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PubMed1992

Modified cases of chickenpox after varicella vaccination: correlation of protection with antibody response.

Four thousand forty-two healthy children and adolescents, ages 12 months to 17 years, were vaccinated with a single dose of live attenuated varicella vaccine (VARIVAX; Merck Sharp and Dohme Research Laboratories) containing approximately 1000 to 1625 plaque-forming units/dose during clinical trials conducted from 1987 to 1989. Clinical follow-up of vaccinees revealed that 2.1 and 2.4% of vaccinees developed modified cases of varicella in the first and second years, respectively, after vaccination. Most of those who developed varicella postvaccination had an attenuated illness, characterized by fewer lesions and a lower incidence of fever (greater than or equal to 100 degrees F, oral) than after natural infection. The likelihood of developing varicella postvaccination decreased (P less than 0.0001) as the 6-week postvaccination glycoprotein-based enzyme-linked immunosorbent assay titer increased. In addition the number of lesions in these cases tended to decrease (P = 0.07 for Year 1 and P = 0.02 for Year 2) as the 6-week glycoprotein-based enzyme-linked immunosorbent assay titer increased. Thus the 6-week postvaccination glycoprotein-based enzyme-linked immunosorbent assay titer can be used as a surrogate marker for protection from natural disease.

Adolescent↗
PubMed2005

Effectiveness of the Oka/GSK attenuated varicella vaccine for the prevention of chickenpox in clinical practice in Israel.

BACKGROUND: The varicella Oka/Merck vaccine has been shown to be very effective in clinical practice; however, several recent studies reported reduced effectiveness. The varicella Oka/GSK vaccine (Varilrix; GlaxoSmithKline Biologicals), which has been subjected to fewer effectiveness studies, was licensed in Israel for voluntary use in 2000. This study was planned to estimate the effectiveness of the varicella Oka/GSK vaccine among children 1-5 years of age. METHODS: Recent reports of varicella were retrieved from the Tel Aviv Health District. Two age-matched control subjects who attended the same day-care center and/or resided in the same neighborhood and had not contracted varicella in the past were recruited for each varicella case. The parents of case and control subjects were interviewed regarding the history of varicella vaccination and the severity of illness. RESULTS: A total of 151 case subjects (mean age, 2.9 +/-1.1 years) and 298 control subjects (mean age, 3.0 +/-1.1 years) were recruited. Vaccination rates for case and control subjects were 6.6% and 38.3%, respectively (P < 0.001). Disease among vaccinated children was significantly milder, as measured by several indices, including parental perception of the illness, presence of fever, time until the lesions dried and days of day care missed. Vaccine effectiveness against varicella of any severity with these figures was 88% (95% confidence interval, 77-94%), and effectiveness against moderate/severe illness was 100%. CONCLUSIONS: Our data demonstrate that the varicella Oka/GSK vaccine used in clinical practice is highly effective in prevention of varicella (especially moderate/severe disease) among children, including those attending day-care centers.

Age Distribution↗
PubMed2005

Chickenpox.

PURPOSE OF REVIEW: Varicella-zoster virus (VZV) remains a public health issue around the globe despite the availability of a live attenuated vaccine and several highly active antiviral agents. A program of universal infant vaccination against varicella was introduced in the US almost 10 years ago. Epidemiological data continue to accumulate that will inform decision-making on vaccine use elsewhere. These findings, together with relevant advances in VZV virology, form the substance of this review. RECENT FINDINGS: Understanding of the pathogenesis of varicella has significantly advanced with the demonstration that the cation-independent mannose 6-phosphate receptor is critical to both entry and egress of enveloped VZV. While our knowledge of intervening events remains sketchy, the future study of VZV will be facilitated by the recent successful cloning of the VZV genome into a bacterial artificial chromosome. Models of latency and reactivation are also being developed, which may help us to understand the epidemiology of herpes zoster in vaccinated populations. Continued evidence of decline in the incidence of varicella, associated hospitalizations and deaths suggests that the vaccine as used in the US is highly effective. However, rates of breakthrough disease are significant and sufficient to sustain outbreaks, even among highly vaccinated populations. This is so despite the generally reduced infectiousness of varicella occurring in vaccinated individuals. There is some evidence of attrition of the immune response over time following immunization in a small proportion of vaccinees. SUMMARY: Our ability to prevent and treat varicella still outstrips our knowledge of pathogenetic and immune mechanisms. Further clinical advances are likely to arise from growing understanding of VZV biology.

Animals↗
PubMed2000

Chickenpox attributable to a vaccine virus contracted from a vaccinee with zoster.

Five months after 2 siblings were immunized with varicella vaccine, 1 developed zoster. Two weeks later the second sibling got a mild case of chicken pox. Virus isolated from the latter was found to be vaccine type. Thus, the vaccine strain was transmitted from the vaccinee with zoster to his sibling. Vaccinees who later develop zoster must be considered contagious. varicella-zoster, zoster, vaccine, transmission, rash, PstI.

Chickenpox↗