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2.
Curr Opin Nephrol Hypertens ; 28(6): 581-586, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31567282

RESUMEN

PURPOSE OF REVIEW: Kidney transplant recipients are at high risk of contracting infections, some of which are considered vaccine-preventable, because of their highly immunosuppressed state. In this vulnerable group of patients, infection can lead to poor outcomes including graft failure and death, thus vaccination in the posttransplant population is an important strategy in order to mitigate this risk. The present review is aimed at providing an update on recent advances with respect to vaccination strategies in kidney transplant recipients. RECENT FINDINGS: General principles behind vaccination in kidney transplantation have remained consistent over many years. More recently, efforts have been focused on developing newer strategies for vaccination against influenza and herpes zoster in organ transplant recipients. Newer data on the immunogenicity of vaccines directed against pneumococcal disease, human papillomavirus, and hepatitis B virus in kidney transplant recipients have become available and will also be discussed in the present review. SUMMARY: Kidney transplant recipients are highly-vulnerable to contracting serious infections by way of their immunosuppressed state and their dampened ability to mount an immunogenic response to vaccines. Thus, ongoing advances in vaccination strategies in this group of patients should be an important area of focus of future research in order to help promote healthier living and greater survival postkidney transplant.


Asunto(s)
Trasplante de Riñón/efectos adversos , Vacunación , Vacunas contra Hepatitis B/inmunología , Vacuna contra el Herpes Zóster/inmunología , Humanos , Vacunas contra la Influenza/inmunología , Vacunas Meningococicas/inmunología , Vacunas contra Papillomavirus/inmunología , Vacunas Neumococicas/inmunología
3.
Pediatrics ; 144(3)2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31471448

RESUMEN

CONTEXT: Live vaccines usually provide robust immunity but can transmit the vaccine virus. OBJECTIVE: To assess the characteristics of secondary transmission of the vaccine-strain varicella-zoster virus (Oka strain; vOka) on the basis of the published experience with use of live varicella and zoster vaccines. DATA SOURCES: Systematic review of Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for articles published through 2018. STUDY SELECTION: Articles that reported original data on vOka transmission from persons who received vaccines containing the live attenuated varicella-zoster virus. DATA EXTRACTION: We abstracted data to describe vOka transmission by index patient's immune status, type (varicella or herpes zoster) and severity of illness, and whether transmission was laboratory confirmed. RESULTS: Twenty articles were included. We identified 13 patients with vOka varicella after transmission from 11 immunocompetent varicella vaccine recipients. In all instances, the vaccine recipient had a rash: 6 varicella-like and 5 herpes zoster. Transmission occurred mostly to household contacts. One additional case was not considered direct transmission from a vaccine recipient, but the mechanism was uncertain. Transmission from vaccinated immunocompromised children also occurred only if the vaccine recipient developed a rash postvaccination. Secondary cases of varicella caused by vOka were mild. LIMITATIONS: It is likely that other vOka transmission cases remain unpublished. CONCLUSIONS: Healthy, vaccinated persons have minimal risk for transmitting vOka to contacts and only if a rash is present. Our findings support the existing recommendations for routine varicella vaccination and the guidance that persons with vaccine-related rash avoid contact with susceptible persons at high risk for severe varicella complications.


Asunto(s)
Vacuna contra la Varicela/inmunología , Vacuna contra el Herpes Zóster/inmunología , Infección por el Virus de la Varicela-Zóster/transmisión , Vacuna contra la Varicela/efectos adversos , Exantema/virología , Vacuna contra el Herpes Zóster/efectos adversos , Humanos , Inmunocompetencia , Huésped Inmunocomprometido , Factores de Riesgo , Seroconversión , Índice de Severidad de la Enfermedad , Vacunas Atenuadas
4.
Nurse Pract ; 44(9): 43-47, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31436592

RESUMEN

The recombinant zoster vaccine (Shingrix) was approved to help combat the incidence of shingles in patients age 50 years and older and the CDC now recommends it over the zoster vaccine live (Zostavax). This article highlights practical considerations to help clinicians appropriately apply the most recent vaccine recommendations to their patients.


Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/prevención & control , Guías de Práctica Clínica como Asunto , Anciano , Anciano de 80 o más Años , Vacuna contra el Herpes Zóster/inmunología , Humanos , Persona de Mediana Edad , Vacunas Sintéticas
5.
J Manag Care Spec Pharm ; 25(9): 989-994, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31456496

RESUMEN

BACKGROUND: Pharmacies have a unique opportunity to address suboptimal adult vaccination rates, but few solutions have proven effective. Such strategies are challenged by the lack of access that many pharmacies have to a patient's complete immunization history; consequently, they are unable to identify which of their patients actually require vaccination. A pharmacy-based strategy that leverages such information could enhance efforts to increase rates of guideline-based vaccination. OBJECTIVE: To determine the effect on vaccination rates of an automated telephonic intervention for adults in need of either pneumococcal vaccination or herpes zoster vaccination, or both. METHODS: Over a 1-year period, patients with identified vaccine gaps at 246 pharmacies of 3 pharmacy chains were randomly assigned to receive either usual care or an automated telephonic prompt for pneumococcal and/or herpes zoster vaccines based on patient records contained in state immunization registries and pharmacy data. The primary outcome was the proportion with administration of at least one of the vaccines offered between March 2016 and January 2017 based on intention-to-treat principles. Subgroup analyses included vaccination rates by age and sex. An as-treated analysis was also performed. RESULTS: 21,971 patients were included in the study, 57% of whom were female, with a mean age of 63 years. Vaccine administration proportions were 0.0214 (236/11,009) in the intervention group, and 0.0205 (225/10,962) in the control group (OR = 1.05, 95% CI = 0.87-1.26). Results did not differ in subgroup analyses based on patient age, sex, or individual pharmacy chain. Among intervention patients, 3,666 (0.333) completed the call by listening to the entire prompt. In an as-treated analysis comparing individuals who completed calls versus control, the intervention increased the odds of vaccination by 26% (OR = 1.26, 95% CI = 1.00-1.61). CONCLUSIONS: The automated prompt did not significantly increase vaccination rates. Potential barriers included intervention technical flaws, low rates of connecting with patients, insufficient follow-up by the pharmacy, and patients placing a relatively low priority on being vaccinated. DISCLOSURES: This project was funded by Pfizer and Merck through a grant from the Pharmacy Quality Alliance. Stolpe was an employee of the Pharmacy Quality Alliance at the onset of this project and an employee of Scientific Technologies Corporation during the data collection phase of the project. Stolpe has also served on the advisory board for Merck. Choudhry has no conflicts of interest to declare.


Asunto(s)
Servicios Comunitarios de Farmacia/estadística & datos numéricos , Inmunización/estadística & datos numéricos , Teléfono/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Femenino , Vacuna contra el Herpes Zóster/inmunología , Humanos , Vacunas contra la Influenza/inmunología , Masculino , Persona de Mediana Edad , Farmacéuticos/estadística & datos numéricos , Vacunas Neumococicas/inmunología , Sistema de Registros , Encuestas y Cuestionarios
6.
Hautarzt ; 70(8): 645-656, 2019 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-31270550

RESUMEN

Herpes zoster (HZ) is caused by the reactivation of varicella zoster virus. The incidence of herpes zoster and associated problems increases with age. With a life-long prevalence of 30%, every second 85-year-old person experiences HZ once in his lifetime. Three therapeutic columns are based on antiviral, topical and analgetic therapies. An extreme handicap is acute and persistent pain which can develop into postherpetic neuralgia (PHN). Those pain symptoms are predominantly neuropathic. The management of acute and chronic manifestation of pain may be challenging. HZ vaccination represents a substantial improvement in terms of prevention of herpes zoster and reduction of long-term complications, such as PHN. The permanent vaccination commission of the Robert Koch Institute recommends vaccination with dead virus for all persons over the age of 60 years. Risk groups like immunosuppressed patients are advised to be vaccinated starting at the age of 50 years.


Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/complicaciones , Herpesvirus Humano 3/patogenicidad , Neuralgia Posherpética/prevención & control , Vacunación , Anciano , Anciano de 80 o más Años , Envejecimiento/inmunología , Antivirales/uso terapéutico , Herpes Zóster/tratamiento farmacológico , Vacuna contra el Herpes Zóster/inmunología , Humanos , Persona de Mediana Edad , Neuralgia Posherpética/tratamiento farmacológico
7.
Hum Vaccin Immunother ; 15(12): 2865-2872, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31216205

RESUMEN

In two pivotal efficacy studies (ZOE-50; ZOE-70), the adjuvanted recombinant zoster vaccine (RZV) demonstrated >90% efficacy against herpes zoster (HZ).Adults aged ≥50 or ≥70 years (ZOE-50 [NCT01165177]; ZOE-70 [NCT01165229]) were randomized to receive 2 doses of RZV or placebo 2 months apart. Vaccine efficacy and safety were evaluated post-hoc in the pooled (ZOE-50/70) population according to the number and type of selected medical conditions present at enrollment.At enrollment, 82.3% of RZV and 82.7% of placebo recipients reported ≥1 of the 15 selected medical conditions. Efficacy against HZ ranged from 84.5% (95% Confidence Interval [CI]: 46.4-97.1) in participants with respiratory disorders to 97.0% (95%CI: 82.3-99.9) in those with coronary heart disease. Moreover, efficacy remained >90% irrespective of the number of selected medical conditions reported by a participant.As indicated by the similarity of the point estimates, this post-hoc analysis suggests that RZV efficacy remains high in all selected medical conditions, as well as with increasing number of medical conditions. No safety concern was identified by the type or number of medical conditions present at enrollment.


Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/inmunología , Herpes Zóster/prevención & control , Neuralgia Posherpética/prevención & control , Potencia de la Vacuna , Adyuvantes Inmunológicos/administración & dosificación , Anciano , Enfermedad Crónica , Comorbilidad , Interpretación Estadística de Datos , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Neuralgia Posherpética/inmunología , Factores de Riesgo , Vacunación , Vacunas Sintéticas/inmunología
8.
Phytomedicine ; 60: 152905, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31182297

RESUMEN

BACKGROUND: Vaccine adjuvants are compounds that significantly enhance/prolong the immune response to a co-administered antigen. The limitations of the use of aluminium salts that are unable to elicite cell responses against intracellular pathogens such as those causing malaria, tuberculosis, or AIDS, have driven the development of new alternative adjuvants such as QS-21, a triterpene saponin purified from Quillaja saponaria. PURPOSE: The aim of this review is to attempt to clarify the mechanism of action of QS-21 through either receptors or signaling pathways in vitro and in vivo with special emphasis on the co-administration with other immunostimulants in new adjuvant formulations, called adjuvant systems (AS). Furthermore, the most relevant clinical applications will be presented. METHODS: A literature search covering the period 2014-2018 was performed using electronic databases from Sci finder, Science direct, Medline/Pubmed, Scopus, Google scholar. RESULTS: Insights into the mechanism of action of QS-21 can be summarized as follows: 1) in vivo stimulation of Th2 humoral and Th1 cell-mediated immune responses through action on antigen presenting cells (APCs) and T cells, leading to release of Th1 cytokines participating in the elimination of intracellular pathogens. 2) activation of the NLRP3 inflammasome in mouse APCs with subsequent release of caspase-1 dependent cytokines, Il-1ß and Il-18, important for Th1 responses. 3) synthesis of nearly 50 QS-21 analogs, allowing structure/activity relationships and mechanistic studies. 4) unique synergy mechanism between monophosphoryl lipid A (MPL A) and QS-21, formulated in a liposome (AS01) in the early IFN-γ response, promoting vaccine immunogenicity. The second part of the review is related to phase I-III clinical trials of QS-21, mostly formulated in ASs, to evaluate efficacy, immunogenicity and safety of adjuvanted prophylactic vaccines against infectious diseases, e.g. malaria, herpes zoster, tuberculosis, AIDS and therapeutic vaccines against cancer and Alzheimer's disease. CONCLUSION: The most advanced phase III clinical applications led to the development of two vaccines containing QS-21 as part of the AS, the Herpes Zoster vaccine (HZ/su) (Shingrix™) which received a license in 2017 from the FDA and a marketing authorization in the EU in 2018 and the RTS,S/AS01 vaccine (Mosquirix™) against malaria, which was approved by the EMA in 2015 for further implementation in Sub-Saharan countries for routine use.


