Dreyer Sean, Hemarajata Peera, Hogeling Marcia, Henderson Gregory P
University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
Pediatr Dermatol. 2017 Nov;34(6):665-667. doi: 10.1111/pde.13265. Epub 2017 Sep 25.
BACKGROUND/OBJECTIVES: Herpes zoster (HZ) is caused by reactivation of the varicella zoster virus (VZV), and typically causes a painful, vesicular, dermatomal rash in adults over the age of fifty. However, HZ has been known to present in immunocompetent pediatric patients, which account for under 1% of total cases. Pediatric cases are typically caused by natural infection with VZV, but among vaccinated children up to half of cases can be due to vaccine-strain VZV. We present two such cases of vaccine-strain HZ in pediatric patients.
This is a retrospective study of two cases seen at UCLA-affiliated sites. PCR and Sanger sequencing, using previously described PCR primers, determined the presence of two vaccine-strain-specific single nucleotide polymorphisms.
We report two cases of vaccine-strain HZ in immunocompetent pediatric patients who had previously received the varicella vaccine, affecting the right thigh in the first patient and the left leg in the second. Varicella-strain VZV positivity was confirmed by PCR. Both patients had received the varicella vaccine at 12 months of age. Both patients achieved complete resolution of symptoms after 7-day courses of acyclovir.
While vaccination against VZV has overall reduced the incidence of both varicella and HZ in US children, given the widespread use of the VZV vaccine, awareness of the possibility of vaccine-induced HZ remains an important consideration.
背景/目的：带状疱疹（HZ）由水痘-带状疱疹病毒（VZV）再激活引起，通常在50岁以上成年人中引发疼痛性水疱性皮节皮疹。然而，免疫功能正常的儿科患者也会出现HZ，其病例占总病例数的比例不到1%。儿科病例通常由VZV自然感染引起，但在接种疫苗的儿童中，高达一半的病例可能由疫苗株VZV引起。我们报告两例儿科患者的疫苗株HZ病例。
这是一项对在加州大学洛杉矶分校附属机构就诊的两例病例的回顾性研究。使用先前描述的PCR引物进行PCR和桑格测序，确定两个疫苗株特异性单核苷酸多态性的存在。
我们报告两例免疫功能正常的儿科患者的疫苗株HZ病例，这两名患者此前均接种过水痘疫苗，第一例患者右侧大腿受累，第二例患者左侧腿部受累。通过PCR确认水痘株VZV阳性。两名患者均在12个月大时接种了水痘疫苗。两名患者在接受7天疗程的阿昔洛韦治疗后症状完全缓解。
虽然接种VZV疫苗总体上降低了美国儿童水痘和HZ的发病率，但鉴于VZV疫苗的广泛使用，认识到疫苗诱导HZ的可能性仍然是一个重要的考虑因素。
