RESUMEN
A flow cytometry-adapted fluorescent antibody to membrane antigen (FAMA) assay to detect IgG antibodies against varicella-zoster virus (VZV) was developed and tested in 62 serum samples, showing 90.32% accuracy obtained from a receiver operating characteristic (ROC) curve with a 0.9125 (95% confidence interval [CI], 0.829 to 1.00) area below the curve compared to the result with standard FAMA.
Asunto(s)
Anticuerpos Antivirales/sangre , Citometría de Flujo , Técnica del Anticuerpo Fluorescente , Herpesvirus Humano 3/inmunología , Inmunidad , Antígenos de Superficie , Humanos , Inmunoglobulina G/sangre , Curva ROC , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To determine the safety and immunogenicity of varicella vaccine in children with human immunodeficiency virus (HIV) infection. Children (n = 41) who were mildly affected by HIV (Centers for Disease Control and Prevention stage N1 or A1) and had no history or serum antibody indicative of prior varicella infection were immunized with two doses of live attenuated varicella vaccine. RESULTS: A minority of the vaccine recipients had mild local or systemic reactions. Vaccination had no effect on the clinical stage of HIV or the HIV RNA plasma load. CD4 cell percentage and CD4 cell count were marginally decreased at week 4 after the first vaccination; this effect was no longer present at week 8 after vaccination. Two months after the second dose of vaccine, 60% of vaccine recipients had anti-varicella antibody in their serum, and 83% had a positive lymphocyte proliferation assay response to varicella antigen. CONCLUSION: On the basis of its safety and immunogenicity, varicella vaccine should be considered in the childhood vaccines given to mildly affected HIV-infected children.
Asunto(s)
Anticuerpos Antivirales/sangre , Vacuna contra la Varicela/efectos adversos , Varicela/inmunología , Infecciones por VIH/inmunología , Recuento de Linfocito CD4 , Vacuna contra la Varicela/inmunología , Niño , Preescolar , Humanos , Lactante , Estudios Multicéntricos como Asunto , Carga ViralRESUMEN
A 5-year-old white boy in remission from acute lymphoblastic leukemia who was receiving maintenance anticancer chemotherapy had approximately 200 vesicular skin lesions 1 month after receiving live attenuated varicella vaccine. About 2 to 3 weeks later, a mild illness resembling varicella occurred in his susceptible siblings and in three of his classmates. Vaccine-type varicella-zoster virus was demonstrated by polymerase chain reaction in swab specimens from vesicular lesions in his two siblings, in whom antibody to varicella-zoster virus also developed.
Asunto(s)
Varicela/transmisión , Herpesvirus Humano 3 , Vacunas Virales/efectos adversos , Varicela/complicaciones , Varicela/etiología , Vacuna contra la Varicela , Preescolar , Femenino , Herpesvirus Humano 3/inmunología , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/inmunología , Vacunas Atenuadas/efectos adversosRESUMEN
To examine whether the live varicella vaccine virus is attenuated, we analyzed varicella vaccine-induced contact cases of clinical chickenpox in healthy siblings of immunized children with leukemia. A rash developed approximately 1 month later in 156 children with leukemia who had been vaccinated. Vaccine-type virus was isolated from 25 of these children. Of 88 known susceptible healthy siblings who were exposed to a vaccine with a rash and from whom follow-up information was available, there was evidence of infection in 15 (17%). Of 15 siblings with seroconversion, 11 (73%) also acquired a mild rash with an average of 38 lesions and no accompanying systemic symptoms. Vaccine-type virus was isolated from four of the contact siblings. Tertiary transmission was documented once. Contact siblings with seroconversion were protected during future household exposure to chickenpox, which occurred in four instances. There was a direct relationship between transmission from vaccinees to varicella-susceptible close contacts and the presence and number of skin lesions in children with leukemia after vaccination. We conclude that in the transmission of varicella, the virus probably originates from skin lesions of infected persons and reaches the respiratory tract of those with secondary cases by the airborne route. On the basis of the mildness of the contact illness, the higher-than-normal rate of subclinical primary infection with varicella-zoster virus in contacts, and the lower-than-normal rate of spread of the vaccine virus to susceptible children in the household, we further conclude that the vaccine virus is attenuated. There was no evidence of reversion of the vaccine virus to virulence.
