Reactivation Of Varicella Zoster Virus Research Articles

Incident Herpes Zoster and Risk of Dementia: A Population-Based Danish Cohort Study.

Herpes zoster (HZ) is caused by reactivation of the neurotrophic varicella-zoster virus (VZV). Zoster may contribute to development of dementia through neuroinflammation, cerebral vasculopathy, or direct neural damage, but epidemiologic evidence is limited. We used data from linked nationwide Danish registries to conduct a cohort study of the association between zoster and dementia during 1997-2017. As secondary aims, we examined whether associations were more pronounced for zoster involving cranial nerves (mainly ophthalmic zoster) or the CNS and Alzheimer disease as an outcome. We included people aged ≥40 years with zoster and a general population comparison cohort matched 5:1 by sex and birth year. We identified zoster and dementia in the registries using prescription records in the community and hospital diagnoses. We used Cox regression to compute confounder-adjusted hazard ratios (HRs) with 95% CIs for dementia associated with zoster during 0-1 year and 1-21 years of follow-up. We compared the cumulative incidence of dementia, inverse probability weighted for confounders. The study included 247,305 people with zoster and 1,235,890 matched general population comparators (median age 64 years; 61% female). The HR of all-cause dementia was 0.98 (95% CI 0.92-1.04) during the first year and 0.93 (95% CI 0.90-0.95) thereafter in people with zoster vs matched comparators. Dementia was diagnosed in 9.7% of patients with zoster and 10.3% of matched comparators by the end of follow-up. We observed no increased long-term risk of dementia in subgroup analyses, except possibly in people with CNS infection (HR 1.94; 95% CI 0.78-4.80). Analyses of Alzheimer disease as a separate outcome showed similar results. HZ is not associated with an increased risk of dementia, and contrary to expectation, we found a small decrease in the risk. The explanation for this finding is unclear, and systematic errors should be considered. Patients with CNS involvement had an almost 2-fold increased relative risk of dementia. The population attributable fraction of dementia due to this rare complication is estimated at 0.014%. Therefore, universal vaccination against VZV in the elderly is unlikely to reduce dementia risk.

Immunogenicity of Varicella Zoster Virus DNA Vaccines Encoding Glycoprotein E and Immediate Early Protein 63 in Mice.

Herpes zoster (HZ) is caused by the reactivation of latent varicella-zoster virus (VZV) from the sensory ganglia due to aging or immunosuppression. Glycoprotein E (gE) is a widely used vaccine antigen for specific humoral and cellular immune responses. Immediate early protein 63 (IE63) is expressed during latency, suggesting that it is a potential antigen against HZ reactivation. In this study, HZ DNA vaccines encoding gE, IE63, IE63-2A-gE (where 2A is a self-cleaving sequence), or IE63-linker-gE were developed and investigated for immunogenicity in mice. The results showed that each HZ DNA vaccine induced VZV-specific antibody production. The neutralizing antibody titer elicited by IE63-2A-gE was comparable to that elicited by gE or live attenuated HZ vaccine (LAV). IE63-2A-gE-induced gE or IE63-specific INF-γ+ T cell frequencies in splenocytes were comparable to those of LAV. Furthermore, IE63-2A-gE, gE, or IE63 led to a significant increase in IFN-γ (IE63 stimulation) and IL-2 (gE stimulation) secretion compared to LAV, showing a Th1-biased immune response. Moreover, IE63-2A-gE and gE induced cytotoxic activity of CD8+ T cells compared to that of LAV. This study elucidates that the IE63-2A-gE DNA vaccine can induce both humoral and cell-mediated immune responses, which provides a candidate for the development of an HZ vaccine.

