Varicella-Zoster Virus (Varicella and Shingles)

2021 ◽  
Author(s):  
Anne Gershon
Keyword(s):  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
The United States ◽  
Primary Immune Response ◽  
Wild Type Virus ◽  
High Dose ◽  
Healthy Children ◽  
Zoster Vaccine ◽  
Live Attenuated Vaccine ◽  
Varicella Zoster

A live attenuated vaccine against varicella (later also used to prevent zoster) was developed in 1974 by Takahashi and colleagues. Varicella vaccine was licensed for universal immunization of healthy children in the United States in 1995. It is also now used for this purpose in at least 15 additional countries all over the world. Varicella is disappearing in the US. Varicella vaccine has proven extremely safe and side effects are unusual, mild, and less serious than varicella or its complications. 85% of children are protected completely after 1 dose; the 15% who develop varicella despite immunization usually (but not always) have mild infections. These 15%, however, can transmit the wild type virus to others. Therefore, for optimal effect, 2 doses are required, mostly to address children who did not have an optimal primary immune response after the first dose. Waning immunity does not seem to pose a serious problem, but surveillance of vaccinees is continuing. It was demonstrated in 2005 that at a high dose of vaccine – 15 times higher than that used for prevention of varicella in children - zoster in adults can also be safely prevented. The live attenuated zoster vaccine is effective in approximately 50% of healthy individuals over age 60 who have had varicella in the past, and therefore have latent infection with varicella-zoster virus. It is given as one dose, but its effect runs out about 8 years after vaccination. In 2017, a new vaccine against zoster was also introduced. This is a subunit vaccine which does not contain contagious virus. It is even more effective than the older zoster vaccine and is over 95% effective in adults 50–≥70 years of age in preventing zoster and post herpetic neuralgia.

scholarly journals Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

2020 ◽  
Vol 35 (13) ◽  
pp. 889-895 ◽  
Author(s):  
Veena Ramachandran ◽  
Stephen C. Elliott ◽  
Kathie L. Rogers ◽  
Randall J. Cohrs ◽  
Miles Weinberger ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
The United States ◽  
Vaccine Virus ◽  
Virus Reactivation ◽  
Wild Type ◽  
Varicella Zoster ◽  
Intravenous Acyclovir

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

scholarly journals Detection of Antibodies to Varicella-Zoster Virus in Recipients of the Varicella Vaccine by Using a Luciferase Immunoprecipitation System Assay

2014 ◽  
Vol 21 (9) ◽  
pp. 1288-1291 ◽  
Author(s):  
Jeffrey I. Cohen ◽  
Mir A. Ali ◽  
Ahmad Bayat ◽  
Sharon P. Steinberg ◽  
Hosun Park ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
High Throughput ◽  
Fluorescent Antibody ◽  
Varicella Vaccine ◽  
The United States ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Viral Capsid Antigen ◽  
Glycoprotein E ◽  
Varicella Zoster

ABSTRACTA high-throughput test to detect varicella-zoster virus (VZV) antibodies in varicella vaccine recipients is not currently available. One of the most sensitive tests for detecting VZV antibodies after vaccination is the fluorescent antibody to membrane antigen (FAMA) test. Unfortunately, this test is labor-intensive, somewhat subjective to read, and not commercially available. Therefore, we developed a highly quantitative and high-throughput luciferase immunoprecipitation system (LIPS) assay to detect antibody to VZV glycoprotein E (gE). Tests of children who received the varicella vaccine showed that the gE LIPS assay had 90% sensitivity and 70% specificity, a viral capsid antigen enzyme-linked immunosorbent assay (ELISA) had 67% and 87% specificity, and a glycoprotein ELISA (not commercially available in the United States) had 94% sensitivity and 74% specificity compared with the FAMA test. The rates of antibody detection by the gE LIPS and glycoprotein ELISA were not statistically different. Therefore, the gE LIPS assay may be useful for detecting VZV antibodies in varicella vaccine recipients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00921999.)

