Prevention or Modification of Varicella Using Zoster Immune Plasma

Abstract

\s=b\Zoster immune plasma (ZIP) was given to 31 susceptible immunocompromised children one to seven days (median, two days) following household, playmate, or hospital exposures to varicella. The average amount of ZIP transfused was 7 ml/kg. Twenty-one children did not develop varicella or persistent antibodies to varicella-zoster virus (VZV).Eight (26%) of the 31 contracted clinical varicella. Seven cases were mild, but in one child, who was given ZIP seven days after exposure, visceral disease developed and the child died. Two children had subclinical varicella that was documented by persistence of VZV antibodies for at least ten months after passive immunization. Because none of the 30 children given ZIP one to six days following exposure had severe varicella, we conclude that ZIP is effective in preventing or modifying varicella in immunocompromised patients if given shortly after exposure.(Am J Dis Child 131: [693][694][695][696] 1977) Varicella can be a severe and even fatal disease in patients with cancer or immunodeficiency states.14 Because a large number of children with acute lymphocytic leukemia or renal allografts are cared for at the University of Minnesota Health Sciences Center, we found it desirable to have our own supply of zoster immune plasma (ZIP) for attempted prophylaxis of varicella in such pa¬ tients. Our experience with the use of ZIP in 31 children is the subject of this report. SUBJECTS AND METHODS PatientsThe patients had malignancy and /or primary or acquired immunodeficiency. They lacked a history of varicella and had recent intimate contact with varicella. An intimate contact was defined as a house¬ hold member with varicella, an exposure of at least an hour to a schoolmate or play¬ mate with varicella, or exposure on a hospital ward or clinic to a person with varicella. The patient was considered at risk if varicella developed in the contact within 24 hours after the exposure or if the contact had varicella lesions that were not yet crusted at the time of exposure. The patients were given ZIP intravenously in a dose of approximately 7 ml/kg as soon as possible after exposure. The recipient was given a transfusion with blood groupmatched plasma if possible. Two and four weeks after their child's exposure the parents were contacted and questioned regarding signs and symptoms in the chil¬ dren. If varicella developed, the patient was examined by a physician to confirm the diagnosis. Serum was drawn for vari¬ cella-zoster virus (VZV) antibody titers before the administration of ZIP and three to eight weeks later. Recipients of ZIP in whom varicella did not develop, but who had VZV antibodies in the second serum specimen, were tested again 3 to 14 months after exposure. This investigation was approved by the University of Minnesota Committee on the Use of Human Subjects in Research, and informed consent was obtained from parents or guardians before participation. Preparation of ZIPZoster immune plasma was obtained from healthy adults between the ages of 17 and 66 years who had had he...

Prophylaxe und Therapie von Varicella-zoster-Virus-Infektionen bei immunsupprimierten Kindern

“…Kommt es zu einer manifesten Erkrankung, ist der Verlauf abgeschwächt, und die Komplikationsrate ist reduziert [5,21,27,29]. Bei frühzeitiger Anwendung innerhalb der ersten 24 h nach der Exposition bleibt eine Infektion in vielen Fällen aus oder die Erkrankung verläuft subklinisch.…”

“…Eine aktuelle Studie von 1995, in die 294 Kinder mit ALL eingingen, ergab einen disseminierten Verlauf bei 13 von 42 Varizellenerkrankungen (30%), Fünf der Kinder (12%) starben an Organkomplikationen [5].Weder eine positive Vorgeschichte hinsichtlich Varizellen (n = 2) noch die postexpositionelle Gabe von VZIG (n = 20) hatte in Einzelfällen Schutz vor Ausbruch der Erkrankung geboten. Auch eine i.v.…”

“…So beschränkt sich der sinnvolle Einsatz auf Fälle, in denen eine erfolgte Exposition rechtzeitig für die empfohlene VZIG-Gabe innerhalb der ersten 24 bis maximal 72 h erkannt wurde [5,21]. So beschränkt sich der sinnvolle Einsatz auf Fälle, in denen eine erfolgte Exposition rechtzeitig für die empfohlene VZIG-Gabe innerhalb der ersten 24 bis maximal 72 h erkannt wurde [5,21].…”

Application of immune adherence hemagglutination test in the screening of blood donors carrying a high titer antibody to varicella-zoster virus.

“…The present results suggest that an enough VZVIP and VZVIG with a high IAHA antibody titer can be obtained from the blood donors by routine screening at blood centers, and can be used for passive immunization for the prevention of varicella in high-risk patients. Balfour et al (1977) reported that the doses of an average of 7 ml of VZVIP with CF titer of >32 per kg body weight was markedly effectiv in preventing or modifying varicella in immunocompromised patients if given shortly after exposure to a varicella patient. Judelsohn et al (1974) showed that if 5 ml of VZVIG with CF titer of >2,560 were administrated to 56 high-risk children after close exposure to active varicella, then 49 children of them had no clinical evidence of varicella, and 7 developed mild varicella which was not life-theratening.…”

“…It is well known that the administration of VZV immunoglobulin (VZVIG) or immune plasma (VZVIP) to the immunosuppressed patients is markedly effective and safe (Judelsohn et al 1974;Balfour et al 1977;Lane et al 1980). The source of VZVIG or VZVIP, however, is limited, because they have been obtained from the blood of convalescents from herpes zoster infection.…”