Letter To The Editor

The studies of Zaia et al demonstrating a practical method for preparation of hyperimmune globulin, varicella-zoster immune globulin (VZIG), for passive immunization against varicella are encouraging. Consequently, in the future, it should be possible to obtain VZIG for high-risk children who have known exposures to varicella-zoster virus. However, we believe that history has demonstrated that passive immunization is rarely a substitute for active immunization, and varicella is no exception to this rule. Passive immunization will be of no value if (1) persons are unaware that they were exposed or (2) they wait too long after exposure before notifying their physician.

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Case 3

Oxford Case Histories in Infectious Diseases and Microbiology ◽

10.1093/med/9780198846482.003.0003 ◽

2020 ◽

pp. 14-18

Author(s):

Andrew Woodhouse

Keyword(s):

Varicella Zoster Virus ◽

Immune Globulin ◽

Passive Immunization ◽

Evidence Base ◽

Drug Levels ◽

Varicella Zoster ◽

Intravenous Treatment ◽

Varicella Pneumonia

Chickenpox is caused by varicella-zoster virus and is predominantly a self-limiting disease of childhood. Chickenpox in adults is more likely to be associated with complications such as varicella pneumonia. Treatment with antivirals is helpful in adults if given early after the onset of rash in uncomplicated disease. In complicated disease such as pneumonia, intravenous treatment is essential to optimize drug levels although an evidence base for this is lacking. Exposure to varicella during pregnancy is a particular concern for non-immune women and passive immunization with varicella immune globulin is indicated.

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Antibody to varicella-zoster virus after passive immunization against chickenpox

Journal of Clinical Microbiology ◽

10.1128/jcm.8.6.733-735.1978 ◽

1978 ◽

Vol 8 (6) ◽

pp. 733-735

Author(s):

A A Gershon ◽

S Piomelli ◽

M Karpatkin ◽

E Smithwick ◽

S Steinberg

Keyword(s):

High Risk ◽

Varicella Zoster Virus ◽

Geometric Mean ◽

Passive Immunization ◽

Immune Serum ◽

Immune Serum Globulin ◽

Serum Globulin ◽

Varicella Zoster ◽

Antibody Titers ◽

Immunofluorescence Antibody

Antibody titers to varicella-zoster virus were measured in varicella-susceptible immunocompromised children 48 h after they received either one of two lots of zoster immune globulin (ZIG) or a selected lot of immune serum globulin (ISG). Globulin was given to modify varicella in these children after exposure to varicella or zoster. Indirect immunofluorescence antibody titers (FAMA) of children after receipt of globulin ranged from less than 1:2 to 1:32. Geometric mean FAMA titers were highest after 1.2 ml of ISG per kg (FAMA titer 1:128) and 0.16 ml of ZIG lot A per kg (FAMA titer 1:1,024). Selected batches of ISG titering 1:128 or greater by FAMA, at a dose of 1.2 ml/kg, may be used to attempt to modify varicella in susceptible high-risk individuals when ZIG is not available.

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PREVENTION OF VARICELLA IN HIGH RISK CHILDREN: A COLLABORATIVE STUDY

PEDIATRICS ◽

10.1542/peds.50.5.718 ◽

1972 ◽

Vol 50 (5) ◽

pp. 718-722

Author(s):

Philip A. Brunell ◽

Anne A. Gershon ◽

Walter T. Hughes ◽

Harris D. Riley ◽

John Smith

Keyword(s):

High Risk ◽

Immune Globulin ◽

Cellular Immunity ◽

Normal Child ◽

Collaborative Study ◽

Normal Children ◽

Leukemic Child ◽

Adequate Dosage ◽

High Risk Children

It has been shown that varicella can be prevented in susceptible normal children by administration of zoster immune globulin (ZIG) following exposure. A dose adequate to prevent illness in a normal child, however, appeared only to modify the disease when given to a leukemic child. It appeared, therefore, that larger quantities of antibody might be required to prevent varicella in high risk children. A collaborative study was thus undertaken to evaluate the efficacy of ZIG in children considered to be at high risk from varicella. Susceptible children with leukemia or other malignancies, or with defects in cellular immunity on either a genetic or an iatrogenic basis were considered to be at high risk. Such children from collaborating centers were preregistered in the study, and ZIG was administered after a household exposure to varicella had occurred. Nine high risk children received ZIG within 48 hours following a household exposure. Varicella was prevented or modified in eight of these children. One child who received a less potent preparation of ZIG developed progressive varicella, but subsequently recovered. ZIG in adequate dosage, administered within 48 hours of exposure, may be expected to prevent or modify varicella in high risk children.

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Efficacy of Zoster Immune Globulin

PEDIATRICS ◽

10.1542/peds.53.4.476 ◽

1974 ◽

Vol 53 (4) ◽

pp. 476-480

Author(s):

Richard G. Judelsohn ◽

Joel D. Meyers ◽

Robert J. Ellis ◽

Elaine K. Thomas

Keyword(s):

High Risk ◽

Disease Control ◽

Immune Globulin ◽

Immune Status ◽

Clinical Symptoms ◽

Normal Children ◽

Therapeutic Modalities ◽

Immunosuppressive Medications ◽

Life Threatening ◽

High Risk Children

Varicella may be a life-threatening infection in children who have immunodeficiency diseases or who are taking immunosuppressive medications. It was previously demonstrated that zoster immune globulin (ZIG) can prevent varicella in normal children if given within 72 hours of exposure, and its possible efficacy has been reported in high-risk immunodeficient children as well. A program for the distribution of ZIG to high-risk susceptibles was established at the Center for Disease Control in 1971. In 1972, 56 high-risk children were treated with ZIG after exposure. Forty-nine recipients had no clinical symptoms of varicella; at least 34 of these 49 had undetectable CF antibody before treatment, though their immune status by other serologic techniques was unknown. In the seven recipients who developed varicella, the disease was not life-threatening. ZIG may be preferable to other available therapeutic modalities in the prevention or modification of varicella.

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