Jamani Kareem, MacDonald Judy, Lavoie Martin, Williamson Tyler S, Brown Christopher B, Chaudhry Ahsan, Jimenez-Zepeda Victor H, Duggan Peter, Tay Jason, Stewart Douglas, Daly Andrew, Storek Jan
Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Blood Adv. 2016 Nov 30;1(2):152-159. doi: 10.1182/bloodadvances.2016000836. eCollection 2016 Dec 13.
Varicella zoster virus (VZV) disease (usually cutaneous zoster) occurs frequently after hematopoietic cell transplantation (HCT), and postherpetic neuralgia (PHN) results in poor quality of life. The optimal prophylaxis of VZV disease/PHN has not been established. At our center, before 2008, VZV prophylaxis consisted of ∼1 year of post-HCT acyclovir/valacyclovir ("old strategy"), whereas post-2008 prophylaxis consisted of 2 years of acyclovir/valacyclovir followed by immunization using varicella vaccine ("new strategy"). We performed a retrospective study comparing the cumulative incidence of VZV disease and PHN among patients who completed the old strategy (n = 153) vs the new strategy (n = 125). Patients who completed the old strategy had a significantly higher cumulative incidence of VZV disease (33% vs 17% at 5 years, ≤ .01) and PHN (8% vs 0% at 5 years, = .02). In conclusion, VZV prophylaxis with 2 years of acyclovir/valacyclovir followed by vaccination appears to result in a low incidence of VZV disease and may eliminate PHN.
水痘带状疱疹病毒（VZV）疾病（通常为皮肤带状疱疹）在造血细胞移植（HCT）后频繁发生，且带状疱疹后神经痛（PHN）会导致生活质量下降。VZV疾病/PHN的最佳预防方案尚未确定。在我们中心，2008年之前，VZV预防措施包括HCT后使用阿昔洛韦/伐昔洛韦约1年（“旧策略”），而2008年之后的预防措施则是先使用阿昔洛韦/伐昔洛韦2年，然后接种水痘疫苗（“新策略”）。我们进行了一项回顾性研究，比较了完成旧策略的患者（n = 153）与完成新策略的患者（n = 125）中VZV疾病和PHN的累积发病率。完成旧策略的患者VZV疾病的累积发病率显著更高（5年时分别为33%和17%，P≤0.01），PHN的累积发病率也更高（5年时分别为8%和0%，P = 0.02）。总之，先使用阿昔洛韦/伐昔洛韦2年然后接种疫苗进行VZV预防，似乎可降低VZV疾病的发病率，并可能消除PHN。
