1
|
Alsultan M, Kliea M, Hassan Q, Basha K. Delayed acyclovir therapy for disseminated varicella zoster in an adult kidney transplant recipient: a case report and literature review. Ann Med Surg (Lond) 2023; 85:481-5. [PMID: 36923769 DOI: 10.1097/MS9.0000000000000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/25/2022] [Indexed: 03/06/2023] Open
Abstract
Kidney transplant recipients are at increasing risk for reactivation of varicella-zoster virus (VZV) infection. Presentation of case A 31-year-old male was admitted with fever, chest pain, and dyspnea. Also, the complaints accompanied by generalized maculopapular, vesicular, hemorrhagic, itching, and painful rash with pustules and crusts on an erythematous base fill the entire body for the last 10 days. Chest computed tomography scan showed diffuse miliary and ground-glass opacities. The patient had a previous history of chickenpox infection in childhood, no recent contact with individuals suffering from VZV infection, and no known pretransplant serology for VZV. Due to the high clinical suspicion of reactivated VZV with pneumonitis and severe disseminated form, we started the treatment with intravenous acyclovir (ACV) for 10 days followed by oral ACV for a total of 21 days, along with stopping mycophenolate mofetil and increasing the prednisolone dose to 10 mg/d. The clinical status was improved and the rash receded with a flaked surface for old lesions. Conclusion We experienced a successful ACV treatment for delayed and severe VZV infection with a literature review of VZV pneumonitis among kidney transplant recipients. To the best of our knowledge, this is the first case that presented a disseminated skin form with pneumonitis of VZV from Syria. This case supports the initiation of antiviral therapy for transplant patients even after 72 hours the onset of the rash despite the lack of evidence in these circumstances.
Collapse
|
2
|
Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Burden of vaccine-preventable diseases among at-risk adult populations in the US. Hum Vaccin Immunother 2022; 18:2054602. [PMID: 35446725 PMCID: PMC9225203 DOI: 10.1080/21645515.2022.2054602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Life-course immunization holds significant benefit for population health by reducing the burden of vaccine-preventable diseases (VPD) through vaccinating individuals at different stages and circumstances in life. The study aimed to determine the epidemiologic, clinical, economic, and societal burden of VPDs among at-risk adult subpopulations in the United States. A systematic literature review was conducted for articles published between January 2010 and June 2020, which identified 72 publications. There was heterogeneity in available epidemiology data, with the prevalence of VPDs ranging from 1.1% to 68.7%. Where the disease burden was described, outcomes were typically worse among high-risk subpopulations than in the general population. Several VPDs, including herpes zoster, meningococcal, and pneumococcal infections were associated with increased costs. This review suggests that subpopulations may not frequently interact with the healthcare system, or their risk factors may not be recognized by healthcare providers, and therefore individuals may not be appropriately targeted for vaccination.
Collapse
Affiliation(s)
- Irina Kolobova
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Mawuli Kwame Nyaku
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | | | - Megan O'Brien
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| |
Collapse
|
3
|
Molochkova OV, Kovalev OB, Luzan PY, Ilyina NO, Ganiev SA, Konovalov AK, Shamsheva OV, Egorova NY, Zotova AD, Rossina AL, Korsunskiy AA, Galeeva EV, Guzhavina AA, Tebenkov AV, Shatalov VG. A case of chickenpox with multiple bacterial complications requiring surgical treatment. Det infekc 2022. [DOI: 10.22627/2072-8107-2022-21-3-61-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Chickenpox is a controlled infection, even a single vaccination effectively prevents the development of severe forms (up to 98%).Purpose — to demonstrate a case of severe chicken pox in a child aged 3.8 years with secondary infection of the skin of the right subscapular region and subcutaneous fat (phlegmon of the trunk) of streptococcal etiology.The diagnosis of varicella was confirmed by the detection of Varicella-Zoster virus DNA by PCR from the skin. Surgical treatment was performed — opening and drainage of phlegmon, purulent-serous discharge was obtained, sowing was performed, Streptococcus pyogenes was isolated.The child received antibiotic therapy — cefepime sulbactam, amikacin, acyclovir, infusion therapy, local treatment.Conclusions. The given clinical case demonstrates the development of a severe bacterial complication of chicken pox, which required surgical treatment and substantiates the need for vaccination against chicken pox and its possible complications.
