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1.
PLoS One ; 16(10): e0256642, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34673809

RESUMO

Varicella infection is a highly contagious disease which, whilst mild in most cases, can cause severe complications. Varicella vaccination is available privately in Sweden and is currently being reviewed for inclusion in the Swedish Public Health Agency's national immunisation program (NIP). A cross-sectional study of parents of Swedish children aged 1-8 years (n = 2212) was conducted to understand parental acceptance, beliefs and knowledge around varicella infection and vaccination. Respondents generally viewed varicella infection as a mild disease, with only a small proportion aware of potential severe complications. While 65% of respondents were aware of the vaccine, only 15% had started the course of vaccination as of February 2019. Further, 43% of parents did not intend to vaccinate, most commonly due to lack of inclusion in the NIP, but also due to perception of mild disease. Nevertheless, if offered within the NIP, 85% of parents would be highly likely to vaccinate their child. A number of statistically significant differences in awareness and behaviours were observed between sociodemographic subgroups. In general, women were more aware of vaccination (72%) compared to men (58%). Among unemployed or respondents with elementary school education, awareness was below 43%, and among respondents with high income the awareness was above 75%. Similarly, among unemployed or respondents with a low income the vaccination rate was as low as 30% compared with at least 57% among respondents with a high income. Respondents from metropolitan areas, those with university degrees and respondents with a higher income were more likely to be aware of the varicella vaccine and to have vaccinated their child. Whilst inclusion in the NIP is clearly the main driver for uptake, these identified knowledge gaps should inform educational efforts to ensure that all parents are informed of the availability and benefits of the varicella vaccine independent of socioeconomic status.


Assuntos
Vacina contra Varicela/administração & dosagem , Varicela/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Recusa de Vacinação/psicologia , Vacinação/estatística & dados numéricos , Atitude Frente a Saúde , Vacina contra Varicela/imunologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Herpesvirus Humano 3/imunologia , Humanos , Lactente , Masculino , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , Suécia , População Urbana
3.
PLoS One ; 16(5): e0251644, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33984060

RESUMO

OBJECTIVES: Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. DESIGN: Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. SETTING: National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. PARTICIPANTS: Hypothetical cohorts of people aged 12 months and 65-years at baseline. INTERVENTIONS: Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies. MAIN OUTCOME MEASURES: Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). RESULTS: It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million. CONCLUSIONS: The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective-the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.


Assuntos
Vacina contra Varicela/administração & dosagem , Varicela/prevenção & controle , Vacina contra Herpes Zoster/administração & dosagem , Herpes Zoster/prevenção & controle , Programas de Imunização/economia , Adolescente , Adulto , Idoso , Varicela/economia , Varicela/epidemiologia , Varicela/transmissão , Vacina contra Varicela/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Herpes Zoster/economia , Herpes Zoster/epidemiologia , Herpes Zoster/transmissão , Vacina contra Herpes Zoster/economia , Herpesvirus Humano 3/imunologia , Herpesvirus Humano 3/patogenicidade , Humanos , Programas de Imunização/métodos , Programas de Imunização/estatística & dados numéricos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Suécia/epidemiologia , Resultado do Tratamento , Ativação Viral , Adulto Jovem
4.
BMC Infect Dis ; 21(1): 475, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34034659

RESUMO

BACKGROUND: Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs). METHODS: The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined. RESULTS: The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI = 27.2-41.4%), with serosusceptibility more common among males than females (p < 0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded. CONCLUSIONS: One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.