DNA sequence analysis of varicella-zoster virus gene 62 from subclinical infections in healthy children immunized with the Oka varicella vaccine

Vaccine ◽  
2008 ◽  
Vol 26 (44) ◽  
pp. 5627-5632 ◽  
Author(s):  
Yasuyuki Gomi ◽  
Takao Ozaki ◽  
Naoko Nishimura ◽  
Atsushi Narita ◽  
Michio Suzuki ◽  
...  
Keyword(s):  
Sequence Analysis ◽  
Varicella Zoster Virus ◽  
Dna Sequence ◽  
Varicella Vaccine ◽  
Dna Sequence Analysis ◽  
Healthy Children ◽  
Varicella Zoster ◽  
Virus Gene

Varicella in Pediatric Patients

1993 ◽  
Vol 27 (7-8) ◽  
pp. 938-949 ◽  
Author(s):  
Laureen A. Drwal-Klein ◽  
Carmel A. O'Donovan
Keyword(s):  
Varicella Zoster Virus ◽  
Antiviral Therapy ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Varicella Vaccine ◽  
Clinical Manifestations ◽  
Search Term ◽  
Healthy Children ◽  
Varicella Zoster ◽  
Treatment And Prevention

OBJECTIVE: To summarize the literature describing the epidemiology, transmission, clinical manifestations, diagnosis, treatment, and prevention of varicella in the pediatric population. DATA SOURCES: A literature search of English-language articles from 1982 to 1992 using MEDLINE and bibliographies of relevant articles. The search term used was varicella. STUDY SELECTION: All review articles and original studies addressing the epidemiology, transmission, clinical manifestations, complications, diagnosis, treatment, and prevention of varicella in pediatric patients were reviewed. Emphasis was placed on controlled studies done in the US. DATA EXTRACTION: Data from human studies were extracted by the authors and evaluated according to patient population, sample size, dosing regimen, efficacy, and safety. DATA SYNTHESIS: Varicella-zoster virus is a highly contagious virus that produces a common and costly disease in the pediatric population. The primary manifestation of varicella is the eruption of vesicular lesions. In most cases varicella is benign, but it can be associated with serious complications. Diagnosis is based primarily on clinical findings. Otherwise healthy children have traditionally received only symptomatic treatment for varicella, but recent literature suggests that antiviral therapy may be useful in these patients. Immunocompromised patients benefit from both symptomatic and antiviral therapy. Isolation and varicella-zoster immune globulin are used to prevent varicella. In the future, varicella vaccine will play an important role in preventing the disease. Varicella vaccine has been shown to be immunogenic and clinically effective in both healthy and immunocompromised children. Adverse reactions associated with the vaccine include fever, injection-site reactions, and rash. Although zoster can follow vaccination, the incidence appears to be lower in vaccinated individuals. Preliminary studies have shown that the vaccine provides protection from varicella-zoster virus for an extended period of time. CONCLUSIONS: Varicella is a common, usually benign disease of childhood. All patients may benefit from symptomatic therapy. Current literature does not support the use of antiviral therapy in all pediatric patients with varicella. When commercially available, varicella vaccine will play an important role in prevention. Long-term studies are needed to fully assess the risk of developing varicella and zoster following vaccination.

scholarly journals Immunogenicity of Varicella-Zoster Virus Glycoprotein E Formulated with Lipid Nanoparticles and Nucleic Immunostimulators in Mice

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 310
Author(s):  
Han Cao ◽  
Yunfei Wang ◽  
Ning Luan ◽  
Cunbao Liu
Keyword(s):  
Nucleic Acids ◽  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
Lipid Nanoparticles ◽  
Zoster Vaccine ◽  
Glycoprotein E ◽  
Preclinical Trial ◽  
Varicella Zoster ◽  
Virus Glycoprotein ◽  
Polycytidylic Acid

Theoretically, the subunit herpes zoster vaccine ShingrixTM could be used as a varicella vaccine that avoids the risk of developing shingles from vaccination, but bedside mixing strategies and the limited supply of the adjuvant component QS21 have made its application economically impracticable. With lipid nanoparticles (LNPs) that were approved by the FDA as vectors for severe acute respiratory syndrome coronavirus 2 vaccines, we designed a series of vaccines efficiently encapsulated with varicella-zoster virus glycoprotein E (VZV-gE) and nucleic acids including polyinosinic-polycytidylic acid (Poly I:C) and the natural phosphodiester CpG oligodeoxynucleotide (CpG ODN), which was approved by the FDA as an immunostimulator in a hepatitis B vaccine. Preclinical trial in mice showed that these LNP vaccines could induce VZV-gE IgG titers more than 16 times those induced by an alum adjuvant, and immunized serum could block in vitro infection completely at a dilution of 1:80, which indicated potential as a varicella vaccine. The magnitude of the cell-mediated immunity induced was generally more than 10 times that induced by the alum adjuvant, indicating potential as a zoster vaccine. These results showed that immunostimulatory nucleic acids together with LNPs have promise as safe and economical varicella and zoster vaccine candidates.