Collapse
Affiliation(s)
| | - O. B. Kovalev
- Pirogov Russian National Research Medical University
| | - P. Yu. Luzan
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - N. O. Ilyina
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - Sh. A. Ganiev
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - A. K. Konovalov
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | | | | | - A. D. Zotova
- Pirogov Russian National Research Medical University
| | - A. L. Rossina
- Pirogov Russian National Research Medical University
| | - A. A. Korsunskiy
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - E. V. Galeeva
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - A. A. Guzhavina
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - A. V. Tebenkov
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| | - V. G. Shatalov
- Children's City Clinical Hospital No. 9 named after G.N. Speransky
| |
Collapse
|
4
|
Abstract
The live attenuated varicella vaccine is intended to mimic the tempo and nature of the humoral and cell-mediated immune responses to varicella infection. To date, two doses of varicella vaccine administered in childhood have been very effective in generating varicella-zoster virus (VZV) immune responses that prevent natural infection for at least several decades. After primary infection, the infecting VZV establishes latency in sensory and cranial nerve ganglia with the potential to reactivate and cause herpes zoster. Although, the immune responses developed during varicella are important for preventing herpes zoster they wane with increasing age (immune senescence) or with the advent of immune suppression. Protection can be restored by increasing cell-mediated immune responses with two doses of an adjuvanted recombinant VZV glycoprotein E vaccine that stimulates both VZV-and gE-specific immunity. This vaccine provides ~85-90% protection against herpes zoster for 7-8 years (to date).
Collapse
Affiliation(s)
- Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Adriana Weinberg
- Departments of Pediatrics, Medicine, and Pathology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
5
|
Müller F, Chandra S, Wright V, Rashid M, Redditt V. Concordance of self-reported varicella history and serology among adolescent and adult refugee patients at a primary care clinic in Toronto, Canada. Vaccine 2021; 39:6391-6397. [PMID: 34563396 DOI: 10.1016/j.vaccine.2021.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previous studies have found higher rates of varicella susceptibility among migrants from tropical regions. This study seeks to estimate the prevalence of varicella susceptibility in a cohort of newly arrived refugees and refugee claimants at a primary care clinic in Toronto and to compare patients' self-reported history of varicella infection with serologic test results. METHODS We conducted a retrospective chart review of 1888 refugee patients aged 13 years and older rostered at a specialized primary care clinic in Toronto from December 2011 to October 2017. Basic sociodemographic variables, self-reported varicella history, and varicella serologic results were examined. RESULTS Based on serologic testing, 8.5% of individuals were varicella non-immune, with highest rates of varicella susceptibility among adolescents aged 13-19 years (13.5%). All adults over age 60 were varicella immune on serology (n = 56). A positive self-reported history of varicella infection was strongly predictive of varicella immunity on serology (PPV 96.8%; 95% CI: 95.2-97.9). A self-reported history of no prior varicella infection did not correlate reliably with serologic test results (NPV 15.8%; 95% CI: 13.3-18.0). A substantial proportion of patients (34.1%) were unsure of their varicella history. CONCLUSION Identification and immunization of varicella susceptible refugee newcomers remains a health care priority. Self-reported history of varicella infection had mixed reliability as a predictor of varicella immunity.
