Long ‐term study showed that vaccination protected paediatric renal transplant recipients from life‐threatening varicella zoster virus
Acta Paediatrica, EarlyView.
Herpes zoster (HZ) results from reactivation of latent varicella zoster virus (VZV) presenting as a dermatomal rash. Diminished cellular immunity to VZV increases HZ risk and incidence in solid organ transplant (SOT) is higher than the general population. Immunogenicity and safety of the inactivated varicella vaccine (RZV, Shingrix) has been demonstrated in renal transplant (KT) but data in heart transplant (HT) are lacking.
Herpes zoster, otherwise known as shingles, can be a devastating complication after heart transplantation due to persistent and severe herpetic neuralgia. Our heart transplant patients are recommended to have the shingles vaccine prior to heart transplantation, but this is not always achieved. We sought to assess whether the shingles vaccine did indeed prevent clinical shingles development after heart transplantation.
CONCLUSIONSWe confirm that seroprotection for vaccine-preventable disease is affected by treatment for pediatric malignancy. A single booster dose of vaccine might be a practical way to restore vaccine immunity in patients after chemotherapy.
After allogeneic stem cell transplant (SCT), varicella zoster virus (VZV) necessitates long term chemoprophylaxis due to limitations of the live vaccine. The recombinant subunit vaccine containing VZV glycoprotein E with AS01B adjuvant system (HZ/su, or Shingrix) has safety and efficacy data after autologous transplantation. However, data is absent in the setting of allogeneic SCT. Due to the highly immunogenic AS01b subunit component, concerns regarding stimulation of graft versus host disease (GVHD) reaction have prompted some institutions to avoid routine HZ/su vaccination early after SCT.
Hematopoietic cell transplant (HCT) recipients are at high risk for Varicella zoster virus (VZV) reactivation. Shingrix, the adjuvanted recombinant zoster vaccine, is a new alternative to the live-attenuated VZV vaccine for immunocompromised individuals. Post-marketing data on its immunogenicity and safety in HCT is limited.
Condition: Herpes Zoster Intervention: Biological: HZ/su vaccine (GSK1437173A) Sponsor: GlaxoSmithKline Not yet recruiting
This NIHR Signal says that the risk of shingles is about 10% per year in adults after autologous stem cell transplant. The evidence summary indicates that two doses of deactivated herpes zoster vaccine could be a safe and effective way to reduce that risk by about two thirds.This effect is similar to another, heat-treated, non-live vaccine. Either vaccine could reduce the pain and need for medical treatment associated with shingles, and long-lasting complications such as post-herpetic neuralgia. It's not yet known if people need to continue taking acyclovir as well.
CONCLUSION: Both HZ and PHN are associated with considerable disutility in recipients of auto-HSCT. Costs were comparable to published estimates in other immunocompromised subjects.The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT01229267). PMID: 31721601 [PubMed - as supplied by publisher]
Conclusions. VZV immunization of pediatric solid organ transplant recipients confers sustained seroprotection.