Assuntos
Anticorpos Antivirais/sangue , Vacina contra Varicela/imunologia , Varicela/epidemiologia , Varicela/prevenção & controle , Surtos de Doenças/prevenção & controle , Pessoal de Saúde , Herpesvirus Humano 3/imunologia , Imunização Secundária/métodos , Vacinação/métodos , Adolescente , Adulto , Anticorpos Antivirais/imunologia , Varicela/sangue , Varicela/virologia , Vacina contra Varicela/administração & dosagem , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Imunogenicidade da Vacina , Imunoglobulina G/sangue , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Estudos Soroepidemiológicos , Resultado do Tratamento , Adulto Jovem
5.
Medicine (Baltimore) ; 100(16): e25351, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879665

RESUMO

RATIONALE: Primary varicella-zoster virus (VZV) infection may be associated with hemophagocytic lymphohistiocytosis (HLH), as well as with acute pancreatitis. However, there is few data concerning the evolution and the optimal treatment of these rare associations. PATIENT CONCERNS: A 57-year-old immunocompromised woman, who was treated for chronic lymphocytic leukemia 3 years prior to admission, was hospitalized with abdominal pain revealing severe acute pancreatitis. The day after admission, a pruritic rash appeared on her face, trunk, and limbs, sparing the palmoplantar regions. At the same time, fever, thrombocytopenia (27 × 109/L), major hyperferritinemia (11,063 µg/mL), hypertriglyceridemia (2.56 mmol/L) and elevated lactate dehydrogenase levels (1441 IU/L) suggested HLH. DIAGNOSIS: The diagnosis of chickenpox (varicella) was established. Primary VZV infection was then confirmed: cutaneous and plasma VZV polymerase chain reactions were positives, VZV serology was negative for IgG. INTERVENTIONS: Treatment with aciclovir was started intravenously after the onset of the rash, for a total of 10 days. A 48-h surveillance in intensive care was carried out. OUTCOMES: Acute pancreatitis and biological abnormalities evolved favorably under aciclovir. Platelet count was normalized 6 days after admission to hospital. LESSONS: A favorable outcome of primary VZV infection associated with severe acute pancreatitis and probable HLH in an immunocompromised patient is possible with aciclovir alone.


Assuntos
Herpesvirus Humano 3/imunologia , Hospedeiro Imunocomprometido/imunologia , Linfo-Histiocitose Hemofagocítica/imunologia , Pancreatite/imunologia , Infecção pelo Vírus da Varicela-Zoster/imunologia , Doença Aguda , Feminino , Humanos , Linfo-Histiocitose Hemofagocítica/virologia , Pessoa de Meia-Idade , Pancreatite/virologia , Infecção pelo Vírus da Varicela-Zoster/virologia
6.
Leuk Res ; 106: 106569, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33857746

RESUMO

Acute Promyelocytic Leukemia (APL) is a unique subtype of acute myeloid leukemia that is highly responsive to minimally myelosuppressive therapy with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). We and others have observed a higher than expected incidence of herpes zoster reactivation in APL patients treated with ATO. Memorial Sloan Kettering Cancer Center (MSKCC) has been using ATO since 1997 in all relapsed APL patients, and more recently has included it in our front-line APL regimens. Here we present a retrospective analysis of the factors contributing to herpes zoster reactivation among APL patients.


Assuntos
Antineoplásicos/efeitos adversos , Trióxido de Arsênio/efeitos adversos , Herpes Zoster/etiologia , Herpesvirus Humano 3 , Ativação Viral/efeitos dos fármacos , Antineoplásicos/uso terapêutico , Trióxido de Arsênio/uso terapêutico , Suscetibilidade a Doenças , Herpes Zoster/diagnóstico , Herpesvirus Humano 3/efeitos dos fármacos , Herpesvirus Humano 3/imunologia , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Leucemia Promielocítica Aguda/complicações , Leucemia Promielocítica Aguda/tratamento farmacológico , Estudos Retrospectivos
7.
J Virol ; 95(12)2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762414