Collapse
Affiliation(s)
- Frank Müller
- Crossroads Clinic Women's College Hospital 76 Grenville Street, Toronto ON, M5S 1B2, Canada; Department of General Practice, University Medical Center Göttingen/Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany.
| | - Shivani Chandra
- Crossroads Clinic Women's College Hospital 76 Grenville Street, Toronto ON, M5S 1B2, Canada; Women's College Hospital Institute for Health System Solutions and Virtual Care Women's College Hospital 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
| | - Vanessa Wright
- Crossroads Clinic Women's College Hospital 76 Grenville Street, Toronto ON, M5S 1B2, Canada.
| | - Meb Rashid
- Crossroads Clinic Women's College Hospital 76 Grenville Street, Toronto ON, M5S 1B2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada.
| | - Vanessa Redditt
- Crossroads Clinic Women's College Hospital 76 Grenville Street, Toronto ON, M5S 1B2, Canada; Women's College Hospital Institute for Health System Solutions and Virtual Care Women's College Hospital 76 Grenville Street, Toronto, ON M5S 1B2, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada.
| |
Collapse
|
6
|
Yamaguchi H, Nozu K, Ishiko S, Nagase H, Ninchoji T, Nagano C, Takeda H, Unzaki A, Ishibashi K, Morioka I, Iijima K, Ishida A. Epidemiological impact of universal varicella vaccination on consecutive emergency department visits for varicella and its economic impact among children in Kobe City, Japan. J Infect Chemother 2022; 28:35-40. [PMID: 34620534 DOI: 10.1016/j.jiac.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Previous studies reported a dramatic decline in the incidence of varicella and varicella-related deaths after implementing universal varicella vaccination (VarV). Although previous studies reported the effectiveness and economic impact of VarV, they were unknown in the emergency department (ED) setting. METHODS To determine the effectiveness and economic impact of VarV in the ED, Kobe, Japan, we retrospectively reviewed the clinical database of consecutive patients younger than 16 years presenting to our primary ED from 2011 to 2019. RESULTS Of the 265,191 children presenting to our ED, 3,092 patients were clinically diagnosed with varicella. The number of patients with varicella was approximately 500 annually, before introducing the universal two-dose VarV for children aged 1 to <3 years in October 2014, in the Japanese national immunization program, and decreased to approximately 200 in 2019. The number of patients with varicella younger than 1 year (ineligible for the vaccination) also decreased. Regarding the economic impact, the medical cost in our ED reduced after the introduction of VarV was JPY 4.1 million (US$ 40,049) annually. From the central data, approximately 95% of children were vaccinated after October 2014; however, a relatively large percentage of infected unvaccinated children (59.0%) presented to ED in this study. After the implementation of the universal VarV, infection was mainly observed in older children (i.e., the unvaccinated generation). CONCLUSIONS Our data showed the effectiveness and economic impact of VarV in the ED setting. Additionally, our data suggested that the public vaccination program should include older unvaccinated children and other unvaccinated individuals.
Collapse
|
7
|
Gans H, Chemaly RF. Varicella zoster immune globulin (human) (VARIZIG) in immunocompromised patients: a subgroup analysis for safety and outcomes from a large, expanded-access program. BMC Infect Dis 2021; 21:46. [PMID: 33430796 PMCID: PMC7798258 DOI: 10.1186/s12879-020-05656-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
Background Immunocompromised children and adults are at increased risk for severe disease and death following varicella zoster virus infection. Varicella zoster immune globulin (human) (VARIZIG) is recommended for post-exposure prophylaxis to prevent or attenuate varicella infection in high-risk individuals. Methods An open-label, expanded-access program provided VARIZIG to high-risk individuals exposed to varicella or herpes zoster. Immunocompromised participants were stratified by type of immunocompromising condition (“oncologic immunodeficiency”, “primary immunodeficiency”, “solid organ transplant” [SOT], “hematopoietic cell transplant” [HCT], and “other”). Patient characteristics, type of exposure and varicella outcome, and safety data were assessed. Results This analysis included 40 adults (primary [n = 6] or oncologic [n = 10] immunodeficiencies, history of SOT [n = 5] or HCT [n = 6], and other [n = 13]), and 263 children (primary [n = 13] or oncologic [n = 152] immunodeficiencies, history of SOT [n = 36] or HCT [n = 17], and other [n = 45]). Among adults and children, 48% vs 72% were exposed to varicella, 38% vs 16% were exposed to herpes zoster, and 15% vs 12% had an unspecified exposure. Overall incidence of varicella infection in adults after VARIZIG use was 6%; incidence of varicella infection in children after VARIZIG use was 7%. Similar rates were noted in each subgroup. Most cases of varicella were mild, with two children developing > 100 lesions and no cases of varicella-related pneumonia or encephalitis. Varicella-related hospitalizations occurred primarily in children with oncologic immunodeficiencies. One serious adverse event (serum sickness) was considered related to VARIZIG and occurred in a child with oncologic immunodeficiency. There were no varicella- or VARIZIG-related deaths. Conclusions These data indicate that VARIZIG may reduce severity of varicella in immunocompromised children and adults. Trial registration This study was retrospectively registered with the public clinical trial identification NCT00338442 at https://www.clinicaltrials.gov on 20 June 2006.
