History Of Varicella Research Articles

Phase 3, open-label, Russian, multicenter, single-arm trial to evaluate the immunogenicity of varicella vaccine (VARIVAX™) in healthy infants, children, and adolescents

ABSTRACT Varicella (chickenpox) is a common, highly contagious disease caused by primary infection with varicella zoster virus (VZV), which can result in bacterial superinfection, central nervous system complications, and hospitalization. Stage 2 of this Phase 3 open-label study (ClinicalTrials.gov identifier: NCT03843632) enrolled 100 healthy infants, children, and adolescents (12 months–6 years, n = 37; 7–12 years, n = 33; 13–17 years, n = 30) without a clinical history of varicella. Participants aged 12 months–12 years were administered 1 dose of VARIVAX™ 0.5 mL (Varicella Virus Vaccine Live [Oka/Merck]) and adolescents aged 13–17 years were administered 2 doses 6 weeks apart. For participants seronegative at baseline (VZV antibody titer <1.25 glycoprotein enzyme-linked immunosorbent assay [gpELISA] units/mL), immunogenicity was assessed by seroconversion (VZV antibody titer ≥5 gpELISA units/mL) and VZV antibody geometric mean titers 6 weeks after the final dose. For participants who were VZV seropositive at baseline (VZV antibody titer ≥1.25 gpELISA units/mL), immunogenicity was assessed by antibody titer geometric mean fold rise and percentage of participants with ≥4-fold rise in antibody titer 6 weeks after the final dose. A Vaccine Report Card was used to report solicited and unsolicited adverse events through 42 days post-vaccination. After series completion among seronegative participants across age groups (n = 74), 98.6% demonstrated seroconversion 6 weeks post-vaccination; among seropositive participants (n = 26), 65.4% had ≥4-fold rise in antibody titer 6 weeks post-vaccination. No new safety signals were observed. Administering VARIVAX to infants, children, and adolescents resulted in an acceptable immune response with a safety profile consistent with the licensed product.

Self-assessment questions

A 35-year-old multiparous woman has called maternity admissions clinic to say she is 20 weeks pregnant and her first child has developed a vesicular rash on their trunk consistent with chicken pox. She is worried she might contract varicella. What is the first next step?A.Take bloods for varicella IgG and IgMB.Tell her to ring back if she develops a rash.C.Get her to come in for an urgent review in maternity admissionsD.Give IVIGE.Enquire as to whether she has a definitive history of chicken pox or not.

Concordance of self-reported varicella history and serology among adolescent and adult refugee patients at a primary care clinic in Toronto, Canada

BackgroundPrevious studies have found higher rates of varicella susceptibility among migrants from tropical regions. This study seeks to estimate the prevalence of varicella susceptibility in a cohort of newly arrived refugees and refugee claimants at a primary care clinic in Toronto and to compare patients’ self-reported history of varicella infection with serologic test results. MethodsWe conducted a retrospective chart review of 1888 refugee patients aged 13 years and older rostered at a specialized primary care clinic in Toronto from December 2011 to October 2017. Basic sociodemographic variables, self-reported varicella history, and varicella serologic results were examined. ResultsBased on serologic testing, 8.5% of individuals were varicella non-immune, with highest rates of varicella susceptibility among adolescents aged 13–19 years (13.5%). All adults over age 60 were varicella immune on serology (n = 56). A positive self-reported history of varicella infection was strongly predictive of varicella immunity on serology (PPV 96.8%; 95% CI: 95.2–97.9). A self-reported history of no prior varicella infection did not correlate reliably with serologic test results (NPV 15.8%; 95% CI: 13.3–18.0). A substantial proportion of patients (34.1%) were unsure of their varicella history. ConclusionIdentification and immunization of varicella susceptible refugee newcomers remains a health care priority. Self-reported history of varicella infection had mixed reliability as a predictor of varicella immunity.