RESUMO

Two herpes zoster (HZ) vaccines licensed in the United States are recommended by the Advisory Committee on Immunization Practices (ACIP): (i) live-attenuated vaccine (ZVL) using vOka strain varicella-zoster virus (VZV) and (ii) recombinant adjuvanted vaccine (RZV) containing recombinant varicella-zoster virus (VZV) glycoprotein E (gE). Two phase 3 clinical trials of RZV led the Advisory Committee on Immunization Practices (ACIP) to recommend it with preferred status. VZV T cell-mediated immunity (CMI), but not humoral immunity, is considered essential for protection against HZ. Published studies of humoral immunity focused on VZV-specific IgG concentration. To complement reports comparing the CMI responses to these vaccines, we compared humoral responses in ZVL and RZV recipients, emphasizing functional qualities (avidity and neutralization). Baseline avidities to a VZV glycoprotein mixture (gp) were near the upper limit of detection, but avidity to gE was much lower. Small increases in gp avidity were observed for both RZV and ZVL vaccination (19 and 12 avidity index units [AIU], respectively). RZV boosted both gE avidity and VZV neutralizing antibody significantly more than ZVL (mean gE avidity boost, 47 AIU versus 22 AIU; mean neutralizing antibody boost, 22-fold versus 8-fold). Increases in neutralizing antibodies strongly correlated with gE avidity increases (r = 0.5) and moderately with gp avidity increases (r = 0.23). After 1 year, 81% of RZV recipients and only 18% of ZVL recipients retained >50% of their peak avidity boosts. These results are consistent with the CMI responses to these vaccines: RZV responses are skewed to long-term memory, whereas ZVL preferentially induces transient effector responses.IMPORTANCE These observations further distinguish the immunogenicity and duration of the immune response of the two vaccines. In addition, measurements of functional humoral immunity (IgG avidity and neutralizing antibody) in response to zoster immunization, alone or combined with other immune markers, might contribute to practical in vitro correlates of protection. Combined with previous observations of the cell-mediated response to these vaccines, this study suggests that vaccine development will benefit from more expansive and granular assessments of acquired immunity during early phase 1 immunogenicity trials.


Assuntos
Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Vacina contra Herpes Zoster/imunologia , Herpesvirus Humano 3/imunologia , Adjuvantes Imunológicos , Idoso , Idoso de 80 Anos ou mais , Anticorpos Neutralizantes/sangue , Anticorpos Neutralizantes/imunologia , Afinidade de Anticorpos , Ensaio de Imunoadsorção Enzimática , Herpes Zoster/prevenção & controle , Humanos , Imunogenicidade da Vacina , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Pessoa de Meia-Idade , Vacinas Atenuadas/imunologia , Vacinas de Subunidades/imunologia , Vacinas Sintéticas/imunologia , Proteínas do Envelope Viral/imunologia
8.
Clin Exp Immunol ; 205(1): 63-74, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33714219

RESUMO

Previous studies have demonstrated that the status of the T cell compartment and inflammation-related factors are associated with the immunogenicity of the varicella-zoster virus (VZV) vaccine in older adults; however, little is known about the roles of other immune cell subsets known to influence the generation and maintenance of immunological memory. Responses to a live-attenuated VZV vaccine were studied in relation to peripheral blood mononuclear cell (PBMC) composition and function in a sample of 30 nursing home residents (aged 80-99 years). Interferon-gamma enzyme-linked immunospot (ELISPOT) was used to measure VZV responses at baseline and 6 weeks following vaccination, and associations were sought with the frequencies of monocytes and T, B and natural killer (NK) cells and the production and secretion of cytokines following their ex-vivo stimulation with different agents. While only the frequency of interleukin (IL)-6+ CD14+ monocytes was inversely associated with post-vaccination VZV response, amounts of IL-1ß, IL-10, IL-17A and tumour necrosis factor (TNF) secreted by PBMCs and the frequency of IL-1ß+ CD14+ monocytes was positively correlated with pre-vaccination VZV response. Furthermore, both bivariate correlation and causal mediation analyses supported the notion that IL-1ß+ CD14+ monocytes were significant mediators of the associations between IL-1ß and TNF secretion by PBMCs and pre-vaccination VZV responses. Our findings implicate a strong cytokine response mediated by inflammatory IL-1ß+ monocytes in coordinating responses of long-lived VZV-reactive memory T cells, but with an opposing effect of IL-6+ CD14+ monocytes. Whether monocyte status promotes or inhibits the induction and/or maintenance of these memory T cells later in life has yet to be determined.