Prevalence of and factors associated with herpes zoster in England: a cross-sectional analysis of the Health Survey for England

BackgroundHerpes zoster (commonly called shingles) is caused by the reactivation of varicella zoster virus, and results in substantial morbidity. While the risk of zoster increases significantly with age and immunosuppression, relatively little is known about other risk factors for zoster. Moreover, much evidence to date stems from electronic healthcare or administrative data. Hence, the aim of this study was to explore potential risk factors for herpes zoster using survey data from a nationally-representative sample of the general community-dwelling population in England.MethodsData were extracted from the 2015 Health Survey for England, an annual cross-sectional representative survey of households in England. The lifetime prevalence of self-reported herpes zoster was described by age, gender and other socio-demographic factors, health behaviours (physical activity levels, body mass index, smoking status and alcohol consumption) and clinical conditions, including; diabetes, respiratory, digestive and genito-urinary system and mental health disorders. Logistic regression models were then used to identify possible factors associated with shingles, and results were presented as odds ratios with 95% confidence intervals.ResultsThe lifetime prevalence of shingles among the sample was 11.5% (12.6% among women, 10.3% among men), which increased with age. After adjusting for a range of covariates, increased age, female gender (odds ratio: 1.21; 95%CI: 1.03, 1.43), White ethnic backgrounds (odds ratio: 2.00; 95%CI: 1.40, 2.88), moderate physical activity 7 days per week (odds ratio: 1.29; 95%CI: 1.01, 1.66) and digestive disorders (odds ratio: 1.51; 95%CI: 1.13, 1.51) were each associated with increased odds of having had herpes zoster.ConclusionsAge, gender, ethnicity and digestive disorders may be risk factors for herpes zoster among a nationally representative sample of adults in England. These potential risk factors and possible mechanisms should be further explored using longitudinal studies.

Cellular Immune Response after Vaccination with an Adjuvanted, Recombinant Zoster Vaccine in Allogeneic Hematopoietic Stem Cell Transplant Recipients.

Hematopoietic stem cell transplant (HSCT) recipients have a high risk of developing primary varicella-zoster virus (VZV) infection and reactivation. VZV vaccination may prevent infection and reactivation. In the current study, recipients of allogeneic HSCT (34 females, 45 males) were vaccinated with adjuvanted, recombinant zoster vaccine Shingrix™, which contains the VZV glycoprotein E. Cellular immunity against various VZV antigens was analyzed by interferon-gamma ELISpot. Peripheral blood mononuclear cells (PBMC) of recipients with versus without prior shingles (n = 36 and n = 43, respectively) showed approximately twofold higher VZV-specific responses prior to and post vaccination. After the first and second vaccination, ELISpot responses towards the glycoprotein E were significantly higher in males versus females (median of spots increment 18 versus 1 and 17 versus 4, respectively, p ≤ 0.02 each). Multivariate analysis showed that shingles and sex both impacts significantly on VZV immunity. Whereas vaccination-induced changes could hardly be detected after stimulation with a whole VZV antigen, there was a significant increase in responses towards glycoprotein E after vaccination (p < 0.005). These data indicate that vaccination with Shingrix™ augmented cellular, VZV-specific immunity in HSCT recipients. Shingles and male sex could both be identified as factors leading to increased immunity.

A Case Report on Herpes Zoster Ophthalmicus with Postherpetic Neuralgia

Herpes Zoster Ophthalmicus (HZO), also known as Ophthalmic Zoster, caused by the reactivation of the Varicella Zoster Virus (VZV), VZV reactivation commonly affects the ophthalmic division of the trigeminal nerve and subsequently the eye. HZO is considered an ophthalmologic emergency. The most common complication of HZO is postherpetic neuralgia (PHN). HZO is a diagnosed based on history and cutaneous findings. Antivirals medications such as acyclovir, valacyclovir and famciclovir remain the mainstay of therapy for HZO. HZO represents approximately 10 to 25% of all cases of herpes zoster. Here, we report an interesting case of HZO and it's complication PHN in a 61 years old male patient.

Real-world evidence from over one million COVID-19 vaccinations is consistent with reactivation of the varicella-zoster virus.

