title: Use of an inactivated varicella vaccine in recipients of hematopoietic-cell transplants.
abstract: BACKGROUND
  The reactivation of varicella-zoster virus from latency causes zoster and is common among recipients of hematopoietic-cell transplants.
  
  
  METHODS
  We randomly assigned patients who were scheduled to undergo autologous hematopoietic-cell transplantation for non-Hodgkin's or Hodgkin's lymphoma to receive varicella vaccine or no vaccine. Heat-inactivated, live attenuated varicella vaccine was given within 30 days before transplantation and 30, 60, and 90 days after transplantation. The patients were monitored for zoster and for immunity against varicella-zoster virus for 12 months.
  
  
  RESULTS
  Of the 119 patients enrolled, 111 received a transplant. Zoster developed in 7 of 53 vaccinated patients (13 percent) and in 19 of 58 unvaccinated patients (33 percent) (P=0.01). After two patients in whom zoster developed before transplantation were excluded, the respective rates were 13 percent and 30 percent (P=0.02). In vitro CD4 T-cell proliferation in response to varicella-zoster virus (expressed as the mean stimulation index) was greater in patients who received the vaccine than in those who did not at 90 days, after three doses (P=0.04); at 120 days, after all four doses (P<0.001); at 6 months (P=0.004); and at 12 months (P=0.02). The risk of zoster was reduced for each unit increase in the stimulation index above 1.6; a stimulation index above 5.0 correlated with greater than 93 percent protection. Induration, erythema, or local pain at the injection site was observed in association with 10 percent of the doses.
  
  
  CONCLUSIONS
  Inactivated varicella vaccine given before hematopoietic-cell transplantation and during the first 90 days thereafter reduces the risk of zoster. The protection correlates with reconstitution of CD4 T-cell immunity against varicella-zoster virus.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif 94305-5208, USA.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Hata
authors.forename: Hideomi
authors.initials: H
authors.lastname: Asanuma
authors.forename: Mary
authors.initials: M
authors.lastname: Rinki
authors.forename: Margaret
authors.initials: M
authors.lastname: Sharp
authors.forename: Ruby M
authors.initials: RM
authors.lastname: Wong
authors.forename: Karl
authors.initials: K
authors.lastname: Blume
authors.forename: Ann M
authors.initials: AM
authors.lastname: Arvin
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000276:immunology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006562:Herpes Zoster / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007371:Interferon-gamma / Q000276:immunology; D008223:Lymphoma / Q000276:immunology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D014182:Transplantation, Autologous / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral; D019433:Chickenpox Vaccine; D007074:Immunoglobulin G; D014409:Tumor Necrosis Factor-alpha; D015164:Vaccines, Inactivated; D007371:Interferon-gamma