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- Varicella zoster virus: chickenpox and shingles. [Journal Article]
- Nurs Stand 2014 Apr 16; 28(33):52-8.
The varicella zoster virus causes two infections: varicella, also known as chickenpox occurring mostly in childhood, and herpes zoster, also known as shingles affecting mainly older people. Varicella usually occurs in children under ten years of age. It is generally a mild infection and in the UK vaccination is not offered as part of the routine immunisation programme. However, adults who develop varicella are at risk of developing complications and the infection is likely to be more severe. Serious complications are a particular risk for pregnant women, unborn children, neonates and those who are immunocompromised. Nurses whose work brings them into contact with those at risk have a vital role in providing information about the importance of avoiding varicella. After the acute infection, the varicella zoster virus gains access to the ganglia in the sensory nervous system where it can remain dormant for years. Reactivation results in herpes zoster, a common and unpleasant illness. A vaccine for herpes zoster was introduced for people aged 70-79 in the UK in September 2013.
- Two-dose varicella vaccination coverage among children aged 7 years--six sentinel sites, United States, 2006-2012. [Journal Article]
- MMWR Morb Mortal Wkly Rep 2014 Feb 28; 63(8):174-7.
In 2007, the Advisory Committee on Immunization Practices (ACIP) recommended a routine second dose of varicella vaccine for children at age 4-6 years, in addition to the first dose given at age 12-15 months. One strategy recommended for increasing varicella vaccination coverage is a school entry requirement of proof of varicella immunity. To determine the extent of implementation of the routine 2-dose varicella vaccination program, the number of states with a 2-dose varicella vaccination elementary school entry requirement in 2012 was compared with the number in 2007, and 2-dose varicella vaccination coverage during 2006 was compared with coverage in 2012 among children aged 7 years, using data from six Immunization Information System (IIS) sentinel sites. The number of states (including the District of Columbia) with a 2-dose varicella vaccination elementary school entry requirement increased from four in 2007 to 36 in 2012. Two-dose varicella vaccination coverage levels among children aged 7 years in the six IIS sentinel sites increased from a range of 3.6%-8.9% in 2006 to a range of 79.9%-92.0% in 2012 and were approaching the levels of 2-dose measles, mumps, and rubella (MMR) coverage, which had a range of 81.9%-94.0% in 2012. These increases suggest substantial progress in implementing the routine 2-dose varicella vaccination program in the first 6 years since its recommendation by ACIP. Wider adoption of 2-dose varicella vaccination school entry requirements might help progress toward the Healthy People 2020 target of 95% of kindergarten students having received 2 doses of varicella vaccine.
- Notes from the field: varicella-associated death of a vaccinated child with leukemia - California, 2012. [Case Reports, Journal Article]
- MMWR Morb Mortal Wkly Rep 2014 Feb 21; 63(7):161.
Varicella, a contagious viral disease, is typically self-limited but can result in serious complications, especially among persons who are immunocompromised. On April 10, 2012, a girl aged 4 years with acute lymphoblastic leukemia (ALL) was exposed to a mildly ill cousin who developed a varicella rash 2 days later. The episode was reported to the child's oncologist after 13 days. The girl was prescribed 7 days of oral acyclovir for prophylaxis and concurrently began her scheduled chemotherapy, which included a 5-day course of dexamethasone (prednisone equivalent dose of 23 mg/day). Twenty-two days after her varicella exposure, the girl was taken to an emergency department for fever and abdominal pain. She was treated symptomatically; her caretakers were instructed to discontinue chemotherapy and to follow up with her oncologist. Two days later, the girl returned to the emergency department with a generalized rash. She was hospitalized and treated with intravenous acyclovir and antibiotics. However, she developed multiorgan failure and died on May 7. Varicella was confirmed by polymerase chain reaction testing, and no alternative diagnoses were found for her acute illness.
- [Is vaccination against varicella efficacious and how long does the protection last?]. [English Abstract, Journal Article, Review]
- Med Wieku Rozwoj 2013 Oct-Dec; 17(4):341-6.
Despite the availability of varicella vaccines, few countries have introduced a universal varicella vaccination to their national immunisation programmes. Major concerns are vaccine efficacy against varicella and herpes zoster as well as duration of post-vaccination protection. This review study presents up-to-date classification of varicella-zoster viral clades, sensitive laboratory tests used for assessment of humoral response against the vaccine-type virus OKA antigens in vaccinees, and benefits of universal varicella vaccination in the USA (since 1995) and in Germany (since 2004). Current views on potential rise in zoster incidence after implementation of routine varicella immunisation have been also analyzed.
- Noninfluenza vaccination coverage among adults - United States, 2012. [Journal Article]
- MMWR Morb Mortal Wkly Rep 2014 Feb 7; 63(5):95-102.