Analytical epidemiology of multiple sclerosis in the Republic of Kabardino-Balkaria

Multiple sclerosis (MS) is a common autoimmune disease, which etiology includes a complex of genetic and environmental factors. Data suggests that their interaction can influence the age of the clinical manifestations and the course of the disease. Therefore, the study of risk factors of MS in regions with different ethnic compositions of the population and climatic and geographical characteristics is of considerable interest.Objective: to study MS risk factors prevalence in the Republic of Kabardino-Balkaria (RKB).Patients and methods. This case-control study of the representation of risk factors included a cohort of 112 MS patients living in two regions of the RKB (Nalchik and the Prokhladnensky district). The MS diagnosis was established with the McDonald criteria (2017). MS risk factors were assessed with a unified questionnaire. 112 respondents (matched by the main demographic characteristics and place of residence) were included in the control group.Results and discussion. MS patients from the Prokhladnensky district were significantly more likely to contact harmful chemical compounds, had higher consumption of smoked meat products; and suffered from viral infections more often (all differences were significant, p&lt;0.05). More patients with MS, regardless of their place of residence, had a history of scarlet fever than the controls (n=23; 19.5% and n=14; 13.4%, ratio indicator 0.43 (95% CI 0.32–1.01), p=0.041), and the maximum significance of this factor was found in patients who suffered from scarlet fever after the age of 15 years (n=7; 6.3% and n=1; 0.9%, ratio indicator 2.45 (95% CI 1.92–3.21), p=0.041). More patients with MS had a history of chickenpox (n=70; 62.5% and n=55; 41.1%; ratio indicator 0.78 (95% CI 0.65–0.94, p=0.032), the frequency of this factor was most significant in early (up to 7 years) disease onset. Regardless of the place of residence, patients with MS were more likely to suffer from tonsillitis and sinusitis in childhood (p=0.032).Conclusion. In the RKB, as in other regions of the Russian Federation, the risk of MS, along with a genetic predisposition, is primarily determined by environmental factors, such as contact with potentially harmful chemicals, history of somatic diseases, characteristics of the ecological situation, etc. Therefore, MS risk is higher in people exposed to these factors before the age of 7 years and does not depend on the place of residence.

Live attenuated vaccine efficacy six months after intravenous immunoglobulin therapy for Kawasaki disease

BackgroundDue to the presence of maternal passive antibodies, the measles vaccine is ineffective if administered before age 12–15 months. The optimal timing for administering a live attenuated vaccine (LAV) after intravenous immunoglobulin therapy (IVIG) for Kawasaki disease (KD) has not been fully investigated. The recommended interval between vaccination and IVIG therapy for KD differs by country. The present study aimed to evaluate efficacy of LAV six months after IVIG therapy for KD in Japan. MethodsThe present, single-arm, prospective, interventional study included patients aged 6 months or older with no medical history of measles, rubella, varicella or mumps or vaccinations against these diseases. The subjects received these vaccinations for the first time at six months after IVIG therapy. Virus-specific IgG levels for each virus measured by EIA was examined at nine months after IVIG therapy. If the results were negative, the subjects received a booster vaccination at 12 months after IVIG therapy. The primary outcome was the prevalence of positivity for antibodies after the initial and booster vaccinations. ResultsThe present study enrolled 32 subjects, 31% of whom were female, with an average age of 10.8 (standard deviation 2.8) months at IVIG therapy. At six months after IVIG therapy, 9% and 6% of the subjects were seropositive for measles and varicella titers, respectively, but were seronegative for the mumps and rubella titers. The seroconversion rate for measles, mumps, rubella, and varicella after the initial vaccination was 88%, 6%, 78%, and 16%, respectively. The seroconversion rate after a booster vaccination was 100% for measles and rubella, 97% for mumps, and 77% for varicella. ConclusionsThe seroconversion rate was low for LAV at six months after a single dose of IVIG for KD, but seroconversion was achievable with a booster vaccination at 12 months.Clinical Trial Registration: UMIN-CTR, UMIN000007174, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000008452.