Assuntos
Herpes Zoster/imunologia , Herpesvirus Humano 3/imunologia , Interleucina-1beta/imunologia , Monócitos/imunologia , Infecção pelo Vírus da Varicela-Zoster/imunologia , Idoso de 80 Anos ou mais , Linfócitos B/imunologia , Citocinas/imunologia , Feminino , Herpes Zoster/virologia , Humanos , Memória Imunológica/imunologia , Inflamação/imunologia , Inflamação/virologia , Células Matadoras Naturais/imunologia , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/virologia , Masculino , Casas de Saúde , Linfócitos T/imunologia , Vacinação/métodos , Vacinas Atenuadas/imunologia , Infecção pelo Vírus da Varicela-Zoster/virologia
9.
Transplantation ; 105(10): 2316-2323, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528118

RESUMO

BACKGROUND: Immunization of varicella-zoster virus (VZV)-seronegative solid organ transplant (SOT) patients using the live-attenuated varicella vaccine is generally contraindicated, leaving no widely applicable immunization option. The recombinant subunit herpes zoster vaccine (RZV) is indicated for VZV-seropositive persons to prevent shingles but could potentially also protect VZV-seronegative persons against varicella. We performed a safety and immunogenicity evaluation of RZV in VZV-seronegative SOT recipients as an option for protection. METHODS: VZV-seronegative adult SOT patients with no history of varicella/shingles vaccine or disease were given 2 doses of RZV vaccine 2-6 mo apart. Blood was drawn prevaccination (V1), before the second dose (V2), and 4 wk after the second dose (V3). Humoral immunity (anti-glycoprotein E) and cell-mediated immunity were evaluated, with polyfunctional cells defined as cells producing ≥2 cytokines. RESULTS: Among 31 eligible VZV-seronegative SOT patients screened, 23 were enrolled. Median age was 38 y and median time since transplant procedure was 3.8 y. The most frequent transplant types were liver (35%) and lung (30%). Median anti-glycoprotein E levels significantly increased from V1 to V3 (P = 0.001) and V2 to V3 (P < 0.001), even though only 55% had a positive seroresponse. Median polyfunctional CD4 T-cell counts increased from V1 to V2 (54/106 versus 104/106 cells; P = 0.041) and from V2 to V3 (380/106; P = 0.002). Most adverse events were mild with no rejection episodes. CONCLUSIONS: RZV was safe and elicited significant humoral and cellular responses in VZV-seronegative SOT patients and has the potential to be considered as a preventive strategy against primary varicella.


Assuntos
Vacina contra Herpes Zoster/administração & dosagem , Herpesvirus Humano 3/imunologia , Imunogenicidade da Vacina , Transplante de Órgãos , Infecção pelo Vírus da Varicela-Zoster/prevenção & controle , Adulto , Anticorpos Antivirais/sangue , Biomarcadores/sangue , Feminino , Vacina contra Herpes Zoster/efeitos adversos , Herpesvirus Humano 3/patogenicidade , Humanos , Imunidade Celular/efeitos dos fármacos , Imunidade Humoral/efeitos dos fármacos , Imunização , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/efeitos adversos , Estudo de Prova de Conceito , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Vacinas Sintéticas/administração & dosagem , Infecção pelo Vírus da Varicela-Zoster/imunologia , Infecção pelo Vírus da Varicela-Zoster/virologia , Proteínas do Envelope Viral/imunologia
10.
BMC Infect Dis ; 21(1): 46, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430796

RESUMO

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.


Assuntos
Herpes Zoster/imunologia , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3/imunologia , Soros Imunes , Imunização Passiva/métodos , Hospedeiro Imunocomprometido , Profilaxia Pós-Exposição/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Herpes Zoster/epidemiologia , Herpes Zoster/virologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
11.
BMC Infect Dis ; 21(1): 117, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33499826

