Herpes zoster in three healthy children immunized with varicella vaccine (Oka/Biken); the causative virus differed from vaccine strain on PCR analysis of the IV variable region (R5) and of a Pst I‐site region

Abstract

This study was undertaken to determine whether the causative virus was a vaccine-derived or wild-type virus when zoster occurred in healthy children immunized with varicella vaccine (Oka/Biken). The DNAs of clinical isolated strains and vaccine strain (Oka/Biken) were analyzed by the polymerase chain reaction with two sets of primers for the variable region IV (R5 tandem direct reiterations, TDR) and for the region with a PstI site in a middle portion of the long unique segment of the varicella zoster virus genome. Of six zoster patients after vaccination with Biken, three clinical isolates were examined and had two copies in R5 TDR and were PstI-site positive. Therefore, these strains were different from the vaccine-type strain (Oka/Biken), which had two copies in R5 TDR and was PstI-site-negative. The mean age of onset of zoster was 4 years. The mean age of vaccination was 25 months. The mean interval between vaccination and onset of zoster was 22 months. Hence the results indicate that the causative virus of zoster in healthy children immunized with varicella vaccine (Oka/Biken) was wild type and differed from the vaccine strain. Some vaccinees probably do not have protective immunity for a long time after immunization because the mean interval between vaccination and onset of zoster was 22 months.

Herpes Zoster in an Immunocompetent Child without a History of Varicella

“…Clinical manifestations of HZ in immunocompetent children have been reported. We reviewed 27 previous reports in literature, which comprised 39 immunocompetent children with HZ, all of which were related to a history of either varicella or varicella vaccination ( Table 1 ) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. In these 39 reported cases, there were 23 male patients and 15 female patients, while one case report did not reveal the sex of the patient.…”

“…Meanwhile, it was reported that five patients were infected with wild-type VZV without previous exposure to varicella or HZ or any other contact history. Thus, HZ in children may also arise from subclinical infection of VZV [ 7 , 9 , 11 ]. Additionally, despite clustered vesicular lesions in dermatomal distribution being the most common symptom of HZ in children, previous reports also include cases of central nervous system (CNS) infection, in which either wild type or vaccine strain was found in the virology screening for the cerebrospinal fluid (CSF) and further led to meningitis or encephalitis [ 13 , 16 , 18 , 19 , 34 ].…”

“…Therefore, in the reviewed articles, VZV-specific IgM tests were performed in 14 cases and positive results of three cases; while VZV-specific IgG test were performed in 13 cases and positive results of all cases. Specific IgM was positive in three cases, two of which were caused by the vaccine strain [ 7 , 10 , 13 , 22 , 27 , 29 , 31 , 32 ]. In fact, Kangro et al and Min et al suggested HZ would show an IgM-positive result [ 35 , 36 ].…”