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Live attenuated varicella vaccine use in immunocompromised children and adults
Insights
Live attenuated varicella vaccine is safe and effective for children with leukemia in remission and healthy adults. It significantly reduces chickenpox risk and severity, with mild side effects like rash in some cases.
Area of Science:
- Immunology
- Pediatrics
- Vaccinology
Background:
- Varicella-zoster virus (VZV) poses a significant risk to immunocompromised individuals, including children with leukemia.
- Live attenuated varicella vaccine is a critical tool for preventing VZV infections.
Purpose of the Study:
- To evaluate the safety and immunogenicity of live attenuated varicella vaccine in children with leukemia in remission and healthy adults.
- To assess the vaccine's efficacy in preventing and modifying varicella infections in high-risk populations.
Main Methods:
- Administered live attenuated varicella vaccine to 307 children with leukemia in remission and 86 healthy adults.
- Monitored for adverse events, including vaccine-associated rash and herpes zoster.
- Assessed vaccine efficacy by tracking chickenpox (varicella) incidence and severity after exposure.
Main Results:
- The vaccine was well-tolerated and immunogenic in both groups.
- The primary side effect in leukemic children was a vaccine-associated rash, with potential for limited infectiousness.
- No increase in herpes zoster or leukemia relapse was observed.
- Vaccination provided excellent protection against severe varicella, reducing the attack rate by approximately 80% in leukemic children.
- Breakthrough varicella cases were mild, indicating disease modification.
Conclusions:
- Live attenuated varicella vaccine is safe and effective for children with leukemia in remission and healthy adults.
- The vaccine significantly protects against severe varicella and may prevent or modify infections in high-risk individuals.
- Potential use for preventing nosocomial varicella is suggested.
Abstract:
Live attenuated varicella vaccine has been administered to 307 children with leukemia in remission and to 86 healthy adults. The vaccine was well tolerated and immunogenic. The major side effect in leukemic children receiving maintenance chemotherapy was development of a vaccine-associated rash. Vaccinees in whom a rash developed were potentially somewhat infectious to others about 1 month after immunization. Vaccination was not associated with an increase in the incidence of herpes zoster or in relapse of leukemia. Vaccination provided excellent protection against severe varicella. It was associated with a significant decrease in the attack rate of chickenpox following an intimate exposure to varicella-zoster virus, conferring about 80% protection in leukemic children. The cases of breakthrough varicella that occurred were mild. Thus, the vaccine may either prevent or modify varicella in high-risk individuals. It may also have use for prevention of nosocomial varicella.