Utah Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
Biol Blood Marrow Transplant. 2018 Sep;24(9):1783-1787. doi: 10.1016/j.bbmt.2018.04.003. Epub 2018 Apr 10.
Reactivation of varicella zoster virus (VZV) remains a significant public health burden for long-term survivors of hematopoietic cell transplantation. Delayed immune reconstitution after transplantation due to immunosuppression, post-transplant therapies, poor engraftment, and graft-versus-host disease leave a large number of patients at risk for herpes zoster (shingles) and its highly morbid complications. Although prophylaxis with acyclovir or valacyclovir has reduced the incidence of VZV reactivation as long as prophylaxis is continued, the incidence of disease in the late post-transplant period or after stopping prophylaxis is greater in the hematopoietic cell transplantation population than the general public. Therefore, additional interventions beyond long-term use of prophylactic antivirals are required to suppress VZV. Vaccines to elicit VZV-specific immunity represent one method to enhance prevention of VZV reactivation, but care must be taken with live vaccines. Inactivated vaccines have been developed and require well-designed studies to determine their safety and efficacy in this high-risk population. Here, we report the available evidence for established and newly developed vaccines for VZV and discuss our view on their role in protecting our transplant survivors against VZV reactivation.
水痘带状疱疹病毒 (VZV) 的再激活仍然是造血细胞移植长期幸存者的重大公共卫生负担。由于免疫抑制、移植后治疗、植入不良和移植物抗宿主病，移植后免疫重建延迟，使大量患者面临带状疱疹（带状疱疹）及其高度致命并发症的风险。虽然阿昔洛韦或伐昔洛韦预防可在预防持续的情况下降低 VZV 再激活的发生率，但造血细胞移植人群在移植后晚期或停止预防后的疾病发生率高于普通人群。因此，需要除长期使用预防性抗病毒药物以外的其他干预措施来抑制 VZV。引发 VZV 特异性免疫的疫苗是增强 VZV 预防再激活的一种方法，但必须谨慎使用活疫苗。已经开发出灭活疫苗，需要精心设计研究来确定它们在这种高危人群中的安全性和有效性。在这里，我们报告了 VZV 现有疫苗和新开发疫苗的证据，并讨论了它们在保护我们的移植幸存者免受 VZV 再激活方面的作用。
