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

Ritter, J.; Jürgens, H.; Boos, J.

doi:10.1007/s001120050262

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…In conclusion, our findings confirm previous small studies on treating children suffering from HZ with brivudine [22][23][24]. Compared to those studies, we investigated a significantly larger cohort of patients and could demonstrate that immunocompromised children can be safely treated with brivudine.…”

Section: Discussionsupporting

confidence: 89%

Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster

Vogel¹,

Wetzel²,

Wutzler³

et al. 2023

Chemotherapy

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Introduction: Herpes zoster (HZ) is caused by endogenous reactivation of latent varicella-zoster virus (VZV) that persists in sensory ganglia after primary infection. The incidence and severity of HZ increase during immunosuppression. Especially, immunocompromised patients are at high risk of developing a cutaneous rash and suffering from delayed healing of lesions. Bromovinyl deoxyuridine (brivudine), one of the most potent oral inhibitors of VZV replication, is widely used in the therapy of HZ in adult patients, particularly in Europe. In this study, we investigated the efficacy of brivudine in immunocompromised children to provide an outpatient treatment option. Methods: In this retrospective study, we included 64 immunocompromised pediatric patients with a median age of 14 years. Forty-seven patients received immunosuppressive therapy as part of hematopoietic stem cell transplantation and 17 patients as part of chemotherapy. Primary diagnosis was made clinically by examining the nature and the localization of the skin lesions. Laboratory confirmation was conducted based on the detection of VZV DNA in vesicle fluid and blood samples. Brivudine was administered orally at a single dose of 2 mg/kg per day. We monitored the patients’ response for the full time of treatment and observed the time of full crusting of lesions, loss of crusts, and any adverse effects that occurred. Results: Patients received medication for 7–21 days (median: 14 days). All children responded promptly to antiviral treatment and recovered completely from their HZ infections without complications. Crusting of lesions was reached after 3–14 days (median: 6 days). Full healing of skin lesions was ascertained within 7–21 days (median: 12 days). Overall, brivudine therapy was well tolerated. No clinical side effects during or after the treatment were observed. High compliance was achieved due to the once-daily dosing regimen. All patients were treated in an outpatient manner. Conclusion: Oral brivudine was a very effective and well-tolerated therapy in immunocompromised children with HZ infection. The oral administration offers the potential for outpatient treatment of HZ in these patients.

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Section: Discussionsupporting

confidence: 89%

Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster

Vogel¹,

Wetzel²,

Wutzler³

et al. 2023

Chemotherapy

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“…Lethal drug interactions can occur if both drugs are taken. In conclusion, our ndings con rm previous small studies on treating children suffering from HZ with brivudin (Benoit et al, 1985;Heidl et al, 1991;Rössig et al, 1998). Compared to those studies, we investigated a signi cantly larger cohort of patients and could demonstrate that immunocompromised children can be safely treated with brivudin.…”

Section: Discussionsupporting

confidence: 87%

Treatment of herpes zoster with brivudin in immunocompromised children

Vogel

Wetzel

Wutzler

et al. 2022

Preprint

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Purpose: Herpes zoster (HZ) is caused by endogenous reactivation of latent varicella-zoster virus (VZV) that persists in sensory ganglia after primary infection. The incidence and severity of HZ increases during immunosuppression. Especially immunocompromised patients are at high risk of developing a cutaneous rash and suffering from delayed healing of lesions. Bromovinyl deoxyuridine (brivudin), one of the most potent oral inhibitors of VZV replication, is widely used in therapy of HZ in adult patients, particularly in Europe. In this study, we investigated the efficacy of brivudin in immunocompromised children to provide an outpatient treatment option. Methods: In this prospective study, we included 64 immunocompromised pediatric patients with a median age of 14 years. Forty-seven patients received immunosuppressive therapy as part of hematopoietic stem cell transplantation and 17 patients as part of chemotherapy. Primary diagnosis was made clinically by examining the nature and the localization of the skin lesions. Laboratory confirmation was conducted based on the detection of VZV DNA in vesicle fluid and blood samples. Brivudin was administered orally at a single dose of 2-5 mg/kg per day. We monitored the patients’ response for the full time of treatment and observed the time of full crusting of lesions, loss of crusts, and any adverse effects that occurred. Results: Patients received medication for 7-21 days (median: 14 days). All children responded promptly to antiviral treatment and recovered completely from their HZ infections without complications.Crusting of lesions was reached after 3-14 days (median: 6 days). Full healing of skin lesions was ascertained within 7-21 days (median: 12 days). Overall, brivudin therapy was well tolerated. No clinical side effects during or after the treatment were observed. High compliance was achieved due to the once-daily dosing regimen. All patients were treated in an outpatient manner. Conclusion: Oral brivudin was a very effective and well-tolerated therapy in immunocompromised children with HZ infection. The oral administration offers potential for outpatient treatment of HZ in these patients.

