Varicella Antibodies Research Articles

Optimizing Varicella Vaccination Strategy: A Study on Age and Dose Impacts on Antibody Levels.

Seropositivity study of Varicella in Healthy Populations in Guangzhou, China. Infection with varicella-zoster virus (VZV) leads to skin and mucous membranes blisters and the complications can be life threatening. A seroepidemiological study conducted from 2020 to 2022 in Guangzhou, China, aimed to evaluate varicella antibody levels. We measured varicella antibody concentrations using an enzyme-linked immunosorbent assay. A total of 3300 people were enrolled in the study. The mean varicella antibody level was 171.2 mIU/mL (95% CI: 158.9, 184.4), with an overall positivity rate of 67.00% (95% CI: 65.37, 68.60). The mean level of those positive subjective was 581.2 mIU/mL (95% CI: 552.3, 611.5). Varicella antibody levels were found to be influenced by age, vaccination dosage, and history of varicella infection. Antibody level increased with age and the number of vaccinations. The antibody induced by the varicella vaccine remained at protective levels for at least 6 years post-vaccination. We recommend two doses of the varicella vaccine for both children and adults and the integration of the varicella vaccine into the national routine immunization program.

EVALUATION OF HEPATITIS A, HEPATITIS B, HEPATITIS C, HIV, MUMPS, MEASLES, RUBELLA, AND VARICELLA IMMUNITY STATUS OF HEALTH SCIENCES STUDENTS

Objective: It is aimed to determine the immunity status of ...University health sciences faculty students against diseases specified in the Turkish Ministry of Health's Health Personnel Screening Protocol for Communicable Diseases. Method: The data of patients who were admitted to …University Family Medicine outpatient clinics between 01.01.2018-31.12.2023, and were tested for at least one of the following tests: HAV antibody (anti-HAV IgG), Hepatitis B surface antigen (HBsAg), antibody against Hepatitis B surface antigen (anti-Hbs), HCV antibody (anti-HCV), HIV antibody (anti-HIV), measles antibody (Measles IgG), mumps antibody (Mumps IgG), rubella antibody (Rubella IgG), varicella antibody (VZV IgG), were retrospectively analyzed. The data of 9051 Health Sciences Faculty students were included in the study. Results: The median age of 9050 students was 22 (min=18, max=30, IQR=2), 6253 (69.10%) were female. While 5 (0.1%) students were HIV-positive, no HCV-positive students were found. The most immunized diseases were Rubella (97%), Varicella (93%), and Hepatitis B (80%); the least immunized disease was Measles (36.9%). AntiHbs and VZV IgG positivity were higher at younger ages (p

Waning of Humoral Immunity to Vaccine-Preventable Diseases in Children Treated for Acute Lymphoblastic Leukemia: A Single-Center Retrospective Cross-Sectional Analysis

The survival rates of children with acute lymphoblastic leukemia (ALL) have improved over the years, but infections remain a significant cause of morbidity and mortality. Chemotherapy has a range of harmful side effects including the loss of protective antibodies against vaccine-preventable diseases. The objective of this study was to evaluate the serological status of pediatric ALL cases before and after intensive chemotherapy. Children treated and followed for ALL at Dokuz Eylül University were included in this retrospective cross-sectional study. Antibody levels against hepatitis A, hepatitis B, and rubella were routinely assessed at both the time of diagnosis and 6 months after completion of chemotherapy. Measles, mumps, and varicella antibody levels were evaluated at only 6 months after treatment. Seventy-eight children who completed chemotherapy for ALL were enrolled in the study. All participants had non-protective antibody levels for at least one of the diseases. The highest seropositivity rate was found for hepatitis A (55.1%) and the lowest for measles (17.9%) after chemotherapy. Overall, 50.7%, 30.6%, and 45.7% of the patients significantly lost their humoral immunity against hepatitis B, hepatitis A, and rubella, respectively. Patients in the higher-risk group for ALL had lower seropositivity rates than patients of the other risk groups. There were statistically significant relationships between the protective antibody rates for hepatitis A and varicella and the ages of the patients. Except for hepatitis A vaccination, pre-chemotherapy vaccination did not affect post-chemotherapy serology. On the other hand, all children with a history of varicella before diagnosis showed immunity after chemotherapy. Patients with ALL, including those previously fully vaccinated, are at great risk of infection due to the decrease in protective antibody levels after chemotherapy. There is a need for routine post-chemotherapy serological testing and re-vaccination based on the results obtained.

