Early reconstitution of immunity and decreased severity of herpes zoster in bone marrow transplant recipients immunized with inactivated varicella vaccine.
Varicella-zoster virus (VZV) causes herpes zoster after bone marrow transplantation (BMT). The immunogenicity of heat-inactivated varicella vaccine and effects on VZV pathogenesis were evaluated in 75 BMT patients randomized to receive vaccine or no intervention. Among 14 patients given a single dose at 1 month after transplantation, the mean (+/-SE) stimulation index (SI) was 12.20 +/- 3.13 compared with 4.83 +/- 2.74 (P = .036) in 14 unvaccinated patients, but clinical disease was not altered. Among 24 patients vaccinated at 1, 2, and 3 months, mean SI was 8.43 +/- 3.89 versus 2.00 +/- 0.33 (P = .014) in 23 unvaccinated patients at 4 months and 8.56 +/- 2.81 versus 5.30 +/- 2.47 (P = .043) at 5 months. Disease severity associated with VZV reactivation was decreased dramatically in vaccinees given three doses; severity scores were 6.4 +/- 1.0 versus 11.8 +/- 1.1 (P = .007). This experience with varicella vaccine in BMT patients is the first evidence that active immunization can reduce morbidity due to herpesvirus reactivation in high-risk populations.
Redman
R L
RL
Department of Pediatrics, Stanford University School of Medicine, California 94305, USA.
Nader
S
S
Zerboni
L
L
Liu
C
C
Wong
R M
RM
Brown
B W
BW
Arvin
A M
AM
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology; D019433:Chickenpox Vaccine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D005260:Female; D006562:Herpes Zoster / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014611:Vaccination; D015164:Vaccines, Inactivated / Q000008:administration & dosage; D014775:Virus Activation
D019433:Chickenpox Vaccine; D015164:Vaccines, Inactivated