Collapse
Affiliation(s)
- Hayley Gans
- Departments of Pediatrics and Division of Infectious Diseases, Stanford University School of Medicine, 300 Pasteur Drive, Unit G312, Stanford, CA, 94305, USA.
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 402, Houston, TX, 77030, USA
| |
Collapse
|
8
|
Petraglia TCDMB, Farias PMCDM, Sá GRSE, Santos EMD, Conceição DAD, Maia MDLDS. Vaccine failures: assessing yellow fever, measles, varicella, and mumps vaccines. CAD SAUDE PUBLICA 2020; 36Suppl 2:e00008520. [PMID: 33146313 DOI: 10.1590/0102-311x00008520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022] Open
Abstract
Vaccination is one of the greatest public health interventions, based on its safety and effectiveness, but vaccination does not always mean immunization. Numerous aspects related both to the individual that receives the vaccine and the specificity of each vaccine administered are part of the process of obtaining adequate immunization, and it is essential to observe the aspects in order to avoid vaccine failures. The analysis of immunogenicity and effectiveness studies for the measles, varicella, and mumps vaccines point to the need to incorporate two doses into the basic vaccination calendars in order to control these diseases. Epidemiological studies that analyzed outbreaks of these diseases identified cases in individuals that received two doses of the vaccine, which may indicate likely secondary failure. For the yellow fever vaccine, the current discussion lies in the ideal number of doses for individual protection. The World Health Organization recommends a single dose for life. Despite the few reports in the literature concerning vaccine failures, immunogenicity studies demonstrate waning protection over the years, mainly in the pediatric age bracket. In the current scenario of elimination and control of diseases, associated with the decrease in the circulation of the wild-type viruses, the role of epidemiological surveillance is crucial for expanding knowledge on the multiple factors involved, culminating in vaccine failures and the emergence of outbreaks. Outbreaks of vaccine-preventable diseases negatively impact the credibility of immunization programs, leading to low vaccination coverage rates and interfering in vaccination's success.
