Risk Of Varicella-zoster Virus Infection Research Articles

Anti-CD20 antibody therapy and risk of infection in patients with demyelinating diseases

BackgroundAnti-CD20 antibody therapy may be associated with an increased risk of infections. We therefore investigated risk factors for infection in patients with demyelinating diseases treated with anti-CD20 antibody therapy. MethodsIn this retrospective uncontrolled study, patients ever treated with anti-CD20 antibodies at an academic clinic were identified through the Danish Multiple Sclerosis Registry (DMSR). Data were collected from medical charts and the DMSR. We assessed occurrence of severe infections (requiring hospitalization), varicella zoster virus (VZV), major comorbidities and routine laboratory values for lymphocytes, IgG and IgM. ResultsA total of 447 patients ever treated with anti-CD20 antibody therapy were identified; of these 416 with 649 patient years of follow-up were still under therapy. In this group, seven patients had VZV infections, and 16 patients had been hospitalized with infections during up to three years of follow-up on anti-CD20 therapy. Comorbidity was recorded in 80 patients. The risk of severe infection was associated with comorbidities, higher age, longer duration of treatment, and higher Expanded Disability Status Scale (EDSS) scores. In multivariable analyses treatment duration, EDSS scores and presence of comorbidity were independently associated with risk of severe infections. Serum concentrations of IgG and IgM decreased with increasing duration of therapy but were not associated with risk of severe infections. Patients with VZV infection had lower lymphocyte counts and lower serum concentrations of IgM. In multivariable analyses only lymphocyte counts were independently associated with risk of VZV infection. ConclusionsIn this retrospective study of patients treated with anti-CD20 antibodies, the risk of infections requiring hospitalization was independently associated with comorbidities, duration of treatment, and higher EDSS scores. Risk of VZV infection was independently associated with lymphopenia. Future studies investigating strategies for mitigating risk of infection in patients treated with anti-CD20 antibodies are warranted, especially for older patients, patients with higher levels of disability and for patients with a longer duration of treatment.

Increased risk of varicella-zoster virus infection in patients with breast cancer after adjuvant radiotherapy: A population-based cohort study.

Background/PurposeLimited evidence has been obtained on varicella-zoster virus (VZV) infection in patients with breast cancer as a complication related to adjuvant radiotherapy. We conducted a cohort study aimed to assess the risk of VZV infection in this patient setting.Materials and methodsWe used the National Health Insurance Research Database to identify 65,981 patients with breast cancer in Taiwan who underwent breast surgery between 2000 and 2011. After a 1:1 propensity score match was obtained between patients with and without radiotherapy, a competing risk regression model was constructed to estimate the hazard ratios and the incidence rate difference (IRD) of VZV infection in the patients with breast cancer receiving radiotherapy and those not receiving radiotherapy.ResultsAfter adjusting for covariates, the radiotherapy cohort showed a 1.51-fold higher risk (95% confidence interval = 1.06–5.16, p = 0.02, IRD = 4.98/10000 person-years) of subsequent VZV infection than the nonradiotherapy cohort. Furthermore, VZV infection risk was 3.85-fold higher among patients aged >65 years who received radiotherapy than among those of the same age who did not receive radiotherapy (95% confidence interval = 1.1–13.4, p < 0.05, IRD = 11.09/10000 person-years). The risk increased with adjusted hazard ratio of 6.6 (95% confidence interval I = 1.51–28.8, p < 0.05, IRD = 32.01/10,000 person-years) and 7.08 (95% confidence interval = 1.64–30.5, p < 0.01, IRD = 35.72/10,000 person-years) in follow-up period less than 3 months and 3–5 months respectively.ConclusionRadiotherapy was associated with an increased risk of VZV infection among patients with breast cancer. The risk was significantly higher in older patient (>65 years old) and/or those who received chemotherapy. Regular clinical follow-up and additional serological testing in the first 5 months after radiotherapy are recommended.

Increased Risk of Varicella-Zoster Virus Infection in Breast Cancer Patients Treated with Adjuvant Radiation Therapy - A Population Based Cohort Study

We conducted a cohort study aimed to assess the risk of varicella-zoster virus (VZV) infection in breast cancer patients treated with adjuvant radiotherapy (RT). We identified 65980 breast patients who received breast surgery from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2011. After 1:1 propensity score match, competing-risk regression model was performed to estimate the hazard ratios (HRs) of VZV infection with breast cancer receiving RT cohort to the non-RT cohort. After adjusting for covariates, the RT cohort had a 1.53-fold increased risk (95% CI=1.07-2.18, p value=0.02) of subsequent VZV infection in comparison to the non-RT cohort. There was 3.85-fold of VZV infection risk among RT patients who are over 65 years old (95% CI=1.1-13.4, p value<0.05). If we focused the occurrence of zoster within 6 months post-RT, there was a high risk of zoster in RT cohort (adjusted SHR=6.8, 95% CI=2.39-19.3, p value<0.001). Our finding demonstrated that RT is associated with an increased risk of VZV infection in breast cancer patient, especially in older women, within first 6 months post-RT.