Susceptibility of cadets and recruits to chickenpox: A seroprevalence study

BackgroundRegular outbreaks of chickenpox are reported among cadets and recruits in the army undergoing training, resulting in morbidity and loss in terms of training days. Vaccination policy in the army mandates that all cadets and recruits be vaccinated against chickenpox on joining the training centers. However, 100% vaccination of trainees is not achieved. Hence, seroprevalence data among cadets and recruits were collected with the aim to assess the need for vaccination against chickenpox. MethodsThe data were collected from cadets and recruits undergoing training in military training centers by simple random sampling. Blood samples were collected from all study participants for IgG enzyme-linked immunosorbent assay for varicella zoster. A structured questionnaire was also used to collect information from all participants. ResultsA total of 2041 cadets and recruits between the ages of 19–29 years were studied of which 96.1% were males. Of all participants, 49.9% were seropositive showing varicella zoster virus (VZV) IgG antibody in the serum, and 29.1% study participants gave positive history of having had varicella in the past. The sensitivity of definite positive history of varicella when compared with presence of VZV IgG antibodies was found to be 55.50% while specificity was found to be 97.17%. ConclusionA very large majority of cadets and recruits that joined the army are susceptible to chickenpox. Hence, the risk of repeated chickenpox outbreaks in these training centers remains very high. As the sensitivity of history of past infection of chickenpox is relatively low, it cannot be used as a tool to determine the susceptibility of the trainees to the infection.

Insights on the Impact of External and Internal Boosting on Varicella-Zoster Virus Reactivation Based on Evidence From the First Decade of the United States Universal Varicella Vaccination Program.

Since the licensure of the varicella vaccine in the United States in 1995 and the implementation of the universal varicella vaccination program, varicella infection rates, and associated morbidity and mortality rates have decreased. However, controversy exists over whether universal vaccination has resulted in an increased incidence of herpes zoster (HZ). In 1965, Dr. Hope-Simpson hypothesized that exogenous exposures to the wild-type varicella-zoster virus (wt-VZV) provide immune boosts that inhibit HZ; therefore, reducing the amount of circulating wt-VZV may have the negative effect of increasing the incidence of HZ. A historical review of data from the Centers for Disease Control and Prevention-sponsored Antelope Valley Varicella Active Surveillance Project, along with other studies, is provided to investigate the exogenous boosting hypothesis in the first decade post-vaccine licensure. These data indicated that adoption of universal varicella vaccination led to (1) significant HZ incidence rate increases among children, adolescents, and adults with a history of wild-type varicella and (2) decline in varicella vaccine efficacy after the initial post-licensure period. These effects were likely due to reduced exogenous exposures from children shedding wt-VZV. Appropriate methodologies for ongoing research are also discussed, both in studies during the first decade post-licensure and more recent work.

Case report: aseptic meningitis secondary to varicella-zoster virus (VZV) without an exanthem post MMR vaccination

BackgroundVaricella-zoster virus (VZV) is a known cause of aseptic meningitis, with a predisposition for an immunocompromised population. A dermatomal rash usually accompanies aseptic meningitis secondary to VZV.Case presentationWe report the case of a 31-year-old male with a history of chickenpox in childhood and recent shingles who presented with severe frontal headaches secondary to VZV meningitis. The patient had also recently received the measles-mumps-rubella (MMR) vaccine. He recovered without any neurological sequala.ConclusionThis case report describes an immunocompetent patient with recent MMR vaccination who developed aseptic meningitis secondary to VZV without any dermatomal involvement (Zoster Sine Herpete).

Cervicofacial Herpes Zoster Complicating Ganglion-Pulmonary Tuberculosis: Case Report and Review of the Literature: A Case Report

Tuberculosis is an infectious disease; it has a variable degree of presentation, most often pulmonary while the extrapulmonary location is dominated by lymph node involvement, especially cervical. On the other hand, herpes zoster results from the reactivation of the virus that causes varicella. Here, we report the case of cervicofacial herpes zoster complicating ganglion-pulmonary tuberculosis in a 19-year-old female patient with a history of varicella during childhood, who presents bilateral lymphadenopathy, the diagnosis of pulmonary and lymph node tuberculosis is confirmed by histology, she has treated with anti-tuberculosis drugs and the evolution was marked by the presence of lymphadenopathy and the appearance of cervicofacial herpes zoster

Cross-Sectional Study of Varicella Zoster Virus Immunity in Healthy Korean Children Assessed by Glycoprotein Enzyme-Linked Immunosorbent Assay and Fluorescent Antibody to Membrane Antigen Test.

