Goldstein S L, Somers M J, Lande M B, Brewer E D, Jabs K L
Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA.
Pediatr Nephrol. 2000 Apr;14(4):305-8. doi: 10.1007/s004670050764.
Varicella, or chickenpox, is very communicable and has been shown to be transmitted to nearly 90% of household contacts. Severe varicella infections with fatal complications have been noted in children receiving corticosteroids despite the administration of varicella-zoster immune globulin (VZIG). The use of post-exposure acyclovir prophylaxis in immunocompetent children exposed to a household contact with varicella has been shown to decrease the transmission rate of varicella significantly. We studied the safety and efficacy of acyclovir prophylaxis as an adjunctive preventive measure in 8 children (10 separate exposures) receiving corticosteroids for renal disease. Four children (6 separate exposures) served as controls. No adverse reactions were reported with the acyclovir prophylaxis. The maximum change between pre- and study serum creatinine levels was 0.1 mg/dl. None of the 8 patients who received acyclovir prophylaxis developed chickenpox. One of these 8 patients developed humoral immunity to varicella despite the absence of clinical infection. One of 4 patients who received VZIG prophylaxis alone developed chickenpox. These data support the use of acyclovir prophylaxis as an adjunctive measure to VZIG for the prevention of potentially serious varicella infection in children receiving steroids.
水痘，即鸡痘，具有很强的传染性，已证实其可传染给近90%的家庭接触者。尽管使用了水痘-带状疱疹免疫球蛋白（VZIG），但接受皮质类固醇治疗的儿童中仍出现了伴有致命并发症的严重水痘感染。对于接触过水痘家庭接触者的免疫功能正常的儿童，使用接触后阿昔洛韦预防已被证明可显著降低水痘的传播率。我们研究了阿昔洛韦预防作为辅助预防措施在8名因肾病接受皮质类固醇治疗的儿童（10次单独接触）中的安全性和有效性。4名儿童（6次单独接触）作为对照。阿昔洛韦预防未报告不良反应。研究前和研究时血清肌酐水平的最大变化为0.1mg/dl。接受阿昔洛韦预防的8名患者中无一例患水痘。这8名患者中有1例尽管没有临床感染，但对水痘产生了体液免疫。仅接受VZIG预防的4名患者中有1例患水痘。这些数据支持将阿昔洛韦预防作为VZIG的辅助措施，用于预防接受类固醇治疗的儿童潜在的严重水痘感染。
