(1/283) Risk factors for breakthrough varicella in healthy children.

AIM: To evaluate the risk factors for breakthrough varicella in a follow up study of a cohort of 181 healthy children immunised when aged 9-24 months with a reformulated Oka strain varicella vaccine (SmithKline Beecham Biologicals/Oka). DESIGN: The children were randomised in a double blind manner into one of four groups to receive one of two production lot vaccine batches, at two different titres (high titre, 10(3.9) and 10(4.0) plaque forming units (pfu); low titre (heat exposed), 10(2.7) and 10(2.8) pfu). The overall seroconversion rate after immunisation was 99%. RESULTS: One hundred and sixty-eight patients were available for review after a mean (SD) follow up of 35 (9) months after vaccination. Multivariate analysis indicated that risk factors for breakthrough varicella were household contact with varicella (adjusted odds ratio (OR), 19.89; 95% confidence interval (CI), 18.39 to 21.39), vaccination age of < or = 14 months (adjusted OR, 2.30; 95% CI, 1.69 to 2.90), and receiving low titre (10(2.7) pfu) vaccine (adjusted OR, 2.13; 95% CI, 1.54 to 2.73). All children who developed breakthrough varicella, had a modified varicella illness, except for three, all of whom had received low titre vaccine. CONCLUSION: The identification of young immunisation age (< or = 14 months) and low titre vaccine as risk factors for breakthrough varicella have important implications for the implementation of varicella vaccination programmes in healthy children.  (+info)

(2/283) Prevention of varicella. Update recommendations of the Advisory Committee on Immunization Practices (ACIP).

In February 1999, the Advisory Committee on Immunization Practices (ACIP) expanded recommendations for varicella (chickenpox) vaccine to promote wider use of the vaccine for susceptible children and adults. The updated recommendations include establishing child care and school entry requirements, use of the vaccine following exposure and for outbreak control, use of the vaccine for some children infected with the human immunodeficiency virus (HIV), and vaccination of adults and adolescents at high risk for exposure. These recommendations also provide new information on varicella vaccine postlicensure safety data.  (+info)

(3/283) Varicella-zoster virus-specific cellular immunity in subjects given acyclovir after household chickenpox exposure.

The time course of primary cell-mediated immune responses to varicella-zoster virus (VZV) among persons receiving acyclovir prophylaxis after exposure to chickenpox has not been well defined. Fifteen children who had household exposure to varicella received prophylactic acyclovir (40 mg/kg/day for 7-14 days after exposure) and were studied for development of both antibody and cell-mediated immunity (CMI) to VZV. Twelve developed antibodies and/or CMI; 10 had no symptoms and 2 manifested mild varicella. Two were already immune to varicella and had booster immune responses. One was not infected and subsequently developed full-blown varicella. Although acyclovir given after exposure to VZV is highly effective and does not appear to attenuate the immune response, it remains necessary to confirm whether, in the absence of clinical varicella, persons acquire specific immunity.  (+info)

(4/283) Infant vaccinations and risk of childhood acute lymphoblastic leukaemia in the USA.

Previous studies have suggested that infant vaccinations may reduce the risk of subsequent childhood leukaemia. Vaccination histories were compared in 439 children (ages 0-14) diagnosed with acute lymphoblastic leukaemia (ALL) in nine Midwestern and Mid-Atlantic states (USA) between 1 January 1989 and 30 June 1993 and 439 controls selected by random-digit dialing and individually matched to cases on age, race and telephone exchange. Among matched pairs, similar proportions of cases and controls had received at least one dose of oral poliovirus (98%), diphtheria-tetanus-pertussis (97%), and measles-mumps-rubella (90%) vaccines. Only 47% of cases and 53% of controls had received any Haemophilus influenzae type b (Hib) vaccine (relative risk (RR) = 0.73; 95% confidence interval (CI) 0.50-1.06). Although similar proportions of cases (12%) and controls (11%) received the polysaccharide Hib vaccine (RR = 1.13; 95% CI 0.64-1.98), more controls (41%) than cases (35%) received the conjugate Hib vaccine (RR = 0.57; 95% CI 0.36-0.89). Although we found no relationship between most infant vaccinations and subsequent risk of childhood ALL, our findings suggest that infants receiving the conjugate Hib vaccine may be at reduced risk of subsequent childhood acute lymphoblastic leukemia. Further studies are needed to confirm this association and, if confirmed, to elucidate the underlying mechanism.  (+info)

(5/283) Immunisation against varicella in end stage and pre-end stage renal failure. Trans-Pennine Paediatric Nephrology Study Group.