The prevalence of varicella is especially high among children in the age group of 4–6 years in South Korea, regardless of vaccination. We investigated the immune status of healthy children enrolled in day-care centers and compared pre- and post-vaccination immunity. Antibody titers were measured using a glycoprotein enzyme-linked immunosorbent assay (gpEIA) kit, and the seroconversion rate was assessed using a fluorescent antibody to membrane antigen (FAMA) test. Among 541 vaccinated children, 109 (20.1%) had breakthrough varicella. However, 13 (72.2%) of the 18 unvaccinated children had a history of varicella. The gpEIA geometric mean titers (GMTs) of pre- and 5 weeks post-vaccination in 1-year-old children were 14.7 and 72 mIU/mL, respectively, and the FAMA seroconversion rate was 91.1%. The gpEIA GMTs of 2-, 3-, 4-, 5-, and 6-year-old children were 104.1, 133.8, 223.5, 364.1, and 353.0 mIU/mL, respectively. Even though the gpEIA GMT increased with age, the pattern of gpEIA titer distribution in 4- to 6-year-old vaccinees without varicella history represented both waning immunity and natural boosting immunity. These results suggest that some vaccinees are vulnerable to varicella infection. Therefore, it is necessary to consider a two-dose varicella vaccine regimen in South Korea.

Evaluation of varicella vaccine effectiveness during outbreaks in schools or nurseries by cross-sectional study

ObjectiveThe aim of this study was to elucidate vaccine effectiveness (VE) during varicella outbreaks in schools and nurseries in Japan. MethodsAn outbreak was defined as emergence of three or more cases of varicella within 21 days at the same institute. Clinical information such as varicella vaccination status, and history of varicella was collected. If a child had varicella during the outbreak, information about absences, fever, and disease severity was collected. ResultsFrom September 2018 to January 2020, four outbreaks were reported around our institute from three elementary schools and one nursery. A total of 676 children were analyzed in this study. Seventy-six children (11.2%) were unvaccinated, 309 (45.7%) had received one dose of vaccine, and 291 (43.0%) had received two doses. Most children in Pre-K2 (1–2 years old) to Pre-K6 (5–6 years old), who were the targets of the national immunization schedule, received two doses. Meanwhile, most children older than third grade received single dose. Seventy-five children (11.1%) had varicella. Varicella prevalence from Pre-K5 to the third grade was greater than 10%. The adjusted VEs of single- and two-dose of varicella vaccine were 57.8% and 89.0%. The number of days absent was significantly longer in unvaccinated children than single-dose recipients (P = 0.0145). Unvaccinated children had significantly more severe skin eruptions than single-dose recipients (P = 0.0046) and two-dose recipients (P = 0.0258). ConclusionsAlthough VEs of single-dose varicella vaccination during outbreaks was not high, the VE of two-dose vaccination was similar to that in a previously reported case-control study.

Health Impact and Cost-effectiveness Assessment for the Introduction of Universal Varicella Vaccination in Switzerland.

Varicella, caused by the varicella-zoster virus, is a highly contagious infectious disease with substantial health and economic burden to society. Universal varicella vaccination (UVV) is not yet recommended by the Swiss National Immunization Program, which instead recommends catch-up immunization for children, adolescents and adults 11-40 years of age who have no reliable history of varicella or are varicella-zoster virus-IgG seronegative. The objective of this study was to perform an assessment of health impact and cost-effectiveness comparing UVV with current practice and recommendations in Switzerland. A dynamic transmission model for varicella was adapted to Switzerland comparing 2 base-case schedules (no infant vaccination and 10% coverage with infant vaccination) to 3 different UVV schedules using quadrivalent (varicella vaccine combined with measles-mumps-rubella) and standalone varicella vaccines administered at different ages. Modeled UVV coverage rates were based on current measles-mumps-rubella coverage of approximately 95% (first dose) and 90% (second dose). Direct medical costs and societal perspectives were considered, with cost and outcomes discounted and calculated over a 50-year time horizon. UVV would reduce the number of varicella cases by 88%-90%, hospitalizations by 62%-69% and deaths by 75%-77%. UVV would increase direct medical costs by Swiss Franc (CHF) 39-49 (US $43-54) per capita and costs from a societal perspective by CHF 32-40 (US $35-44). Incremental quality-adjusted life-years per capita increased by 0.0012-0.0014. Incremental cost-effectiveness ratios for the UVV schedules versus the base-case were CHF 31,194-35,403 (US $34,452-39,100) per quality-adjusted life-year from the direct medical cost perspective and CHF 25,245-29,552 (US $27,881-32,638) from the societal perspective. UVV appears highly effective and cost-effective when compared with current clinical practice and recommendations in Switzerland from both a direct medical costs perspective and societal perspective.

