FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 347:26-34 July 4, 2002 Number 1 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The reactivation of varicella–zoster virus from latency causes zoster and is common among recipients of hematopoietic-cell transplants.

Methods We randomly assigned patients who were scheduled to undergo autologous hematopoietic-cell transplantation for non-Hodgkin's or Hodgkin's lymphoma to receive varicella vaccine or no vaccine. Heat-inactivated, live attenuated varicella vaccine was given within 30 days before transplantation and 30, 60, and 90 days after transplantation. The patients were monitored for zoster and for immunity against varicella–zoster virus for 12 months.

Results Of the 119 patients enrolled, 111 received a transplant. Zoster developed in 7 of 53 vaccinated patients (13 percent) and in 19 of 58 unvaccinated patients (33 percent) (P=0.01). After two patients in whom zoster developed before transplantation were excluded, the respective rates were 13 percent and 30 percent (P=0.02). In vitro CD4 T-cell proliferation in response to varicella–zoster virus (expressed as the mean stimulation index) was greater in patients who received the vaccine than in those who did not at 90 days, after three doses (P=0.04); at 120 days, after all four doses (P<0.001); at 6 months (P=0.004); and at 12 months (P=0.02). The risk of zoster was reduced for each unit increase in the stimulation index above 1.6; a stimulation index above 5.0 correlated with greater than 93 percent protection. Induration, erythema, or local pain at the injection site was observed in association with 10 percent of the doses.

Conclusions Inactivated varicella vaccine given before hematopoietic-cell transplantation and during the first 90 days thereafter reduces the risk of zoster. The protection correlates with reconstitution of CD4 T-cell immunity against varicella–zoster virus.

Source Information

From the Departments of Pediatrics (A.H., H.A., M.R., M.S., A.M.A.), Health Research and Policy (R.M.W.), and Medicine (K.B.), Stanford University School of Medicine, Stanford, Calif.

Address reprint requests to Dr. Arvin at the Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Dr., Rm. G312, Stanford, CA 94305-5208.

Full Text of this Article

Related Letters:

Varicella Vaccine in Recipients of Hematopoietic-Cell Transplants
Kami M., Kim S.-W., Takaue Y., Mehta J., Arvin A. M., Blume K. G.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1624-1625, Nov 14, 2002. Correspondence

This article has been cited by other articles:

• Fuks, L., Shitrit, D., Fox, B. D., Amital, A., Raviv, Y., Bakal, I., Kramer, M. R. (2009). Herpes zoster after lung transplantation: incidence, timing, and outcome.. Ann. Thorac. Surg. 87: 423-426 [Abstract] [Full Text]  
• Erard, V., Guthrie, K. A., Varley, C., Heugel, J., Wald, A., Flowers, M. E. D., Corey, L., Boeckh, M. (2007). One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation. Blood 110: 3071-3077 [Abstract] [Full Text]  
• Landmeier, S., Altvater, B., Pscherer, S., Eing, B. R., Kuehn, J., Rooney, C. M., Juergens, H., Rossig, C. (2007). Gene-Engineered Varicella-Zoster Virus Reactive CD4+ Cytotoxic T Cells Exert Tumor-Specific Effector Function. Cancer Res. 67: 8335-8343 [Abstract] [Full Text]  
• Kochenderfer, J. N., Simpson, J. L., Chien, C. D., Gress, R. E. (2007). Vaccination regimens incorporating CpG-containing oligodeoxynucleotides and IL-2 generate antigen-specific antitumor immunity from T-cell populations undergoing homeostatic peripheral expansion after BMT. Blood 110: 450-460 [Abstract] [Full Text]  
• Boeckh, M., Kim, H. W., Flowers, M. E. D., Meyers, J. D., Bowden, R. A. (2006). Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation--a randomized double-blind placebo-controlled study. Blood 107: 1800-1805 [Abstract] [Full Text]  
• Arvin, A. (2005). Aging, Immunity, and the Varicella-Zoster Virus. NEJM 352: 2266-2267 [Full Text]  
• Oxman, M. N., Levin, M.J., Johnson, G.R., Schmader, K.E., Straus, S.E., Gelb, L.D., Arbeit, R.D., Simberkoff, M.S., Gershon, A.A., Davis, L.E., Weinberg, A., Boardman, K.D., Williams, H.M., Zhang, J. H., Peduzzi, P.N., Beisel, C.E., Morrison, V.A., Guatelli, J.C., Brooks, P.A., Kauffman, C.A., Pachucki, C.T., Neuzil, K.M., Betts, R.F., Wright, P.F., Griffin, M.R., Brunell, P., Soto, N.E., Marques, A.R., Keay, S.K., Goodman, R.P., Cotton, D.J., Gnann, J.W. Jr., Loutit, J., Holodniy, M., Keitel, W.A., Crawford, G.E., Yeh, S.-S., Lobo, Z., Toney, J.F., Greenberg, R.N., Keller, P.M., Harbecke, R., Hayward, A.R., Irwin, M.R., Kyriakides, T.C., Chan, C.Y., Chan, I.S.F., Wang, W.W.B., Annunziato, P.W., Silber, J.L., the Shingles Prevention Study Group, (2005). A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults. NEJM 352: 2271-2284 [Abstract] [Full Text]  
• Hambleton, S., Gershon, A. A. (2005). Preventing Varicella-Zoster Disease. Clin. Microbiol. Rev. 18: 70-80 [Abstract] [Full Text]  
• Sande, M. A., Ronald, A. R. (2004). Update in Infectious Diseases. ANN INTERN MED 140: 290-295 [Full Text]  
• Molrine, D. C., Antin, J. H., Guinan, E. C., Soiffer, R. J., MacDonald, K., Malley, R., Malinoski, F., Trocciola, S., Wilson, M., Ambrosino, D. M. (2003). Donor immunization with pneumococcal conjugate vaccine and early protective antibody responses following allogeneic hematopoietic cell transplantation. Blood 101: 831-836 [Abstract] [Full Text]  
• Kami, M., Kim, S.-W., Takaue, Y., Mehta, J., Arvin, A. M., Blume, K. G. (2002). Varicella Vaccine in Recipients of Hematopoietic-Cell Transplants. NEJM 347: 1624-1625 [Full Text]  
• (2002). Varicella Vaccine Prevents Herpes Zoster After Bone Marrow Transplantation. Journal Watch Dermatology 2002: 7-7 [Full Text]  
• (2002). Varicella Vaccine Protective for Hematopoietic-Cell Transplant Recipients. JWatch Infect. Diseases 2002: 6-6 [Full Text]  
• Antin, J. H. (2002). Long-Term Care after Hematopoietic-Cell Transplantation in Adults. NEJM 347: 36-42 [Full Text]