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World Journal of Gastroenterology 2013年第21期19卷 3347-3351页

作者： Christopher Ma Brennan Walters Richard N Fedorak Division of Gastroenterology University of AlbertaEdmontonAL T6G 2X8Canada

Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.

关键词： varicella zoster virus Meningitis Crohn’s disease Adalimumab Infliximab corticosteroids Antitumor necrosis factor

varicella zoster virus vaccines: potential complications and possible improvements

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Virologica Sinica 2014年第5期29卷 265-273页

作者： Benjamin Silver Hua Zhu Department of Microbiology Biochemistry & Molecular Genetics Rutgers New Jersey Medical School

varicella zoster virus(VZV) is the causative agent of varicella(chicken pox) and herpes zoster(shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine(v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons. The reactivation is sometimes associated with postherpetic neuralgia(PHN), a severe pain along the affected sensory nerves that can linger for years, even after the herpetic rash resolves. In addition to the older population that develops a secondary infection resulting in herpes zoster, childhood breakthrough herpes zoster affects a small population of vaccinated children. There is a great need for a neuro-attenuated vaccine that would prevent not only the varicella manifestation, but, more importantly, any establishment of latency, and therefore herpes zoster. The development of a genetically-defined live-attenuated VZV vaccine that prevents neuronal and latent infection, in addition to primary varicella, is imperative for eventual eradication of VZV, and, if fully understood, has vast implications for many related herpesviruses and other viruses with similar pathogenic mechanisms.

关键词： varicella zoster virus herpesvirus vaccine neurovirulence neuro-attenuation latency latent infection herpes zoster shingles chicken pox ORF7

Incidence and consequences of varicella in children treated for cancer in Guatemala

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World Journal of Pediatrics 2016年第3期12卷 320-326页

作者： Amy E.Caruso Brown Edwin J.Asturias Mario Melgar Federico A.Antillon-Klussmann Pamela Mettler Myron J.Levin Center for Bioethics and Humanities and Department of Pediatrics SUNY Upstate Medical University Center for Global Health and Department of Epidemiology Colorado School of Public HealthAuroraColoradoUSA National Unit of Pediatric Oncology Guatemala CityGuatemala Department of Biostatistics and Informatics Colorado Biostatistics ConsortiumColorado School of Public HealthAuroraColoradoUSA Section of Pediatric Infectious Diseases Department of PediatricsUniversity of Colorado Denver Anschutz Medical CampusAuroraColoradoUSA

Background:varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children,despite treatment with antiviral *** varicella vaccine programs have significantly decreased this risk in many highincome countries,but in most low-income and middleincome countries,the burden of varicella in children treated for malignancy is poorly defi ***:We retrospectively reviewed records of children at the National Unit of Pediatric Oncology(UNOP)in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity,mortality,treatment interruption,and ***:Fifty-nine cases of varicella were *** was 23.4 cases per 1000 person-years(p-y).66.1%of cases occurred in children with leukemia(median age 5.2 years;interquantile range 3.4-7 years)and 41.0%of these occurred during maintenance *** of exposure was identified for 14/59(23.7%)*** were hospitalized(71.2%)and given intravenous acyclovir(64.4%).Eight(13.6%)children required critical care,and two(3.4%)died from disseminated varicella with multiorgan *** was delayed or omitted due to varicella in 50%.No signifi cant differences in outcomes based on nutritional and immunologic status were *** minimum average cost of treatment per episode was 598.75 ***:varicella is a significant problem in children treated for cancer in Guatemala,where effective post-exposure prophylaxis is *** the absence of universal varicella vaccination,strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden.

关键词： cancer developing countries immunocompromised host oncology varicella

Successful rescue of acute liver failure and hemophagocytic lymphohistiocytosis following varicella infection: A case report and review of literature

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World Journal of Clinical Cases 2018年第13期6卷 659-665页

作者： Li-Na Zhang Wei Guo Ji-Hong Zhu Yang Guo Department of Rheumatology and Immunology Peking University People’s Hospital Department of Emergency Peking University People’s Hospital

Herein we report a case of acute liver failure(ALF) and hemophagocytic lymphohistiocytosis(HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction(PCR) amplifications of varicella-zoster virus(VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient's symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life

