Hardy I R, Gershon A A
Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York.
Infect Dis Clin North Am. 1990 Mar;4(1):159-73.
Five to 10% of people reach adulthood still susceptible to VZV, which generally causes more severe primary disease in adults than seen in children. A live attenuated varicella vaccine was developed in Japan in the early 1970s and has now been tested in several trials in healthy children, immunocompromised children, and healthy adults. The vaccine is highly immunogenic in healthy children, conferring immunity for at least 7 to 10 years with a high degree of protective efficacy. In several trial in adults, the vaccine has been shown to be highly immunogenic. Humoral and cell-mediated immunity wanes in vaccinated adults, however, with antibodies to VZV detectable in approximately only 80% of vaccinated individuals after 1 year, and in approximately 70% from 2 to 6 years after vaccination. In leukemic children who have been vaccinated, however, this loss of detectable antibody has not been correlated with a reduction in protection during this time. Similar analyses have not been made in vaccinated adults because the numbers intimately exposed to VZV have been small. Protective efficacy after household exposure is approximately 65% in adults; however, when breakthrough (i.e., in those who have seroconverted) illness has occurred, it has invariably been mild, so that efficacy in preventing severe disease has been 100%. "Vaccine failures," however, may develop full-blown varicella. Side effects of immunization in adults are mild: a transient local reaction occurs in 10 to 21% and a mild rash in 6 to 8%. There is a theoretical risk of transmission of the attenuated virus if a vaccine-induced rash occurs, which has been documented only in contacts of vaccinated leukemics (any secondary disease has also been mild). To date, there has been no evidence that vaccination increases the risk of developing zoster; on the contrary, studies in leukemic children, who may be considered a "sentinel population" in this regard, suggest that the risk of zoster after vaccination may be reduced compared with the risk after natural infection. Susceptible adults who would most benefit from vaccination against VZV include health care workers, those who care for small children, women of child-bearing age prior to pregnancy, military recruits, and college students.
5%至10%的人成年后仍易感染水痘带状疱疹病毒（VZV），一般来说，该病毒在成人中引发的原发性疾病比儿童更为严重。20世纪70年代初，日本研发出一种减毒活水痘疫苗，目前已在健康儿童、免疫功能低下儿童和健康成人中进行了多项试验。该疫苗在健康儿童中具有高度免疫原性，可提供至少7至10年的免疫力，保护效果显著。在成人的多项试验中，该疫苗也显示出高度免疫原性。然而，接种疫苗的成人中，体液免疫和细胞介导免疫会逐渐减弱，接种1年后，约只有80%的接种者可检测到VZV抗体，接种2至6年后，这一比例约为70%。不过，在接种疫苗的白血病儿童中，这段时间内可检测到的抗体减少与保护作用降低并无关联。由于密切接触VZV的成年人数较少，尚未对其进行类似分析。成人家庭接触后的保护效果约为65%；然而，当出现突破性感染（即血清转化者）疾病时，病情通常较轻，因此预防严重疾病的效果为100%。不过，“疫苗接种失败”者可能会患上典型的水痘。成人免疫接种的副作用较轻：10%至21%的人会出现短暂的局部反应，6%至8%的人会出现轻微皮疹。如果出现疫苗诱导的皮疹，存在减毒病毒传播的理论风险，不过仅在接种疫苗的白血病患者的接触者中记录到这种情况（任何继发性疾病也都较轻）。迄今为止，尚无证据表明接种疫苗会增加患带状疱疹的风险；相反，在白血病儿童（在这方面可被视为“哨兵人群”）中的研究表明，与自然感染后的风险相比，接种疫苗后患带状疱疹的风险可能会降低。最能从接种VZV疫苗中获益的易感成人包括医护人员、照顾幼儿的人、怀孕前的育龄妇女、新兵和大学生。
