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Kamboj M, Bohlke K, Baptiste DM, Dunleavy K, Fueger A, Jones L, Kelkar AH, Law LY, LeFebvre KB, Ljungman P, Miller ED, Meyer LA, Moore HN, Soares HP, Taplitz RA, Woldetsadik ES, Kohn EC. Vaccination of Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1699-1721. [PMID: 38498792 PMCID: PMC11095883 DOI: 10.1200/jco.24.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To guide the vaccination of adults with solid tumors or hematologic malignancies. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. RECOMMENDATIONS The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Mini Kamboj
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Kieron Dunleavy
- MedStar Georgetown University Hospital, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Abbey Fueger
- The Leukemia and Lymphoma Society, Rye Brook, NY
| | - Lee Jones
- Fight Colorectal Cancer, Arlington, VA
| | - Amar H Kelkar
- Harvard Medical School, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Per Ljungman
- Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Eric D Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Heloisa P Soares
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | | | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD
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2
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Arvin AM. Creating the "Dew Drop on a Rose Petal": the Molecular Pathogenesis of Varicella-Zoster Virus Skin Lesions. Microbiol Mol Biol Rev 2023; 87:e0011622. [PMID: 37354037 PMCID: PMC10521358 DOI: 10.1128/mmbr.00116-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023] Open
Abstract
Varicella-zoster virus (VZV) is a human alphaherpesvirus that causes varicella (chicken pox) as the primary infection in a susceptible host. Varicella is very contagious through its transmission by direct contact with vesicular skin lesions that contain high titers of infectious virus and respiratory droplets. While the clinical manifestations of primary VZV infection are well recognized, defining the molecular mechanisms that drive VZV pathogenesis in the naive host before adaptive antiviral immunity is induced has been a challenge due to species specificity. This review focuses on advances made in identifying the differentiated human host cells targeted by VZV to cause varicella, the processes involved in viral takeover of these heterogenous cell types, and the host cell countermeasures that typically culminate in a benign illness. This work has revealed many unexpected and multifaceted mechanisms used by VZV to achieve its high prevalence and persistence in the human population.
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Affiliation(s)
- Ann M. Arvin
- Stanford University School of Medicine, Stanford, California, USA
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3
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Kinganda-Lusamaki E, Baketana LK, Ndomba-Mukanya E, Bouillin J, Thaurignac G, Aziza AA, Luakanda-Ndelemo G, Nuñez NF, Kalonji-Mukendi T, Pukuta ES, Nkuba-Ndaye A, Lofiko EL, Kibungu EM, Lushima RS, Ayouba A, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Delaporte E, Peeters M, Ahuka-Mundeke S. Use of Mpox Multiplex Serology in the Identification of Cases and Outbreak Investigations in the Democratic Republic of the Congo (DRC). Pathogens 2023; 12:916. [PMID: 37513764 PMCID: PMC10385798 DOI: 10.3390/pathogens12070916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Human Mpox cases are increasingly reported in Africa, with the highest burden in the Democratic Republic of Congo (DRC). While case reporting on a clinical basis can overestimate infection rates, laboratory confirmation by PCR can underestimate them, especially on suboptimal samples like blood, commonly used in DRC. Here we used a Luminex-based assay to evaluate whether antibody testing can be complementary to confirm cases and to identify human transmission chains during outbreak investigations. We used left-over blood samples from 463 patients, collected during 174 outbreaks between 2013 and 2022, with corresponding Mpox and VZV PCR results. In total, 157 (33.9%) samples were orthopox-PCR positive and classified as Mpox+; 124 (26.8%) had antibodies to at least one of the three Mpox peptides. The proportion of antibody positive samples was significantly higher in Mpox positive samples (36.9%) versus negative (21.6%) (p < 0.001). By combining PCR and serology, 66 additional patients were identified, leading to an Mpox infection rate of 48.2% (223/463) versus 33.9% when only PCR positivity is considered. Mpox infections were as such identified in 14 additional health zones and 23 additional outbreaks (111/174 (63.8%) versus 88/174 (50.6%)). Our findings highlight the urgent need of rapid on-site diagnostics to circumvent Mpox spread.