Varicella Seroprevalence in Pediatric Populations: Results from a Single-Center Study

Objective: Varicella is a highly contagious illness with potentially severe complications, especially in young children. In Turkey, the varicella vaccine was integrated into the Universal Varicella Vaccination program in 2013, targeting 12-month-old infants. While officially reported varicella cases have decreased considerably in the past two decades, underreporting remains a challenge. This study aimed to investigate varicella seropositivity in a tertiary center. Material and Methods: A qualitative immunoassay, the enzyme-linked immunosorbent assay (ELISA), was employed to detect anti-varicella antibodies. Serum samples were collected from individuals aged 4 to 18 residing in Turkey. Information on vaccination records, varicella history, and disease notification was also collected. Results: The varicella IgG antibody records were accessed for a total of 90 children. The overall prevalence of positive varicella antibodies was 58.0% (n=47) in the study population. Seropositivity rates were 67.2% for the 4-6 age group and 30% for the 7-12 age group. Notably, the 4-6 age group showed a significant association between seropositivity and age [p=0.005; OR=4.85; 95%CI (1.614-14.569)]. Conclusion: The seropositivity rate of 58% for chickenpox is concerning. In light of this, conducting more extensive studies will provide valuable guidance. It may be worth considering the administration of an additional dose of the varicella vaccine within the age range of 4-6 years. Further research is necessary to assess the potential benefits and feasibility of implementing such a vaccination strategy.

Maternal varicella antibodies in children aged less than one year: Assessment of antibody decay.

To investigate maternal antibody levels to varicella in infants <12 months of age in Ontario, Canada. In this study, we included specimens from infants <12 months of age, born at ≥37 weeks gestational age, who had sera collected at The Hospital for Sick Children (Toronto, Canada) between 2014-2016. We tested sera using a glycoprotein-based enzyme-linked immunosorbent assay (gpELISA). We measured varicella susceptibility (antibody concentration <150mIU/mL) and mean varicella antibody concentration, and assessed the probability of susceptibility and concentration between one and 11 months of age using multivariable logistic regression and Poisson regression. We found that 32% of 196 included specimens represented infants susceptible to varicella at one month of age, increasing to nearly 80% at three months of age. At six months of age, all infants were susceptible to varicella and the predicted mean varicella antibody concentration declined to 62 mIU/mL (95% confidence interval 40, 84), well below the threshold of protection. We found that varicella maternal antibody levels wane rapidly in infants, leaving most infants susceptible by four months of age. Our findings have implications for the timing of first dose of varicella-containing vaccine, infection control measures, and infant post-exposure prophylaxis recommendations.

Effect of vaccine program on IgG antibody titers for measles, rubella, varicella, and mumps in young adults in Japan: Survey between 2018 and 2021

IntroductionImproved routine immunizations in Japan have led to a reduction in vaccine-preventable diseases. Due to changes in the vaccination program, current young adults received their second vaccination for measles and rubella at different times depending on their birth year, and most of them have not been vaccinated against varicella and mumps. This study investigated the effect of vaccine programs on the immunity of people in Japan. MethodsImmunoglobulin G antibody (IgG) titers against four viruses were determined by enzyme immunoassay in 795 students at a medical university. Titers for measles and rubella were compared according to the students’ birth dates (Group 1: April 2, 1990–April 1, 2000; Group 2: April 2, 2000–). ResultsThe titers of students that satisfied the standard IgG values against measles, rubella, varicella, and mumps were 24.3%, 56.9%, 87.4%, and 47.2%, respectively. Measles and rubella titers were lower in group 2 (estimated mean period from last vaccination, 7.0 years) than group 1 (13.5 years) (p = 0.023 measles, p = 0.037 rubella), indicating attenuation of titers over time. Varicella and mumps antibody prevalence indicated that these infections were endemic, whereas rates of negative titers were higher than those for measles and rubella. ConclusionsIgG titers against viruses were affected by vaccination programs. Declining titers after vaccination should be monitored when the diseases are almost eliminated and boosting is absent. Antibody testing is meaningful for recommending vaccinations and for surveillance of waning immunity. Continuous improvements of vaccination program should be considered to prevent and eliminate diseases.

