Wootton Susan H, Law Barbara, Tan Ben, Mozel Michelle, Scheifele David W, Halperin Scott
University of British Columbia, Vancouver, British Columbia, Canada.
Pediatr Infect Dis J. 2008 Feb;27(2):112-8. doi: 10.1097/INF.0b013e31815948b5.
Varicella zoster virus causes varicella (chickenpox) and can reactivate to cause herpes zoster (HZ). In Canada, live attenuated varicella vaccine was recommended for routine use among healthy susceptible children age 1 year and older, in 1999. Varicella vaccine has had a profound impact on the incidence of varicella; however the impact on HZ remains uncertain.
Surveillance for HZ admissions was conducted by the Immunization Monitoring Program, Active (IMPACT) surveillance network comprising 12 centers representing over 90% of pediatric tertiary care beds in Canada. Active surveillance for HZ was undertaken in 1991-1996 and reintroduced in 1999. A clinical diagnosis was accepted, with or without laboratory confirmation. For each case, a detailed case report form was completed.
In total, 648 children were admitted with HZ; 342 (52.8%) were boys and the mean age was 9.9 +/- 4.4 years. Five hundred seventy-seven (89.0%) were immunocompromised and 71 immunocompetent (10.8%). Five hundred seventy-one (88.1%) had a history of varicella zoster virus infection. Varicella vaccination was documented in 4 children before admission. Most (85.5%) presented with localized disease. Immunocompetent children were more likely than immunocompromised children to be hospitalized with ophthalmic disease (odds ratio 5.1, P < 0.001) or with at least 1 complication (odds ratio 3.0, P < 0.001). Only 1 death was attributable to HZ.
Immunocompromised children represented the overwhelming majority of IMPACT hospitalized cases. Complications directly resulting from HZ were common in immunocompetent children. As varicella vaccine use becomes more widespread, the IMPACT network will continue to play an important role in monitoring the changing epidemiology of HZ in children.
水痘带状疱疹病毒可引起水痘，并可再次激活引发带状疱疹。1999年，加拿大建议1岁及以上健康易感儿童常规接种减毒活水痘疫苗。水痘疫苗对水痘发病率产生了深远影响；然而，其对带状疱疹的影响仍不确定。
由免疫监测项目主动监测（IMPACT）网络开展带状疱疹住院病例监测，该网络由12个中心组成，代表了加拿大90%以上的儿科三级护理床位。1991 - 1996年对带状疱疹进行了主动监测，并于1999年重新开展。临床诊断无论有无实验室确诊均可接受。针对每例病例，填写详细的病例报告表。
共有648名儿童因带状疱疹住院；342名（52.8%）为男孩，平均年龄为9.9±4.4岁。577名（89.0%）免疫功能低下，71名免疫功能正常（10.8%）。571名（88.1%）有水痘带状疱疹病毒感染史。4名儿童在入院前有接种水痘疫苗记录。大多数（85.5%）表现为局部疾病。免疫功能正常的儿童比免疫功能低下的儿童更易因眼部疾病住院（优势比5.1，P<0.001）或至少有1种并发症（优势比3.0，P<0.001）。仅1例死亡归因于带状疱疹。
免疫功能低下儿童占IMPACT住院病例的绝大多数。免疫功能正常儿童中由带状疱疹直接导致的并发症很常见。随着水痘疫苗的使用越来越广泛，IMPACT网络将继续在监测儿童带状疱疹流行病学变化方面发挥重要作用。
