Ojha Rohit P, Stallings-Smith Sericea, Aviles-Robles Martha J, Gomez Sergio, Somarriba María Mercedes, Caniza Miguela A
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN, 38105, USA.
Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA.
Eur J Pediatr. 2016 Apr;175(4):581-5. doi: 10.1007/s00431-015-2672-8. Epub 2015 Nov 26.
Limited evidence is available about varicella-zoster virus (VZV) infection among pediatric cancer patients in developing countries, which raises questions about the generalizability of VZV vaccine recommendations for pediatric cancer patients (derived from developed countries) to these settings. We assessed the incidence and case-fatality of VZV infection at three institutions in developing countries (Argentina, Mexico, and Nicaragua). Individuals eligible for our study were aged <20 years and actively receiving cancer-directed therapy. We estimated a summary incidence rate (IR) and case-fatality risk with corresponding 95 % confidence limits (CL) of VZV infection across sites using random-effects models. Our study population comprised 511 pediatric cancer patients, of whom 64 % were aged <10 years, 58 % were male, and 58 % were diagnosed with leukemia. We observed a total of 10 infections during 44,401 person-days of follow-up across the 3 sites (IR = 2.3, 95 % CL 1.2, 4.2). The summary case-fatality risk was 10 % (95 % CL 1.4, 47 %) based on one death.
Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. VZV vaccine recommendations for pediatric cancer patients in developed countries may be generalizable to developing countries.
• Current recommendations, based on evidence from pediatric cancer patients in developed countries, contraindicate varicella-zoster virus (VZV) vaccination until completion of cancer-directed therapy and recovery of immune function. • The generalizability of these VZV vaccine recommendations to pediatric cancer patients in developing countries is unknown because of limited information about the incidence and case-fatality of VZV in these settings. What is New: • Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. • VZV vaccine recommendations based on evidence from pediatric cancer patients in developed countries may be generalizable to pediatric cancer patients in developing countries.
关于发展中国家儿科癌症患者中水痘带状疱疹病毒（VZV）感染的证据有限，这引发了对于（源自发达国家的）VZV疫苗针对儿科癌症患者的推荐意见在这些环境中的可推广性的质疑。我们评估了三个发展中国家（阿根廷、墨西哥和尼加拉瓜）机构中VZV感染的发病率和病死率。符合我们研究条件的个体年龄小于20岁且正在接受针对癌症的治疗。我们使用随机效应模型估计了各研究点VZV感染的汇总发病率（IR）和病死率风险以及相应的95%置信区间（CL）。我们的研究人群包括511名儿科癌症患者，其中64%年龄小于10岁，58%为男性，58%被诊断为白血病。在3个研究点的44401人日随访期间，我们共观察到10例感染（IR = 2.3，95% CL 1.2，4.2）。基于1例死亡，汇总病死率风险为10%（95% CL 1.4，47%）。
我们的结果表明，三个发展中国家的儿科癌症患者中VZV感染的发病率和病死率较低。发达国家针对儿科癌症患者的VZV疫苗推荐意见可能适用于发展中国家。
• 基于发达国家儿科癌症患者的证据，目前的推荐意见指出，在完成针对癌症的治疗并恢复免疫功能之前，禁忌接种水痘带状疱疹病毒（VZV）疫苗。• 由于关于这些环境中VZV感染发病率和病死率的信息有限，这些VZV疫苗推荐意见对发展中国家儿科癌症患者的可推广性尚不清楚。新发现：• 我们的结果表明，三个发展中国家的儿科癌症患者中VZV感染的发病率和病死率较低。• 基于发达国家儿科癌症患者证据的VZV疫苗推荐意见可能适用于发展中国家的儿科癌症患者。