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Affiliation(s)
- Eddy Kinganda-Lusamaki
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Lionel Kinzonzi Baketana
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Etienne Ndomba-Mukanya
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Julie Bouillin
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Guillaume Thaurignac
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Adrienne Amuri Aziza
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Gradi Luakanda-Ndelemo
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Nicolas Fernandez Nuñez
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Thierry Kalonji-Mukendi
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Elisabeth Simbu Pukuta
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Antoine Nkuba-Ndaye
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Emmanuel Lokilo Lofiko
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Emile Malembi Kibungu
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Robert Shongo Lushima
- Programme National de Lutte Contre le Monkeypox et les Fièvres Hémorragiques Virales, Ministère de la Santé (PNLMPX-FHV), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
| | - Eric Delaporte
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Martine Peeters
- TransVIHMI, University of Montpellier (UM), French Institute of Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa P.O. Box 1197, Democratic Republic of the Congo
- Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa (CUK), Université de Kinshasa (UNIKIN), Kinshasa P.O. Box 127, Democratic Republic of the Congo
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Singh US, Konreddy AK, Kothapalli Y, Liu D, Lloyd MG, Annavarapu V, White CA, Bartlett MG, Moffat JF, Chu CK. Prodrug Strategies for the Development of β-l-5-(( E)-2-Bromovinyl)-1-((2 S,4 S)-2-(hydroxymethyl)-1,3-(dioxolane-4-yl))uracil (l-BHDU) against Varicella Zoster Virus (VZV). J Med Chem 2023; 66:7038-7053. [PMID: 37140467 DOI: 10.1021/acs.jmedchem.3c00545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Varicella zoster virus (VZV) establishes lifelong infection after primary disease and can reactivate. Several drugs are approved to treat VZV diseases, but new antivirals with greater potency are needed. Previously, we identified β-l-5-((E)-2-bromovinyl)-1-((2S,4S)-2-(hydroxymethyl)-1,3-(dioxolane-4-yl))uracil (l-BHDU, 1), which had significant anti-VZV activity. In this communication, we report the synthesis and evaluation of numerous l-BHDU prodrugs: amino acid esters (14-26), phosphoramidates (33-34), long-chain lipids (ODE-l-BHDU-MP, 38, and HDP-l-BHDU-MP, 39), and phosphate ester prodrugs (POM-l-BHDU-MP, 41, and POC-l-BHDU-MP, 47). The amino acid ester l-BHDU prodrugs (l-phenylalanine, 16, and l-valine, 17) had a potent antiviral activity with EC50 values of 0.028 and 0.030 μM, respectively. The phosphate ester prodrugs POM-l-BHDU-MP and POC-l-BHDU-MP had a significant anti-VZV activity with EC50 values of 0.035 and 0.034 μM, respectively, and no cellular toxicity (CC50 > 100 μM) was detected. Out of these prodrugs, ODE-l-BHDU-MP (38) and POM-l-BHDU-MP (41) were selected for further evaluation in future studies.