Varicella-zoster virus infection and pregnancy

Varicella-zoster virus is a herpes virus that causes mild to moderate disease when primary infection (chickenpox) is acquired in childhood, but leading to great morbidity and mortality in adults, with even more complications in pregnant women. As a physiologic adaptation in pregnancy that diminishes the possibility of fetal rejection, the altered maternal immune system is the reason why complications are more frequent in this segment of adult population. Moreover, a great concern is represented by the risk of vertical transmission to the fetus that can lead to congenital varicella syndrome (CVS) in the first 2 trimesters or to neonatal varicella if the mother develops the illness perinatally. Antiviral treatment reduces the gravity of the clinical manifestations, but the existent data shows that it doesn’t influence the rate of fetal transmission. Immunoglobulin anti-VZV (VZIG) can be given as prophylaxis when there has been described contact with the virus. Vaccination should be offered to all non-immunized women at the prenatal visit to diminish the maternal and fetal risks in case of subsequent exposure. The purpose of this review is to update the current understanding regarding the best management of varicella infection in pregnancy, based on the latest data from literature and guidelines. An electronic research for relevant reviews and articles published in the last 5 years was made, using PubMed, Medline, Cochrane Data Base, and also the current international guidelines promoted by the Obstetrics and Gynecology Societies in Canada, United States, Ireland and United Kingdom. The importance of prenatal detection of non-immunized women by serologic testing for varicella antibodies should not be overlooked, and subsequent vaccination should be advised to lower the significant complications associated with developing the disease in pregnancy. In case of varicella infection in pregnancy, adequate treatment should be immediately initiated with immunoglobulin and antivirals. Careful follow-up with serial fetal echography should assess if there are abnormalities of fetal development consistent with congenital varicella syndrome. Future mothers need to be advised about the probability of vertical transmission and the associated fetal malformations. Future consideration must focus on identifying the woman at childbearing age at risk and facilitate the vaccination.

渡航前相談における成人の麻疹・風疹・ムンプス・水痘抗体検査がキャッチアップ接種に与える影響

渡航前相談における成人の麻疹・風疹・ムンプス・水痘抗体検査がキャッチアップ接種に与える影響

Measles Vaccination in the Presence of Maternal Measles Antibody Reduces All-Cause Child Mortality - A Planned Cohort Study Nested in a Randomised Trial

