Northern Institute of Cancer Research, Newcastle University, Newcastle Upon Tyne, UK.
Curr Opin Infect Dis. 2011 Jun;24(3):203-11. doi: 10.1097/QCO.0b013e328345d666.
The prevention of varicella in children with cancer is generally agreed to be an important goal, because of their elevated risk of varicella zoster virus (VZV)-associated morbidity and mortality. However, there is a lack of consensus on the best means of achieving this. Here, we review the existing evidence in relation to postexposure prophylaxis against varicella in this group and summarize data regarding the role of active vaccination.
Death from varicella during treatment for cancer is now rare, but VZV disease and its prevention remain significant problems in paediatric oncology practice. Measures to reduce VZV exposure amongst seronegative individuals are often neglected. When exposure is known to have occurred, early administration of varicella zoster immune globulin (VZIG) is generally protective against severe and complicated varicella. However, many centres in the UK and Japan use an oral antiviral agent, aciclovir, in place of VZIG. Published evidence for the efficacy of aciclovir as postexposure prophylaxis (PEP) relates mostly to healthy children, with no controlled studies in the immunocompromised.
Good evidence already supports the administration of varicella vaccine to healthy susceptible family contacts of children with malignancy, but not to patients themselves. Further data are urgently needed to inform the choice of PEP against VZV in the immunocompromised.
预防儿童癌症患者水痘带状疱疹病毒（VZV）感染是一个重要目标，因为他们有发生 VZV 相关发病率和死亡率升高的风险。然而，在实现这一目标的最佳方法上，尚未达成共识。在这里，我们回顾了与该人群暴露后预防水痘相关的现有证据，并总结了关于主动疫苗接种作用的数据。
癌症治疗期间死于水痘的情况现已罕见，但 VZV 疾病及其预防仍然是儿科肿瘤学实践中的重要问题。减少血清阴性个体 VZV 暴露的措施经常被忽视。当已知发生暴露时，早期给予水痘带状疱疹免疫球蛋白（VZIG）通常可预防严重和复杂的水痘。然而，在英国和日本的许多中心，使用抗病毒药物阿昔洛韦代替 VZIG。关于阿昔洛韦作为暴露后预防（PEP）疗效的已发表证据主要与健康儿童有关，在免疫功能低下的患者中没有对照研究。
已有充分证据支持对恶性肿瘤患儿的健康易感家属接触者接种水痘疫苗，但不支持对患者本身接种。迫切需要更多数据来为免疫功能低下者选择 VZV 的 PEP 提供信息。