Collapse
Affiliation(s)
| | | | - Glória Regina Silva E Sá
- Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | | |
Collapse
|
9
|
Yu H, Wang Y, Peng Q, Shao Y, Duan C, Zhu Y, Dong S, Li C, Shi Y, Zhang N, Zheng Y, Chen Y, Jiang Q, Zhong P, Zhou Y. Influence of coarse particulate matter on chickenpox in Jiading District, Shanghai, 2009-2018: A distributed lag non-linear time series analysis. Environ Res 2020; 190:110039. [PMID: 32810505 DOI: 10.1016/j.envres.2020.110039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
Although the link between ambient air pollution and some infectious diseases has been studied, few studies have explored so far, the relationship between chickenpox and particulate matter. Daily chickenpox counts in Jiading District, Shanghai, were collected from 2009 to 2018. Time series analysis was conducted to describe the trends of the daily number of chickenpox cases and the concentration of particulate matter 10 μm or less (PM10). The distributed lag non-linear model (DLNM) was developed to assess the lag and non-linear relationship between the number of chickenpox cases and PM10 concentration adjusting for meteorological factors and other pollutants. Spatiotemporal scanning was used to detect the clustering of chickenpox cases. There was a concomitant relationship between the number of chickenpox cases and PM10 concentration, especially in the period of high PM10 concentration. DLNM results showed a nonlinear relationship between the number of chickenpox cases and PM10 concentration with the maximum effect of PM10 being lagged for 13-14 days, which was consistent with the average incubation period of chickenpox. PM10 was significantly associated with the daily number of chickenpox cases when above 300 μg/m3. The risk of chickenpox increased with increasing PM10 concentration and the association was strongest at the lag of 14 day (RR = 1.13, 95% CI: 1.04-1.23) for PM10 concentration of 500 μg/m3 versus 50 μg/m3. The study provides evidence that high PM10 concentration increases the risk of chickenpox spreading.
Collapse
Affiliation(s)
- Hongjie Yu
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yingjian Wang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Qian Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yueqin Shao
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Chunmei Duan
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yefan Zhu
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Shurong Dong
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Chunlin Li
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Ying Shi
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Na Zhang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Yingyan Zheng
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Qingwu Jiang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Peisong Zhong
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China.
| | - Yibiao Zhou
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China; Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong an Road, Xuhui District, Shanghai, 200032, China; Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
| |
Collapse
|
10
|
Carter-Pokras O, Hutchins S, Gaudino JA, Veeranki SP, Lurie P, Weiser T, DeMarco M, Khan NF, Cordero JF. The role of epidemiology in informing United States childhood immunization policy and practice. Ann Epidemiol 2020; 62:100-14. [PMID: 33065268 DOI: 10.1016/j.annepidem.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 08/17/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022]
Abstract
One of the ten greatest public health achievements is childhood vaccination because of its impact on controlling and eliminating vaccine-preventable diseases (VPDs). Evidence-based immunization policies and practices are responsible for this success and are supported by epidemiology that has generated scientific evidence for informing policy and practice. The purpose of this report is to highlight the role of epidemiology in the development of immunization policy and successful intervention in public health practice that has resulted in a measurable public health impact: the control and elimination of VPDs in the United States. Examples in which epidemiology informed immunization policy were collected from a literature review and consultation with experts who have been working in this field for the past 30 years. Epidemiologic examples (e.g., thimerosal-containing vaccines and the alleged association between the measles, mumps, and rubella (MMR) vaccine and autism) are presented to describe challenges that epidemiologists have addressed. Finally, we describe ongoing challenges to the nation's ability to sustain high vaccination coverage, particularly with concerns about vaccine safety and effectiveness, increasing use of religious and philosophical belief exemptions to vaccination, and vaccine hesitancy. Learning from past and current experiences may help epidemiologists anticipate and address current and future challenges to respond to emerging infectious diseases, such as COVID-19, with new vaccines and enhance the public health impact of immunization programs for years to come.
Collapse
|
11
|
Grose C, Enquist LW. The round trip model for severe herpes zoster caused by live attenuated varicella vaccine virus. J Med Virol 2020; 92:938-940. [PMID: 31943220 PMCID: PMC7354881 DOI: 10.1002/jmv.25664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
Varicella vaccine is a live attenuated varicella‐zoster virus. Varicella vaccine can enter latency and later reactivate as herpes zoster. Pseudorabies virus is another herpesvirus closely related to varicella‐zoster virus. The round trip model for pseudorabies virus explains pathogenesis of herpes zoster from vaccine virus.