Background: Several smaller studies suggested that measles vaccination (MV) in the presence of maternal measles antibody (MatAb) reduces all-cause mortality. We tested the hypothesis that children receiving early MV at 4 months in the presence of MatAb would have 35% lower mortality than children receiving MV at 4 months with no detectable MatAb. We further hypothesised that among children, who did not receive early MV, there would be no difference in mortality between those with and without MatAb. Methods: The study was an observational study nested within a randomised controlled trial (RCT) of early MV, carried out in Guinea-Bissau from 2011-2019. The RCT compared the mortality between 4 and 60 months of age for children randomised 2:1 to two doses of MV at 4 and 9 months of age or to only one dose of MV at 9 months of age. At enrolment in the RCT, a blood sample was collected from all children. A multiplex immunoassay was used to determine the measles MatAb level; as control exposures, levels of varicella, mumps and rubella antibody were assessed. We assessed overall mortality as a function of randomisation group and presence of MatAb in Cox proportional hazards models. Results: 6,598 children were enrolled in the RCT, 6,239 (95%) had a valid enrolment blood sample. In children receiving early MV at enrolment, mortality was 50% (95% CI: 20-68%) lower for those vaccinated in the presence of MatAb (n=3132; 51 died) compared with those vaccinated in the presence of no MatAb (n=1028, 31 died). There was no beneficial effect of having MatAb in children who did not receive early MV (test of interaction, p=0.045). The result was specific for measles antibody; no effect was found for varicella, mumps or rubella antibodies. In a meta-analysis of five available studies, MV in the presence of MatAb was consistently associated with lower mortality compared with MV in the absence of MatAb, the combined meta-estimate indicating 55% (35-68%) lower mortality. Interpretation: The results support the previous findings that MV in the presence of maternal antibody enhances the beneficial effects of MV on child survival. Earlier measles vaccination should be considered. Further research is needed to examine whether it is beneficial to vaccinate women of fertile age to transfer higher level of maternal antibodies to their children. Trial Registration (for the RCT): NCT01486355 Funding: The RCT was funded by an ERC Starting Grant to Christine S Benn (ERC-2009-StG-243149) and by a “Center of Excellence” grant from the Danish National Research Foundation (DNRF108). The work on non-specific effects of vaccines has been supported by the Danish Council for Development Research, Ministry of Foreign Affairs, Denmark [grant number 104.Dan.8.f.], Novo Nordisk Foundation and European Union FP7 support for OPTIMUNISE (grant: Health-F3-2011-261375). The funding agencies had no role in the study design, data collection, data analysis, data interpretation, or the writing of the report. Declaration of Interests: Authors declare no competing interests. Ethics Approval Statement: The protocol was approved by the National Ethical Committee in Guinea-Bissau and given consultative approval by the Danish Central Ethical Committee

Seroprevalence of antibodies against varicella among medical students - a need for immunization record for medical school admission

Introduction and Aim:This study was conducted at a medical University in UAE to assess the risk of acquiring Varicella – a vaccine-preventable disease, by estimating antibody titers among the clinically exposed students to provide a scientific implementation of immunization guideline during admission to medical school.&#x0D; Materials and Methods: This cross-sectional study involved 88 students in clinical years attending a medical college in the UAE. The students' demographics, vaccination data, and history of natural infection with vaccine-preventable communicable infectious diseases were collected, with more significance on Varicella. Blood samples were collected to determine varicella IgG via ELISA.&#x0D; &#x0D; Results:Out of 88 medical students, 20.45% of students had vaccination during childhood and 60.22%of students had a natural infection in the last five years. Three students (3.4%), who had childhood vaccination acquired the infection which is statistically significant during their clinical study years. 70.4% of students who had childhood vaccination and natural infection are at risk of acquiring varicella infections due to the waning of antibodies. 13.64% were found to be negative for varicella antibody titers are at the highest risk.&#x0D; &#x0D; Conclusion:Medical students are most susceptible to acquiring the infection. Medical Universities should take up a policy, that each student needs to take booster vaccinations as a mandatory requirement before admission into the first year, which is practiced as an admission protocol in Western countries like the United States of America but not in Asian countries. Special emphasis should be placed on catch-up vaccination of students because the likelihood of severe infection increases with age.

One single-center cross-sectional investigation on varicella antibody level of all age groups in Chinese people

ABSTRACT Varicella outbreaks were mainly reported in developed regions with high vaccine coverage, but not in undeveloped areas. It is still not clear that whether the published data of varicella epidemiology could reflect the reality in China or not. In 2019, 657 subjects from People’s Hospital of Chongqing Youyang County were included. Anti-varicella-zoster virus (VZV) IgG antibodies were determined by ELISA. The anti-VZV IgG levels were categorized as positive when values were ≥100 mIU/mL. Our results showed that the rates of anti-VZV IgG seropositivity (χ2 = 328.957, P < .0001) and geometric mean titers (P < .0001) were significantly influenced by age. The seropositivity declined dramatically from 84.5% in subjects ≤3 m of age, to 7.9% in subjects of >3 m-1 y (P < .0001). Then, the positivity rate increased slowly as age to 26.7% in >1-<3 y (P = .0006), and 34.5% in 3-<7 y (P = .4294). A steady rise (45.6%) in positivity was observed in subjects aged 7-<18 y. After then, the positivity began to increase robustly. A total of 87.8% of adults aged 18-<40 y had acquired VZV-specific immunity (P < .0001). The highest positivity rate was found in 40-<60 y (98.3%) and ≥60 y (98.2%) group. In conclusion, most subjects of >3 m-<7 y age were susceptible to VZV. The proportion of subjects with natural infection-induced immunity increased with age. Nearly all subjects over 40 ages had positive anti-VZV IgG antibodies, which proved that they were infected by this virus in the past. These results suggested that VarV should be included in the national immunization program in China.

