title: A varicella outbreak in B-cell lymphoma patients receiving rituximab-containing chemotherapy.
abstract: Varicella, characterized by a vesicular rash, occurs primarily in young children. Although older individuals can also be affected or vaccinated, outbreaks among adults are rare. We investigated a small outbreak of varicella in B-cell lymphoma patients for elucidation of risk factor of the disease. We experienced four cases of varicella after an index herpes zoster case. All varicella cases were confirmed varicella zoster virus (VZV) infection by PCR. All varicella cases occurred in diffuse large B-cell lymphoma patients receiving rituximab-containing chemotherapy. On the other hand, only three of the 18 non-varicella patients in the same room were receiving rituximab-containing chemotherapy (P = 0.005). All varicella patients had detectable serum anti-varicella zoster virus IgG antibodies before chemotherapy. Even in the presence of neutralizing antibodies to the virus, lymphoma patients treated with rituximab-containing chemotherapy can possibly become re-infected with varicella. These findings suggest that zoster patients should be strictly isolated in hematology and oncology ward, and prophylactic acyclovir should be considered for such patients when exposed to zoster/varicella.
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: aokamoto@fujita-hu.ac.jp.
authors.forename: Akinao
authors.initials: A
authors.lastname: Okamoto
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Abe
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tsukane
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Inaguma
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masutaka
authors.initials: M
authors.lastname: Tokuda
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Yanada
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Morishima
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Kanie
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yukiya
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Tsuzuki
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Mizuta
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Akatsuka
authors.affiliation: Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.affiliation: Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Yoshikawa
authors.affiliation: Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Emi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002644:Chickenpox / Q000209:etiology* / Q000821:virology; D003428:Cross Infection / Q000209:etiology / Q000821:virology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Lymphoma; Nosocomial infection; Outbreak; Rituximab; Varicella