scholarly journals Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics

2010 ◽  
Vol 23 (1) ◽  
pp. 202-217 ◽  
Author(s):  
D. Scott Schmid ◽  
Aisha O. Jumaan
Keyword(s):  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
Laboratory Diagnosis ◽  
The United States ◽  
Diagnostic Techniques ◽  
Disease Symptoms ◽  
Varicella Zoster ◽  
Diagnostic Approaches ◽  
Effective Diagnosis ◽  
The Impact

SUMMARY The licensure and recommendation of varicella vaccine in the mid-1990s in the United States have led to dramatic declines in varicella incidence and varicella-related deaths and hospitalizations. Varicella outbreaks remain common and occur increasingly in highly vaccinated populations. Breakthrough varicella in vaccinated individuals is characteristically mild, typically with fewer lesions that frequently do not progress to a vesicular stage. As such, the laboratory diagnosis of varicella has grown increasingly important, particularly in outbreak settings. In this review the impact of varicella vaccine on varicella-zoster virus (VZV) disease, arising complications in the effective diagnosis and monitoring of VZV transmission, and the relative strengths and limitations of currently available laboratory diagnostic techniques are all addressed. Since disease symptoms often resolve in outbreak settings before suitable test specimens can be obtained, the need to develop new diagnostic approaches that rely on alternative patient samples is also discussed.

Varicella Vaccine Reflux

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 354-354
Author(s):  
C. J. WHITE
Keyword(s):  
Varicella Zoster Virus ◽  
Primary Infection ◽  
Lymphoblastic Leukemia ◽  
Varicella Vaccine ◽  
Wild Type Virus ◽  
Type Virus ◽  
Wild Type ◽  
Varicella Zoster ◽  
Attenuated Virus ◽  
Sensory Root

In Reply.— Herpes zoster (shingles) is the dermatomal skin eruption resulting from the reactivation of varicella-zoster virus remaining latent in posterior sensory root ganglia following childhood chickenpox (the primary infection with varicella-zoster virus). Since the live attenuated varicella-zoster virus contained in the vaccine replicates in the vaccinee similar to the wild-type virus, establishment of latency is possible for the attenuated strain. Several publications have addressed latency of the attenuated virus following immunization. Two studies have examined the incidence of zoster in children with acute lymphoblastic leukemia (ALL) following immunization with live attenuated varicella-zoster virus.

scholarly journals Comparison of the Whole-Genome Sequence of an Oka Varicella Vaccine from China with Other Oka Vaccine Strains Reveals Sites Putatively Critical for Vaccine Efficacy

2019 ◽  
Vol 93 (9) ◽  
Author(s):  
Qiuhua Wu ◽  
Pierre Rivailler ◽  
Songtao Xu ◽  
Wenbo Xu
Keyword(s):  
Amino Acid ◽  
Varicella Zoster Virus ◽  
Vaccine Efficacy ◽  
Varicella Vaccine ◽  
The Other ◽  
Whole Genome Sequence ◽  
Whole Genome ◽  
Live Attenuated Vaccine ◽  
Live Attenuated Vaccines ◽  
Varicella Zoster

ABSTRACTVaricella-zoster virus (VZV) infection results in varicella mostly in children. Reactivation of the virus causes herpes zoster (HZ), mostly in adults. A live attenuated vaccine (vOka-Biken) was originally derived from the parental strain pOka. Several live attenuated vaccines based on the Oka strain are currently available worldwide. In China, varicella vaccines have been licensed by four manufacturers. In this study, we analyze the whole-genome sequence (WGS) of vOka-BK produced by Changchun BCHT Biotechnology also known as Baike. vOka-BK WGS was compared against the genomic sequences of four other Oka strains: pOka, vOka-Biken, vOka-Varilrix from GlaxoSmithKline, and vOka-Varivax from Merck & Co. A previous study identified 137 single nucleotide polymorphisms (SNPs) shared by all vOkas. The current analysis used these data as a reference to compare with vOka-BK WGS and focused on 54 SNPs located in the unique regions of the genome. Twenty-eight nonsynonymous substitutions were identified, ORF62 and ORF55 featuring the most amino acid changes with 9 and 3, respectively. Among the 54 SNPs, 10 had a different mutation profile in vOka-BK compared to the other three vaccines. A comparison with the clade 3 strain Ellen, known to be attenuated, identified three shared amino acid changes: *130R in ORF0 and R958G and S628G in ORF62. This analysis provides the first comparison of a Chinese varicella vaccine to the other vaccines available worldwide and identifies sites potentially critical for VZV vaccine efficacy.IMPORTANCEVaricella, also known as chickenpox, is a highly contagious disease, caused by varicella-zoster virus (VZV). Varicella is a common childhood disease that can be prevented by a live attenuated vaccine. The first available vaccine was derived from the parental Oka strain in Japan in 1974. Several live attenuated vaccines based on the Oka strain are currently available worldwide. Among the four vaccines produced in China, the vaccine manufactured by Changchun BCHT Biotechnology, also known as Baike, has been reported to be very efficacious. Comparative genomic analysis of the Baike vaccine with other Oka vaccine strains identified sites that might be involved in vaccine efficacy, as well as important for the biology of the virus.