Evaluation of Hepatitis B, Hepatitis A, Measles, Rubella, Mumps and Varicella Antibody Seroprevalences in Vocational School of Health Students

Objective: In the present study, we investigated the seroprevalence of antibodies against hepatitis B, hepatitis A, measles, mumps, rubella and varicella viruses in adolescent students of a Vocational School of Health and aimed to contribute to the future studies intended to increase the vaccination rates of adolescent and health care workers in our country. Material and Method: Ninety-five students of the Vocational School of Health screened for hepatitis B, hepatitis A, measles, mumps, rubella and varicella who were referred to the vaccination unit of our hospital were included in this study. Results: The mean age of the students was 16.4±0.7 years (14- 18 years), 63.2% are girls, 36.8% are boys. None of the students received hepatitis A vaccine and varicella vaccine before. Of all the students, 16.9% tested positive for hepatitis B surface antibody, 8.4% tested positive for hepatitis A IgG, 77.9% tested positive for measles IgG, 92.3% tested positive for mumps IgG, 93% tested positive for rubella IgG and 88.5% tested positive for varicella IgG. Conclusion: In the present study, it was concluded that catch-up vaccination seems necessary for hepatitis A and varicella because contracting these two infections in this age group increases the complication risk caused by the high seronegativity of hepatitis A and the high incidence of natural varicella infection. Conducting similar studies for adolescents and healthcare providers in our country is important to determine pre-contact and post-contact strategies, assess cost-effectiveness of pre-vaccination serology and establish screening and immunization programs.

Seroprevalence of varicella antibodies in adults without clinical history of disease.

Varicella in adults and immunocompromised patients can be severe. The clinical diagnosis of varicella has high accuracy and the history of disease has a high positive predictive value for protection. A significant portion of adults, however, cannot remember if they have had varicella, especially older individuals. We conducted a cross-sectional study to determine the seroprevalence of varicella protective antibodies titers in adults with no clinical history of disease, attended at a Reference Center for Special Immunobiologicals and Travel Medicine in Rio de Janeiro (Brazil). Titration of immunoglobulin G (IgG) antibodies to varicella-zoster was determined by chemiluminescence immunoassay. Among 140 adults without history of varicella, 92% had protective antibody titers. We concluded that seroprevalence of varicella-zoster protection was very high in adults with negative history of disease and the use of serology before vaccination reduced significantly unnecessary vaccine and immunoglobulin use.

Mother-to-Child Transfer of Reactivated Varicella-Zoster Virus DNA and Varicella-Zoster IgG in Pregnancy.

Stress-induced subclinical reactivation of varicella-zoster virus (VZV) has been studied previously. However, subclinical reactivation of VZV induced by the stress of pregnancy has not been investigated. The objective was to study varicella DNA and varicella antibody levels in mothers and their newborn babies. VZV immunoglobulin G (IgG) levels in 350 mother-newborn dyads were studied using indirect enzyme-linked immunosorbent assay testing. A subset of 73 dyads was selected, DNA was isolated from the serum samples, and quantitative polymerase chain reaction (qPCR) was performed. Nearly 15% (14.6%) mothers tested were positive for varicella antibodies (>100 mIU/dL) and 16% were borderline (<100 and >50 mIU/dL). Approximately 16.9% of the babies were positive, and 18% were in borderline. Among those tested for VZV-DNA, 70% of mothers with low VZ-IgG (<100 mIU/dL) and 11.32% of those with high VZ-IgG (>100 mIU/dL) were positive for DNA. Among the newborns, 60% of those with low VZ-IgG and 15% of those with high VZ-IgG were positive for DNA. Mothers who have had VZV infection in the past can transmit VZV DNA to their babies.