Collapse
Affiliation(s)
- Charles Grose
- Virology Laboratory, Children's Hospital, University of IowaIowaIowa
| | - Lynn W. Enquist
- Department of Molecular BiologyPrinceton UniversityPrincetonNew Jersey
| |
Collapse
|
12
|
Abstract
We reported previously that the annual average mortality rate in the United States in 2008-2011 for varicella listed as the underlying cause declined 87% compared with the prevaccine period (1990-1994). Here, we update the analysis with five additional years of data. We used varicella death data from the 2012-2016 Mortality Multiple Cause-of Death records to calculate mortality rates during 2012-2016 and trends since the prevaccine period and end of 1-dose vaccination program (2005-2007). The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.03 per million population during 2012-2016, a 94% reduction from prevaccine years and a 47% reduction from 2005-2007. Varicella deaths continue to decline due to the varicella vaccination program in the United States.
Collapse
Affiliation(s)
| | - Mona Marin
- a National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta , GA , USA
| |
Collapse
|
13
|
Leung J, Reagan-Steiner S, Lopez A, Jeyarajah J, Marin M. Varicella Vaccination Among US Adolescents: Coverage and Missed Opportunities, 2007-2014. J Public Health Manag Pract 2019; 25:E19-26. [PMID: 29889179 DOI: 10.1097/PHH.0000000000000819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Since 2007, 2 doses of varicella vaccine have been routinely recommended, with a catch-up second dose recommended for those who received only 1 prior dose. OBJECTIVE To examine varicella vaccination coverage with 2 or more doses and the proportions of adolescents with evidence of immunity to varicella (≥2 doses of vaccine or varicella history) during 2007-2014. To assess timing of second-dose receipt, factors associated with 2 or more vaccine doses, and missed second-dose opportunities during 2014. DESIGN, SETTING, AND PARTICIPANTS We used data from the 2007-2014 National Immunization Survey-Teen (NIS-Teen), which collects information on adolescents aged 13 to 17 years in the United States. RESULTS From 2007 to 2014, varicella vaccination coverage with 2 or more doses increased from 8.3% to 66.9% in 13- to 15-year-olds and from 3.6% to 56.7% in 16- to 17-year-olds. The proportions with evidence of immunity also increased from 68.0% to 84.1% (13- to 15-year-olds) and 78.6% to 83.4% (16- to 17-year-olds). In 2014, 13.4% of 13- to 15-year-olds and 3.2% of 16- to 17-year-olds had received their second dose at 4 to 6 years of age. Factors most significantly associated with lower coverage with 2 or more doses were not having an 11- to 12-year well-child visit, not receiving an adolescent vaccine, and residence in a state with no 2-dose immunization school entry requirement. Seventy-seven percent of 1-dose vaccinated adolescents had 1 or more missed opportunities to receive their second dose; if were they not missed, 2-dose coverage would have increased from 79.5% to 94.8%. CONCLUSIONS Levels of varicella vaccination coverage with 2 or more doses and the proportion of adolescents with evidence of immunity increased from 2007 to 2014, though 16% lacked evidence of immunity in 2014. Although catch-up campaigns have succeeded, missed vaccination opportunities persist.
Collapse
|
14
|
Abstract
Varicella and zoster continue to cause significant morbidity and even mortality in children and adults. Complications include bacterial superinfection, central nervous system manifestations such as meningitis, encephalitis, and cerebellar ataxia, and pain syndromes especially post herpetic neuralgia. Many developed countries but not all, are now administering live attenuated varicella vaccine routinely, with a decrease in the incidence of disease, providing personal and herd immunity. There is some controversy, however, in some countries concerning whether a decrease in the circulation of wild type virus will result in loss of immunity to VZV in persons who have already had varicella. This manuscript reviews the complications of varicella and zoster in detail, the reasons for development of vaccines against these diseases, complications of vaccinations, and mechanisms by which immunity to this virus develops and is maintained. There are strong indications that the best way to control disease and spread of this virus is by vaccination against both.