English

BACKGROUND This study was conducted to evaluate the maternal and fetal outcome of fever in pregnancy. METHODS The present study was a prospective observational study conducted from April 2012 – March 2014 among patients in the Department of Obstetrics and Gynaecology, Sri Ramachandra Institute of Higher Education and Research Institute, and they were followed up to the time of delivery to determine the maternal and foetal outcome. This is a prospective study and sample size was 120 patients. All patients admitted with fever irrespective of the gestational age and parity were included in the study. The ethical committee of Ramachandra Medical College and Hospital approved the study. Reference CSP-MED / 13 / AUG / 08 / 47. RESULTS Fever in pregnancy nearing term has been associated with adverse outcomes. Even elevated temperature in the first trimester can lead to fetal loss. Urinary tract infection was the most common infection during pregnancy. E. coli was the most common organism isolated. Other aetiologies encountered were dengue, malaria, scrub typhus, leptospirosis, enteric fever, H1N1, Influenza A viral fever, respiratory tract infections, and chicken pox. The most frequently seen adverse outcome in this study was abortion. There was one maternal mortality due to H1N1 and one neonatal mortality due to dengue haemorrhagic fever which was transmitted to the fetus. There was one fetus with multiple anomalies and the mother had a history of chicken pox in the first trimester. There were 15 cases of premature rupture of membrane and 12 cases had preterm labour. Intrapartum fever was associated with postpartum haemorrhage and meconium-stained liquor in some mothers. CONCLUSIONS Fever during pregnancy can potentially lead to adverse maternal and perinatal outcomes even at a low-grade temperature of a short duration of less than a week. Even elevated temperature in the first trimester can lead to fetal loss. Fever in pregnancy nearing term has been associated with adverse perinatal outcomes. Some virulent organisms can lead to fetal anomalies and maternal death. KEY WORDS Fever in Pregnancy, Maternal Outcome, Foetal Outcome

Changes in epidemiological characteristics and sero-prevalence against the varicella zoster virus in school-age children after the introduction of a national immunization program in Japan

ABSTRACT A national immunization program using two doses of live attenuated varicella vaccine was introduced for children aged one to two years in Japan in October 2014. Varicella cases declined after 2014, and immunological status against varicella among vaccinated children changed in post-vaccination era. A retrospective observational study of anti-varicella antibody seroprevalence, varicella vaccination status, and history of varicella among 528 students in the first grade of elementary school was conducted. The percentage of students who received at least a single dose of varicella vaccination increased from 67% (187 of 279 students) in 2007–2008 to 91% (226 of 249 students) in 2017. Students with a history of varicella decreased from 114 of 279 (41%) in 2007–2008 to 48 of 249 (19%, P < .01) in 2017. Among them, the rate of breakthrough varicella after a single dose of vaccine in students with a history of varicella significantly increased from 38% (43 of 114 students) in 2007–2008 to 58% (28 of 48 students) in 2017 (P < .05). The antibody-positive rate significantly decreased from 50% among subjects without varicella zoster who received a single dose (95%CI: 41–58%) in 2007–2008 to 29% (95%CI: 21–38%) in 2017 (P < .01). The antibody-positive rate among students without varicella history who received two doses of vaccine was only 43% (95%CI: 32–55%) in 2017. The number of varicella infections and antibody-positive rate among students without history of varicella who received varicella vaccination decreased after the introduction of a national immunization program.

Herpes zoster in an immunocompetent infant with a history of varicella in early infancy and after a minor injury - case report and literature review

Introduction. Chickenpox is a common pediatric disease, while herpes zoster (HZ) is rare among children, especially among infants. HZ in infancy may appear after intrauterine or postnatal infection with varicella-zoster virus (VZV). We report on a case of HZ in an immunocompetent infant who had a history of chickenpox in early infancy. Case outline. A seven-month-old male infant was presented with skin changes in the left T1 and T2 dermatomes. Skin changes appeared eight days after the infant had a mild left-arm traction injury. The patient?s medical history revealed that he had a mild form of chickenpox at the age of three and a half months. After the clinical diagnosis of HZ was made, he was treated with oral acyclovir 20 mg/kg every six hours for five days and had complete recovery without any sequelae. Conclusion. Risk factors for pediatric HZ are immunosuppression and chickenpox during the first year of life. Local trauma is a reported risk for VZV reactivation among adults. To our best knowledge, our case is the first reported pediatric case in which the injury of the left arm precedes HZ appearance. Routine vaccination against chickenpox may be an important preventive measure because herd immunity will protect infants and immunocompromised children from getting chickenpox and thus HZ.