Seroprevalence of vaccine-preventable diseases among children and adolescents in Singapore: Results from the National Paediatric Seroprevalence Survey 2018

ObjectivesThe Ministry of Health (MOH), Singapore, conducted the National Paediatric Seroprevalence Survey 2018 (NPSS 2018) to estimate the latest immunity levels against measles, rubella, varicella, diphtheria, tetanus and hepatitis B, and the seroprevalence of chronic hepatitis B virus (HBV) carriage in children and adolescents in Singapore. MethodsThe survey involved prospective collection of residual sera from 1,200 children and adolescents aged 1–17 years in two public acute hospitals. Enzyme-linked immunosorbent assays (EIA) or plague reduction neutralisation tests (PRNT) were used to determine the seroprevalence of the vaccine-preventable diseases. ResultsOverall prevalence of measles and rubella antibodies among Singaporean children and adolescents aged 1–17 years were 98.2% (95% CI: 91.2–98.8%) and 94.8% (95% CI: 93.4–95.9%) respectively. 97.1% (95% CI: 96.0–97.9%) of subjects had at least basic protection against diphtheria, while 89.3% (95% CI: 87.5–91.0%) were protected against tetanus. The prevalence of chronic HBV carriage was 0.4% (95% CI: 0.2–1.0%), while 45.7% (95% CI: 42.9–48.5%) were immune against HBV. The seroprevalence for varicella antibodies was 52.9% (95% CI: 50.1–55.7%). Concordance between vaccination status and seroprevalence was observed for measles, rubella, diphtheria and tetanus. ConclusionSingapore’s children and adolescents are well-protected against measles, rubella, diphtheria and tetanus. Continual efforts in ensuring high vaccination coverage should be sustained.

Early disappearance of maternal anti-measles, mumps, rubella, and varicella antibodies in Indian infants

BackgroundImmunization of children with vaccines against Measles, Mumps, Rubella, and Varicella (MMRV) is practiced globally with varied recommendations. In India, measles vaccine is administered alone or as MMR at 9 months age. Varicella vaccine is not routinely used. Immunization age is a function of disappearance of maternal antibodies and natural exposure of the children to the pathogens. In view of the measles-WHO-initiative, we aimed to assess if the current immunization age for measles is still valid. In addition, the kinetics of IgG and IgM antibodies against rubella, mumps and varicella viruses was also examined. MethodsThis cross-sectional study was conducted at a tertiary care hospital in Pune, India. A total of 600 children, 150 each in 6-month/9-month (no vaccination) and 12-month/15-month (minimum 4 weeks post-measles-vaccine) cohorts were included. History of these infections and birth status (term/preterm) was recorded. All serum samples were screened for IgG-anti-MMRV-antibodies while IgG-positives were tested for specific IgM antibodies (ELISA). ResultsAt 6-months, the prevalence of MMRV antibodies was 4.7%, 2.7%, 10.7%, 5.3% respectively depicting disappearance of maternal antibodies in majority of the children. Birth status did not influence antibody positivity. Despite vaccination at ∼9-months, >25% children were still susceptible to measles virus at the age of 12/15-months. The ratio of clinical:subclinical infections was 4:10 (measles) and 12:1 (varicella). All the mumps/rubella IgM positives (1 and 2 respectively) represented subclinical infections. ConclusionDemonstration of early disappearance of maternal antibodies against MMRV viruses leading to the risk of these infections at an early age emphasize need for early immunization of Indian children. Suboptimal response to measles vaccine needs to be seriously addressed especially in view of the WHO’s initiative for measles eradication.