Asunto(s)
Adyuvantes Inmunológicos/farmacología , Vacuna contra el Herpes Zóster/inmunología , Inmunidad Celular/efectos de los fármacos , Lípido A/análogos & derivados , Vacunas contra la Malaria/inmunología , Saponinas/farmacología , Vacunas Sintéticas/inmunología , Adyuvantes Inmunológicos/administración & dosificación , Animales , Células Presentadoras de Antígenos/inmunología , Citocinas/inmunología , Inflamasomas/efectos de los fármacos , Lípido A/administración & dosificación , Lípido A/farmacología , Liposomas/administración & dosificación , Ratones , Saponinas/administración & dosificación , Linfocitos T/inmunología
9.
Cancer ; 125(8): 1301-1312, 2019 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-30707761

RESUMEN

BACKGROUND: The adjuvanted recombinant zoster vaccine (RZV) has demonstrated >90% efficacy against herpes zoster in adults ≥50 years of age and 68% efficacy in autologous hematopoietic stem cell transplant recipients ≥18 years of age. We report the immunogenicity and safety of RZV administered to patients with solid tumors (STs) before or at the start of a chemotherapy cycle. METHOD: In this phase 2/3 observer-blind, multicenter study (NCT01798056), patients with STs who were ≥18 years of age were randomized (1:1) to receive 2 doses of RZV or placebo 1-2 months apart and stratified (4:1) according to the timing of the first dose with respect to the start of a chemotherapy cycle (first vaccination 8-30 days before the start or at the start [±1 day] of a chemotherapy cycle). Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4+ T cell frequencies, and vaccine response rates (VRRs) were assessed 1 month after dose 1 and 1 and 12 months after dose 2. Reactogenicity and safety were assessed in the total vaccinated cohort through 12 months after dose 2. RESULTS: There were 232 participants in the total vaccinated cohort, 185 participants in the according-to-protocol cohort for humoral immunogenicity, and 58 participants in the according-to-protocol cohort for cell-mediated immunogenicity. Postvaccination anti-gE antibody concentrations, gE-specific CD4+ T cell frequencies and VRRs were higher in RZV recipients than in placebo recipients. Solicited adverse events (AEs) were more frequent among RZV recipients than placebo recipients. Incidence of unsolicited AEs, serious AEs, fatalities, and potential immune-mediated diseases were similar between RZV and placebo recipients. CONCLUSION: RZV was immunogenic in patients with STs receiving immunosuppressive chemotherapies. Humoral and cell-mediated immune responses persisted 1 year after vaccination. No safety concerns were identified.


Asunto(s)
Adyuvantes Inmunológicos/administración & dosificación , Anticuerpos Antivirales/metabolismo , Quimioterapia/métodos , Vacuna contra el Herpes Zóster/administración & dosificación , Neoplasias/tratamiento farmacológico , Adulto , Anciano , Antígenos Virales/inmunología , Terapia Combinada , Femenino , Vacuna contra el Herpes Zóster/inmunología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/inmunología , Resultado del Tratamiento , Vacunas Sintéticas , Adulto Joven
10.
Aging Clin Exp Res ; 31(3): 301-307, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30805865