OBJECTIVES: To investigate the seroconversion rate and duration of persistence of protective antibody titres after varicella immunisation in children with renal failure. DESIGN: 32 children (25 end stage and 7 pre-end stage renal failure) were immunised using 2 x 2,000 plaque forming unit doses of varicella vaccine 3 months apart. Varicella antibody titres were measured by enzyme linked immunosorbent assay. RESULTS: All children initially seroconverted after immunisation. At a mean follow up of 20.3 months, 23 of 28 had protective antibody titres, 4 children having died of unrelated causes. Two children required a third booster dose. 11 children underwent renal transplantation; 10 had protective titres at the time of transplantation and, at a mean of 23.4 months after immunisation, 6 currently have protective titres. Minor side effects occurred after 11 vaccine doses in 9 children. No child developed varicella, despite 10 clear episodes of exposure to the wild-type virus. CONCLUSIONS: Varicella immunisation in children with end stage and pre-end stage renal failure results in a high rate of seroconversion and persistence of protective antibody titres. More widespread use of the vaccine before renal transplantation is recommended.  (+info)

(6/283) Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation.

We report a retrospective analysis of VZV infection after haematopoietic stem cell transplantation (HSCT) in children. Thirty-three (30%) of the total 109 children who were transplanted during a 7 year period developed post-transplant VZV infection. Twenty-four of these 33 (73%) children had VZV infection within 1 year following HSCT. The cumulative incidences of post-transplant VZV infection at 1 and 5 years were 26% and 45%, respectively. The positive and negative predictive values of pretransplant VZV serology in recipients on the development of HZ following HSCT were 39% and 88%, respectively. Pretransplant VZV seropositivity in recipients was the only risk factor for post-transplant herpes zoster (HZ) infection on multivariate analysis. All patients responded to acyclovir. The median duration of VZV infection was 5 days. Three (11%) and one (3%) children with HZ developed visceral dissemination and post-herpetic neuralgia, respectively. No mortality was directly attributed to VZV infection. VZV infection remains a major cause of morbidity in children after HSCT. Further studies are warranted to evaluate the potential use of VZV vaccine in these children. Bone Marrow Transplantation (2000) 25, 167-172.  (+info)

(7/283) Vaccination coverage among adolescents 1 year before the institution of a seventh grade school entry vaccination requirement--San Diego, California, 1998.

In 1996, the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Association of Family Physicians, and the American Medical Association recommended routine health-care visits for children aged 11-12 years, emphasizing vaccination with hepatitis B vaccine; measles, mumps, and rubella vaccine (MMR); tetanus and diphtheria toxoids (Td); and varicella vaccine. Because no national data exist regarding vaccination coverage among adolescents, the impact of these recommendations is unknown. In October 1997, California enacted Assembly Bill 381 (AB381) that requires students entering the seventh grade on or after July 1, 1999, to have received three doses of hepatitis B vaccine and two doses of MMR. To assist in planning and implementing AB381, the San Diego County Health Department expanded its 1998 infant and adult vaccination survey to include fifth and sixth graders. This report summarizes the findings from that survey, which indicate that most fifth and sixth graders lacked required and recommended vaccinations.  (+info)

(8/283) Nucleotide sequences that distinguish Oka vaccine from parental Oka and other varicella-zoster virus isolates.

The sequences of approximately 34 kb from the 3' end of the varicella-zoster virus (VZV) Oka vaccine strain and the previously sequenced Dumas strain were compared. Sequence differences were noted in the coding sequences of several VZV open reading frames (ORFs), including ORFs 48, 51, 52, 55, 56, 58, 59, 60, 62, 64, and 68. Tests based on differences in the ORF62 gene and in the ORF64 poly-A region successfully distinguished the Oka vaccine strain from its wild-type parent and from other Japanese and US clinical isolates. These changes remained stable after passage of the virus in humans.  (+info)