National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
Pediatrics. 2019 Sep;144(3). doi: 10.1542/peds.2019-1305.
Live vaccines usually provide robust immunity but can transmit the vaccine virus.
To assess the characteristics of secondary transmission of the vaccine-strain varicella-zoster virus (Oka strain; vOka) on the basis of the published experience with use of live varicella and zoster vaccines.
Systematic review of Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for articles published through 2018.
Articles that reported original data on vOka transmission from persons who received vaccines containing the live attenuated varicella-zoster virus.
We abstracted data to describe vOka transmission by index patient's immune status, type (varicella or herpes zoster) and severity of illness, and whether transmission was laboratory confirmed.
Twenty articles were included. We identified 13 patients with vOka varicella after transmission from 11 immunocompetent varicella vaccine recipients. In all instances, the vaccine recipient had a rash: 6 varicella-like and 5 herpes zoster. Transmission occurred mostly to household contacts. One additional case was not considered direct transmission from a vaccine recipient, but the mechanism was uncertain. Transmission from vaccinated immunocompromised children also occurred only if the vaccine recipient developed a rash postvaccination. Secondary cases of varicella caused by vOka were mild.
It is likely that other vOka transmission cases remain unpublished.
Healthy, vaccinated persons have minimal risk for transmitting vOka to contacts and only if a rash is present. Our findings support the existing recommendations for routine varicella vaccination and the guidance that persons with vaccine-related rash avoid contact with susceptible persons at high risk for severe varicella complications.
活疫苗通常可提供强大的免疫力，但也可能传播疫苗病毒。
根据使用活水痘和带状疱疹疫苗的经验，评估疫苗株水痘-带状疱疹病毒（Oka 株；vOka）二次传播的特征。
对 Medline、Embase、Cochrane 图书馆、护理学和联合健康文献累积索引以及 Scopus 数据库进行系统性检索，以获取截至 2018 年发表的文章。
报告了从接种含活减毒水痘-带状疱疹病毒疫苗的人群中传播 vOka 的原始数据的文章。
我们提取数据以描述索引患者的免疫状态、疾病类型（水痘或带状疱疹）和严重程度、以及传播是否经过实验室确认的 vOka 传播情况。
共纳入 20 篇文章。我们从 11 名免疫功能正常的水痘疫苗接种者中发现了 13 例 vOka 水痘患者。在所有情况下，疫苗接种者均出现皮疹：6 例水痘样皮疹和 5 例带状疱疹。传播主要发生在家庭接触者中。还有 1 例病例未被认为是直接从疫苗接种者传播的，但机制尚不确定。只有在疫苗接种者接种疫苗后出现皮疹的情况下，接种免疫功能低下儿童的疫苗才会发生 vOka 传播。由 vOka 引起的继发性水痘病例较轻。
可能还有其他 vOka 传播病例尚未发表。
健康的、接种过疫苗的人将 vOka 传播给接触者的风险很小，前提是出现皮疹。我们的研究结果支持常规水痘疫苗接种的现有建议，以及有疫苗相关皮疹的人避免与有发生严重水痘并发症风险的易感者接触的指导。