RESUMEN

Herpes zoster (HZ) is a painful cutaneous rash with vesicular lesions, lasting up to 3 weeks, and caused by reactivation of the latent varicella zoster virus (VZV). It may be associated with complications, the most feared being post-herpetic neuralgia. Effective vaccines are available to prevent HZ, but uptake remains low. We report here the conclusions of an expert focus group convened by the European Interdisciplinary Council on Ageing (EICA). The group discussed how existing recommendations regarding HZ vaccination could be better implemented, and how compliance and coverage with HZ vaccination could be enhanced. This report proposes strategies to increase awareness of HZ and its vaccine, enhance vaccine uptake, and educate regarding the role of prevention, including immunization, as a means to "age well". A key strategy that could rapidly and easily be implemented at low cost is co-administration of HZ vaccine with other vaccines scheduled in the target age group. The scientific evidence surrounding the safety and efficacy of co-administration is discussed. Other strategies, such as active calls, publicity campaigns and national vaccine registries are also outlined. There is a compelling need for a full consensus document that carries weight across all the healthcare professions involved in vaccination, to issue simple and basic recommendations for all healthcare providers.


Asunto(s)
Envejecimiento , Grupos Focales , Vacuna contra el Herpes Zóster/inmunología , Vacunación , Adulto , Europa (Continente) , Humanos
11.
Aging Clin Exp Res ; 31(3): 421-423, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30737649

RESUMEN

Recently, the National Immunization Plan (NIP) in Italy has highlighted the importance of immunization practices also for adults, including vaccinations against influenza, Pneumococcus (PNO) and HZ. In response to the NIP, the Calabria region decided to offer HZ vaccination to the two cohorts of 65- and 70-year-old subjects. We at the Reggio Calabria Local Health Services, concentrated our efforts on addressing all the above-mentioned shortcomings and, as a first measure, we addressed the convenience problem by scheduling the HZ vaccine administration during the same visit as the pneumococcal vaccination (PCV13 vaccine). The adhesion rates were satisfactory in both cohorts-such high levels of vaccine coverage for HZ and PCV13 had never been reached before in our region and are still among the highest in Italy. However, the main result was undoubtedly the significantly high rate of PCV13 and HZ vaccine co-administration without safety problems.


Asunto(s)
Vacuna contra el Herpes Zóster/inmunología , Vacunación , Anciano , Femenino , Humanos , Programas de Inmunización , Italia , Masculino , Vacunas Neumococicas/inmunología
13.
J Med Virol ; 91(5): 829-835, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30613990

RESUMEN

Varicella-zoster virus (VZV)-specific cell-mediated immunity (CMI) is critical for preventing and controlling the onset of herpes zoster (HZ). To assess VZV CMI, an interferon-γ (IFN-γ) enzyme-linked immunosorbent assay (ELISA) was validated by examining the influence of VZV-specific antigen content, incubation time, and interval from whole blood collection on the assay. In phase II clinical trial, VZV-specific CMI in adults ≥50 years of age administered an HZ vaccine were evaluated by IFN-γ ELISA, as determined by measuring IFN-γ production in the whole blood in response to stimulation with ultraviolet light-inactivated VZV. The VZV-specific IFN-γ levels varied among individuals from prevaccination (baseline) to 6 weeks postvaccination. In most subjects, VZV-specific CMI was increased at 6 weeks postvaccination. The HZ vaccine elicited a significant increase in the VZV-specific CMI response as measured by ELISA; the geometric mean fold-rises from baseline to 6 weeks postvaccination were 3.50, 4.22, and 5.24 in the 4.3, 4.7, and 4.9 log plaque-forming unit vaccine groups, respectively, which was significantly higher than in the placebo group (P < 0.05). These results indicate that vaccination enhances the VZV-specific CMI responses in subjects; IFN-γ ELISA is an effective method for evaluating the CMI response and may be useful for identifying individuals at a high risk of HZ infection.