Collapse
Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
| |
Collapse
|
15
|
Abstract
INTRODUCTION Varicella vaccines are highly effective at preventing disease, but varicella may occur among vaccinated persons (termed breakthrough varicella). Breakthrough varicella is generally mild, but severe cases have been reported. The objective of this review is to describe severe breakthrough varicella. Areas covered: We conducted a systematic review of articles published during 1974-2016. A total of 34 articles were included in our review: 21 described breakthrough varicella with disseminated varicella-zoster virus (VZV) infection with other organ involvement in addition to skin (none among two-dose vaccinees); 9 described hospitalized breakthrough varicella without mention of other organ involvement in addition to skin (of which 2 reported 4 two-dose vaccinees); and 4 described both. A total of 52-60 unique breakthrough varicella cases with disseminated VZV infection with other organ involvement in addition to skin reported with the following complications, not mutually exclusive: pneumonia (n = 8-9 cases), neurologic (n = 18-24 cases), hematologic (n = 10-11 cases), ocular (n = 5 cases), renal (n = 2 cases), hepatic (n = 3 cases), secondary infection with bacteremia or sepsis (n = 8 cases), and other complication (n = 4 cases). There were 6 cases of fatal breakthrough varicella. Expert commentary: With >31 million doses distributed annually worldwide since 2007, severe breakthrough varicella can occur but they appear to be uncommon.
Collapse
Affiliation(s)
- Jessica Leung
- Epidemiology Branch, Division of Viral Diseases, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta,
GA, USA
| | - Karen R. Broder
- Immunization Safety Office, Division of Healthcare Quality Promotion,
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control
and Prevention, Atlanta, GA, USA
| | - Mona Marin
- Epidemiology Branch, Division of Viral Diseases, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta,
GA, USA
| |
Collapse
|
16
|
Su JR, Leroy Z, Lewis PW, Haber P, Marin M, Leung J, Jane Woo E, Shimabukuro TT. Safety of Second-Dose Single-Antigen Varicella Vaccine. Pediatrics 2017; 139:peds.2016-2536. [PMID: 28174201 PMCID: PMC6434520 DOI: 10.1542/peds.2016-2536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In 2006, routine 2-dose varicella vaccination for children was recommended to improve control of varicella. We assessed the safety of second-dose varicella vaccination. METHODS We identified second-dose single-antigen varicella vaccine reports in the Vaccine Adverse Event Reporting System during 2006 to 2014 among children aged 4 to 18 years. We analyzed reports by age group (4-6 and 7-18 years), sex, serious or nonserious status, most common adverse events (AEs), and whether other vaccines were administered concomitantly with varicella vaccine. We reviewed serious reports of selected AEs and conducted empirical Bayesian data mining to detect disproportional reporting of AEs. RESULTS We identified 14 641 Vaccine Adverse Event Reporting System reports after second-dose varicella vaccination, with 494 (3%) classified as serious. Among nonserious reports, injection site reactions were most common (48% of children aged 4-6 years, 38% of children aged 7-18 years). The most common AEs among serious reports were pyrexia (31%) for children aged 4 to 6 years and headache (28%) and vomiting (27%) for children aged 7 to 18 years. Serious reports of selected AEs included anaphylaxis (83), meningitis (5), encephalitis (16), cellulitis (52), varicella (6), herpes zoster (6), and deaths (7). One immunosuppressed adolescent was reported with vaccine-strain herpes zoster. Only previously known AEs were reported more frequently after second-dose varicella vaccination compared with other vaccines. CONCLUSIONS We identified no new or unexpected safety concerns for second-dose varicella vaccination. Robust safety monitoring remains an important component of the national varicella vaccination program.
