Cuerden Claire, Gower Charlotte, Brown Kevin, Heath Paul T, Andrews Nick, Amirthalingam Gayatri, Bate Jessica
Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK.
Department of Immunisation and Counter Measures, Public Health England Colindale, London, UK.
Arch Dis Child. 2022 Oct 19;107(11):1029-1033. doi: 10.1136/archdischild-2022-324396.
To compare the occurrence of chickenpox in children with cancer who received varicella immunoglobulin (VZIG) or aciclovir as postexposure prophylaxis (PEP).
Prospective multicentre service evaluation of children with cancer who received either VZIG or aciclovir as PEP following significant exposure to varicella zoster virus (VZV) over a 24-month period from May 2018.
Data were collected from 9 UK Paediatric Oncology Primary Treatment Centres.
Children under 16 years old with a diagnosis of cancer and/or previous haematopoietic stem cell transplant who were VZV seronegative at exposure and/or diagnosis and received PEP following significant VZV exposure.
The primary outcome was the incidence of breakthrough varicella within 6 weeks of VZV exposure and treatment with PEP.
A total of 105 eligible patients were registered with a median age of 4.9 years (range 1.1-10.5 years). Underlying diagnoses were acute leukaemia (64), solid tumours (22), Langerhans cell histiocytosis (9), central nervous system (CNS) tumours (8) and other (2). Aciclovir was received by 86 patients (81.9%), 18 received VZIG (17.1%) and 1 valaciclovir (0.9%). There were seven reported break-through VZV infections in 103 patients at follow-up (7/103, 6.8%). Clinical VZV developed in 5/84 of the aciclovir group (6.0%, 95% CI 2.0 to 13.3) and 2/18 of VZIG group (11.1%, 95% CI 1.4 to 34.7). All breakthrough infections were either mild (5/7) or moderate (2/7) in severity.
Aciclovir is a safe and effective alternative to VZIG as VZV PEP in children with cancer and should be considered as standard of care.
比较接受水痘免疫球蛋白（VZIG）或阿昔洛韦作为暴露后预防（PEP）的癌症患儿水痘的发生率。
对2018年5月起的24个月内，接受VZIG或阿昔洛韦作为VZV暴露后PEP的癌症患儿进行前瞻性多中心服务评估。
数据收集自9家英国儿科肿瘤初级治疗中心。
16岁以下诊断为癌症和/或既往有造血干细胞移植史、暴露时和/或诊断时VZV血清学阴性且在VZV显著暴露后接受PEP的儿童。
主要结局是VZV暴露和PEP治疗后6周内突破性水痘的发生率。
共登记了105例符合条件的患者，中位年龄为4.9岁（范围1.1 - 10.5岁）。基础诊断包括急性白血病（64例）、实体瘤（22例）、朗格汉斯细胞组织细胞增多症（9例）、中枢神经系统（CNS）肿瘤（8例）和其他（2例）。86例患者（81.9%）接受了阿昔洛韦，18例接受了VZIG（17.1%），1例接受了伐昔洛韦（0.9%）。随访时103例患者中有7例报告发生突破性VZV感染（7/103，6.8%）。阿昔洛韦组84例中有5例发生临床VZV（6.0%，95%CI 2.0至13.3），VZIG组18例中有2例发生（11.1%，95%CI 1.4至34.7）。所有突破性感染严重程度均为轻度（5/7）或中度（2/7）。
阿昔洛韦作为癌症患儿VZV PEP是VZIG的一种安全有效的替代药物，应被视为标准治疗方案。