Vaccinations are recommended throughout life to prevent vaccine-preventable diseases and their sequelae. Adult vaccination coverage, however, remains low for most routinely recommended vaccines and well below Healthy People 2020 targets. In October 2013, the Advisory Committee on Immunization Practices (ACIP) approved the adult immunization schedule for 2014. With the exception of influenza vaccination, which is recommended for all adults each year, vaccinations recommended for adults target different populations based on age, health conditions, behavioral risk factors (e.g., injection drug use), occupation, travel, and other indications. To assess vaccination coverage among adults aged ≥19 years for selected vaccines, CDC analyzed data from the 2012 National Health Interview Survey (NHIS). This report summarizes the results of that analysis for pneumococcal, tetanus toxoid-containing (tetanus and diphtheria vaccine [Td] or tetanus and diphtheria with acellular pertussis vaccine [Tdap]), hepatitis A, hepatitis B, herpes zoster (shingles), and human papillomavirus (HPV) vaccines by selected characteristics (age, race/ethnicity, and vaccination target criteria). Influenza vaccination coverage estimates for the 2012-13 influenza season have been published separately. Compared with 2011, only modest increases occurred in Tdap vaccination among adults aged 19-64 years, herpes zoster vaccination among adults aged ≥60 years, and HPV vaccination among women aged 19-26 years; coverage among adults in the United States for the other vaccines did not improve. Racial/ethnic gaps in coverage persisted for all six vaccines and widened for Tdap, herpes zoster, and HPV vaccination. Increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults. The Community Preventive Services Task Force and other authorities have recommended that health-care providers incorporate vaccination needs assessment, recommendation, and offer of vaccination into routine clinical practice for adult patients.
- [The clinical and epidemic characteristics of shingles (herpes zoster) and its prevention with vaccines]. [English Abstract, Journal Article, Review]
- Ter Arkh 2013; 85(11):130-3.
The review gives data on the clinical manifestations, complications, and epidemiological characteristics of herpes zoster. It discusses prospects for and foreign experience with vaccination against chickenpox and exacerbations of herpes zoster.
- [Viral vaccines in the national vaccination program--views of the near future]. [English Abstract, Journal Article]
- Duodecim 2013; 129(22):2427-33.
Both conventional virus vaccines and those being introduced in the near future are either live attenuated viruses or nonliving inactivated viruses, mere virus-like particles (VLP) or purified proteins. Live vaccines yield a "more natural" immunity, but in many cases also a nonliving vaccine is sufficient to protect from viral infections. Influenza vaccines are of both types. The commencing HPV vaccination program will be conducted with a VLP vaccine comprising two serotypes. A live chickenpox vaccine will be introduced in the national vaccination program in the next few years. In addition, a shingles vaccine is needed. The live oral rotavirus vaccine works well.
- Molecular characterisation of varicella zoster virus genotypes in Sri Lanka. [Journal Article, Research Support, Non-U.S. Gov't]
- Ceylon Med J 2013 Dec; 58(4):153-6.
Genotyping of wild type of varicella zoster virus (VZV) in Sri Lanka would help to distinguish the VZV wild type infection from varicella vaccine associated infections.PCR-RFLP analysis of VZV ORF 38, 54 and 62 was used for genotyping in VZV from blood or vesicular fluid from 31 patients with chickenpox or herpes zoster. The PstI restriction site of ORF 38, BglI restriction site of ORF 54 and SmaI restriction site of ORF 62 were analyzed using RFLP to determine the genotype.Except for one strain, all other VZV isolates had the genotype characteristic of the wild type VZV strain PstI+BglI+ SmaI-, which was characteristic of the Asian strain. None of the isolates had the American or the European VZV profile (PstI+BglI-) but were similar to isolates from Africa and Asia (PstI+BglI+). Interestingly, one of the VZV strains isolated from a patient with chickenpox had the characteristic genotype of the vaccine strain PstI- BglI+ SmaI+.The genotype of the VZV in Sri Lanka is similar to the Asian VZV genotype and can be easily distinguished from the VZV vaccine strain by using the polymorphisms in ORF 38, ORF 54 and ORF 62.
- Comparing active and passive varicella surveillance in Philadelphia, 2005-2010: recommendations for the transition to nationwide passive varicella disease surveillance. [Comparative Study, Journal Article]
- Public Health Rep 2014 Jan-Feb; 129(1):47-54.
The Philadelphia Department of Public Health (PDPH) conducts active surveillance for varicella in West Philadelphia. For its approximately 300 active surveillance sites, PDPH mandates biweekly reports of varicella (including zero cases) and performs intensive case investigations. Elsewhere in Philadelphia, surveillance sites passively report varicella cases, and abbreviated investigations are conducted. We used active varicella surveillance program data to inform the transition to nationwide passive varicella surveillance.We compared classification of reported cases, varicella disease incidence, and reporting completeness for active and passive surveillance areas for 2005-2010. We assessed reporting completeness using capture-recapture analysis of 2- to 18-year-old cases reported by schools/daycare centers and health-care providers.From 2005 to 2010, PDPH received 3,280 passive and 969 active surveillance varicella case reports. Most passive surveillance reports were classified as probable cases (18% confirmed, 56% probable, and 26% excluded), whereas nearly all of the active surveillance reports were either confirmed or excluded (36% confirmed, 11% probable, and 53% excluded). Overall incidence rates calculated using confirmed/probable cases were similar in the active and passive surveillance areas. Detection of laboratory-confirmed, breakthrough, and moderate-to-severe cases was equivalent for both surveillance areas.Although active surveillance for varicella results in better classified cases, passive surveillance provides comparable data for monitoring disease trends in breakthrough and moderate-to-severe varicella. To further improve passive surveillance in the two-dose-varicella vaccine era, jurisdictions should consider conducting periodic enhanced surveillance, encouraging laboratory testing, and collecting additional varicella-specific variables for passive surveillance.
- Prevention of herpes zoster in older adults. [Comment, Journal Article]
- Am Fam Physician 2013 Nov 1; 88(9):578.