Immunization of Healthy Adults with Live Attenuated Varicella Vaccine

Gershon, Anne A.; Steinberg, Sharon; LaRussa, Philip; Ferrara, Angelo; Hammerschlag, Margaret R.; Gelb, Lawrence D.

doi:10.1093/infdis/158.1.132

Cited by 176 publications

(63 citation statements)

References 16 publications

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“…42,59,60 No published data are available on the proportion of adolescents or adults who achieve a gpELISA concentration of Ն5 U/mL after either 1 or 2 doses of varicella vaccine. Persistence of antibody over the ensuing decade in this population varies, but studies using the FAMA assay have suggested that approximately 30% of adults lose detectable antibodies over this time period.…”

Section: Immunogenicitymentioning

confidence: 99%

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Bocchini¹,

Baltimore²,

Bernstein³

et al. 2007

Pediatrics

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National varicella immunization coverage using the current 1-dose immunization strategy has increased among vaccine-eligible children 19 through 35 months of age from 27% in 1997 to 88% by 2005. These high immunization rates have resulted in a 71% to 84% decrease in the reported number of varicella cases, an 88% decrease in varicella-related hospitalizations, a 59% decrease in varicellarelated ambulatory care visits, and a 92% decrease in varicella-related deaths in 1-to 4-year-old children when compared with data from the prevaccine era. Despite this significant decrease, the number of reported cases of varicella has remained relatively constant during the past 5 to 6 years. Since vaccine effectiveness for prevention of disease of any severity has been 80% to 85%, a large number of cases of varicella continue to occur among people who already have received the vaccine (breakthrough varicella), and outbreaks of varicella have been reported among highly immunized populations of schoolchildren. The peak age-specific incidence has shifted from 3-to 6-year-old children in the prevaccine era to 9-to 11-year-old children in the postvaccine era for cases in both immunized and unimmunized children during these outbreaks. Outbreaks of varicella are likely to continue with the current 1-dose immunization strategy.After administration of 2 doses of varicella vaccine in children, the immune response is markedly enhanced, with Ͼ99% of children achieving an antibody concentration (determined by glycoprotein enzyme-linked immunosorbent assay) of Ն5 U/mL (an approximate correlate of protection) and a marked increase in geometric mean antibody titers after the second vaccine dose. The estimated vaccine efficacy over a 10-year observation period of 2 doses for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella, compared with those who are given 1 dose, during the first 10 years after immunization.To achieve greater levels of immunity with fewer serosusceptible people, greater protection against breakthrough varicella disease, and reduction in the number of outbreaks that occur nationwide among school-aged populations, a 2-dose varicella immunization strategy is now recommended for children Ն12 months of age. All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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Section: Immunogenicitymentioning

confidence: 99%

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Bocchini¹,

Baltimore²,

Bernstein³

et al. 2007

Pediatrics

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“…It is highly sensitive because the preservation of the structure of the surface glycoproteins on infected cells allows neutralising antibodies to be detected [389] . It has been used to assess protection against varicella as a value of ≥ 4 correlates with protection [215,347,376,[390][391][392] . Its limitations are that it is semi-quantitative, cannot be automated, and requires specialised personnel and specific equipment; reading is subjective and subject to inter-laboratory variability [30] .…”

Section: Ifamentioning

confidence: 99%

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn. Core tip: Although varicella during pregnancy is infrequent and congenital varicella syndrome (CVS) is rare, every available means should be used to prevent and diagnose them. Microbiology laboratories can be crucial in these situations: Evaluating a mother's immune status with sensitive and specific tests for the detection of antibodies; allowing a rapid diagnosis with molecular biology tests when a clinical manifestation may be due to different etiologies; following pregnant women with varicella for the prenatal diagnosis of CVS with close collaboration between molecular biology investigators and specialists in imaging diagnostics.De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World

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“…The development by Takahashi and his colleagues of the live attenuated Oka strain of VZV in the early 1970s made it possible to immunize VZV-naive children and adults against varicella [33][34][35][36] and to explore the possibility of boosting VZV-CMI in older adults [21,31]. Subsequent studies have demonstrated that Oka-derived VZV vaccines can elicit a significant increase in VZV-CMI in immunocompetent older adults [32,[37][38][39] and can reduce the incidence and severity of HZ in recipients of bone marrow allografts [40,41].…”

mentioning

confidence: 99%

Vaccination against Herpes Zoster and Postherpetic Neuralgia

Oxman¹,

Levin²

2008

J INFECT DIS

160

100

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Background. Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause significant morbidity in older adults. The incidence and severity of HZ and PHN increase with age in association with an age-related decline in varicellazoster virus (VZV)-specific cell-mediated immunity (VZV-CMI). VZV vaccines can boost VZV-CMI. Therefore, we tested the hypothesis that VZV vaccination would protect older adults against HZ and PHN.Methods. We enrolled 38,546 adults у60 years of age in a randomized, double-blind, placebo-controlled trial of an investigational HZ vaccine and actively followed subjects for the development of HZ. The primary end point was the burden of illness due to HZ (HZ BOI), a composite measure of the incidence, severity, and duration of pain and discomfort caused by HZ. The secondary end point was the incidence of PHN.Results. Subject retention was 195%. HZ vaccine reduced the HZ BOI by 61.1% (95% confidence interval [CI], 51.1%-69.1%;) and reduced the incidence of PHN by 66.5% (95% CI, 47.5%-79.2%; ). The P ! .001 P ! .001 incidence of HZ was also reduced by 51.3% (95% CI, 44.2%-57.6%;). HZ vaccine was well tolerated; P ! .001 injection site reactions were generally mild. HZ vaccine neither caused nor induced HZ.Conclusion. The Shingles Prevention Study demonstrated that HZ vaccine significantly reduced the morbidity due to HZ and PHN in older adults.

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Immunization of Healthy Adults with Live Attenuated Varicella Vaccine

Cited by 176 publications

References 16 publications

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Vaccination against Herpes Zoster and Postherpetic Neuralgia

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