High susceptibility to varicella among urban and rural pregnant women in South India: a brief report.

Varicella infection during pregnancy has serious and/or difficult implications and in some cases lethal outcome. Though epidemiological studies in developing countries reveal that a significant proportion of patients may remain susceptible during pregnancy, such an estimate of susceptible women is not known in India. We designed this study to study the prevalence and factors associated with susceptibility to varicella among rural and urban pregnant women in South India. We prospectively recruited 430 pregnant women and analysed their serum varicella IgG antibodies as surrogates for protection. We estimated seroprevalence, the validity of self-reported history of chickenpox and factors associated with varicella susceptibility. We found 23 (95% CI 19.1-27.3) of women were susceptible. Nearly a quarter (22.2%) of the susceptible women had a history of exposure to chickenpox anytime in the past or during the current pregnancy. Self-reported history of varicella had a positive predictive value of 82.4%. Negative history of chickenpox (adjusted prevalence ratio (PR) 1.85, 95% CI 1.15-3.0) and receiving antenatal care from a rural secondary hospital (adjusted PR 4.08, 95% CI 2.1-7.65) were significantly associated with susceptibility. We conclude that high varicella susceptibility rates during pregnancy were noted and self-reported history of varicella may not be a reliable surrogate for protection.

Neuroprotective, antiamnesic and antianxiety potentials of MEMJCM-2 in mice

Introduction: Herpes zoster is a very common clinical condition caused by varicella zoster virus. Few studies are done covering the aspects like clinical presentation, epidemiology of this very common yet old disease. Objective: To find out clinical presentation, morphological pattern, evolution of herpes zoster along with its comorbid conditions. Materials and Methods: This was an analytical study conducted from June 2008 to December 2016 based on a preformed proforma carried out at skin department of rural based tertiary health care center. We have used Chi square test to analyze and tabulate the data obtained. It is an Observational and cross-sectional study. Results: Total 938 patients of herpes zoster were enrolled in the study. The incidence of herpes zoster amongst skin OPD cases was found to be 0.38%. The male to female ratio was found to be 1.37:1. Herpes zoster was mainly seen in the age group of 40-60 years (33.8%). The most common prodromal symptom seen was itching in 458 cases (41.5%). Most common presenting complaint was pain in 458 patients (41.50%). The past history of chicken pox was present in 22.7% patients. The commonest segment affected was thoracic in 374 cases (38.9%). Unidermatomal involvement was seen in 886(94.5%) cases, while multidermatomal involvement was seen in 43(4.6%) cases and disseminated in 9 (0.9%) cases. All the cases were screened for HIV, out of them; 40 (4.3%) were seropositive for HIV. Conclusion: Herpes zoster more commonly occurs in the age group of 40-60 years. Most common presenting complaint is burning type of pain. Most common dermatome involved is thoracic dermatome. Keywords: Herpes Zoster, Varicella zoster virus, Dermatome.

