Varicella: to vaccinate or not to vaccinate?

Gershon, Anne A.

doi:10.1136/adc.79.6.470

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…Similar findings were reported for cynomolgus macaques vaccinated with TC-83 and challenged with aerosolized VEEV [18]. A small percentage of human vaccinees typically fail to seroconvert following a single immunization with live-attenuated vaccines, including those for varicella [19] measles [20], hepatitis B [21] and VEEV strain TC-83 [22]. However, vaccinees who fail to seroconvert may be protected from subsequent exposure to virus, which can be associated with a virus-specific cell-mediated immune response [23].…”

Section: Discussionsupporting

confidence: 68%

A chimeric Sindbis-based vaccine protects cynomolgus macaques against a lethal aerosol challenge of eastern equine encephalitis virus

Roy

Adams²,

Wang³

et al. 2013

Vaccine

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Eastern equine encephalitis virus (EEEV) is a mosquito-borne alphavirus that causes sporadic, often fatal disease outbreaks in humans and equids, and is also a biological threat agent. Two chimeric vaccine candidates were constructed using a cDNA clone with a Sindbis virus (SINV) backbone and structural protein genes from either a North (SIN/NAEEEV) or South American (SIN/SAEEEV) strain of EEEV. The vaccine candidates were tested in a nonhuman primate (NHP) model of eastern equine encephalitis (EEE). Cynomolgus macaques were either sham-vaccinated, or vaccinated with a single dose of either SIN/NAEEEV or SIN/SAEEEV. After vaccination, animals were challenged by aerosol with a virulent North American strain of EEEV (NA EEEV). The SIN/NAEEEV vaccine provided significant protection, and most vaccinated animals survived EEEV challenge (82%) with little evidence of disease, whereas most SIN/SAEEEV-vaccinated (83%) and control (100%) animals died. Protected animals exhibited minimal changes in temperature and cardiovascular rhythm, whereas unprotected animals showed profound hyperthermia and changes in heart rate post-exposure. Acute inflammation and neuronal necrosis were consistent with EEEV-induced encephalitis in unprotected animals, whereas no encephalitis-related histopathologic changes were observed in the SIN/NAEEEV-vaccinated animals. These results demonstrate that the chimeric SIN/NAEEEV vaccine candidate protects against an aerosol EEEV exposure.

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Section: Discussionsupporting

confidence: 68%

A chimeric Sindbis-based vaccine protects cynomolgus macaques against a lethal aerosol challenge of eastern equine encephalitis virus

Roy

Adams²,

Wang³

et al. 2013

Vaccine

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“…Universal childhood vaccination against varicella is a controversial issue, however, there is support for immunization of high-risk populations [ 6 , 7 ]. Vaccination in the high-risk groups, especially prior to the onset of end-stage renal disease (ESRD), may decrease the number of patients with varicella infection, thereby reducing the graft and patient loss in addition to reducing the costs associated with the usual approaches.…”

Section: Introductionmentioning

confidence: 99%

Chickenpox infection after renal transplantation

Kaul

Sharma

Bhadhuria

et al. 2012

Clinical Kidney Journal

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Background.Chicken pox, although a common infection among children, is rare in immunocompromised patients, particularly renal transplant recipients, and carries a very high incidence of morbidity and mortality There is little data on chickenpox in adult renal transplant recipients, although reports have suggested that it may follow a virulent course requiring frequent hospitalization, and in severe cases can cause death.Aims.To evaluate the incidence, severity and complications of a varicella/chickenpox infection in renal transplant recipients over 10 years follow-up.Results.An incidence of 1.48% of our patients were diagnosed with varicella infection during this 10-year period from June 2000 to June 2010 in our live-related renal transplant program, with a median patient age of 39 years (range 21–54 years). Graft dysfunction was observed among five patients following the infection, two of whom became dialysis-dependent. The other three had mild graft dysfunction from which they subsequently recovered, suggesting that infection was responsible for graft dysfunction. None of them developed rejection following exposure or with modification of immunosuppression. All of our patients required admission with 47.8% presenting with various presentations, with orchitis, pancreatitis, encephalitis and gastritis each affecting 8.6% of the patients. All patients were managed with intravenous acyclovir for 2 weeks followed by oral acyclovir for 3 months. The infection was associated with an increased mortality of 13.4% due to superadded infections and central nervous system involvement in one patient with fatal bilateral pneumonia.Conclusions.This infection, which is a benign disease with a largely stable course among the general population, can have severe outcomes for immunocompromised patients, accounting for almost 90% with significant morbidity and mortality in the 8.6% of infected patients, thus highlighting the importance of pre-transplant vaccination in this subgroup of the population.

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“…Although data on vaccination in seronegative adults with chronic kidney disease are limited, expert opinion is of the view that the benefits of vaccination before transplantation are likely to outweigh the risks (10–13). In a recent study, nine (3.2%) of 280 adult patients awaiting a kidney transplant were shown to be susceptible to VZV by serological testing.…”

Section: Discussionmentioning

confidence: 99%

Fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient: should renal patients be vaccinated against VZV before transplantation?

Robertson

Newbigging

Carman

et al. 2005

Clinical Transplantation

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We describe a case of fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient. This promoted a survey of all 383 adult patients awaiting a renal transplant in Scotland, which showed a low level of Varicella zoster virus (VZV) awareness but a willingness to consider vaccination if non immune. 359/363 serum samples tested were seropositive for VZV antibody giving a susceptibility to VZV of 1.2%. Although data on vaccination in adults with chronic kidney disease are limited, expert opinion is of the view that the benefits of vaccinating immunocompetent seronegative patients before transplantation are likely to outweigh the risks. We believe that adult patients awaiting a transplant in the UK should be tested for their susceptibility to VZV and that early vaccination should be offered to those who are both immunocompetent and seronegative.

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Varicella: to vaccinate or not to vaccinate?

Cited by 9 publications

References 9 publications

A chimeric Sindbis-based vaccine protects cynomolgus macaques against a lethal aerosol challenge of eastern equine encephalitis virus

A chimeric Sindbis-based vaccine protects cynomolgus macaques against a lethal aerosol challenge of eastern equine encephalitis virus

Chickenpox infection after renal transplantation

Fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient: should renal patients be vaccinated against VZV before transplantation?

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