Asunto(s)
Vacuna contra el Herpes Zóster/inmunología , Herpesvirus Humano 3/inmunología , Inmunidad Celular , Interferón gamma/análisis , Infección por el Virus de la Varicela-Zóster/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Ensayo de Inmunoadsorción Enzimática , Femenino , Vacuna contra el Herpes Zóster/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Placebos/administración & dosificación
14.
Hum Vaccin Immunother ; 15(4): 772-777, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30676834

RESUMEN

There are two licensed herpes zoster vaccines. One is a live vaccine (ZVL) based on an attenuated varicella-zoster virus (VZV). The other is a recombinant vaccine (RZV) based on the VZV glycoprotein E (gE) combined with AS01B, a multicomponent adjuvant system. RZV is superior to ZVL in efficacy, and differs from ZVL in that protection is not diminished by the age of the vaccinee and has not waned significantly during 4 years of follow-up. Immunologic studies demonstrated higher peak memory and persistence of T cell responses in RZV compared with ZVL recipients. RZV recipients also showed development and persistence of polyfunctional T cell responses. Taken together, we conclude that the immunologic data parallel and support the higher efficacy over time of RZV compared with ZVL.


Asunto(s)
Vacuna contra el Herpes Zóster/inmunología , Herpes Zóster/prevención & control , Linfocitos T/inmunología , Proteínas del Envoltorio Viral/inmunología , Adyuvantes Inmunológicos , Ensayos Clínicos como Asunto , Humanos , Memoria Inmunológica , Vacunación , Vacunas Atenuadas/inmunología , Vacunas Sintéticas/inmunología
15.
Viral Immunol ; 32(3): 151-157, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30694731

RESUMEN

Limited data on varicella zoster virus (VZV) vaccine responses are available in HIV-positive adults, especially among those with end-stage renal disease on dialysis or undergoing kidney transplantation (KT). Serological and T cell responses were analyzed using anti-VZV IgG titers, enzyme-linked immunosorbent assay and flow cytometric intracellular cytokine staining (ICS) in two HIV-positive kidney transplant candidates undergoing dialysis and receiving VZV immunization. The results were compared with two HIV-positive and two HIV-negative VZV-seropositive patients (two kidney transplant candidates and two kidney transplant recipients), and with one HIV-negative vaccinee. HIV-positive VZV-susceptible patients received two doses of VZV vaccine 12 weeks apart. No adverse events were reported. Serological data were indicative of immunological response in one patient and corresponded to T cell responses. The second patient showed only a transient increase in anti-VZV IgG titers, but reported positive CD4+ T cell responses that were maintained after KT. Positive T cell and serological responses were detected in both HIV-positive and HIV-negative controls. VZV vaccination appeared safe and effective in HIV-positive KT candidates. VZV-specific T cell immunity was detected among transplant candidates and after KT. The assessment of VZV-specific T cell immunity using flow cytometric ICS may be more reliable compared to serology in assessing responses to VZV vaccine in this group.


Asunto(s)
Infecciones por VIH/sangre , Vacuna contra el Herpes Zóster/inmunología , Herpes Zóster/inmunología , Inmunidad Celular , Diálisis Renal , Linfocitos T/inmunología , Adulto , Anticuerpos Antivirales/sangre , Linfocitos T CD4-Positivos/inmunología , Femenino , VIH/inmunología , Vacuna contra el Herpes Zóster/administración & dosificación , Humanos , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Pruebas Serológicas
16.
J Infect Dis ; 219(8): 1338-1346, 2019 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-30445431