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Affiliation(s)
- Uma S Singh
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Ananda K Konreddy
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Yugandhar Kothapalli
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Dongmei Liu
- State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Megan G Lloyd
- State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Vidya Annavarapu
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Catherine A White
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Michael G Bartlett
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Jennifer F Moffat
- State University of New York, Upstate Medical University, Syracuse, New York 13210, United States
| | - Chung K Chu
- Department of Pharmaceutical and Biomedical Science, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
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Frantzis I, Messina M, Taylor JM, Aschheim K, Hu H, Hairston JC, Lauren CT, Gershon A, Feldstein N, Orange J, Saiman L. Varicella in the neonatal ICU due to the Varicella vaccine Oka strain. J Neonatal Perinatal Med 2023; 16:179-182. [PMID: 36744349 PMCID: PMC10346796 DOI: 10.3233/npm-221031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Varicella vaccination of non-immune post-partum women is recommended to reduce the risk of chickenpox in mothers and their infants. Though rare, transmission of the varicella vaccine strain vOka can occur from recent vaccinees to non-immune contacts who usually develop mild chickenpox. METHODS/RESULTS Here we describe an infant hospitalized in the neonatal ICU with vaccine-strain varicella due to transmission from their mother who received the varicella vaccine post-partum. We describe the infection prevention and control strategies implemented to prevent further transmission. CONCLUSION Vaccine-strain varicella transmission from mother to infant is a rare event and its occurrence in the neonatal ICU setting can be challenging. Anticipatory guidance for mothers vaccinated in the postpartum period and support of parents of an infected infant are recommended.
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Affiliation(s)
- Irene Frantzis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Maria Messina
- Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, USA
| | - Jenny M. Taylor
- Current affiliation: Department of Pediatrics, Northwell Health Physician Partners, Northern Westchester Hospital, Mount Kisco, NY USA
| | - Katherine Aschheim
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Helen Hu
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Jacqueline C. Hairston
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christine T. Lauren
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anne Gershon
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Neil Feldstein
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jordan Orange
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, USA
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Saringkarisate K, Len KA, Melish ME, Prothero BK, Ching N. Vaccine-Strain Varicella Virus Transmitted to a Term Infant Following Maternal Postpartum Vaccination. J Pediatric Infect Dis Soc 2022; 11:452-453. [PMID: 35751631 DOI: 10.1093/jpids/piac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/07/2022] [Indexed: 11/14/2022]
Abstract
Varicella is a highly contagious disease caused by Varicella-zoster virus (VZV). The American College of Obstetricians and Gynecologists (ACOG) adopted the routine administration of varicella vaccine to varicella non-immune mothers postpartum before leaving the facility per the Advisory Committee in Immunization Practices (ACIP) recommendation of Varicella prevention. While the vaccine is well-tolerated, a live attenuated vaccine has the potential to cause clinical symptoms and complications, including rash. Secondary transmission of the vaccine virus from healthy persons is rare. Only 13 confirmed cases of secondary transmission from 11 immunocompetent vaccine recipients have been reported. We report the confirmed case of extensive neonatal varicella disease in a neonate after exposure to a vaccine varicella rash that developed after maternal postpartum vaccination.
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Affiliation(s)
- Kornkanok Saringkarisate
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Kyra A Len
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA.,Hawai'i Pacific Health Medical Group, Honolulu, Hawaii, USA
| | - Marian E Melish
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA.,Hawai'i Pacific Health Medical Group, Honolulu, Hawaii, USA
| | | | - Natascha Ching
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA.,Hawai'i Pacific Health Medical Group, Honolulu, Hawaii, USA
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7
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Moro PL, Leung J, Marquez P, Kim Y, Wei S, Su JR, Marin M. Safety Surveillance of Varicella Vaccines in the Vaccine Adverse Event Reporting System, United States, 2006-2020. J Infect Dis 2022; 226:S431-S440. [PMID: 36265846 DOI: 10.1093/infdis/jiac306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND . The Vaccine Adverse Event Reporting System (VAERS) is the United States national passive vaccine safety surveillance system. We updated the data on the safety of single-antigen varicella vaccine (VAR) and assessed the safety of combination measles, mumps, rubella, and varicella vaccine (MMRV) licensed in the United States using VAERS data. METHODS US VAERS reports received after administration of VAR and MMRV during 2006-2020 were identified. Reports were analyzed by vaccine type, age, seriousness, most common adverse events (AEs), and concomitant vaccines. We reviewed medical records of selected reports of AEs of special interest and conducted empirical