RESUMO

BACKGROUND: Herpes zoster (HZ) infection of hematopoietic stem cell transplant (HSCT) patients is of clinical concern. Vaccination could help restore immunity to varicella zoster virus (VZV); however, temporal changes in immunogenicity and safety of live HZ vaccines after HSCT is still unclear. The aim of this study was to elucidate the temporal immunogenicity and safety of the HZ vaccine according to time since HSCT and to determine optimal timing of vaccination. METHODS: Live HZ vaccine was administered to patients 2-5 years or > 5 years post-HSCT. Control groups comprised patients with a hematologic malignancy who received cytotoxic chemotherapy and healthy volunteers. Humoral and cellular immunogenicity were measured using a glycoprotein enzyme-linked immunosorbent assay (gpELISA) and an interferon-γ (IFN-γ) enzyme-linked immunospot (ELISPOT) assay. Vaccine-related adverse events were also monitored. RESULTS: Fifty-six patients with hematologic malignancy (41 in the HSCT group and 15 in the chemotherapy group) along with 30 healthy volunteers were enrolled. The geometric mean fold rises (GMFRs) in humoral immune responses of the 2-5 year and > 5 year HSCT groups, and the healthy volunteer group, were comparable and significantly higher than that of the chemotherapy group (3.15, 95% CI [1.96-5.07] vs 5.05, 95% CI [2.50-10.20] vs 2.97, 95% CI [2.30-3.83] vs 1.42, 95% CI [1.08-1.86]). The GMFR of cellular immune responses was highest in the HSCT 2-5 year group and lowest in the chemotherapy group. No subject suffered clinically significant adverse events or reactivation of VZV within the follow-up period. CONCLUSION: Our findings demonstrate that a live HZ vaccine is immunogenic and safe when administered 2 years post-HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Vacina contra Herpes Zoster , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3/imunologia , Transplantados , Vacinas Vivas não Atenuadas , Idoso , Anticorpos Antivirais/imunologia , Estudos de Casos e Controles , Feminino , Seguimentos , Neoplasias Hematológicas/epidemiologia , Neoplasias Hematológicas/imunologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Vacina contra Herpes Zoster/efeitos adversos , Vacina contra Herpes Zoster/imunologia , Humanos , Imunogenicidade da Vacina/fisiologia , Masculino , Pessoa de Meia-Idade , Transplantados/estatística & dados numéricos , Resultado do Tratamento , Vacinação/efeitos adversos , Vacinação/métodos , Vacinação/estatística & dados numéricos , Vacinas Vivas não Atenuadas/efeitos adversos , Vacinas Vivas não Atenuadas/imunologia
12.
BMC Infect Dis ; 21(1): 12, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407202

RESUMO

BACKGROUND: Over the last two decades, several countries have initiated universal varicella vaccination (UVV) programs in infants. In 2019, the Swiss National Immunization Technical Advisory Group (NITAG) decided to start evaluating the introduction of universal varicella vaccination. There is a theoretical concern that suboptimal vaccination coverage could lead to a shift in the varicella incidence to older age groups, thereby potentially increasing complication rates. To achieve a high vaccination coverage rate, it is important that practicing physicians comply with a potential recommendation for UVV. We studied the perception of varicella and the current vaccination behavior among Swiss pediatricians and general practitioners (GPs) who treat children. We also assessed their intention to advise parents to vaccinate their children against varicella in the event the Swiss NITAG will recommend UVV. METHODS: Primary data was collected through a structured, 20-min online survey with Swiss pediatricians and GPs who treat children. RESULTS: 150 physicians participated in the study: 40 GPs in the German-speaking part, 20 GPs in the French-speaking part, 67 pediatricians in the German-speaking part, and 23 pediatricians in the French-speaking part. The majority (64%) of all participants reported that they currently recommend varicella vaccination for risk groups according to the national immunization plan. About one third of physicians (35%) - predominantly pediatricians - currently already recommend it for all infants. In these situations, a measles, mumps, rubella, varicella combination vaccine is currently used by 58% for the first dose and by 59% for the second dose. 86% of participants stated that they would advise parents to have their children vaccinated against varicella in case of a recommendation for UVV by the Swiss NITAG. 68% responded that they expect many questions from parents and 65% agreed that they have good arguments to convey the importance of varicella vaccination. CONCLUSIONS: The survey study results show that most participating pediatricians and GPs indicated a favorable attitude towards childhood vaccination against varicella in the setting of a Swiss NITAG recommendation for UVV. This data shows the importance of NITAG recommendations in influencing vaccine education and supporting achievement of high coverage of varicella vaccination.


