Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
Pediatr Blood Cancer. 2012 Jan;58(1):12-6. doi: 10.1002/pbc.22759. Epub 2010 Sep 16.
The available guidelines for varicella vaccination of susceptible children with acute lymphoblastic leukemia (ALL) have become increasingly conservative. However, vaccination of those who have remained in continuous complete remission for 1 year and are receiving chemotherapy is still considered a reasonable option. There is little available data to allow a comparison of the risk versus benefit of vaccinating these patients.
We retrospectively reviewed mortality due to varicella in the records of 15 pediatric ALL study groups throughout Europe, Asia, and North America during the period 1984-2008.
We found that 20 of 35,128 children with ALL (0.057%; 95% confidence interval [CI], 0.037-0.088%) died of VZV infection. The mortality rate was lower in North America (3 of 11,558 children, 0.026%; 95% CI, 0.009-0.076%) than in the Asian countries (2 of 4,882 children, 0.041%; 95% CI, 0.011-0.149%) and in Europe (15 of 18,688 children, 0.080%; 95% CI, 0.049-0.132%) consistent with the generally higher rate of VZV vaccination in North America. Fourteen of the 20 patients (70%) died during the first year of treatment for ALL. One death was attributed to varicella vaccination.
The negligible rate of fatal varicella infection in children with ALL, the risk that accompanies vaccination, and the necessity of withholding chemotherapy for vaccination appear to outweigh the potential benefit of varicella vaccination for children during treatment of ALL.
适用于急性淋巴细胞白血病（ALL）的易感儿童的水痘疫苗接种指南变得越来越保守。然而，对于那些持续完全缓解 1 年且正在接受化疗的儿童，接种疫苗仍被认为是合理的选择。关于接种这些患者的风险与获益，可用的数据很少。
我们回顾性地分析了 1984 年至 2008 年期间，欧洲、亚洲和北美的 15 个儿科 ALL 研究组的记录中水痘导致的死亡率。
我们发现，35128 例 ALL 患儿中有 20 例（0.057%；95%置信区间[CI]，0.037-0.088%）死于 VZV 感染。北美的死亡率较低（11558 例中有 3 例，0.026%；95%CI，0.009-0.076%），低于亚洲国家（4882 例中有 2 例，0.041%；95%CI，0.011-0.149%）和欧洲（18688 例中有 15 例，0.080%；95%CI，0.049-0.132%），这与北美的 VZV 疫苗接种率普遍较高一致。20 例患者中有 14 例（70%）在 ALL 治疗的第一年死亡。1 例死亡归因于水痘疫苗接种。
在 ALL 患儿中，致命性水痘感染的发生率极低，接种疫苗的风险以及为接种而必须停止化疗的必要性似乎超过了在 ALL 治疗期间为儿童接种水痘疫苗的潜在获益。