Bayesian data mining to identify disproportionally reported AEs. RESULTS During 2006-2020, approximately 132.8 million VAR doses were distributed; 40 684 reports were received in VAERS (30.6/100 000 doses distributed), with 4.1% classified as serious (1.3/100 000 doses distributed). Approximately 35.5 million MMRV doses were distributed; 13 325 reports were received (37.6/100 000 doses distributed) with 3.3% classified as serious (1.3/100 000 doses distributed). The most common adverse health events after both VAR and MMRV were injection site reactions (31% and 27%), rash (28% and 20%), and fever (12% and 14%), respectively. Vaccination errors accounted for 23% of reports after VAR administration and 41% after MMRV administration, but ≥95% of them did not describe an adverse health event. AEs associated with evidence of vaccine strain varicella-zoster virus (vVZV) infection included meningitis, encephalitis, herpes zoster, and 6 deaths (all in immunocompromised persons with contraindications for vaccination). No new or unexpected AE was disproportionally reported. CONCLUSIONS No new or unexpected safety findings were detected for VAR and MMRV given as recommended, reinforcing the favorable safety profiles of these vaccines. Providers should obtain specimens for viral testing and strain-typing for serious AEs if they consider vVZV as the possible causative agent.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yeowon Kim
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shaokui Wei
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Arvin AM. Insights From Studies of the Genetics, Pathogenesis, and Immunogenicity of the Varicella Vaccine. J Infect Dis 2022; 226:S385-S391. [PMID: 36265853 DOI: 10.1093/infdis/jiac278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
While the varicella vaccine was created with approaches established for other live attenuated viral vaccines, novel methods to probe virus-host interactions have been used to explore the genetics, pathogenesis, and immunogenicity of the vaccine compared to wild-type varicella-zoster virus (VZV). As summarized here, a mechanism-based understanding of the safety and efficacy of the varicella vaccine has been achieved through these investigations.
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Affiliation(s)
- Ann M Arvin
- Departments of Pediatrics and Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA
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9
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Daly KP, Sharma TS. Experience with Live Attenuated Varicella Vaccination in Pediatric Heart Transplant Recipients: Considering a New Path Forward. J Heart Lung Transplant 2022; 41:1027-1028. [DOI: 10.1016/j.healun.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022] Open
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Abstract
Michiaki Takahashi developed the live attenuated varicella vaccine in 1974 . This was the first, and is still the only, herpesvirus vaccine. Early studies showed promise, but the vaccine was rigorously tested on immunosuppressed patients because of their high risk of fatal varicella; vaccination proved to be lifesaving. Subsequently, the vaccine was found to be safe and effective in healthy children. Eventually, varicella vaccine became a component of measles mumps rubella vaccine, 2 doses of which are administered in the USA to ~90% of children. The incidence of varicella has dropped dramatically in the USA since vaccine-licensure in 1995. Varicella vaccine is also associated with a decreased incidence of zoster and is protective for susceptible adults. Today, immunocompromised individuals are protected against varicella due to vaccine-induced herd immunity. Latent infection with varicella zoster virus occurs after vaccination; however, the vaccine strain is impaired for its ability to reactivate.
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Affiliation(s)
- Anne A Gershon
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael D Gershon
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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11
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Otero-Romero S, Sánchez-Montalvá A, Vidal-Jordana A. Assessing and mitigating risk of infection in patients with multiple sclerosis on disease modifying treatment. Expert Rev Clin Immunol 2021; 17:285-300. [PMID: 33543657 DOI: 10.1080/1744666x.2021.1886924] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: The important development that the multiple sclerosis (MS) treatment field has experienced in the last years comes along with the need of dealing with new adverse events such as the increase risk of infections. In the shared therapeutic decision-making process, the MS expert neurologist should also balance the risks of specific infections under each particular treatment and be familiar with new mitigation strategies.Areas covered: In this review, the authors provide an up-to-date review of the infection risk associated with MS treatments with a specific focus on risk mitigating strategies. The search was conducted using Pubmed® database (2000 - present) to identify publications that reported infection rates and infection complications for each treatment (interferon beta, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, cladribine, natalizumab, alemtuzumab, rituximab, and ocrelizumab).Expert opinion: Since the emergence of the first natalizumab-related PML case, the arrival of new MS therapies has come hand in hand with new infectious complications. MS-specialist neurologist has to face new challenges regarding the management of immunosuppression-related infectious complications. The implementation of patient-centered management focus on preventive and mitigating strategies with a multidisciplinary approach should be seen in the future as a marker of excellence of MS management.