Assuntos
Vacina contra Varicela/uso terapêutico , Varicela/prevenção & controle , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Herpesvirus Humano 3/imunologia , Pediatras/psicologia , Vacinação/psicologia , Varicela/epidemiologia , Varicela/virologia , Vacina contra Varicela/imunologia , Feminino , Humanos , Programas de Imunização , Incidência , Masculino , Pais/psicologia , Inquéritos e Questionários , Suíça/epidemiologia , Vacinas Combinadas/imunologia , Vacinas Combinadas/uso terapêutico
13.
Am J Dermatopathol ; 43(4): 298-299, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33156024

RESUMO

ABSTRACT: Patients with eosinophilic pustular folliculitis (EPF), a sterile eosinophilic infiltration of hair follicles, often present with papulopustules that tend to form annular plaques. Histopathologic examination revealed eosinophilic infiltration around the pilosebaceous units and eosinophilic microabscess formation. Although the pathogenesis of EPF is unknown, T-helper type 2 immune responses were suggested to be important based on their stimulating effect on the sebaceous glands. Here, we report the first case of EPF associated with herpes zoster, indicating that herpes zoster and EPF are correlated with T-helper type 2 immune responses.


Assuntos
Eosinofilia/patologia , Foliculite/patologia , Herpes Zoster/patologia , Herpesvirus Humano 3/patogenicidade , Dermatopatias Vesiculobolhosas/patologia , Pele/patologia , Eosinofilia/tratamento farmacológico , Eosinofilia/imunologia , Eosinofilia/virologia , Feminino , Foliculite/tratamento farmacológico , Foliculite/imunologia , Foliculite/virologia , Herpes Zoster/imunologia , Herpes Zoster/virologia , Herpesvirus Humano 3/imunologia , Antagonistas dos Receptores Histamínicos/uso terapêutico , Interações Hospedeiro-Patógeno , Humanos , Pele/efeitos dos fármacos , Pele/imunologia , Pele/virologia , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Dermatopatias Vesiculobolhosas/imunologia , Dermatopatias Vesiculobolhosas/virologia , Esteroides/uso terapêutico , Células Th2/imunologia , Resultado do Tratamento , Adulto Jovem
14.
Retin Cases Brief Rep ; 15(1): 43-44, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29528885

RESUMO

PURPOSE: To the best of our knowledge, we present a rare case report describing an occurrence of acute retinal necrosis in an otherwise healthy individual who received the shingles vaccine. METHODS: Observational case report. PATIENT: A 63-year-old healthy and immunocompetent white man presented with change of vision in the left eye after blunt trauma. A diagnosis of corneal abrasion was made. During follow-up, a detailed history discovered a progressive deterioration in vision over the past few weeks. Three months before presentation, he had received the shingles vaccine (Zostavax); 1 month before presentation, he reported an episode of varicella skin eruption on the face. RESULTS: On examination, the patient was found to have acute retinal necrosis with white satellite lesions in the fundus of the left eye. An anterior chamber paracentesis and polymerase chain reaction confirmed the diagnosis of varicella-zoster virus. CONCLUSION: Varicella-zoster virus reactivation after shingles vaccination may predispose both immunocompetent and immunocompromised individuals to herpes-zoster ophthalmicus, leading to acute retinal necrosis.


