title: Live attenuated varicella-zoster vaccine in hematopoietic stem cell transplantation recipients.
abstract: Hematopoietic stem cell transplantation (HSCT) recipients are at risk for varicella-zoster virus (VZV) reactivation. Vaccination may help restore VZV immunity; however, the available live attenuated VZV vaccine (Zostavax) is contraindicated in immunocompromised hosts. We report our experience with using a single dose of VZV vaccine in 110 adult autologous and allogeneic HSCT recipients who were about 2 years after transplantation, free of graft-versus-host disease, and not receiving immunosuppression. One hundred eight vaccine recipients (98.2%) had no clinically apparent adverse events with a median follow-up period of 9.5 months (interquartile range, 6 to 16; range, 2 to 28). Two vaccine recipients (1.8%) developed a skin rash (one zoster-like rash with associated pain, one varicella-like) within 42 days post-vaccination that resolved with antiviral therapy. We could not confirm if these rashes were due to vaccine (Oka) or wild-type VZV. No other possible cases of VZV reactivation have occurred with about 1178 months of follow-up. Live attenuated zoster vaccine appears generally safe in this population when vaccinated as noted; the overall vaccination risk needs to be weighed against the risk of wild-type VZV disease in this high-risk population.
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: nissa@partners.org.
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Issa
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
authors.affiliation: Department of Pharmacy, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Houry
authors.initials: H
authors.lastname: Leblebjian
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Alicia
authors.initials: A
authors.lastname: Galar
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Shea
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Baden
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D053061:Herpes Zoster Vaccine; D014613:Vaccines, Attenuated
keywords: HSCT; Varicella-zoster vaccine