RESUMEN

INTRODUCTION: Live attenuated zoster vaccine (Zostavax) was used to test the hypothesis that constitutive level of interleukin 10 (IL-10), which may be high in elderly subjects, impairs vaccine efficacy. If constitutive IL-10 impairs vaccine efficacy, the effectiveness of viral vaccines might be improved by transient inhibition of IL-10 before vaccination. METHODS: Zostavax was given to 26 patients (age, 60-80 years). IL-10 and immunity to varicella zoster virus (VZV) were measured at baseline and after vaccination. Fluorescent antibody to membrane antigen (FAMA) assays and glycoprotein enzyme-linked immunosorbent assays (gpELISAs) were used to assess humoral immunity; anti-varicella virus T-cell responses were studied in a subset of subjects. In a prospective animal model, T-cell responses to chimeric vaccines against lymphocytic choriomeningitis virus (LCMV) were assessed in mice that express or lack IL-10. RESULTS: FAMA assays revealed significant boosting (by 4-fold) of humoral immunity, which occurred only in subjects (10 of 26) with a low constitutive IL-10 level (ie, <20 pg/mL); moreover, the Zostavax-induced FAMA and gpELISA responses were inversely related to the constitutive IL-10 level. Significant VZV-specific T-cell responses followed vaccination only in subjects with a low constitutive IL-10 level. Vaccine-induced LCMV-specific T-cell responses in mice lacking IL-10 were greater than in wild-type animals. CONCLUSIONS: A high constitutive IL-10 level adversely affects vaccine efficacy.


Asunto(s)
Vacuna contra el Herpes Zóster/inmunología , Herpesvirus Humano 3/inmunología , Interleucina-10/sangre , Anciano , Anciano de 80 o más Años , Animales , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Inmunidad Humoral/inmunología , Masculino , Ratones , Ratones Noqueados , Persona de Mediana Edad
18.
J Infect Dis ; 219(2): 335-338, 2019 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-30165651

RESUMEN

Protection against zoster conferred by zoster vaccine live (ZVL; Zostavax) wanes over time. We compared varicella-zoster virus cell-mediated immunity (VZV-CMI) of adults ≥70 years who received a second dose of ZVL ≥10 years after the initial dose with de novo-immunized age-matched controls. Before and during the first year after vaccination, VZV-CMI was significantly higher in reimmunized compared with de novo vaccinees. At 3 years, VZV-CMI differences between groups decreased and only memory responses remained marginally higher in reimmunized participants. In conclusion, the increase in VZV-CMI generated by reimmunization with ZVL is at least equally persistent compared with de novo immunization.


Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/inmunología , Herpesvirus Humano 3/inmunología , Inmunidad Celular/inmunología , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Femenino , Humanos , Memoria Inmunológica , Interferón gamma/inmunología , Interleucina-2/inmunología , Masculino , Vacunación , Vacunas Atenuadas/inmunología
19.
Vasc Endovascular Surg ; 53(1): 75-78, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30122132

RESUMEN

Hypersensitivity vasculitis (HV) or leukocytoclastic vasculitis is a rare small-vessel vasculitis that may occur as a manifestation of the body's extreme allergic reaction to a drug, infection, or other foreign substance. Characterized by the presence of inflammatory neutrophils in vessel walls, HV results in inflammation and damage to blood vessels, primarily in the skin. Histologically, when neutrophils undergo leukocytoclasia and release nuclear debris into the vasculature, vascular damage manifests as palpable purpura. The incidence of HV is unknown and its relationship and interaction with certain vaccinations is rare and poorly understood. Affected patients with HV generally have a good prognosis; however, fatality may occur if organs such as the central nervous system, heart, lungs, or kidneys are involved. We report a unique case of a 60-year-old man who presented with a serious case of HV after receiving the herpes zoster vaccine. A thorough literature review yielded only one similar case of vascular reaction to the varicella vaccine that was reported in the Annals of Internal Medicine in 1997; however, no other reported cases with regard to the herpes zoster vaccine have been found. Our case presents a rare glimpse into HV that may result from varicella vaccine administration.


Asunto(s)
Hipersensibilidad a las Drogas/etiología , Vacuna contra el Herpes Zóster/efectos adversos , Vasculitis Leucocitoclástica Cutánea/inducido químicamente , Antibacterianos/uso terapéutico , Biopsia , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/inmunología , Glucocorticoides/uso terapéutico , Vacuna contra el Herpes Zóster/inmunología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Vacunación , Vasculitis Leucocitoclástica Cutánea/diagnóstico , Vasculitis Leucocitoclástica Cutánea/inmunología
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