关键词： Acute liver failure Immune dysregulation Hyperferritinemia Hemophagocytic lymphohistiocytosis varicella infection Skin rash

Seroprevalence of varicella zoster virus in Colombo district, Sri Lanka

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Asian Pacific Journal of Tropical Medicine 2018年第1期11卷 53-57页

作者： Hathshya M Munasingha Ananda Amarasinghe Neelika G Malavige Nalini Sathiakumar Department of Epidemiology School of Public HealthUniversity of Alabama at Birmingham Public Health Specialist/Medical Epidemiologist Office-WHO Manila Department of Microbiology University of Sri Jayawardenapura

Objective: To determine the seroprevalence of varicella zoster virus(VZV) antibodies among the population residing in the Colombo district of Sri Lanka. Methods: A cross-sectional population-based study was conducted which included 1 258 participants. Blood samples were collected and questionnaires administered to obtain sociodemographic information and history of varicella and/or herpes zoster. Serum samples were assayed for VZV IgG antibodies using a commercial enzyme-linked immunosorbent assay kit. Results: Overall, the seroprevalence was 54.2%(95% CI= 51.5% 57.0%). Children below 1 year of age were seronegative, and only about 20.0% of children between 1 and 10 years of age were seropositive. Seropositivitiy increased with age and by the age of 40 years 74.3% were seropositive. Among women of childbearing age, the overall seroprevalence was about 62.0%(95% CI = 57.7%-66.1%) but was low 37.0% in the 15-19 age group. Conclusion: In this population, 45.8% lacked natural immunity against varicella. Of women of childbearing age, 39.9% lacked immunity and in the subgroup of women 15-19 years of age, 63.0% women lacked immunity. In light of the country's success with the control and high coverage of other vaccine preventable diseases and that the vaccine is available in the private sector, the inclusion of varicella vaccine in the national immunization program may be considered.

关键词： Colombo district Seroprevalence Sri Lanka Vaccine varicella

Epidemiological characteristics of varicella in Chongqing,China,2014-2021

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Medical Data Mining 2024年第2期7卷 32-38页

作者： Yong-Jiao Hu Qing Wang Mu-Nan Zhang Xin Zeng Quan-Hong Lu Zheng Zhang Ping Cheng Jing Deng School of Public Health Chongqing Medical UniversityChongqing 400016China Institute of Immunization Program Chongqing Center for Disease Control and PreventionChongqing 400042China

Background:To analyze the epidemiological characteristics of varicella epidemics in Chongqing Municipality from 2014 to 2021,and to provide a scientific basis for the formulation of varicella prevention and control ***:Data on the incidence of varicella outbreaks and vaccination data in Chongqing from 2014 to 2021 were collected through the China Disease Control and Prevention Information System and statistically analyzed using descriptive epidemiological ***:From 2014 to 2021,213,715 cases of varicella were reported in Chongqing Municipality,with an average annual incidence rate of 86.26/100,000,with a statistically significant difference(χ^(2)=24,972.069,Pvaricella incidence is seasonal,with peaks in May/June and October/December each year,presenting a“double-peak distribution”.The average annual incidence rate of varicella in municipal districts was 90.74/100,000,which was higher than that of counties 69.62/100,000 and autonomous counties 84.04/100,000;the average annual incidence rate of varicella in males was 89.37/100,000,and in females,82.22/100,000,with the difference not being statistically significant;the age of onset of the disease was mainly in the group of people under 15 years of age,with a total of 190,021 cases reported(88.9%),with 5-9 years old(35.7%)as the high incidence age *** incidence occupation was dominated by students in 133,733 cases(62.6%).Conclusion:The overall varicella epidemic in Chongqing is on the rise,and has obvious seasonal,regional and population distribution *** prevention and control of varicella epidemic should be strengthened,the publicity of varicella vaccine should be increased,and it is recommended that varicella vaccine should be included in the national immunization program.