BackgroundReactivation of the varicella‐zoster virus (VZV), which causes herpes zoster (HZ, synonym: shingles) in humans, can be a rare adverse reaction to vaccines. Recently, reports of cases after COVID‐19 vaccination have arisen.ObjectivesThe aim of this study was to assess whether the frequency of HZ is found to increase after COVID‐19 vaccination in a large cohort, based on real‐world data. As a hypothesis, the incidence of HZ was assumed to be significantly higher in subjects who received a COVID‐19 vaccine (Cohort I) vs. unvaccinated individuals (Cohort II).MethodsThe initial cohorts of 1 095 086 vaccinated and 16 966 018 unvaccinated patients were retrieved from the TriNetX database and were matched on age and gender in order to mitigate confounder bias.ResultsAfter matching, each cohort accounted for 1 095 086 patients. For the vaccinated group (Cohort I), 2204 subjects developed HZ within 60 days of COVID‐19 vaccination, while among Cohort II, 1223 patients were diagnosed with HZ within 60 days after having visited the clinic for any other reason (i.e. not vaccination). The risk of developing shingles was calculated as 0.20% and 0.11% for cohort I and cohort II, respectively. The difference was statistically highly significant (P < 0.0001; log‐rank test). The risk ratio and odds ratio were 1.802 (95% confidence interval [CI] = 1.680; 1.932) and 1.804 (95% CI = 1.682; 1.934).ConclusionsConsistent with the hypothesis, a higher incidence of HZ was statistically detectable post‐COVID‐19 vaccine. Accordingly, the eruption of HZ may be a rare adverse drug reaction to COVID‐19 vaccines. Even though the molecular basis of VZV reactivation remains murky, temporary compromising of VZV‐specific T‐cell‐mediated immunity may play a mechanistic role in post‐vaccination pathogenesis of HZ. Note that VZV reactivation is a well‐established phenomenon both with infections and with other vaccines (i.e. this adverse event is not COVID‐19‐specific).

Characteristics of herpes zoster infection in patients with COVID-19: a systematic scoping review.

BackgroundAlthough there is literature reporting correlations between varicella zoster virus (VZV) infections and COVID‐19, insufficient evidence exists in this regard. This scoping review aims to identify the existing evidence regarding clinical characteristics of primary VZV infection or reactivation in COVID‐19.MethodsFollowing the PRISMA Extension for Scoping Reviews, MEDLINE and EMBASE were searched for all peer‐reviewed articles with relevant keywords including “Zoster,” “Herpes,” and “COVID‐19” from their inception to November 20, 2021.ResultsA total of 19 articles with three observational studies and 16 case reports or series were included. Primary VZV infections or reactivation were observed in 25 patients. Forty‐eight percent of the patients had disseminated VZV infection. The median time of VZV‐related rash after the onset of respiratory symptoms was 7.0 days (interquartile range: 0–18.8). Those with COVID‐19 and primary VZV infection or reactivation had low lymphocyte counts with a median of 0.67 × 103/μl.ConclusionThis scoping review identified uncertainty and a lack of strong evidence to see the association between primary VZV infection or reactivation and COVID‐19. However, those with COVID‐19 may be more likely to have disseminated VZV, which poses an additional challenge from an infection prevention standpoint. Future studies are warranted to determine the association between primary VZV infection or reactivation and long‐term consequences related to COVID‐19.

Herpes zoster in the era of COVID 19: A prospective observational study to probe the association of herpes zoster with COVID 19 infection and vaccination.

Herpes zoster (HZ) is caused by reactivation of the latent varicella zoster virus (VZV) following decline in cell‐mediated immunity. All over the world, in the past couple of years, the Corona Virus 2019 (COVID‐19) has emerged as a viral cause of severe acute respiratory syndrome corona virus 2 (SARS‐CoV‐2) infection. Based on the current limited evidence, co‐infection of COVID‐19 with VZV or reactivation of VZV after COVID‐19 vaccination has been sporadically reported. All patients diagnosed with HZ, in Farwaniya Hospital in Kuwait, from March 2020 to July 2021, having either (A) a positive COVID‐19 polymerase chain reaction (PCR) test, or (B) been vaccinated against SARS‐CoV‐2 were enrolled in the study. All patients' demographic information, medical history, laboratory findings, and vaccination status was documented. All statistical analyses were performed using SPSS Statistics version 21.0 software. Twelve cases infected with COVID‐19 with a positive PCR (group 1) and five cases vaccinated against SARS‐CoV‐2 (group 2) were documented. Out of the 12 COVID‐19 infected patients (group 1), only two patients (16.67%) required hospitalization, while the remaining 10 patients had mild/moderate lymphopenia. Furthermore, amongst the 12 positive COVID‐19 cases, four patients with HZ were diagnosed within the first week of COVID‐19, while the remaining eight cases were diagnosed within 8 weeks of COVID‐19. Thoracic segments were affected in five cases (41.67%), cervical in one case (8.33%), cranial in two cases (16.67%), lumbar in three cases (25%) and sacral in one case (8.33%). In group 2, three patients presented with HZ within 4 weeks of having received the first dose of the vaccine and two patients after the second dose. Blood investigations for all five vaccinated patients did not show any abnormalities. Cervical segments were affected in two patients (40%), and cranial, thoracic, and lumbar segment in the remaining patients respectively (20%). Experts must be aware of the probable increased risk of HZ during the COVID 19 pandemic. We propose appropriate curative and preventive measures against HZ infection, including a systematic follow‐up of these patients to ensure that they stick to extreme safety measures till the diagnosis of COVID‐19 is omitted.