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Affiliation(s)
- Susana Otero-Romero
- Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, International Health Program Catalan Institute of Health (PROSICS), Universitat Autònoma De Barcelona, Barcelona, Spain.,Micobacteria Infections Study Group (GEIM) of the Spanish Society of Infectious Diseases (SEIMC), Spain
| | - Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat). Hospital Universitari Vall d'Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain
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Kelgeri C, Kelly DF, Brant A, Patel M, Gupte GL. Principles of immunisation in children with solid organ transplant. Arch Dis Child 2021; 106:219-223. [PMID: 32938624 DOI: 10.1136/archdischild-2020-319822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
Vaccine-preventable diseases (VPD) are a significant risk to paediatric solid organ transplant (SOT) recipients on lifelong immunosuppressive therapy. Children progressing to end-stage organ dysfunction are unable to mount a robust immune response. Hence, it is important to plan vaccination early in the course of disease, especially if a child is anticipated to be a SOT candidate. Vaccine recommendations need to be individualised in this population based on vaccine history and serology. Catch-up or accelerated schedules may be used to complete vaccinations before transplant. Post-transplant, immunisation is recommenced in consultation with the transplant team taking into context the time since transplant and the intensity of the immunosuppressive regime. Inactivated vaccines are safe post-transplant but postexposure prophylaxis may still be required in children with inadequate immunity to VPD. Specific vaccines may be advised for SOT recipients travelling abroad (in consultation with a travel clinic) or those entering high-risk professions. Additionally, the vaccination status of all household members and close contacts should be reviewed and optimised, offering additional protection to the transplant recipient.
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Affiliation(s)
- Chayarani Kelgeri
- Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Dominic F Kelly
- Department of Paediatrics, University of Oxford, Oxford, Oxfordshire, UK
| | - Alexandra Brant
- Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mitul Patel
- Department of Microbiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Girish L Gupte
- Department of Paediatric Hepatology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Advances and Perspectives in the Management of Varicella-Zoster Virus Infections. Molecules 2021; 26:molecules26041132. [PMID: 33672709 PMCID: PMC7924330 DOI: 10.3390/molecules26041132] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
Varicella-zoster virus (VZV), a common and ubiquitous human-restricted pathogen, causes a primary infection (varicella or chickenpox) followed by establishment of latency in sensory ganglia. The virus can reactivate, causing herpes zoster (HZ, shingles) and leading to significant morbidity but rarely mortality, although in immunocompromised hosts, VZV can cause severe disseminated and occasionally fatal disease. We discuss VZV diseases and the decrease in their incidence due to the introduction of live-attenuated vaccines to prevent varicella or HZ. We also focus on acyclovir, valacyclovir, and famciclovir (FDA approved drugs to treat VZV infections), brivudine (used in some European countries) and amenamevir (a helicase-primase inhibitor, approved in Japan) that augur the beginning of a new era of anti-VZV therapy. Valnivudine hydrochloride (FV-100) and valomaciclovir stearate (in advanced stage of development) and several new molecules potentially good as anti-VZV candidates described during the last year are examined. We reflect on the role of antiviral agents in the treatment of VZV-associated diseases, as a large percentage of the at-risk population is not immunized, and on the limitations of currently FDA-approved anti-VZV drugs. Their low efficacy in controlling HZ pain and post-herpetic neuralgia development, and the need of multiple dosing regimens requiring daily dose adaptation for patients with renal failure urges the development of novel anti-VZV drugs.
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