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“…Obwohl nicht nur die Sicherheit und Wirksamkeit des Varizellen-Impfstoffes sondern auch die deutlich niedrigere Frequenz von Herpes zoster nach VZV-Impfung in den zitierten Studien bei Leukämiepatienten in Remission und bei gesunden Kindern überzeugend dargestellt wurden [10,35] (II) und klare Empfehlungen von Seiten der STIKO und DGPI vorliegen (A, III), hat sich die Varizellenimpfung von Leukämie-und Tumorpatienten in den meisten Zentren der GPOH bisher nicht durchgesetzt [11,29]. Wesentliche Gründe dafür sind die bei Leukämiepatienten in zeitlichem Zusammenhang mit der Impfung notwendigen Unterbrechungen der Dauertherapie für die Gewährleistung einer ausreichenden Lymphozytenzahl und die damit verbundene Sorge, durch Therapieverzögerung das Rezidivrisiko des Patienten zu erhöhen.…”

Section: Empfehlungen Zur Varizellen-impfungunclassified

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Graubner¹,

Liese²,

Belohradsky³

2001

Klin Padiatr

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Vaccination has been an important part of antiinfectious prophylaxis in pediatric oncology comprising immunizations with special indication like varicella vaccine and follow-up of routine immunizations after chemotherapy and bone marrow transplantation (BMT). Studies from the last decade demonstrate a loss of long term immunity to immunization preventable disease in most patients with chemotherapy and BMT who had received appropriate immunization before. So far routine vaccination programs following intensive chemotherapy have not been studied prospectively. Immunization programs following BMT have shown that immunizations with tetanus toxoid, diphtheria toxoid, inactivated poliovirus vaccine and influenza vaccine - given at least 12 months after transplantation - are safe and effective. Vaccination with live attenuated trivalent vaccine against measles, mumps and rubella in patients without chronic "graft versus host disease" (GVHD) and without ongoing immunosuppressive therapy, performed 24 months after transplantation, proved to be safe too. Recommendations have been published by 5 different official groups: (1.) "Ständige Impfkommission" (STIKO) and (2.) "Deutsche Gesellschaft für pädiatrische Infektiologie" (DGPI) recommend varicella vaccine für children with leukemia in remission for at least 12 months, for children with solid tumors and for patients getting an organ transplantation. Both societies do not comment on the schedule of booster vaccinations (with live attenuated vaccines) after the end of chemotherapy and after BMT. (3.) "Qualitätssicherungsgruppe" der "Gesellschaft für pädiatrische Onkologie und Hämatologie" (QS-GPOH) recommends immunization with nonliving vaccines when the patient is off therapy for at least 3 months and immunization with live attenuated vaccines when he is off therapy for at least 6 months. This group does not comment on varicella vaccine which has been controversial among pediatric oncologists. (4.) The " Infectious disease working party of the European group for Blood and Marrow Transplantation" (EBMT) recommends immunization with nonliving vaccines when the patient is off transplantation for at least 12 months, without GVHD and without immunosuppressive therapy. (5.) The "Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant (HSCT) Recipients" published by the following american institutions and societies: "Centers for Disease Control and Prevention", "Infectious Diseases Society of America" and "American Society of Blood and Marrow Transplantation" recommend that patients should be routinely revaccinated after transplantation if they are off immunosuppressive therapy and do not suffer from GVHD: beginning of vaccinations with nonliving vaccines in the second year after HSCT, beginning of vaccinations with live attenuated vaccines in the third year after HSCT. Life-long seasonal influenza vaccination is recommended for all HSCT candidates and recipients, beginning during the influenza season before HSCT and resuming > 6 months after HS...

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

Cited by 4 publications

References 23 publications

Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster

Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster

Treatment of herpes zoster with brivudin in immunocompromised children

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