measure the effect of a vaccine because they correlate with a vaccine's protective efficacy against the target disease. While the concept of a correlate of protection usually refers to establishing a protective level of antibody titre, identifying a clear-cut value is often impossible because vaccine efficacy is not related solely to the antibody titre. We propose examining the relationship between disease protection and the whole distribution of antibody responses rather than a single cut-off level. In particular, we use failure-time models to estimate the relationship between long-term disease breakthroughs and primary antibody responses after vaccination. We apply these models to show that the varicella antibody response measured by glycoprotein enzyme-linked immunosorbent assay 6 weeks after vaccination strongly correlate with protection against varicella (chickenpox); we used 7-year follow-up data from children who received one dose of a live attenuated varicella (Oka/Merck) vaccine. In addition, we explore the potential use of these models to predict long-term disease breakthrough rates and to estimate the predicted vaccine efficacy of a similar varicella vaccine made with a modified manufacturing process.
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Affiliation(s)
- Ivan S F Chan
- Clinical Biostatistics, Merck Research Laboratories, Merck & Co., West Point, PA 19486, USA.
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25
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Abstract
A 51-year-old white woman 6 months status post cadaveric renal transplant developed a mild case of primary varicella-zoster (VZ). It is hypothesized that the limited nature of her illness was due to infection with vaccine-type VZ virus instead of wild-type VZ. Approximately 1 month prior, she had daily household contact with a child who had developed a rash after immunization with live attenuated varicella vaccine. This case highlights several important questions. Should special precautions be undertaken with renal transplant recipients naive to varicella infection after vaccination of household contacts? Should pretransplant immunization with varicella vaccine be performed routinely in naive patients? Should naive patients transplanted and maintained on immunosuppressive therapy be vaccinated? Until there are clinical trials to answer these questions, it may be instructive to consider the recommendations for pediatric and immunocompromised patients.
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Affiliation(s)
- Claire A Scanlon-Kohlroser
- Division of Renal Medicine and Transplantation Medicine, Department of Medicine and Pediatrics, University of Massachusetts Medical School and Fallon Clinic, Worcester, MA, USA
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26
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Abstract
OBJECTIVES To present a review of varicella disease, vaccine development and implementation of universal vaccination, discuss common questions about the vaccine and the epidemiology of the disease since licensure of the varicella vaccine. METHODS Review the incidence of complications from varicella disease prior to vaccine licensure, safety of the varicella vaccine from clinical trials and post-marketing surveillance data, the impact of the vaccine on disease incidence where high vaccine coverage has been achieved, and address some barriers to vaccination. Raise issues that developed since 1995. RESULTS The safety data gathered during the 20-year-gestation period of this vaccine prior to licensure has been confirmed. The vaccine works-in areas where vaccine coverage is over 70%, there has been a decline in disease, most marked in the age group with the best vaccine coverage (the 1-4-year olds), leading to a concern that unexposed susceptible children may reach adulthood and remain susceptible unless better practice of universal vaccination of ALL susceptible is practiced. CONCLUSIONS Varicella disease has declined in areas with moderate vaccine coverage. Continued implementation of existing vaccine policies will lead to further reductions of varicella morbidity and mortality throughout the USA.
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Affiliation(s)
- Barbara Watson
- Department of Pediatrics, Albert Einstein Hospital, Division of Disease Control, Philadelphia Department of Public Health, PA, USA.
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27
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Jacquet A, Haumont M, Massaer M, Garcia L, Mazzu P, Daminet V, Grégoire D, Jacobs P, Bollen A. Immunogenicity of a recombinant varicella-zoster virus gE-IE63 fusion protein, a putative vaccine candidate against primary infection and zoster reactivation. Vaccine 2002; 20:1593-602. [PMID: 11858867 DOI: 10.1016/s0264-410x(01)00486-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The varicella-zoster virus (VZV) envelope glycoprotein E (gE) and immediate early protein 63 (IE63) are well known targets for specific humoral and cell-mediated immune responses during VZV infection and latency, respectively. The present study evaluated the immunogenicity of an engineered chimeric recombinant gE-IE63 (recgE-IE63) protein secreted from CHO cells, wherein a soluble form of gE, deleted of its anchor and cytoplasmic domains was fused to IE63. Guinea pig vaccinations with adjuvanted recgE-IE63 elicited a strong and specific humoral immune response directed to each counterpart. Sera from recgE-IE63-immunized animals neutralized cell-free VZV. This neutralizing capacity was dependent only on the recgE moiety as serum depletions on recgE-immobilized sepharose totally abolished VZV neutralization. The cell-mediated immune response induced by recgE-IE63 was evaluated in lymphoproliferation assays. An antigen-specific proliferative response was demonstrated after lymphocyte stimulation with recIE63 but not with recgE. We conclude that recombinant chimeric recgE-IE63 induced both humoral and cell-mediated immune responses and thus could constitute a putative subunit vaccine candidate against VZV primary infection and zoster reactivation.
