Varicella-Zoster Virus (VZV) Reactivation Is Related to the Low Response of VZV-Specific Immunity after Chickenpox in Infancy

Abstract

To clarify the cause of herpes zoster in immunocompetent children, specific humoral and cellular immunity was determined using an ELISA and a lymphoproliferative assay, respectively, in infants < 1 year of age and children > or = 1 year of age who had chickenpox. Thirteen (59.1%) of 22 infants, 17 (81.0%) of 21 children > or = 1 year of age (P < .02), and 13 (86.7%) of 15 children > or = 2 years of age (P < .001) had positive varicella-zoster virus (VZV)-specific cellular immunity. VZV-specific antibodies in infants were significantly lower than those in children > or = 1 year old (P < .01) and > or = 2 years old (P < .001). The possibility of subclinical reactivation was demonstrated by an increase in the specific cellular or humoral immunity (or both) in all of 6 infants who had negative specific cellular immunity. The low response of specific immunity and the immunologic evidence of reactivation in infants after chickenpox provide a possible explanation for the finding that chickenpox in infancy is a risk factor for herpes zoster.

Varicella: to vaccinate or not to vaccinate?

“…This observation is in keeping with that of Terada et al who showed that the cell mediated immune response to VZV is age dependent 17. Young infants with varicella develop lower cell mediated immunity responses than older children.…”

Taking stock of infections and antibiotic resistance in the elderly and long-term care facilities: A survey of existingand upcoming challenges

“…The incidence and severity of shingles and postherpetic neuralgia (PHN) increase with age in association with a progressive decline in cell-mediated immunity to VZV. The triggers for reactivation of VZV are poorly understood, and protection may involve external boosting, internal boosting, or other mechanisms [53][54][55][56][57]. Risk factors associated with VZV include increasing age and impaired cell-mediated immunity.…”

Herpes Zoster in the First Year of Life Following Postnatal Exposure to Varicella-zoster Virus

“…8,11 Terada et al 11 conclude that immunological status before primary infection with VZV is important and affects reactivation of VZV. They observed that, 6 to 7 weeks after primary varicella, infants had a lower response of VZV-specific cellular and humoral immunity compared with children who had infection at older ages (Ͼ1 year).…”

“…Low response in specific VZV immunity is a valid reason to consider varicella in the first year of life as a risk factor for development of herpes zoster in otherwise healthy children. 7,8,11,13,14 Terada et al 15 showed that healthy immunocompetent children who had primary VZV before 1 year of age remained positive for VZV (as determined by polymerase chain reaction) for the longest period. From these data, Terada et al 15 hypothesized that a "subclinical reactivation" puts infants with a history of primary varicella at risk for herpes zoster.…”