Abstract
This narrative review focuses on the herpes zoster (HZ) and its prevention in transplant patients. Varicella zoster virus (VZV) is highly contagious and distributed worldwide in humans. Primary VZV infection usually causes varicella and then establishes a lifelong latency in dorsal root ganglia. Reactivation of VZV leads to HZ and related complications such as postherpetic neuralgia. Age and decreased immunity against VZV are important risk factors for developing HZ. Transplant patients are at increased risk for developing HZ and related complications due to their immunocompromised status and the need for lifetime immunosuppression. Diagnosis of HZ in transplant patients is often clinically difficult, and VZV-specific antibodies should be determined by serologic testing to document prior exposure to VZV during their pre-transplant evaluation process. Although antiviral agents are available, vaccination should be recommended for preventing HZ in transplant patients considering their complicated condition and weak organ function. Currently, there are two licensed HZ vaccines, of which one is a live-attenuated vaccine and the other is a HZ subunit vaccine. Both vaccines have shown promising safety and efficacy in transplants patients and especially the subunit vaccine could be administered post-transplant since this vaccine does not contain any live virus. Larger studies are needed about safety and immunogenicity of HZ vaccines in transplant populations, and extra efforts are needed to increase vaccine usage according to guidelines.
Highlights
Varicella zoster virus (VZV) belongs to the Alphaherpesvirinae subfamily and is a member of the Varicellovirus genus
Several studies suggested that humoral immu nity appears later and plays a less prominent role in bridling primary VZV infections compared with cellular immunity
Postherpetic neuralgia tends to be underdiagnosed and inadequately managed, so treatments of postherpetic neuralgia (PHN) are palliative and shortening of duration and severity of pain is the main goal of PHN management [55, 56]
Summary
Varicella zoster virus (VZV) belongs to the Alphaherpesvirinae subfamily and is a member of the Varicellovirus genus. Several studies suggested that humoral immu nity appears later and plays a less prominent role in bridling primary VZV infections compared with cellular immunity. This is supported by the fact that children with B cell deficiencies often recover uncomplicated from primary varicella infections, while children with T cell deficiencies are at high risk of progressive varicella [7]. With regard to prevention of VZV reactivation, cell-mediated immunity (CMI) is believed to be more important than antibodies, the mechanisms of protection are not fully understood.
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