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Affiliation(s)
- Alain Jacquet
- Department of Applied Genetics, Institut de Biologie et de Médecine Moléculaires, Université Libre de Bruxelles, Rue des Professeurs Jeener et Brachet 12, B-6041 Gosselies, Belgium.
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28
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Abstract
This article reviews the history and development of live attenuated varicella vaccine from its early days in Japan to its widespread use throughout the world. The vaccine has proven extremely safe after immunization of as many as 10 million healthy children and adults in the United States alone. The vaccine is also highly immunogenic and offers close to 100% protection from severe chickenpox and 90% protection from illness. It is expected to have a major impact on the epidemiology of varicella and zoster in countries with high vaccine uptake.
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Affiliation(s)
- A A Gershon
- Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, New York, USA.
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29
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Webb NJ, Fitzpatrick MM, Hughes DA, Brocklebank TJ, Judd BA, Lewis MA, Postlethwaite RJ, Smith PA, Corbitt G. Immunisation against varicella in end stage and pre-end stage renal failure. Trans-Pennine Paediatric Nephrology Study Group. Arch Dis Child 2000; 82:141-3. [PMID: 10648369 PMCID: PMC1718197 DOI: 10.1136/adc.82.2.141] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the seroconversion rate and duration of persistence of protective antibody titres after varicella immunisation in children with renal failure. DESIGN 32 children (25 end stage and 7 pre-end stage renal failure) were immunised using 2 x 2,000 plaque forming unit doses of varicella vaccine 3 months apart. Varicella antibody titres were measured by enzyme linked immunosorbent assay. RESULTS All children initially seroconverted after immunisation. At a mean follow up of 20.3 months, 23 of 28 had protective antibody titres, 4 children having died of unrelated causes. Two children required a third booster dose. 11 children underwent renal transplantation; 10 had protective titres at the time of transplantation and, at a mean of 23.4 months after immunisation, 6 currently have protective titres. Minor side effects occurred after 11 vaccine doses in 9 children. No child developed varicella, despite 10 clear episodes of exposure to the wild-type virus. CONCLUSIONS Varicella immunisation in children with end stage and pre-end stage renal failure results in a high rate of seroconversion and persistence of protective antibody titres. More widespread use of the vaccine before renal transplantation is recommended.
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Affiliation(s)
- N J Webb
- Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK.
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30
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Abstract
The concerns raised by parents and physicians about varicella immunization are reasonable and need to be acknowledged. We believe, however, that the available information strongly suggests that these concerns should not impede implementation of universal immunization against varicella. In fact, some of these concerns are best resolved by universal immunization. Some people argue that only a small percentage of people with varicella will have a significant complication and therefore vaccinating all is unnecessary. Yet, a small percentage of 3.5 to 4 million cases per year is not an insignificant number. There is a precedent for changing immunization practice because of relatively small risks when the risks in question are serious. For example, immunization practice has changed because we have decided that 8 to 10 cases per year of vaccine-associated paralytic poliomyelitis (of 770 million doses) is unacceptable. Vaccination has been the most important health care advance of the past 40 years. Now that varicella can be added to the list of vaccine-preventable diseases, we can help our patients avoid both the common and the uncommon but much more severe complications of this disease, as well as the considerable economic burden. Although the chances that any individual will have a complication are small, if your patient is the statistic, the odds are meaningless. How can we continue to accept even mild disease from varicella, let alone severe complications, when the disease is now preventable by an effective, safe vaccine? Not immunizing patients puts them at medical risk and us at legal risk.
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Affiliation(s)
- B Watson
- Philadelphia Department of Public Health, Division of Disease Control Immunization Program, Pennsylvania 19146, USA
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31
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Carlton S, Evans T, Tyring SK. New antiviral agents for dermatologic disease. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1998; 17:243-55. [PMID: 9859911 DOI: 10.1016/s1085-5629(98)80020-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The topic of antiviral agents for dermatologic disease is an area that is rapidly changing and expanding as our knowledge of herpes viruses, HIV, and human papilloma viruses continues to expand. New drugs are continuing to make therapy for these viruses more efficacious day by day. This review will discuss the recent advances in antiviral therapy, new therapies currently being developed or studied, and the future of antiviral vaccines.