Assuntos
Infecções Oculares Virais/complicações , Vacina contra Herpes Zoster/efeitos adversos , Herpesvirus Humano 3/imunologia , Retina/patologia , Síndrome de Necrose Retiniana Aguda/etiologia , Vacinação/efeitos adversos , Infecção pelo Vírus da Varicela-Zoster/complicações , Infecções Oculares Virais/prevenção & controle , Infecções Oculares Virais/virologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Retina/virologia , Síndrome de Necrose Retiniana Aguda/diagnóstico , Infecção pelo Vírus da Varicela-Zoster/prevenção & controle , Infecção pelo Vírus da Varicela-Zoster/virologia
15.
Biochem Soc Trans ; 48(6): 2415-2435, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33259590

RESUMO

Varicella-zoster virus (VZV) is the causative agent of chicken pox (varicella) and shingles (zoster). Although considered benign diseases, both varicella and zoster can cause complications. Zoster is painful and can lead to post herpetic neuralgia. VZV has also been linked to stroke, related to giant cell arteritis in some cases. Vaccines are available but the attenuated vaccine is not recommended in immunocompromised individuals and the efficacy of the glycoprotein E (gE) based subunit vaccine has not been evaluated for the prevention of varicella. A hallmark of VZV pathology is the formation of multinucleated cells termed polykaryocytes in skin lesions. This cell-cell fusion (abbreviated as cell fusion) is mediated by the VZV glycoproteins gB, gH and gL, which constitute the fusion complex of VZV, also needed for virion entry. Expression of gB, gH and gL during VZV infection and trafficking to the cell surface enables cell fusion. Recent evidence supports the concept that cellular processes are required for regulating cell fusion induced by gB/gH-gL. Mutations within the carboxyl domains of either gB or gH have profound effects on fusion regulation and dramatically restrict the ability of VZV to replicate in human skin. This loss of regulation modifies the transcriptome of VZV infected cells. Furthermore, cellular proteins have significant effects on the regulation of gB/gH-gL-mediated cell fusion and the replication of VZV, exemplified by the cellular phosphatase, calcineurin. This review provides the current state-of-the-art knowledge about the molecular controls of cell fusion-dependent pathogenesis caused by VZV.


Assuntos
Herpesvirus Humano 3/imunologia , Interações Hospedeiro-Patógeno , Infecção pelo Vírus da Varicela-Zoster/virologia , Proteínas do Envelope Viral/metabolismo , Internalização do Vírus , Animais , Fusão Celular , Vacina contra Varicela , Dimerização , Regulação Viral da Expressão Gênica , Herpesvirus Humano 3/genética , Humanos , Imunoglobulina E/química , Glicoproteínas de Membrana/metabolismo , Camundongos , Mutagênese , Mutação , Fases de Leitura Aberta , Conformação Proteica , Infecção pelo Vírus da Varicela-Zoster/imunologia , Infecção pelo Vírus da Varicela-Zoster/prevenção & controle , Proteínas Virais/metabolismo , Vírion/metabolismo
16.
Ned Tijdschr Geneeskd ; 1642020 09 16.
Artigo em Holandês | MEDLINE | ID: mdl-33201634

RESUMO

BACKGROUND: When skin abnormalities in patients extend over several dermatomes, disseminated herpes zoster should be suspected. This complication is most often seen in immunocompromised patients. CASE DESCRIPTION: An 87-year-old patient came to the dermatology outpatient clinic with several vesicles scattered over her body. She was being treated with methotrexate for rheumatoid arthritis. Upon physical examination, we found groups of vesicles in the area of the maxillary nerve as well as several solitary vesicles scattered over her body. We made the diagnosis of 'disseminated herpes zoster'. PCR test of fluid from one of the vesicles found Varicella zoster virus. We treated the patient with intravenous acyclovir for 48 hours after which we treated her with oral acyclovir for another 8 days. We temporarily halted methotrexate. Outpatient follow-up found that the patient's skin abnormalities had diminished significantly. CONCLUSION: The risk of disseminated herpes zoster depends on several factors. Use of immunosuppressants is often not the only contributing factor. Risk of disseminated herpes zoster in a patient who is being treated with methotrexate depends on age, comorbidities and co-medication of the patient.