Collapse
Affiliation(s)
- John R. Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease
| | - Zanie Leroy
- School Health Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion
| | - Paige W. Lewis
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease
| | - Penina Haber
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease
| | - Mona Marin
- Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Leung
- Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Jane Woo
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Springs, MD
| | - Tom T. Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease
| |
Collapse
|
17
|
Lopez AS, Zhang J, Marin M. Epidemiology of Varicella During the 2-Dose Varicella Vaccination Program - United States, 2005-2014. MMWR Morb Mortal Wkly Rep 2016; 65:902-5. [PMID: 27584717 DOI: 10.15585/mmwr.mm6534a4] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Before availability of varicella vaccine in the United States, an estimated 4 million varicella cases, 11,000-13,500 varicella-related hospitalizations, and 100-150 varicella-related deaths occurred annually. The varicella vaccination program was implemented in the United States in 1996 as a 1-dose routine childhood program. Based on data from two varicella active surveillance sites, the varicella vaccination program led to 90% decline in incidence over the next decade (1). However, because of continued varicella outbreaks, a routine 2-dose schedule (at ages 12-15 months and 4-6 years) was recommended and has been in place since 2006 (2). The declines in incidence (1,3-6) made it feasible for states to implement varicella case-based surveillance and to report varicella data to CDC through the National Notifiable Diseases Surveillance System (NNDSS). State data have become the primary source for monitoring trends in varicella incidence nationally (7). Using NNDSS data, CDC previously reported nationwide declines in varicella incidence of 72% from the end of the 1-dose to the early years of the 2-dose varicella vaccination program (2006-2010) (7). This report updates varicella incidence trends to include the most recent years in the 2-dose varicella vaccination program. Between the period 2005-2006 (before the 2-dose recommendation) and 2013-2014, overall varicella incidence declined 84.6%, with the largest declines reported in children aged 5-9 years (89.3%) and 10-14 years (84.8%). The availability of varicella-specific data varied over time. During the last 2 years examined (2013 and 2014), completeness of reporting of two critical variables monitored by CDC, vaccination status (receipt of at least 1 dose of varicella vaccine) of cases and severity of disease based on number of lesions, were 54.2% and 39.1%, respectively. State and local health departments, in collaboration with CDC, should continue working to improve reporting of cases and completeness of critical varicella-specific variables to better monitor impact of the varicella vaccination program.
Collapse
Affiliation(s)
- Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | | | | |
Collapse
|
18
|
Abstract
A 12-year-old male child with Down syndrome, who had recovered from congenital heart disease, succumbed to severe varicella myocarditis. His clinical presentation at admission mimicked acute coronary syndrome. Analysis of this case throws insight into several aspects of varicella myocarditis.
Collapse
|
19
|
Abstract
CONTEXT Several varicella vaccines are available worldwide. Countries with a varicella vaccination program use 1- or 2-dose schedules. OBJECTIVE We examined postlicensure estimates of varicella vaccine effectiveness (VE) among healthy children. DATA SOURCES Systematic review and descriptive and meta-analysis of Medline, Embase, Cochrane libraries, and CINAHL databases for reports published during 1995-2014. STUDY SELECTION Publications that reported original data on dose-specific varicella VE among immunocompetent children. DATA EXTRACTION We used random effects meta-analysis models to obtain pooled one dose VE estimates by disease severity (all varicella and moderate/severe varicella). Within each severity category, we assessed pooled VE by vaccine and by study design. We used descriptive statistics to summarize 1-dose VE against severe disease. For 2-dose VE, we calculated pooled estimates against all varicella and by study design. RESULTS The pooled 1-dose VE was 81% (95% confidence interval [CI]: 78%-84%) against all varicella and 98% (95% CI: 97%-99%) against moderate/severe varicella with no significant association between VE and vaccine type or study design (P > .1). For 1 dose, median VE for prevention of severe disease was 100% (mean = 99.4%). The pooled 2-dose VE against all varicella was 92% (95% CI: 88%-95%), with similar estimates by study design. LIMITATIONS VE was assessed primarily during outbreak investigations and using clinically diagnosed varicella. CONCLUSIONS One dose of varicella vaccine was moderately effective in preventing all varicella and highly effective in preventing moderate/severe varicella, with no differences by vaccine. The second dose adds improved protection against all varicella.
Collapse
Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Melanie Marti
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anita Kambhampati
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Stanley M Jeram
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Jane F Seward
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| |
Collapse
|