1
|
Riccò M, Ferraro P, Zaffina S, Camisa V, Marchesi F, Franzoso FF, Ligori C, Fiacchini D, Magnavita N, Tafuri S. Immunity to Varicella Zoster Virus in Healthcare Workers: A Systematic Review and Meta-Analysis (2024). Vaccines (Basel) 2024; 12:1021. [PMID: 39340051 PMCID: PMC11436139 DOI: 10.3390/vaccines12091021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/29/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Healthcare workers (HCWs) are occupationally exposed to varicella zoster virus (VZV), and their inappropriate vaccination status could contribute to an outbreak involving both professionals and the patients they care for, with a potential impact on the general population. Therefore, since 2007, the Advisory Committee on Immunization Practices (ACIP) recommends that all HCWs have evidence of immunity against varicella. The present meta-analysis was therefore designed to collect the available evidence on the seronegative status of VZV among HCWs. PubMed, Scopus, and Embase databases were searched without backward limit for articles reporting on the seroprevalence of VZV among HCWs, and all articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 1744 initial entries, a total of 58 articles were included in the quantitative analysis (publication range: 1988 to 2024), for a pooled sample of 71,720 HCWs. Moreover, the included studies reported on seroprevalence data on measles (N = 36,043 HCWs) and rubella (N = 22,086 HCWs). Eventually, the pooled seronegative status for VZV was estimated to be 5.72% (95% confidence interval [95% CI] 4.59 to 7.10) compared to 6.91% (95% CI 4.79 to 9.87) for measles and 7.21% (5.36 to 9.64) for rubella, with a greater risk among subjects younger than 30 years at the time of the survey (risk ratio [RR] 1.434, 95% CI 1.172 to 1.756). Interestingly, medical history of either VZV infection/vaccination had low diagnostic performances (sensitivity 76.00%; specificity 60.12%; PPV of 96.12% but PNV of 18.64%). In summary, the available data suggest that newly hired HCWs are increasingly affected by low immunization rates for VZV but also for measles and rubella, stressing the importance of systematically testing test newly hired workers for all components of the measles-pertussis-rubella-varicella vaccine.
Collapse
Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Via Amendola n.2, 42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Occupational Medicine Unit, Direzione Sanità, Italian Railways' Infrastructure Division, RFI SpA, 00161 Rome, Italy
| | - Salvatore Zaffina
- Occupational Medicine Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Vincenzo Camisa
- Occupational Medicine Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | | | - Cosimo Ligori
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Daniel Fiacchini
- AST Ancona, Prevention Department, UOC Sorveglianza e Prevenzione Malattie Infettive e Cronico Degenerative, 60127 Ancona, Italy
| | - Nicola Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Silvio Tafuri
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70121 Bari, Italy
| |
Collapse
|
2
|
Maple PA, Tanasescu R, Constantinescu CS, Valentino P, Capobianco M, D’Orso S, Borsellino G, Battistini L, Ristori G, Mechelli R, Salvetti M, Gran B. Cytomegalovirus, Epstein-Barr Virus, Herpes Simplex Virus, and Varicella Zoster Virus Infection Dynamics in People with Multiple Sclerosis from Northern Italy. Pathogens 2024; 13:499. [PMID: 38921797 PMCID: PMC11206421 DOI: 10.3390/pathogens13060499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Previous exposure to Epstein-Barr virus (EBV) is strongly associated with the development of multiple sclerosis (MS). By contrast, past cytomegalovirus (CMV) infection may have no association, or be negatively associated with MS. This study aimed to investigate the associations of herpesvirus infections with MS in an Italian population. Serum samples (n = 200) from Italian people with multiple sclerosis (PwMS) classified as the relapsing-and-remitting clinical phenotype and (n = 137) healthy controls (HCs) were obtained from the CRESM Biobank, Orbassano, Italy. Both PwMS and HCs samples were selected according to age group (20-39 years, and 40 or more years) and sex. EBV virus capsid antigen (VCA) IgG, EBV nucleic acid-1 antigen (EBNA-1) IgG, CMV IgG, herpes simplex virus (HSV) IgG, and varicella zoster virus (VZV) IgG testing was undertaken using commercial ELISAs. EBV VCA IgG and EBNA-1 IgG seroprevalences were 100% in PwMS and 93.4% and 92.4%, respectively, in HCs. EBV VCA IgG and EBNA-1 IgG levels were higher (p < 0.001) in PwMS compared with HCs. For PwMS, the EBNA-1 IgG levels decreased with age, particularly in females. The CMV IgG seroprevalence was 58.7% in PwMS and 62.9% in HCs. CMV IgG seroprevalence increased with age. The HSV IgG seroprevalence was 71.2% in PwMS and 70.8% in HCs. HSV IgG levels were lower (p = 0.0005) in PwMS compared with HCs. VZV IgG seroprevalence was 97.5% in PwMS and 98.5% in HCs. In the population studied, several herpesvirus infections markers may have been influenced by the age and sex of the groups studied. The lack of a negative association of MS with CMV infection, and the observation of lower levels of HSV IgG in PwMS compared with HCs are findings worthy of further investigation.