Asunto(s)
Varicela/transmisión , Herpesvirus Humano 3/aislamiento & purificación , Vacunas Virales , Varicela/diagnóstico , Vacuna contra la Varicela , Niño , ADN Viral/análisis , Familia , Herpesvirus Humano 3/genética , Humanos , Leucemia/complicaciones , Pruebas Serológicas , Especificidad de la Especie , Vacunas AtenuadasRESUMEN
A survey of varicella and measles has been made in a semiclosed institution housing infants and children in Osaka since 1950. Live measles and varicella vaccines were introduced into the institution in 1974 and 1975, respectively. Nine of 10 measles outbreaks occurred during the 24 years before use of measles vaccine, and only one occurred during the 9 years after introduction of measles vaccine. In contrast, the incidence of varicella outbreaks has not been reduced after introduction of varicella vaccine, although the rate of immune individuals in the population against varicella has been kept at 74.2% for the 8 years since 1975, which was higher than that against measles (65.8%) during the same period. All successfully vaccinated children, however, were resistant to clinical varicella, and the number of clinical cases has been markedly reduced. Using the fluorescent antibody to membrane antigen and varicella zoster virus skin testing, the kinetics of secretory, humoral, and cellular immune responses to VZV was examined in vaccinated and naturally infected subjects and found to be comparable in both groups during repeated exposure to varicella epidemics. These results suggest that the seroepidemiologic behavior of varicella would not be significantly altered after introduction of varicella vaccine, in contrast to that of measles since general use of measles vaccine.
Asunto(s)
Varicela/epidemiología , Herpesvirus Humano 3/inmunología , Vacunas Virales/uso terapéutico , Anticuerpos Antivirales/biosíntesis , Varicela/inmunología , Preescolar , Humanos , Inmunidad Celular , Lactante , Cinética , Sarampión/epidemiología , Vacuna Antisarampión/uso terapéutico , Nasofaringe/metabolismo , Nasofaringe/microbiologíaRESUMEN
By indirect immunofluorescence, enzyme-linked immunosorbent assay, and in vitro lymphocyte proliferation, we studied the antibody and cell-mediated immune response to varicella zoster virus (VZV) in serum, peripheral blood lymphocytes, and tonsillar lymphocytes in 49 children before and after tonsillectomy and adenoidectomy. Among the naturally infected patients seropositive for VZV antibody, most demonstrated VZV-specific proliferation in the peripheral blood and tonsillar lymphocytes, with activity consistently higher in the tonsillar lymphocytes. Several patients seronegative for VZV antibody and without a prior history of clinical chickenpox also manifested VZV-specific proliferation in the tonsillar lymphocytes, and less frequently in peripheral blood lymphocytes. Of these, six children with high levels of activity in tonsillar lymphocytes, with or without high levels in the peripheral blood lymphocytes, failed to develop disease after intimate exposure to VZV in family settings. On the other hand, three other subjects with little or no VZV-specific proliferative activity in the tonsillar lymphocytes developed disease after similar exposure to VZV. These observations suggest the development of VZV-specific mucosal cellular immunity after overt or inapparent exposure to VZV. The appearance of such immunity appears to have a protective role against reinfection even in the absence of detectable serum antibody.
Asunto(s)
Varicela/inmunología , Linfocitos/inmunología , Tonsila Palatina/inmunología , Adolescente , Anticuerpos Antivirales/análisis , División Celular , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente , Herpesvirus Humano 3/inmunología , Humanos , Inmunidad Celular , Técnicas In Vitro , Linfocitos/citología , Membrana Mucosa/inmunologíaRESUMEN
Normal subjects and patients with lymphoma or leukemia were tested for the levels of lymphocytes, E-rosette--forming T-cells, serum and vesicle fluid interferon, and specific in vitro proliferative response to varicella-zoster antigen after clinical varicella or herpes zoster illness. The effect of polyinosinic acid/polycytidilic acid on the immune response was also evaluated. The development of VZ specific cell-mediated response in normal subjects was characterized by intense proliferative activity eight to ten days after the onset of illness, with significant decline 70 to 80 days later. The responses in subjects with lymphoma or leukemia were much lower. Few subjects with chickenpox or zoster with lymphoma or leukemia died during the infection. Death was associated with significant depletion of E-rosette--forming T-cells, and grossly deficient specific cellular response to VZ antigen. Treatment with Poly IC frequently induced elevations in serum as well as vesicle fluid interferon levels, and increased the proliferative activity of lymphocytes against VZ antigen.