Antioxidant and inflammatory biomarkers in herpes zoster.

The risk of herpes zoster (HZ) increases as cell-mediated immunity declines with age. Even though oxidative stress plays a crucial role in the development of HZ, there are few serum biomarkers of the disease's antioxidant activity. The purpose of this study is to investigate the blood levels of major antioxidants in HZ patients. To the best of our knowledge, this is the first study on this issue in the literature. The serum levels of antioxidants including uric acid (UA), total bilirubin (TBİL), albumin (ALB), vitamin D levels, and inflammatory markers such as homocysteine (Hcy) and C-reactive protein (CRP) was retrospectively analyzed in 53 patients with HZ and 53 age-and sex-matched healthy controls (HCs). The relationships between these markers and postherpetic neuralgia (PHN) and the clinical severity of HZ were also evaluated. Serum levels of UA, TBIL, and ALB in patients with HZ were significantly lower than those in the HCs (p < 0.001), while no statistical differences were found in vitamin D levels between the groups. Hcy and CRP levels were significantly increased in HZ patients compared to HCs. Significant differences were observed in the serum levels of UA, Hcy, CRP, and vitamin D in the PHN group versus the non-PHN group (p < 0.001). The presence of inflammatory markers was found to be positively related to disease activity. Furthermore, when compared to the mild or moderate clinical types of HZ, these biomarkers were statistically significant in the severe clinical type. These results suggest that uncontrolled varicella-zoster virus reactivation, acute nerve damage, and PHN may all be associated with low antioxidant levels. These biomarkers may be a protective factor for HZ, but more research is needed to clarify the underlying mechanism.

An adjuvanted zoster vaccine elicits potent cellular immune responses in mice without QS21

Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) when VZV-specific cellular immunity is insufficient to control reactivation. Currently, Shingrix, which contains the VZV gE protein and GSK’s AS01B adjuvant composed of liposomes formulated with cholesterol, monophosphoryl lipid A (MPL) and QS21, is used for prevention of HZ. However, reactogenicity to Shingrix is common leading to poor patient compliance in receiving one or both shots. Here, we evaluated the immunogenicity of a newly formulated gE protein-based HZ vaccine containing Second-generation Lipid Adjuvant (SLA), a synthetic TLR4 ligand, formulated in an oil-in-water emulsion (SLA-SE) without QS21 (gE/SLA-SE). In VZV-primed mouse models, gE/SLA-SE-induced gE-specific humoral and cellular immune responses at comparable levels to those elicited by Shingrix in young mice, as both gE/SLA-SE and Shingrix induce polyfunctional CD4+ T-cell responses. In aged mice, gE/SLA-SE elicited more robust gE-specific T-cell responses than Shingrix. Furthermore, gE/SLA-SE-induced T-cell responses were sustained until 5 months after immunization. Thus, QS21-free, gE/SLA-SE is a promising candidate for development of gE-based HZ vaccines with high immunogenicity—particularly when targeting an older population.