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Affiliation(s)
- S Carlton
- Department of Dermatology, University of Texas Medical Branch, Galveston 77555, USA
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32
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33
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Abstract
Since the FDA has given approval for the manufacture of a varicella vaccine (Varivax), nurses are beginning to administer the vaccine to children. Over 11,000 healthy and immunocompromised children have been immunized since 1979. Varivax has been found to be 95% to 100% effective in conferring immunity for at least 10 years, and it appears to be a safe vaccine. This article presents a review of the research literature on clinical trials of Varivax, and the risks, benefits, and projected cost of the vaccine. Precautions, contraindications, and guidelines for administration are tabled and discussed in a sample case using the Health Belief Model as a theoretical framework. The article includes a discussion of areas for further research and implications for nursing.
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Affiliation(s)
- L Sparks
- Jewish Hospital College of Nursing and Allied Health, St. Louis, MO 63110, USA
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34
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Johnson CE, Stancin T, Fattlar D, Rome LP, Kumar ML. A long-term prospective study of varicella vaccine in healthy children. Pediatrics 1997; 100:761-6. [PMID: 9346974 DOI: 10.1542/peds.100.5.761] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies in Japan and the United States have shown that varicella vaccine is both safe and efficacious. In 1984, we undertook a 10-year prospective study using a research lot of Oka/Merck varicella vaccine to assess antibody persistence and breakthrough chickenpox rates. In 1987, we began a similar prospective study with lots made in production facilities that ended after 6 years because many children were given a second dose. The purpose of this study is to report humoral antibody persistence and breakthrough chickenpox rates after 6 to 10 years of prospective follow-up. METHODS One hundred forty-three seronegative children received a research lot (950 plaque-forming units/dose) with 97.9% seroconversion by an assay for fluorescent antibody to membrane antigen (FAMA). One hundred thirty-eight children received production lots (1145 to 3265 plaque-forming units/dose) with 93.5% seroconversion. Yearly chickenpox exposure surveys were completed by phone, and children were seen by a study nurse whenever chickenpox was suspected. A subset in each group had serum collected every 2 years and tested for FAMA antibody. RESULTS In the research group there have been 25 cases of chickenpox in 137 seroconverters in a period of more than 10 years (yearly rate of 1.7%). In the production lot group there have been 22 cases of chickenpox in 129 seroconverters in a 6-year period (yearly rate of 2.8%). In the research group the median titer rose from 1:16 to 1:64 between 1 and 10 years. In the production group, the median titer did not change between 1, 2, and 4 years. Median antibody titers were compared between the research and production groups at 1, 2, and 4 years and did not differ. The rate of development of modified chickenpox has not increased with time since vaccination, and neither has the case severity. Children with FAMA titers </=8 at 6-weeks' postvaccination were four times more likely to develop chickenpox than those with titers >/=64. CONCLUSIONS 1) Modified chickenpox has occurred in approximately 2% to 3% of vaccinees per year, regardless of the vaccine lot given. 2) FAMA titers have risen between 1 and 10 years in research lot recipients and remained the same in production lot recipients. 3) The likelihood of modified chickenpox developing is inversely related to the 6-week postvaccination FAMA titer.
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Affiliation(s)
- C E Johnson
- Department of Pediatrics, Case Western Reserve School of Medicine at MetroHealth Medical Center, Cleveland Ohio 44109, USA
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35
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Haumont M, Jurdan M, Kangro H, Jacquet A, Massaer M, Deleersnyder V, Garcia L, Bosseloir A, Bruck C, Bollen A, Jacobs P. Neutralizing antibody responses induced by varicella-zoster virus gE and gB glycoproteins following infection, reactivation or immunization. J Med Virol 1997; 53:63-8. [PMID: 9298734 DOI: 10.1002/(sici)1096-9071(199709)53:1<63::aid-jmv11>3.0.co;2-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to compare the antibody responses to varicella-zoster virus (VZV) gE and gB after natural VZV infection and after vaccination with live attenuated OKA vaccine in order to determine the relative importance of these proteins as components of a subunit vaccine. Anti-VZV antibody titers determined by IFA were of the same order of magnitude in sera from individuals with a history of varicella and in vaccinated children but higher in individuals given booster vaccination. The titers of anti-gE and anti-gB antibodies were measured by ELISA using recombinant gE or gB as capture antigen. From these experiments, it appears that the ratio of anti-gE to anti-gB antibody is highly variable from one individual to another but relatively stable over a long period of time for a particular individual, even after a zoster episode. Neutralizing antibodies directed against gE or gB were also measured by subtracting the neutralization titers obtained before and after depletion of the specific antibodies on immobilized recombinant gE, gB, or both. This showed that, with respect to neutralization, anti-gE and anti-gB are equally prevalent in vaccinated children and that anti-gE is generally, but not always, predominant over anti-gB in VZV-infected individuals. Finally, antibodies to these two glycoproteins appear to be predominant among the neutralizing antibodies directed to other VZV antigens.
