Bernstein H H, Rothstein E P, Watson B M, Reisinger K S, Blatter M M, Wellman C O, Chartrand S A, Cho I, Ngai A, White C J
Temple University School of Medicine, Philadelphia, PA.
Pediatrics. 1993 Dec;92(6):833-7.
To prospectively characterize varicella occurring in children previously immunized with a live attenuated varicella vaccine (breakthrough varicella) through daily observation by medical personnel and to compare it with natural varicella followed in the same manner.
A blinded clinical survey.
Four pediatric practices (two private; two hospital-based).
Healthy 12-month-old through 17-year-old children with chickenpox were studied; 92 had natural varicella and 58 had breakthrough varicella. SELECTION PROCEDURES AND INTERVENTIONS: Study personnel, unaware of vaccination status, documented the clinical characteristics of each patient in the office or at the patient's home each day from enrollment until the day after the total number of lesions increased less than 10%. A standard form documenting number and description of lesions, temperature, duration of illness, and associated clinical complaints was completed each day by the same study personnel. Acute and convalescent sera were obtained on breakthrough cases.
Antibody to varicella-zoster virus was measured by the glycoprotein-based enzyme-linked immunosorbent assay. Of those with sera available, 85% were serologically confirmed. Eighty-seven percent of enrollees had a known exposure to chickenpox, with at least two thirds of each group having a greater than 4-hour or a household exposure. The numbers of total and vesicular lesions were significantly higher in the natural varicella group, regardless of exposure status (P = .021 to < .001). The group with breakthrough varicella had a significantly lower incidence of fever (P < .001) and a significantly shorter duration of illness (P < .001). Other associated constitutional complaints and complications were not significantly different between groups.
Varicella in vaccine recipients is clinically modified and significantly less severe than natural disease.
通过医务人员的每日观察，前瞻性地描述既往接种过减毒活水痘疫苗的儿童发生的水痘（突破性水痘），并将其与以相同方式随访的自然水痘进行比较。
一项盲法临床调查。
四家儿科诊所（两家私立；两家医院附属）。
研究患有水痘的12个月至17岁健康儿童；92例为自然水痘，58例为突破性水痘。选择程序和干预措施：研究人员在不知道疫苗接种状况的情况下，从入组直至皮疹总数增加不到10%后的次日，每天在诊所或患者家中记录每位患者的临床特征。同一名研究人员每天填写一份标准表格，记录皮疹数量和描述、体温、病程以及相关临床症状。对突破性病例采集急性期和恢复期血清。
采用基于糖蛋白的酶联免疫吸附测定法检测水痘-带状疱疹病毒抗体。在有血清样本的患者中，85%通过血清学得到确诊。87%的入组者已知接触过水痘，每组中至少三分之二的人有超过4小时的接触或家庭接触。无论接触状况如何，自然水痘组的总皮疹数和水疱性皮疹数均显著更高（P = 0.021至<0.001）。突破性水痘组的发热发生率显著更低（P < 0.001），病程显著更短（P < 0.001）。其他相关的全身症状和并发症在两组之间无显著差异。
疫苗接种者发生的水痘在临床上有所改变，且严重程度明显低于自然发病。