Clinical and neuroradiologic characteristics in varicella zoster virus reactivation with central nervous system involvement

ObjectiveTo investigate the clinical and magnetic resonance imaging (MRI) characteristics of patients with varicella zoster virus (VZV) reactivation involving the cranial nerves and central nervous system (CNS). MethodsThis is a retrospective, multi-center case-series of 37 patients with VZV infection affecting the cranial nerves and CNS. ResultsThe median age was 71 years [IQR 51.5-76]; 21 (57%) were men. Cerebrospinal fluid (CSF) was available in 24/37 (65%); median CSF white blood cell count was 11 [IQR 2-23] cells/μL and protein was 45.5 [IQR 34.5-75.5] mg/dL. VZV polymerase chain reaction (PCR) assays were positive in 6/21 (29%) CSF and 8/9 (89%) ocular samples. Clinical involvement included the optic nerve in 12 (32%), other cranial nerves in 20 (54%), brain parenchyma in 12 (32%) and spinal cord or nerve roots in 4 (11%).Twenty-seven/28 immunocompetent patients' MRIs were available for review (96%). Of the 27, 18 had T1 postcontrast fat saturated sequences without motion artifact to evaluate for cranial nerve enhancement and optic perineuritis (OPN). Eight/18 (44%) demonstrated OPN. All 8 experienced vision loss: 3 optic neuritis, 1 acute retinal necrosis, and 3 CNS vasculitis with 1 central and 1 branch retinal artery occlusion and 1 uveitis. Diplopic patients had cranial nerve and cavernous sinus enhancement.All immunosuppressed patients were imaged. Seven/9 (88%) had extensive neuraxis involvement, including encephalitis, vasculitis and transverse myelitis; one case had OPN. ConclusionOPN is a frequent manifestation in VZV-associated vision loss among immunocompetent patients. Immunosuppressed patients had greater neuraxis involvement. Optimizing MRI protocols may improve early diagnosis in VZV reactivation.

The untapped potential of herpes zoster vaccination

Herpes zoster infection corresponds to the reactivation of latent varicella-zoster virus, and is characterised by a vesicular dermatomal rash, which usually spontaneously resolves, but can result in persistent (>3 months) debilitating pain, known as postherpetic neuralgia. Two vaccines are available against herpes zoster, namely zoster vaccine live (ZVL) and a newer, recombinant zoster vaccine (RZV), available since 2017.

An evidenced based individualistic homoeopathic approach in a case of herpes zoster in geriatric patient: A case report

Herpes-zoster or shingles is an acute, painful, self limiting, cutaneous viral infection that happens due to reactivation of varicella-zoster virus. This is a case report of a geriatric patient, aged 89 years, complaining with sudden vesicular eruption on his forehead with burning pain and oozing yellowish discharge, which transformed into multiple painful blisters overnight. He was treated with individualistic homoeopathic medicine Natrum muriaticum 30C and Natrum muriaticum 200C, administered on the basis of totality of symptoms. Complete healing of skin eruption as well the overall well-being of the patient demonstrating positive role of individualistic homoeopathic treatment in case of herpes-zoster.

Herpes Zoster after Inactivated COVID-19 Vaccination

Previous evidence has linked the relationship between newly onset skin disorder and SARS-CoV-2 infection. Cutaneous manifestations have been reported after exposure to COVID-19 vaccines that are linked to body immune responses. There is limited information about skin disorder that occurs after the COVID-19 vaccination. We report a case of varicella-zoster virus reactivation following inactivated COVID-19 vaccination in a young female patient.

Enhanced Potency and Persistence of Immunity to Varicella-Zoster Virus Glycoprotein E in Mice by Addition of a Novel BC02 Compound Adjuvant