Gastro-intestinal Involvement of Primary Varicella Zoster Virus Infection in a Renal Transplant Recipient

Biopsy proven gastro-intestinal involvement of Varicella Zoster Virus (VZV) infection is rare and has not previously been reported in renal transplant recipients. This case report concerns a 65 year old, VZV seronegative, renal transplant recipient who presented with a non-vesicular rash and abdominal pain. Endoscopy revealed gastro-duodenal ulceration and in gastric biopsies VZV-DNA was detected by polymerase chain reaction assay. We conclude that abdominal pain in the absence of vesicular skin lesions may be the presenting symptom of visceral VZV infection, a potentially life threatening disease. To diminish the risk of VZV infection, patients on the waiting list for transplantation who are VZV seronegative or have non-protective VZV-IgG antibody titers, it is advised to vaccinate for VZV prior to transplantation.

Varicella zoster virus infection in inflammatory bowel disease

The risk of viral infection is increased in immunosuppressed inflammatory bowel disease (IBD) patients. Varicella zoster virus (VZV) is of particular interest in IBD because of a number of reports of severe, disseminated, and occasionally fatal varicella infection in immunosuppressed IBD patients. We reviewed publications describing VZV infection in IBD patients and combined these data with a review of the current literature relating to both primary and secondary varicella in IBD. Twenty cases of primary varicella infection and 32 cases of herpes zoster infection have been reported in IBD. Additional cases are reported in clinical trials. The risk of VZV infection is increased with all immunosuppressants used in IBD, but corticosteroids and combination immunosuppression appear to be a particular risk. Healthcare providers need to be aware of the various manifestations of primary and secondary VZV infection in immunosuppressed IBD patients. Patients should be screened for VZV immunity and vaccinated prior to commencing immunosuppression.

Dynamics in children and adolescents who experience varicella zoster virus infections after haematopoietic stem cell transplantation: a case-control study

We evaluated the incidence of varicella-zoster virus (VZV) infections, including herpes zoster (HZ), and investigated the associated risk factors for HZ and compared lymphocyte subsets of these patients at 1, 3 and 6 months following haematopoietic stem cell transplantation (HSCT) in a case-control study in children and adolescents. The incidence of HZ infection at the first year after HSCT was 17/125 (13·6%). The cumulative incidence of HZ infection was 22/125 (17·6%). Sixteen (73%) cases with HZ and 11 (32%) cases in the control group had a diagnosis of malignant disorder. No significant difference was noted between the HZ group and the control group in absolute lymphocyte number and subsets (except WBC) at the pre-transplant evaluation. Pre-transplant WBC count was statistically lower in the HZ group (P<0·05). The CD4/CD8 ratios were lower in the HZ group during the first 6 months after HSCT, and the decrease was statistically significant at 6 months compared to the control group. In conclusion, patients undergoing HSCT for a malignant disorder had a significantly higher risk of VZV infection than those with non-malignant disorders and pretransplant donor characteristics were not helpful in predicting risk of post-transplant VZV infection.

Varicella Susceptibility in a Canadian Population

To determine susceptibility to varicella zoster virus (VZV) infection among children, pregnant women and health care workers in Newfoundland. Cohort and cross-sectional, province-wide, population-based seroprevalence study. A cohort of 586 children aged one year, a cross-sectional group of 1135 school children aged five to 15 years, 3643 pregnant women aged 15 to 45 years, and 5386 persons in health care settings aged 15 to 55 years. Susceptibility to varicella was determined by enzyme immunoassay based on serum antibody to VZV. Among the cohort of 586 children, 565 (96.4%) did not have detectable VZV antibody at one year of age. The proportion with VZV antibody increased thereafter to 12.8% and 33.9%, respectively, at age two and four years, indicating the extent of exposure to VZV at these ages. Among the 1135 school-age children, the proportion testing positive for VZV antibody increased from 44% at five years of age to 88.9% at 15 years of age, indicating the cumulative incidence of varicella in this age group. Among pregnant women, 92.1% tested positive for VZV antibody, and the corresponding figure for the health care group was 93.1%. In both groups, the proportion testing positive for VZV antibody increased with advancing age, from 89.6% for the 15- to 19-year age group to 96.5% for those over the age of 40 years. The risk of VZV infection increases steadily from one year of age, reaching a peak during school years. The study data support the recent Canadian recommendation to vaccinate any person older than 12 months of age who is susceptible to VZV. Among the adult population, the proportion susceptible will be under 10% for the foreseeable future, and for those at risk, selective vaccination based on their immune status would be a cost effective approach.