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Affiliation(s)
- M Haumont
- Applied Genetics, University of Brussels, Nivelles, Belgium
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36
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37
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Abstract
Varicella-zoster virus (VZV) is a ubiquitous human pathogen that causes varicella, commonly called chicken pox; establishes latency; and reactivates as herpes zoster, referred to as shingles. A live attenuated varicella vaccine, derived from the Oka strain of VZV has clinical efficacy for the prevention of varicella. The vaccine induces persistent immunity to VZV in healthy children and adults. Immunization against VZV also has the potential to lower the risk of reactivation of latent virus. The varicella vaccine may eventually reduce or eliminate herpes zoster, which is a serious problem for elderly and immunocompromised individuals.
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Affiliation(s)
- A M Arvin
- Department of Pediatrics and Microbiology/Immunology, Stanford University Medical Center, California 94305, USA
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38
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Abstract
Anti-varicella-zoster virus serum antibody assays and their use in vaccine development are described. Of particular interest are FAMA and neutralization assays and the gpELISA. These and other assays are compared and summarized in terms of characteristics including biologic relevance, sensitivity, specificity, and suitability for different laboratory and clinical applications.
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Affiliation(s)
- D L Krah
- Department of Virus and Cell Biology, Merck Research Laboratories, West Point, Pennsylvania, USA
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39
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Abstract
The host response to VZV is critical to the outcome of primary VZV infection. The maintenance of immune memory to the virus is required to prevent symptomatic re-infection on exogenous re-exposure to VZV and to prevent symptomatic reactivation of endogenous virus. Immunization with live varicella (Oka) vaccine elicits primary and memory immunity to VZV. Humoral and cell-mediated host responses induced by the wild-type virus and by the vaccine strain are comparable, which is consistent with the clinical observation that varicella vaccine protects against or significantly reduces the clinical symptoms caused by primary VZV infection. Widespread use of the varicella vaccine in healthy children will yield further knowledge about host-virus interactions, such as the role of exogenous re-exposure in maintaining persistent immunity, which will be relevant to vaccine strategies to prevent other human herpesvirus infections.
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Affiliation(s)
- A M Arvin
- Department of Pediatrics and Microbiology/Immunology, Stanford University School of Medicine, California, USA
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40
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Abstract
The Oka varicella vaccine has been tested in clinical trials worldwide in thousands of children. Following licensure in Japan, Korea, Germany, and the United States, the vaccine has been used in several millions of children. The vaccine has been generally well-tolerated with the most common complaints being pain and redness at the injection site and a mild rash following vaccination. The incidence of herpes zoster has not increased in vaccinees and may have decreased. Efficacy rates vary between 65% and 100% depending on the intensity of exposure to natural varicella and the potency of the vaccine. In those few vaccinees who develop MVLS, the rash is generally milder than seen following natural infection (median < 50 versus 300 lesions, respectively, as well as a lower incidence of fever). There has been no evidence to date to indicate waning immunity postvaccination. Studies are in progress in the United States to evaluate whether this will occur and the effect of booster doses of vaccine. It is expected that in countries where there is widespread use of the vaccine in healthy children, disease rates will fall dramatically as will the morbidity and mortality associated with natural varicella in this population.
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41
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Abstract
The live attenuated varicella vaccine, which is available for the prevention of chickenpox, was produced by a classic technology that also has been used for polio, measles, mumps, and rubella vaccines. There are many newer technologies that have been applied to the research and development of other vaccines. Each of these other approaches offers potential advantages and disadvantages relative to the current varicella vaccine.