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

BackgroundIn recent years, outbreaks of varicella have continued to occur, and the coverage rate of varicella vaccine in Jiangsu Province, China, remains unclear. This study aims to analyse the levels of immune antibody against varicella and obtain a comprehensive understanding of the varicella attenuated live vaccine (VarV) coverage rate in children aged 1–9 years in Jiangsu Province.MethodsFrom June to October 2016, a cross-sectional survey was conducted to collect 3631 serum samples from healthy children aged 1–9 years in Jiangsu Province. The immunoglobulin G (IgG) antibody levels of varicella were detected by enzyme-linked immunosorbent assay (ELISA).ResultsThe VarV coverage rate of healthy children was only 43.1% (95% CI: 41.1–44.7%). The seroprevalence after vaccination with a single dose of VarV was only 57.1%, and the overall seropositivity and geometric antibody titre (GMC) were 43.5% and 225.4 mU/ml, respectively. The seropositivity was significantly higher in girls than in boys (χ2 = 18.82, P < 0.001). The difference in seropositivity between the 5–9 age group and 1–4 age group was statistically significant (χ2 = 84.31, P < 0.001). The difference in seropositivity between different regions was statistically significant, with the highest seropositivity in the northern area, 53.7% (χ2 = 35.64, P < 0.001). The seropositivity in the group receiving one dose of VarV was significantly higher than that of the unvaccinated group (χ2 = 205.16, P < 0.001). Linear regression analysis suggested that the GMC of varicella antibodies wanes with the time since vaccination (F = 65.01, P = 0.002).ConclusionThe VarV coverage rate of healthy children in Jiangsu Province was low. Sero-conversion rates were also low after one dose of VarV, and the immune effectiveness of a single dose of VarV was limited. To control the spread of varicella, VarV should be included in the routine immunization program, and strengthened immunization measures for the varicella-susceptible population warrant additional consideration.

Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study

BackgroundMorbidity and mortality following cardiac valve surgery is high. Immunity is an important contributor to outcome. This study examines the relationship of staphylococcal and endotoxin antibody levels to outcome following cardiac surgery.MethodsUsing enzyme-linked immunosorbent assays (ELISA), we measured pre-operative levels of antibodies to endotoxin core (EndoCAb); 3 common staphylococcal epitopes and varicella on saved serum of 60 adult patients scheduled to undergo elective primary surgical aortic valve replacement (AVR). Primary outcome measure was post-operative length of stay (LOS) in hospital with secondary outcomes being development of infective complications, length of stay on the intensive care unit (ICU) and 30-day mortality. Patients were quartiled according to antibody levels and outcomes compared between the quartile groups using Mann-Whitney tests for length of stay and Fisher’s test for development of infection.ResultsSixty patients (34 M, 26 F) were recruited with mean age 73 years (IQR 66–78), mean body mass index (BMI) 27.7 (IQR 25–31) and EuroSCORE II 1.44 (0.95–1.99). Those patients in the lower quartile for pre-operative antibody level had a longer post-operative stay than the upper quartile. EndoCAb (median IgG level Q1 42.2 MU/ml vs Q4 256 MU/ml) 9 vs 6 days, p = 0.025; alpha-toxin (median IgG level Q1 63 U vs Q4 558 U) 10 vs 7 days, p = 0.034; teichoic acid (median IgG level Q1 14 U vs Q4 419 U) 10 vs 8 days, p = 0.441; staphylococcal enterotoxin A (median IgG level Q1 55 U vs Q4 427 U) 9 vs 7 days, p = 0.865; varicella zoster (median IgG level Q1 1.325 U vs Q4 2.54 U) 8 vs 7 days, p = 1.0; and combined antibody levels 10 vs 6 days, p = 0.017. There were no differences in the number developing post-operative infections for each antibody type. The combined antibody analysis suggested a reduction in proportion of individuals developing infection from the upper vs lower quartile: 0 vs 0.33, p = 0.042.ConclusionsThis study again suggests the inverse relationship between endotoxin core antibody levels and outcome following aortic valve surgery as well as suggesting a similar relationship with antibodies to staphylococcus. There is no such relationship for antibody levels against an organism not providing a peri-operative threat. Understanding this relationship may enable therapeutic manipulation of immune status, re-evaluation of risk and further investigation of the low immune state.Trial registrationThe patients in this study are a sub-group of the RELIEF AS study.ClinicalTrials.gov identifier NCT02174471.

