Hardy I, Gershon A A, Steinberg S P, LaRussa P
Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032.
N Engl J Med. 1991 Nov 28;325(22):1545-50. doi: 10.1056/NEJM199111283252204.
The Oka strain of live attenuated varicella vaccine is immunogenic and highly protective, but there has been concern about the risk of zoster after immunization.
We examined the incidence of zoster, risk factors for it, and measures of immune response in children with leukemia who received the vaccine and in appropriate controls.
After a mean follow-up of 4.1 years, zoster was documented in 13 of the 548 vaccinated children with leukemia (2.4 percent). In a subgroup of 96 vaccinated children matched prospectively with 96 children with leukemia who had had natural varicella infections, there were 4 cases of zoster among the vaccinated children and 15 among the controls, for crude incidence rates of 0.80 and 2.46 cases per 100 person-years, respectively (P = 0.01). Of the total of 13 vaccinated children who had zoster, 11 had a skin rash due to varicella-zoster virus, either from the vaccine itself or from breakthrough varicella after household exposure in the period between immunization and the documentation of zoster. In the 268 children who had any type of rash caused by varicella-zoster virus after vaccination, as compared with those who did not have a rash, the relative risk of subsequent zoster was 5.75. For the 21 vaccinated children who received bone marrow transplants, as compared with those who did not, the relative risk of zoster was 7.5. Cell-mediated immunity as assessed by lymphocyte stimulation was lower in 4 children in whom zoster later developed than in 29 controls who had been vaccinated but who did not have zoster (mean stimulation index, 5.1 vs. 23.8; P = 0.0001).
In children with leukemia who receive the live attenuated varicella vaccine, the subsequent incidence of zoster is lower than in children who have natural varicella infections.
减毒活水痘疫苗的Oka株具有免疫原性且高度有效，但人们一直担心接种疫苗后发生带状疱疹的风险。
我们研究了接种疫苗的白血病患儿及适当对照中带状疱疹的发病率、危险因素及免疫反应指标。
平均随访4.1年后，548名接种疫苗的白血病患儿中有13名（2.4%）记录到带状疱疹。在一个前瞻性匹配的亚组中，96名接种疫苗的患儿与96名曾自然感染水痘的白血病患儿相比，接种疫苗的患儿中有4例带状疱疹，对照组中有15例，粗发病率分别为每100人年0.80例和2.46例（P = 0.01）。在总共13名发生带状疱疹的接种疫苗患儿中，11名有因水痘-带状疱疹病毒引起的皮疹，要么来自疫苗本身，要么来自免疫接种至记录到带状疱疹期间家庭接触后的突破性水痘。在接种疫苗后出现任何由水痘-带状疱疹病毒引起皮疹的268名患儿中，与未出现皮疹的患儿相比，随后发生带状疱疹的相对风险为5.75。在21名接受骨髓移植的接种疫苗患儿中，与未接受移植的患儿相比，带状疱疹的相对风险为7.5。通过淋巴细胞刺激评估的细胞介导免疫，在后来发生带状疱疹的4名患儿中低于29名接种疫苗但未发生带状疱疹的对照患儿（平均刺激指数，5.1对23.8；P = 0.0001）。
在接受减毒活水痘疫苗的白血病患儿中，随后带状疱疹的发病率低于自然感染水痘的患儿。
