The cytotoxic T lymphocyte (CTL) response was evaluated in adults given live attenuated varicella vaccine, using target cells expressing varicella-zoster virus (VZV) immediate-early protein (IE62) or VZV glycoproteins gpI, gpIV, or gpV to determine viral protein specificity. The frequency of CTL that recognized IE62 was 1:171,000 +/- 46,000 SE in subjects tested 10 days to 8 weeks after the initial vaccine dose; the induction of CTL specific for gpI was equivalent. CTL recognition of VZV proteins was mediated by CD4+ or CD8+ cells. CTL recognition of IE62 and gpIV persisted in vaccinees (tested approximately 4 years later) and was comparable to that in the naturally immune. The mean frequency of CTL specific for gpV was lower (but not significantly) in vaccinees than in naturally immune subjects. Assay of responder cell frequencies showed persistence of equivalent numbers of T lymphocytes that recognized IE62 and gpI in vaccinees and naturally immune subjects. Immunization with this vaccine elicited memory T lymphocyte responses to VZV comparable to those induced by natural infection.

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This is a very rare complication of chickenpox; only five cases have been previously reported and these were all characterized by anti-Pr cold agglutinin with hemolytic anemia after the onset of chickenpox. We report the first case of hemolytic anemia associated with an anti-I cold agglutinin during the incubation period of chickenpox.

Varicella zoster virus DNA in mononuclear cells was studied by the polymerase chain reaction to obtain virological evidence of reactivation in the children who had contracted chickenpox in infancy. The results appear to explain why chickenpox in infancy is a risk factor for herpes zoster in immunocompetent children. (Arch Dis Child 1995; 73: 162-163

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