Modified Chickenpox in Children Immunized With the Oka/Merck Varicella Vaccine

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Barbara M. Watson ◽  
Sharon A. Piercy ◽  
Stanley A. Plotkin ◽  
Stuart E. Starr
Keyword(s):  
Virus Infection ◽  
Varicella Zoster Virus ◽  
Median Time ◽  
Index Case ◽  
Varicella Vaccine ◽  
Skin Lesions ◽  
Varicella Zoster Virus Infection ◽  
Healthy Children ◽  
Varicella Zoster ◽  
Index Cases

Oka/Merck varicella vaccine has been studied in this institution since 1981. Persistence of antibody for 6 to 8 years has been demonstrated; however, cases of chickenpox have been seen in immunized children. The severity of chickenpox in healthy children who have received Oka/Merck varicella vaccine since 1981 is described. All vaccinees who developed chickenpox-like rashes more than 6 weeks postimmunization were exammined. Of 2163 vaccinees, 164 were examined, of whom 114 had rashes consistent with chickenpox. When sera were available (46%), antibody studies uniformly confirmed varicella-zoster virus infection. Chickenpox occurred 2 to 96 months (median of 44 months) postimmunization. The range for the number of skin lesions was 1 to 285 (median 18) in seroconverters. Symptoms included itching in 39%, fever in 9%, headaches in 7%, lymphadenopathy in 3%, and malaise in 2%; 54% were asymptomatic, except for the rash. The median time to total healing was 5 days. The median time lost from school was 2 days. Thirteen of the children in whom infections developed had failed to seroconvert after immunization. Their infections were similar in severity to those of children who had seroconverted originally. When varicella was introduced into families as a result of chickenpox in an immunized family member (index case), the rate of secondary chickenpox among immunized siblings was 12.2%. Eleven such secondary cases were similar in severity to the 9 index cases. It is concluded that chickenpox is generally mild in previously immunized children.

Live Attenuated Varicella Vaccine: The KMcC Strain in Healthy Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 307-312
Author(s):  
Allan M. Arbeter ◽  
Stuart E. Starr ◽  
Robert E. Weibel ◽  
Beverly J. Neff ◽  
Stanley A. Plotkin
Keyword(s):  
Varicella Zoster Virus ◽  
Lymphocyte Proliferation ◽  
Fluorescent Antibody ◽  
Varicella Vaccine ◽  
Skin Lesions ◽  
Healthy Children ◽  
Varicella Zoster ◽  
Immune Adherence ◽  
50Th Passage

The KMcC strain of live, attenuated varicella-zoster virus vaccine was studied in healthy children as a preliminary step toward varicella vaccine studies with this strain in children with leukemia. Forty-three children were immunized: 26 with the 40th passage vaccine and 17 with the 50th passage. Studies included surveillance for clinical reactivity, oropharyngeal excretion of vaccine virus, viruria, and viremia. Antibody responses were assayed by fluorescent antibody to membrance antigens and immune adherence hemagglutination. Cell-mediated immune responses were assayed by lymphocyte proliferation to varicella-zoster virus specific antigens. There was 100% seroconversion to the KMcC passage 40 and 50 vaccines (by fluorescent antibody to membrane antigen assay). Every child studied developed in vitro lymphocyte proliferation to varicella-zoster virus antigens. Papular skin lesions, probably vaccine related, occurred in 31% of the 40th passage vaccinees but in only 6% of the 50th passage vaccinees. The 50th passage KMcC strain vaccine is sufficiently immunogenic and safe to initiate clinical studies with leukemia patients.

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