Herpes zoster (HZ) is one of two distinct syndromes caused by Varicella-zoster virus (VZV). A primary infection with VZV causes varicella in susceptible young children. After resolution of the primary infection, VZV establishes a lifelong latency within the cranial or dorsal root ganglia. With increasing age, family history of shingles, immunosuppression or other risk factors, there is a decline in the virus-specific T-cell-mediated immune (CMI) response which allows reactivation of latent VZV in the root ganglia resulting in HZ. There are currently two vaccines that have been approved to prevent HZ and postherpetic neuralgia (PHN) but one is a live attenuated vaccine, the protective effect of which is considered to decrease significantly with the age of the recipient. However, a recombinant subunit vaccine may provide targeted VZV-specific cellular and humoral immunity, giving it a more potent and longer-lasting protective effect against HZ. The current study reports the development of a novel adjuvant, BC02 (BCG CpG DNA compound adjuvants system 02), composed of Al(OH)3 inorganic salt adjuvant and BC01 (BCG CpG DNA compound adjuvants system 01), a Toll-like receptor 9 (TLR9) agonist. Immunogenicity and compatibility with recombinant VZV glycoprotein E (gE) in mice were studied. The BC02-adjuvanted gE experimental vaccine was highly effective in eliciting both humoral and cellular immune responses to the recombinant gE glycoprotein and VZV-Oka in a mouse model. The efficient production and long-term persistence of gE and VZV-Oka-specific IFN-γ, IL-2-specific T cells and memory B cells in the early (1W), middle (7W), middle-late (15W), and final (27W) immune stages were established. Results of fluorescent antibody to membrane antigen (FAMA) and serum antibody plaque reduction tests also showed that the BC02 adjuvanted-gE experimental vaccine induced mice to secrete neutralizing antibodies against clinically isolated VZV strains. In combination, the current data suggest that the BC02 compound adjuvant offers a strategy to induce an appropriately strong cellular and humoral immunity against the VZV gE protein subunit to improve vaccine efficacy.

Retrospective evaluation of clinical features in hospitalized herpes zoster patients

Aim: Herpes zoster is a dermatomal vesicular eruption caused by the reactivation of varicella-zoster virus (VZV) that remains latent in the dorsal root ganglia. Due to the impairment of cellular immune capacity with aging, it is commonly seen in advanced age. Approximately 3-10% of the cases need to be hospitalized. We aimed to determine the frequency of dissemination and the demographic and clinical characteristics in hospitalized herpes zoster patients in a dermatology clinic of a tertiary hospital. Materials and Methods: The records of 19 herpes zoster patients hospitalized in our clinic between June 2019 and November 2020 were retrospectively reviewed. Patients' age, gender, dermatome involved, presence of dissemination, concomitant diseases, and development of post-herpetic neuralgia were noted. Results: Disseminated herpes zoster was seen in 36.8% (no:7) of the patients. Of patients 63.2% (no:12) had ophthalmic herpes zoster. The relationship between dissemination and age, gender, presence of immunosuppression and development of post-herpetic neuralgia was not statistically significant. While no death was observed in the non-disseminated group, one patient died in the disseminated herpes zoster group. Conclusion: In this study, the mean age of the patients, the accompanying immunosuppressive state, and the rate of post-herpetic neuralgia were found to be higher in the disseminated herpes zoster group than the non-disseminated group. But it was not significant. Studies on disseminated herpes zoster which have a higher mortality are limited due to the low frequency of the disease. Studies involving larger numbers of patients are needed in order to report the clinical features and mortality rates more clearly in these patients.

Disseminated Herpes Zoster Presenting as Ogilvie Syndrome with Associated Pneumonia and Hepatitis in a Newly Diagnosed HIV Positive Male

Varicella zoster virus (VZV) causes primary infection with varicella (chickenpox) a self-limiting diffuse vesicular rash and establishes latency in dorsal root ganglia. Reactivation of VZV results in a dermatomal vesicular rash known as herpes zoster. In the immunocompromised population, herpes zoster can develop into disseminated disease involving the sensory, peripheral and enteric nervous systems and be associated with extracutaneous manifestations. In this case report, we describe a HIV infected male presenting with Ogilvie syndrome in presence of disseminated herpes zoster with associated pneumonia and hepatitis.

Evaluation of Demographic and Clinical Data of Herpes Zoster Patients Admitted To Tertiary Referral Dermatology Clinic During COVID-19 Pandemic