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Affiliation(s)
- R W Ellis
- Merck Research Laboratories, West Point, Pennsylvania, USA
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42
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Tan AY, Connett CJ, Connett GJ, Quek SC, Yap HK, Meurice F, Lee BW. Use of a reformulated Oka strain varicella vaccine (SmithKline Beecham Biologicals/Oka) in healthy children. Eur J Pediatr 1996; 155:706-11. [PMID: 8839730 DOI: 10.1007/bf01957158] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED The first live-attenuated Oka strain varicella vaccines needed to be stored at -20 degrees C. Reformulation of this vaccine by SmithKline Beecham Biologicals has provided a vaccine shelf life of up to 2 years when stored at +4 degrees C to +8 degrees C. In this study the immunogenicity and reactogenicity of two different production lots of this reformulated vaccine at two different titres each, which corresponded to the release and expected expiry titres, were evaluated. A double-blind randomised clinical trial was conducted in healthy children aged from 9 to 24 months. Immunogenicity was assessed by the measurement of varicella specific antibodies in paired serum samples taken before and from 35 to 63 days post vaccination. Reactogenicity was assessed by the evaluation of any untoward reactions occurring up to 42 days post vaccination. In order to assess protective efficacy, parents of these subjects were contacted approximately 6 months after completion of the trial. One hundred and ninety-one subjects were recruited into the study. Of the 181 initially seronegative subjects who completed the trial according to the protocol, 179 showed seroconversion (98.9%). Reactions to the vaccine were minor and observed in 46/191 (24%) of subjects. Rashes were present in 19, fever in 22, and both fever and rash in 5. Rashes were mainly maculo-papular in nature but were vesicular in 6. Febrile reactions were shortlived. After a 6-month follow up period, attenuated varicella with minor clinical symptoms was diagnosed in 6/52 vaccinees who had close contact with natural varicella (attack rate = 11.5%). CONCLUSION This reformulated vaccine was well tolerated, highly immunogenic and provided protection against varicella. In increased stability allowing refrigerator storage makes it a good candidate for mass vaccination programmes.
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Affiliation(s)
- A Y Tan
- Department of Paediatrics, National University of Singapore
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Abstract
Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization.
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Affiliation(s)
- A M Arvin
- Department of Pediatrics, Stanford University School of Medicine, California 94305-5119, USA.
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Reuman PD, Rathore MH, Ayoub EM. Developments in childhood immunization. CURRENT PROBLEMS IN PEDIATRICS 1996; 26:107-37. [PMID: 8790972 DOI: 10.1016/s0045-9380(96)80026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P D Reuman
- Department of Pediatrics, School of Medicine, University of Florida, Gainesville, USA
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Abstract
Human herpesviruses and human papillomaviruses are ubiquitous and may cause an array of oral disease. Herpesviruses are unique because recurrent localized disease occurs after the primary infection. Human papillomaviruses are known for their ability to produce benign epithelial proliferations and increasingly are implicated in the development of oral cancer. This article reviews the pathogenesis of common oral lesions induced by these viruses.
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Affiliation(s)
- C S Miller
- Department of Oral Health Science, University of Kentucky College of Dentistry, Lexington, USA
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Ngai AL, Staehle BO, Kuter BJ, Cyanovich NM, Cho I, Matthews H, Keller P, Arvin AM, Watson B, White CJ. Safety and immunogenicity of one vs. two injections of Oka/Merck varicella vaccine in healthy children. Pediatr Infect Dis J 1996; 15:49-54. [PMID: 8684876 DOI: 10.1097/00006454-199601000-00011] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare the safety and immunogenicity of a one- vs. two-dose regimen of Oka/Merck varicella vaccine in approximately 2000 healthy children 12 months to 12 years of age. METHODOLOGY Subjects with a negative history of varicella were randomized to receive either one or two injections of the vaccine given 3 months apart and were followed for clinical reactions and serologic response (glycoprotein-based enzyme-linked immunosorbent assay). RESULTS Both one- and two-dose vaccine regimens were generally well-tolerated. The incidences of varicelliform rash and fever were less frequent after the second injection. However, a slight increase in the incidence of injection site reactions was noted after the second injection; these were generally mild. Seroconversion rates by glycoprotein-based enzyme-linked immunosorbent assay were 98.2% (1700 of 1731) after one injection and 99.9% (717 of 718) after two injections. A significant (P < 0.001) boost in geometric mean titers was observed in children who received a second injection of vaccine 3 months after the first injection. Of the children who seroconverted at 6 weeks postregimen (one or two doses as assigned), 99.8% (528 of 529) of the one-dose group and 99.8% (473 of 474) of the two-dose group maintained antibody to varicella at 1 year with geometric mean titers of 19.5 and 31.2, respectively. CONCLUSIONS Administration of a one- or two-dose regimen of the live Oka/Merck varicella vaccine (VARIVAX) is immunogenic and is generally well-tolerated in healthy children 1 to 12 years old. Antibody to varicella persists in > 99% of vaccinees 1 year after vaccination regardless of a one- or two-dose regimen. Long-term follow-up studies of this cohort of children may determine whether a two-dose regimen offers superior protection against chickenpox.
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Affiliation(s)
- A L Ngai
- Merck Research Laboratories, West Point, PA, USA
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48
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49
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Affiliation(s)
- B A Watson
- Division of Allergy, Immunology, and Infectious Diseases, Children's Hospital of Philadelphia, PA
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