Assuntos
Herpes Zoster/imunologia , Herpesvirus Humano 3/imunologia , Hospedeiro Imunocomprometido , Aciclovir/administração & dosagem , Idoso de 80 Anos ou mais , Antivirais/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Feminino , Humanos , Metotrexato/efeitos adversos , Metotrexato/imunologia , Fatores de Risco
17.
Int J Infect Dis ; 101: 269-275, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33011282

RESUMO

OBJECTIVES: The aim of this study was to investigate whether the seroprevalence of IgG antibodies against seven viruses (cytomegalovirus, herpes simplex virus 1&2, measles morbillivirus, parvovirus B19, rubella, and varicella-zoster virus), which can potentially compromise maternal and fetal wellbeing, differs based on country of origin among women with chronic hepatitis B (CHB). METHOD: This study was a single-center, hospital-based cross-sectional study. The study included women with CHB 15-45 years of age, included in the Danish Database for Hepatitis B and C. Seroprevalence estimates were calculated with a 95% confidence interval and were compared between age groups, regions of origin, and to the general population. RESULTS: 177 women were included in the study. Overall, the seroprevalences of antibodies were similar among women with CHB with origin outside Denmark and compared to the general population in Denmark, but there was a notable difference in the seroprevalence of antibodies against herpes simplex 2 between women from Africa (37.1% CI 95% 22.0;55.1) and women from the Middle East (2.5% CI 95% 0.1;14.7). CONCLUSION: Women with CHB whose origin is outside Denmark do not appear to differ, based on origin, or be at greater risk of acquiring these viruses during pregnancy than their Danish counterparts.


Assuntos
Anticorpos Antivirais/sangue , Hepatite B Crônica/sangue , Hepatite B/imunologia , Herpesvirus Humano 3/imunologia , Vírus do Sarampo/imunologia , Parvovirus B19 Humano/imunologia , Vírus da Rubéola/imunologia , Simplexvirus/imunologia , Adolescente , Adulto , Estudos Transversais , Citomegalovirus/imunologia , Dinamarca/epidemiologia , Feminino , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/imunologia , Hepatite B Crônica/virologia , Humanos , Imunoglobulina G/sangue , Pessoa de Meia-Idade , Gravidez , Prevalência , Estudos Soroepidemiológicos , Adulto Jovem
18.
J Heart Lung Transplant ; 39(12): 1445-1454, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33071180

RESUMO

BACKGROUND: Herpes zoster (HZ) is caused by the reactivation of varicella-zoster virus (VZV). Patients with lung transplants are at high risk for HZ owing to their immunocompromised status and the need for lifelong immunosuppression. In this study, patients on the waiting list for lung transplantation were vaccinated by a live-attenuated HZ vaccine (Zostavax, Merck Sharp & Dohme), and the safety and immunogenicity of this vaccine were studied. METHODS: In total, 105 patients with end-stage pulmonary disease (ESPD) were enrolled (68 participants received 1 dose of Zostavax and 37 participants were enrolled as unvaccinated controls). Among them, 43 patients underwent lung transplantation and were followed up for further analysis. VZV immunoglobulin G antibody titers and VZV-specific cell-mediated immunity (CMI) on multiple time points before and after vaccination and before and after transplantation were measured. RESULTS: Immune response to Zostavax was higher in younger patients, highest within 3 months after vaccination, and not influenced by gender or type of ESPD. Age, cytomegalovirus serostatus, and immunity to VZV at baseline impacted the subsequent immune response to the vaccine. Short-term immunosuppressant treatment had strong effects on VZV CMI levels, which returned to a high level at 6 months after transplantation in vaccinated patients. Zostavax did not impact infection or rejection rate after transplantation. CONCLUSIONS: Zostavax was safe and induced a robust humoral and cellular response for patients awaiting lung transplantation regardless of the type of ESPD. Patients younger than the recommended vaccination age of over 50 years showed a strong response and could also benefit from pre-transplant immunization.


Assuntos
Vacina contra Herpes Zoster/farmacologia , Herpesvirus Humano 3/imunologia , Imunidade Celular , Transplante de Pulmão , Cuidados Pré-Operatórios/métodos , Disfunção Primária do Enxerto/prevenção & controle , Insuficiência Respiratória/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/imunologia , Estudos Retrospectivos , Resultado do Tratamento , Vacinas Atenuadas , Adulto Jovem
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