Varicella vaccination in children after bone marrow transplantation

Sauerbrei, Andreas; Prager, J; Hengst, Ulf; Zintl, F; Wutzler, Peter

doi:10.1038/sj.bmt.1700909

Cited by 95 publications

(64 citation statements)

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“…Moreover, the role of immunization with varicella vaccine, which is being studied currently, may be associated with reduced morbidity and should be investigated further. 27,28 …”

Section: Discussionmentioning

confidence: 99%

Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue

Bilgrami

Chakraborty

Rodriguez-Pinero

et al. 1999

Bone Marrow Transplant

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Summary:A retrospective evaluation of 215 consecutive recipients of high-dose chemotherapy (HDC) and autologous stem cell rescue (ASCR) was conducted to ascertain the incidence, temporal course, and outcome of varicella zoster virus (VZV) infection. Herpes zoster was identified in 40 individuals at a median of 69 days following ASCR. Six of these cases occurred at a median of 33 days prior to ASCR but following the initiation of high doses of stem cell mobilization chemotherapy. Twenty-five percent of patients demonstrated cutaneous or systemic dissemination and 32.5% required medical intervention for post-herpetic neuralgia. All except two individuals received antiviral chemotherapy. One patient with active VZV infection died of multiorgan failure 39 days after ASCR. Multivariate analysis of risk factors disclosed the significance of prophylactic acyclovir use in Herpes simplex virus seropositive individuals in reducing the risk of VZV infection. Moreover, the use of busulfan, thiotepa and carboplatin as the conditioning chemotherapy regimen was associated with an increased risk of subsequent VZV infection. The incidence of VZV reactivation after HDC and ASCR is similar to that observed following bone marrow transplantation but has an earlier onset. This may be related to an earlier induction of immunosuppression by stem cell mobilization chemotherapy administered prior to ASCR. We demonstrated a marked reduction in the proliferative and synthetic capacities of peripheral blood mononuclear cells obtained prior to and following stem cell mobilizing chemotherapy. Moreover, greater than 80% of VZV infections occurred within 6 months following ASCR and late cases were seldom observed compared to allogeneic and autologous bone marrow transplantation. The role of antiviral chemoprophylaxis during the period of maximum immunocompromise needs to be studied further in the HDC-ASCR setting.

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“…Moreover, the role of immunization with varicella vaccine, which is being studied currently, may be associated with reduced morbidity and should be investigated further. 27,28 …”

Section: Discussionmentioning

confidence: 99%

Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue

Bilgrami

Chakraborty

Rodriguez-Pinero

et al. 1999

Bone Marrow Transplant

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“…The incidence of VZV infec- tion in children following HSCT varied from 23% to 67%. [2][3][4][5][6] Herpes zoster is one of the common late infections in post-transplant patients. The median onset of HZ following HSCT occurred at the fifth month.…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation

Leung

Chik

et al. 2000

Bone Marrow Transplant

104

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Summary:We report a retrospective analysis of VZV infection after haematopoietic stem cell transplantation (HSCT) in children. Thirty-three (30%) of the total 109 children who were transplanted during a 7 year period developed post-transplant VZV infection. Twenty-four of these 33 (73%) children had VZV infection within 1 year following HSCT. The cumulative incidences of post-transplant VZV infection at 1 and 5 years were 26% and 45%, respectively. The positive and negative predictive values of pretransplant VZV serology in recipients on the development of HZ following HSCT were 39% and 88%, respectively. Pretransplant VZV seropositivity in recipients was the only risk factor for post-transplant herpes zoster (HZ) infection on multivariate analysis. All patients responded to acyclovir. The median duration of VZV infection was 5 days. Three (11%) and one (3%) children with HZ developed visceral dissemination and post-herpetic neuralgia, respectively. No mortality was directly attributed to VZV infection. VZV infection remains a major cause of morbidity in children after HSCT. Further studies are warranted to evaluate the potential use of VZV vaccine in these children. Bone Marrow Transplantation (2000) 25, 167-172. Keywords: haematopoietic stem cell transplantation; herpes zoster; paediatric; varicella-zoster virus Varicella-zoster virus (VZV) is a herpes virus that causes chickenpox (CP) as a primary infection and herpes zoster (HZ) when the latent virus is reactivated. It is a significant cause of morbidity and mortality in immunocompromised patients. Ten percent of children with leukaemia on maintenance chemotherapy died of VZV infection in the preacyclovir era. 1 Haematopoietic stem cell transplantation (HSCT) is now the treatment of choice for some malignant and nonmalignant conditions in children. However, these patients are at high risk of having severe VZV infection because of significant and prolonged immunosuppression in the post-transplant period. The incidence of VZV infec- tion in children following HSCT varied from 23% to 67%. [2][3][4][5][6] Herpes zoster is one of the common late infections in post-transplant patients. The median onset of HZ following HSCT occurred at the fifth month. 7 However, risk factors for post-transplant VZV infection in children are less well defined because there are few reports on this subject. In this study, we review the incidence, risk factors, treatment and clinical outcome of VZV infection in children who underwent HSCT at our centre. Patients and methods Study population and design

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“…Sauerberi et al (35) did not observe any case of chickenpox or herpes zoster for up to 2 years after vaccination in 15 patients who received one dose of VZV vaccine 12 to 23 months after BMT. These data are difficult to interpret since the occurrence of zoster is expected around the sixth month after transplantation and the risk of a second episode is less than 5% in this population.…”

Section: Varicella Vaccinementioning

confidence: 99%

Reimmunization after bone marrow transplantation: current recommendations and perspectives

Machado

2004

Braz J Med Biol Res

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Autologous and allogeneic bone marrow transplantation (BMT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated through a lifetime and therefore need to be revaccinated. Diphtheria toxoid, tetanus toxoid, pertussis vaccine (children <7 years old), Haemophilus influenzae type b conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza vaccine, inactivated polio vaccine and live-attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after BMT. For most of them, the best time to vaccinate, the number of vaccine doses and/or the duration of immunity after vaccination have not been established. Vaccination protocols vary greatly among BMT centers, suggesting that the lack of sufficient data has not permitted the formulation of reliable recommendations. The use of other vaccines and the perspectives for different vaccination protocols are analyzed in this review.

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Varicella vaccination in children after bone marrow transplantation

Cited by 95 publications

References 0 publications

Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue

Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue

Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation

Reimmunization after bone marrow transplantation: current recommendations and perspectives

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