Background: Herpes zoster infection (shingles) occurs due to reactivation of the varicella zoster virus (VZV) usually contracted during childhood. Dermatomal involvement is characterized by vesicular rash. Symptoms such as pain and itching are usually present. Complications may be life-threatening and/or result with sequelae. Psychogenic factors and/or other underlying systemic diseases may provoke reactivation of VZV. Coronavirus disease (COVID-19) infection is one such factor.&#x0D; Objectives: The aim of this study is to evaluate the demographic and clinical data collected from patients admitted to our tertiary referral medical center and diagnosed with herpes zoster during the COVID-19 pandemic.&#x0D; Methods: Six hundred and sixty-one patients admitted to our hospital and diagnosed with herpes zoster between October 2020 and October 2021 were included in the cross-sectional retrospective study.&#x0D; Results: The age range was between 1 and 90, and the mean age was 50.4±19.9 years. Fifty percent were female and 50% were male. Complications were found in 62% of the patients, and 54% had postherpetic neuralgia. A history of an additional comorbidity was found in 79% of the patients. It was observed that 10% of the patients were hospitalized, and their mean age was 66.26±14.4 years. Three percent of the patients had an association with COVID-19 vaccine/infection.&#x0D; Conclusion: Our study is unique because it includes both pediatric and adult patients. Also significant for providing one-year demographic data for shingles during the COVID-19 era.

Efficacy of Intermittent, Oral Famciclovir Prophylaxis for Bortezomib-Induced Herpes Zoster in Multiple Myeloma Patients.

ObjectiveTo explore the efficacy and safety of intermittent, oral famciclovir prophylaxis for bortezomib-induced herpes zoster in multiple myeloma patients.MethodWe retrospectively analyzed the incidence of bortezomib treatment-related varicella-zoster virus reactivation in 719 newly-diagnosed multiple myeloma patients receiving intermittent oral famciclovir prophylaxis, continuous oral acyclovir prophylaxis or no prophylaxis. The definition of intermittent oral famciclovir prophylaxis was oral famciclovir at a dose of 250mg twice daily for 9 days after finishing the last dose of bortezomib therapy every cycle. Age, gender, stage per the International Staging System, type of M protein, baseline of absolute lymphocyte count, absolute neutrophil count, and absolute monocyte count were analyzed to find the potential factors that could predispose to herpes zoster infections.ResultsVaricella-zoster virus infection occurred in 96 patients (13.4%) during bortezomib treatment. The incidence of herpes zoster was significantly higher in the non-prophylaxis group compared with the prophylaxis group (22.9% vs 8.2% P<0.001), while the rate was similar between the intermittent oral famciclovir group and the continuous oral acyclovir group (8.4% vs 7.9% P=0.835). Hepatic and renal toxicity were observed in 12% and 2.8% of the patient respectively in the intermittent famciclovir group, which was similar in the continuous acyclovir group (18.1% and 4.2%). The prophylactic use of antiviral agents is a predictive factor for varicella-zoster virus reactivation.ConclusionIntermittent famciclovir prophylaxis is effective and safe in preventing herpes zoster development and can markedly reduce the duration of oral medicine treatment compared with continuous acyclovir prophylaxis.

Cross-Sectional Retrospective Study to Identify Clinical and Radiographic Features Associated With VZV Reactivation in Cryptogenic Stroke Patients With CSF Testing.

A large proportion of ischemic stroke patients lack a definitive stroke etiology despite extensive diagnostic testing. Varicella-Zoster Virus (VZV) can directly invade blood vessels causing vasculitis and may be associated with cryptogenic stroke (CS). We conducted a retrospective cross-sectional study of CS patients tested for VZV. The following were considered evidence of VZV reactivation (VZV+): positive CSF VZV PCR, anti-VZV IgM in CSF, or anti-VZV IgG CSF/serum ratio of 1:10 or higher. We describe the cohort, report VZV+ proportion with 95% confidence intervals (CI) determined with the Wald method, and compare patient groups using standard statistical tests. A total of 72 CS patients met full study inclusion criteria. Most of the patients were <65years old, had few traditional vascular risk factors, and had multifocal infarcts. Mean age was 49years (SD ±13) and 47% were women. A total of 14 patients (19.4%; CI: 11.4-30.8%) had evidence of CNS VZV reactivation. There was no difference in evaluated demographic or radiographic features between those with versus without evidence of VZV reactivation. History of ischemic stroke in the past year (11/14 vs 25/43, P<.05) and hypertension (13/14 vs 35/58 and P<.05) were associated with VZV+. We found a high proportion of CNS VZV reactivation in a cross-sectional cohort of CS patients selected for CSF testing. Testing for VZV might be reasonable in CS patients who are young, have multifocal infarcts, or had an ischemic stroke within the past year, but additional research is needed.