EPID-06. QUANTIFYING THE POTENTIAL PUBLIC HEALTH IMPACT OF VARICELLA ZOSTER VIRUS (VZV) VACCINATION ON GLIOMA INCIDENCE

Abstract BACKGROUND Varicella zoster virus (VZV) is a neurotropic a-herpesvirus that causes chickenpox and establishes latency in the dorsal root ganglion. Live attenuated VZV vaccine was approved for use in 1995, with the CDC estimating 95% of teens had been vaccinated in 2014. Prior epidemiological literature suggests an association between VZV infection and glioma risk. METHODS We conducted a systematic review and meta-analysis of prior studies on the association between VZV infection and glioma risk. We also identified genetic instruments for VZV infection from prior GWAS and tested these for association with glioma risk in TCGA and GliomaScan (2244 cases, 4914 controls). RESULTS In six previous studies, individuals with positive chickenpox history or anti-VZV IgG seropositivity had 1.8-fold lower odds of glioma (ORmeta=0.55, 95%Cl=0.39–0.77), with similar effects by grade. GWAS hits for personal history of chickenpox (HLA-A Gly107 and rs9266089) and shingles (HLA-AArg97, HLA-DRB1 PheSerHis13, rs2523591, rs41316748 and rs7047299) were not associated with glioma risk, nor were polygenic scores (P &amp;gt;0.05). DISCUSSION Prior VZV infection is associated with reduced glioma risk and, based on analysis of genetic instruments, this appears to be an acquired protection caused by VZV infection rather than innate immunologic differences. VZV infection in known to elicit a broader antibody response than vaccination, but it is unknown whether VZV vaccination provides comparable protection against glioma. Because 89% of U.S. adults have had chickenpox, the “prevented fraction” of glioma due to chickenpox is ~29% of annual incidence. If VZV vaccination confers an equivalent 1.8-fold reduction in glioma risk, this prevented fraction could increase to 32%. However, if VZV vaccination is less protective, it could decrease to just 2%. This potentially drastic increase in glioma incidence in coming decades merits mechanistic studies comparing the neuro-immunologic consequences of VZV vaccination versus chickenpox infection and warrants early public health attention.

Molecular mimicry between varicella, measles virus and Hsp60 in type 1 diabetes associated HLA-DR3/DR4 molecules

Background and aimsType 1 diabetes (T1D) is a multifactorial autoimmune disease that combines genetics and environmental factors. The aim of this study is to determine the environmental risk factors and to investigate how virals infections are risks factors for type 1 diabetics whom have HLA DR3/DR4 predisposition in our population. MethodsThis study includes 233 subjects, 145 diabetics and 88 controls from regions of the extreme western of Algeria. All the informations related to the disease were collected using predesigned questionnaire.Using in silico approach, we attempt to improve the understanding of this analytical result by molecular mimicry, which is associated with the breakdown of several autoimmune pathologies. ResultsThe statistical study showed that history of varicella and measles infection and T1D related inheritance and type 2 diabetes are risk factors for T1D in the population of Tlemcen.We have determined the homologous antigenic regions between the glycoprotein “gE” of the varicella virus, the “hemagglutinin” of measles and the human protein “HSP60” at the level of their sequence and 3D structure. These cross-reactive epitopes bind to MHC class II molecules (HLA DR3/DR4) that predispose to T1D but not to MHC class II molecules (HLA DR2) that protect against T1D.This epitopes induce Th2 cells but only “hemagglutinin” and “Hsp60” can activate Th1 differentiation. This indicates their potential to destroy pancreatic cells β. ConclusionOur study can allow us to adapt biological markers to genetically predisposed T1D and to establish a preventive strategy for healthy genetic predisposed individuals in Tlemcen population.

A Centralized Outbreak of Varicella among Children Attending Preschool in Suzhou, China.

Background Varicella vaccine is available for voluntary purchase with a single dose currently recommended for children aged ≥12 months. An epidemiological study was undertaken in order to determine the characteristics of the outbreak, assess vaccine effectiveness, and examine risk factors for vaccine failure. Methods A varicella case was defined as a generalized papulovesicular rash (without other apparent causes) in a child without prior varicella attending the kindergarten during February 22 to April 7 of 2016. Varicella among vaccinated children (breakthrough varicella) was defined as varicella occurring >42 days after vaccination. Children's vaccination status was verified with immunization records through local vaccination information platform. Results Of the 738 children, 664 (90.0%) had no prior varicella history. Of these, 364 (54.8%) had received a single-dose varicella vaccine before outbreak. A total of 30 cases occurred in the outbreak, and 9 of them (30%) had breakthrough varicella. Age at vaccination (<15 months vs. ≥15 months) and time since vaccination before the outbreak (<3 years vs. ≥3 years) were not related to the occurrence of breakthrough varicella (P > 0.05). Single-dose varicella vaccination was 64.7% effective in preventing any varicella. Conclusions Single-dose varicella vaccine is effective in reducing the varicella attack rate, but not high enough to prevent outbreak. Timely detection and effective isolation are key factors in controlling varicella. Improving single-dose vaccination coverage and implementing two-dose vaccination strategy should be recommended to provide excellent protection to prevent varicella in the future in Suzhou.