关键词： varicella epidemiologic characteristics vaccination preventive and control measures

An economic analysis of varicella immunization in the Singapore military

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Journal of Medical Colleges of PLA(China) 2016年第1期31卷 43-50页

作者： Jake J.K.Goh Marc Ho W.M.Koh Vernon J.Lee Specialist Medicine Centre AFPN 0047 27 Medical Drive #08-01 Singapore 117510 Singapore National University of Singapore MD3 16 Medical Drive Singapore 117597 Singapore

Background:varicella outbreaks occur frequently in closed environments such as those of *** paper compares the economic outcomes of varicella vaccination in enlisted servicemen without prior reported varicella infection or ***:We analyzed the economic outcomes of a varicella vaccination program on all enlisted servicemen without prior reported varicella infection or vaccination in the Singapore Armed Forces(SAF) between December 11,2010–December 20,2013,compared with the previous program of varicella vaccination only for selected personnel between December 1,2007–December 10,***:In the at-risk population of all active SAF servicemen,the program of varicella vaccination for all servicemen without prior reported varicella infection or vaccination upon enlistment would save 72.0 work days per 1000(95% CI:61.2-82.9),valued at SG$6,544 per 1000(95% CI:6,524-6,564),i.e.,costing SG$91.5 per work day saved(95% CI:78.7-107.3).This also results in a reduction of 2.7 varicella cases per 1000 and 5.43 outbreaks per 10000,or a total savings of SG$1,695 per 1000(95% CI:–2,730-6,834),taking into account the cost of work days lost over a three-year period,compared with the previous regime of vaccinations only for selected ***:The varicella vaccination strategy targeting all enlisted servicemen without prior reported varicella infection or vaccination is able to prevent varicella infections and outbreaks,thus reducing absenteeism and days lost.

关键词： varicella Vaccination Military Singapore Economic analysis

varicella-zoster virus as a causative agent of acute retinal necrosis in younger patients

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Chinese Medical Journal 2019年第6期132卷 659-663页

作者： Hai-Yan Xu Meng-Da Li Jun-Jie Ye Chan Zhao Yun-Tao Hu Yu Di Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 China Department of Ophthalmology Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Beijing 102218 China

Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)￠=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before

关键词： Retinal necrosis syndrome Acute varicella zoster virus infection Simplex virus Ganciclovir Acyclovir

Necrotizing fasciitis following varicella in a child

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Chinese Medical Journal 2012年第5期125卷 951-953页

作者： LI Feng XIA Jie Department of Bums and Plastic Surgery First Affiliated Hospitalof General Hospital of Chinese People's Liberation ArmyBeijing 100048China Intensive Care Unit 302 Hospital of Chinese People's LiberationArmyBeijing 100039China

varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications. Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered, Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.

关键词： necrotizing fasciitis varicella child

Analysis of Epidemiological Characteristics of varicella Before and After the Implementation of the Two-dose varicella Vaccine Immunization Program in Banan District of Chongqing City

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Journal of Clinical and Nursing Research 2024年第6期8卷 335-344页

作者： Yundan Cheng Ju Yan Xiaoling Zhu Xiaoxia Jiang Jingzhi Li Hao Leng Chongqing Banan District Disease Prevention and Control Center 79 Bay County AvenueYudong StreetBanan DistrictChongqing 401320China

Objective:To explore the changes in the epidemiological characteristics of varicella before and after implementing the two-dose varicella vaccine(VarV)immunization program in the Banan District of Chongqing and to provide a reference for future epidemic prevention and ***:The data of reported varicella cases in Banan District from 2014 to 2023 were collected and analyzed using the China Disease Prevention and Control Information *** epidemiological methods were employed to assess the changes in the reported incidence of varicella before(2014-2018)and after(2019-2023)the implementation of the two-dose VarV immunization ***:The average annual reported incidence rate of varicella in Banan District from 2014 to 2023 was 81.53 per 100,*** 2014 to 2018,the reported incidence rate showed an upward trend year by year(trend x2=223.96,Pvaricella showed a bimodal distribution,with peak incidence periods in May-June and *** 2014 to 2023,a total of 155,181 doses of VarV were administered in Banan *** estimated annual vaccination rate for the first varicella vaccine(VarV1)from 2019 to 2023 was 86.28%,and for the second dose(VarV2)was 59.18%.The primary vaccination targets were the 5-9-year-old group,accounting for 64.21%.Conclusion:After implementing the two-dose VarV immunization program in Banan District,the vaccination rate increased yearly,and the reported incidence of varicella showed a downward *** incidence rate of varicella in children aged 5-9 years reduced significantly,but the overall downward trend for the entire population was not as ***

关键词： varicella varicella vaccine Immunization program Epidemiological characteristics