Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA.
BMC Infect Dis. 2024 Nov 14;24(1):1296. doi: 10.1186/s12879-024-09776-1.
Routine childhood immunization against varicella-zoster virus has led to a dramatic reduction in the incidence of primary varicella. However, there are rare, yet significant cases reported of reactivated Oka-strain varicella, primarily in immunocompromised hosts.
A 16-year-old female with Hodgkin's lymphoma developed a vesicular rash shortly after completing all chemotherapy treatment. Swabs obtained from the vesicles were positive for varicella-zoster virus. By the time of hospitalization, the patient developed a disseminated rash involving multiple dermatomes. Subsequent polymerase chain reaction confirmed Oka vaccine-strain varicella-zoster virus. The patient had previously received a primary series of immunizations against varicella in 2008 and 2012, with her 2nd dose given 11 years prior to her development of vaccine-strain herpes zoster and 10 years prior to her diagnosis of Hodgkin's lymphoma, respectively. The patient was treated with parenteral acyclovir upon hospitalization and monitored clinically for cutaneous disease progression as well as sequelae. After 8 days of inpatient treatment, her rash had stopped spreading with no new lesions. All earlier lesions had crusted over. No serious sequelae of disease such as pneumonitis, hepatitis, encephalitis, or meningitis occurred, and she made a complete recovery.
There are individual and community-wide benefits to childhood immunization against varicella. This case highlights an unusual presentation of disseminated vaccine-strain herpes zoster in an adolescent with secondary immunodeficiency 11 years after completing primary immunization. In addition, this case informs pediatricians of complications that can arise in immunized subjects if they become immunosuppressed years later. The only way to distinguish between wild-type and vaccine-strain herpes zoster was by viral genotyping. Providers should be cognizant of potential vaccine virus reactivation in their differential. Considerations for work-up and management should include infection control and viral resistance in refractory cases.
常规的儿童水痘-带状疱疹病毒免疫接种导致原发性水痘发病率显著降低。然而，有罕见但有重要意义的报告称，奥卡株水痘会被重新激活，主要发生在免疫功能低下的宿主中。
一名 16 岁女性患有霍奇金淋巴瘤，在完成所有化疗治疗后不久出现水疱性皮疹。从水疱中获得的拭子对水痘-带状疱疹病毒呈阳性。住院时，患者出现了涉及多个皮节的播散性皮疹。随后聚合酶链反应证实为奥卡疫苗株水痘-带状疱疹病毒。该患者曾于 2008 年和 2012 年接受过原发性水痘疫苗系列接种，第 2 剂接种分别在其发生疫苗株带状疱疹和诊断霍奇金淋巴瘤前 11 年和 10 年。患者住院后接受了阿昔洛韦静脉治疗，并在临床上监测皮肤疾病进展和后遗症。住院治疗 8 天后，她的皮疹停止扩散，没有新的病变。所有早期病变均已结痂。没有发生肺炎、肝炎、脑炎或脑膜炎等严重疾病后遗症，她完全康复。
儿童水痘免疫接种具有个体和社区效益。本病例突出了在完成初级免疫接种 11 年后，二级免疫缺陷的青少年中出现的罕见播散性疫苗株带状疱疹表现。此外，该病例提醒儿科医生，如果免疫接种的患者多年后免疫抑制，可能会出现并发症。区分野生型和疫苗株带状疱疹的唯一方法是病毒基因分型。提供者应注意在鉴别诊断中潜在的疫苗病毒重新激活。考虑到难治性病例的感染控制和病毒耐药性，应包括检查和管理。