Varicella (Human Herpes Virus-3) Vaccine Potential Role Against Herpes (HSV-1/HSV-2) Viruses to Prevent HIV-1 Pandemic in Sub- Saharan Africa

Background: Synergy exists between DNA and RNA viruses. It was found that the Human Immunodeficiency Viruses (HIV-1) are RNA viruses at the origin of Acquired Immune Deficiency Syndrome (AIDS). The DNA recurrent herpes diseases are associated to AIDS virus at the origin of Sub-Saharan cancer AIDS pandemic. Objective: It is speculated that a varicella virus (HHV-3) immune defect could originate HSV- 1/HSV-2 recurrent herpes diseases that can be cured by varicella vaccine (2012). Methods: At a Symposium held in Kampala, Uganda (1962), impressive Sub-Saharan cancer epidemics: Hodgkin lymphomas and Kaposi sarcomas have been reported since the onset of the 20th century and remained unexplained. Over one thousand publications related to these cancer epidemics were presented. For millenniums, Bantu populations have been living in tropical forests close to chimpanzees infected by Simian Immune Deficiency viruses (SIV). SIV became Human Immune Deficiency viruses (HIV-1). AIDS is a zoonosis. Results: The DNA and RNA viruses, herpes with HIV-1 viruses, are correlated to Sub- Saharan AIDS infections. They induce an extensive immune deficiency with other herpes viruses such as HHV-4 and HHV-8, which are linked to lymphomas and Kaposi sarcomas. It is postulated that a primary HHV-3 immune weakness could be linked to herpes partnership with AIDS pandemic. Conclusion: The Oka, anti-HHV-3, varicella vaccine is able to cure HSV1/HSV2 recurrent herpes diseases. It induces a specific increase of the varicella antibodies. Thus varicella vaccination could prevent herpes recurrences in Sub-Saharan Africa. One- child dose varicella vaccine could be proposed as the first step to overcome HHV-3 herpes deficiency in order to prevent AIDS pandemic.

A double-blind, randomized, controlled, multi-center safety and immunogenicity study of a refrigerator-stable formulation of VARIVAX®

ObjectiveVARIVAX® (varicella virus vaccine, live Oka/Merck, Merck & Co., Inc., Kenilworth, NJ, USA) was originally licensed as a frozen formulation. A refrigerator-stable formulation of VARIVAX was subsequently developed to allow for increased availability of the product around the world. The objective of this study (V210-051) was to demonstrate that the safety, tolerability and immunogenicity profile of the refrigerator-stable formulation of VARIVAX was similar to the frozen formulation. MethodsIn this double-blind, randomized, multicenter study, healthy 12- to 23-month-old children with negative vaccination and clinical histories for measles, mumps, rubella, varicella, and zoster were vaccinated with either a refrigerator-stable formulation of VARIVAX (at two dosage levels; 8000 PFU [N = 320] or 25,000 PFU [N = 315]) or the frozen formulation of VARIVAX (10,000 PFU, N = 323) given concomitantly with M-M-RII® (measles, mumps, and rubella virus vaccine live, Merck & Co., Inc., Kenilworth, NJ, USA). Children were followed for 42 days after vaccination for adverse experiences. Immunogenicity was evaluated 6 weeks after vaccination. ResultsThe refrigerator-stable formulation of VARIVAX was generally well tolerated. The incidence of adverse experiences was similar between all three groups. No vaccine-related serious adverse experiences were reported with any of the vaccine formulations. The immune response (percentage of subjects with varicella antibody titers ≥5 gpELISA units) for both refrigerator-stable formulations of VARIVAX at 6 weeks postvaccination was similar to that of the frozen formulation. Administration of either refrigerator-stable formulation of VARIVAX with M-M-RII yielded seroconversion rates and GMTs for measles, mumps and rubella that were comparable to those achieved after administration of the frozen formulation of VARIVAX with M-M-RII. ConclusionThe safety, tolerability, and immunogenicity profile of the refrigerator-stable varicella vaccine was similar to that of the frozen formulation.