Collapse
Affiliation(s)
- Peter A. Maple
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Radu Tanasescu
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Cris S. Constantinescu
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Cooper Neurological Institute, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Paola Valentino
- Neuroscience Institute, Cavalieri Ottolenghi, 10043 Orbassano, Italy; (P.V.)
| | - Marco Capobianco
- Neuroscience Institute, Cavalieri Ottolenghi, 10043 Orbassano, Italy; (P.V.)
| | - Silvia D’Orso
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
| | - Giovanna Borsellino
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
| | - Luca Battistini
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
| | - Giovanni Ristori
- Department of Experimental Neuroscience, IRCSS Foundation Santa Lucia, 00179 Rome, Italy
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, 00185 Rome, Italy;
| | - Rosella Mechelli
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- IRCCS, San Raffaele Roma, 00166 Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, 00185 Rome, Italy;
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, 86077 Pozzilli, Italy
| | - Bruno Gran
- Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham School of Medicine, Nottingham NG7 2UH, UK (B.G.)
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| |
Collapse
|
3
|
Li M, Zhu G, Guo Y, Ye Q. Association between emphysema and other pulmonary computed tomography patterns in primary varicella pneumonia: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e38185. [PMID: 38758910 PMCID: PMC11098192 DOI: 10.1097/md.0000000000038185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
This study aims to evaluate chest computed tomography (CT) findings in hospital patients with primary varicella pneumonia (PVP). We retrospectively analyzed CT images of 77 PVP patients using 3D Slicer, an open-source software, to model lesions and lungs. This retrospective cohort study was approved by the Institutional Review Board (Ethical Committee, Renmin Hospital, Hubei University of Medicine, Shiyan, China) and waived the requirement for written informed consent. The left lung was more frequently and severely affected in PVP, with significant differences between the 2 groups in CT involvement percentage of each lung region, except for total lung inflation. Group A showed higher median percentages of lung collapse compared to Group B. The extent of left lung involvement is a critical predictor of emphysema in PVP patients, highlighting the importance of also monitoring the right lung for more severe cases. Lower emphysema levels correspond to more collapsed and infiltrated lung segments, suggesting a more severe clinical presentation.
Collapse
Affiliation(s)
- Meng Li
- Department of Pulmonary & Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Guijuan Zhu
- Department of Gynecology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Yajun Guo
- Department of Pulmonary & Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Qing Ye
- Department of Pulmonary & Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| |
Collapse
|
4
|
Serra F, Cassaniti I, Lilleri D, Pedrazzoli P, Baldanti F, Lasagna A. Herpes zoster in patients with solid tumors treated with immune checkpoint inhibitors. Immunotherapy 2022; 14:389-393. [DOI: 10.2217/imt-2021-0333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tweetable abstract Herpes zoster (HZ) is a vaccine-preventable disease, but the role of the vaccine in cancer patients during immunotherapy (ICIs) is still unknown. The clinical and economic consequences of HZ and the increased use of ICIs require a greater awareness by the oncologist.
Collapse
Affiliation(s)
- Francesco Serra
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
- Dept. of Internal Medicine & Medical Therapy, University of Pavia, Pavia, 27100, Italy
| | - Irene Cassaniti
- Molecular Virology Unit, Dept. of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Daniele Lilleri
- Molecular Virology Unit, Dept. of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
- Dept. of Internal Medicine & Medical Therapy, University of Pavia, Pavia, 27100, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Dept. of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
- Dept. of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
| | - Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| |
Collapse
|
5
|
Bianchi FP, Tafuri S, Larocca AMV, Germinario CA, Stefanizzi P. Long -term persistence of antibodies against varicella in fully immunized healthcare workers: an Italian retrospective cohort study. BMC Infect Dis 2021; 21:475. [PMID: 34034659 PMCID: PMC8152326 DOI: 10.1186/s12879-021-06180-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs). Methods The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined. Results The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI = 27.2–41.4%), with serosusceptibility more common among males than females (p < 0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded. Conclusions One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.
Collapse
Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | | | - Cinzia Annatea Germinario
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| |
Collapse
|