Herpes zoster is an uncommon disease in children, especially in healthy children. The clinical studies and observations of herpes zoster has been focused to children with hemato-oncologic diseases or immuno-compromised conditions. Recently the association of herpes zoster after varicella vaccine (Oka strain) immunization has been concerned and some cases of normal children after varicella vaccination have been reported. We experienced two cases of herpes zoster in healthy children after varicella vaccination.
Chickenpox Vaccine ; Chickenpox* ; Child* ; Herpes Zoster* ; Humans ; Immunization ; Vaccination*

With the determination of the whole genome sequence of varicella-zoster virus (VZV) virus, the successful breakthrough of infectious cloning technology of VZV, and the emergence of effective preventive vaccines, which have been proven to be effective and safe, varicella has become a disease preventable by specific immunity. This article will review the genomic structure, epidemiological characteristics, and research application progress of varicella vaccine and herpes zoster vaccine of varicella zoster virus to provide reference for primary prevention of the disease.
Humans ; Herpesvirus 3, Human/genetics* ; Herpes Zoster/prevention & control* ; Herpes Zoster Vaccine ; Chickenpox Vaccine ; Genomics

Varicella, which is mostly a benign disease, but also can cause considerable health burden in the community, can be prevented by immunization with live attenuated varicella vaccine. Higher uptake of varicella vaccine by universal immunization in North America has apparently been associated with decline in the number of reported cases of varicella, varicella-related hospitalizations, and the number of deaths caused by complications of varicella. On the contrary, there has been some reluctance in endorsing varicella vaccine for universal immunization in most of European countries. Concerns include unanticipated outbreaks of varicella among vaccine recipients, risk of varicella among unvaccinated adults, risk of herpes zoster among vaccinees as well as unvaccinees. Recently developed measles, mumps, rubella, and varicella combination vaccine and herpes zoster vaccine that may be licensed in the upcoming years may be the solution for varicella vaccine to be utilized in a greater scale. In Korea several varicella vaccine products have been utilized since late 1980. The adoption of varicella vaccine for universal immunization since 2005 along with the changing view in varicella prevention strategy mandates more studies for immunogenecity and efficacy of varicella vaccines as well as more surveillance to delineate the changes in epidemiology of varicella in Korea.
Adult ; Chickenpox Vaccine ; Chickenpox* ; Disease Outbreaks ; Epidemiology ; Herpes Zoster ; Herpes Zoster Vaccine ; Hospitalization ; Humans ; Immunization ; Korea ; Measles ; Mumps ; North America ; Rubella ; Vaccination* ; Vaccines

Varicella zoster virus (VZV) causes two diseases: Varicella, a generalized, primary infection, and herpes zoster (zoster), a secondary infection caused by latent VZV reactivation. Zoster can also be caused by latent VZV reactivation after a varicella vaccination. The complications associated with varicella include cutaneous infections, which are the most common, as well as pulmonary and neurological involvement. However, a deep venous thrombosis (DVT) has been rarely described as a varicella-associated complication. Here, we describe the case of a child with varicella zoster who developed a DVT that completely resolved after intravenous acyclovir and subcutaneous low-molecular-weight heparin treatment.
Acyclovir ; Chickenpox ; Chickenpox Vaccine ; Child ; Coinfection ; Heparin, Low-Molecular-Weight ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Vaccination ; Venous Thrombosis

Varicella zoster virus (VZV) causes two diseases: Varicella, a generalized, primary infection, and herpes zoster (zoster), a secondary infection caused by latent VZV reactivation. Zoster can also be caused by latent VZV reactivation after a varicella vaccination. The complications associated with varicella include cutaneous infections, which are the most common, as well as pulmonary and neurological involvement. However, a deep venous thrombosis (DVT) has been rarely described as a varicella-associated complication. Here, we describe the case of a child with varicella zoster who developed a DVT that completely resolved after intravenous acyclovir and subcutaneous low-molecular-weight heparin treatment.
Acyclovir ; Chickenpox ; Chickenpox Vaccine ; Child ; Coinfection ; Heparin, Low-Molecular-Weight ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Vaccination ; Venous Thrombosis

OBJECTIVETo evaluate the breakthrough varicella infection rate and varicella vaccine effectiveness (VE) among children who received 1-dose varicella vaccine.

METHODSA total of 57 180 subjects for the consecutive 4-year birth cohorts were selected from the local children born between 2007 and 2010 in Yinzhou District, Ninghai County and Yuyao City. And they were followed up for varicella from 2008 to 2013. The recipients of the vaccinations were identified through Ningbo Immunization Information System and data on breakthrough infections among the recipients were collected by using China Information System for Disease Control and Prevention. The breakthrough varicella rate and the VE were calculated and the trends of them were described from 2008 to 2013 among 4-year birth cohorts. The cumulative incidence of varicella was compared between vaccinated and unvaccinated children among the consecutive 4-year birth cohorts.

RESULTSThe rate of varicella vaccine coverage, vaccine cumulative incidence among the cohorts was 96.74% (55 317/57 180) and 0.56% (321/57 180). The breakthrough varicella infection for 4-year birth cohorts was 0.44% (244/55 317), and for each birth cohort was 0.95% (142/14 928), 0.44% (61/13 855), 0.22% (29/13 433) and 0.09% (12/13 101), respectively. It was on the rise from 2008 to 2013 and the 2007 birth cohort of it increased fastest from 0.04% (6/14 928) in 2007 to 0.32% (48/14 834) in 2013. The vaccine cumulative incidence of these who vaccinated 1-dose varicella (the breakthrough varicella infection) was lower than these who were unvaccinated (the incidence: 6.25% (37/592), 3.52% (15/426), 3.69% (17/461) and 2.08% (8/384)) by each birth cohort (χ²= 130.27, P < 0.001 for 2007 birth cohort; χ²= 74.11, P < 0.001 for 2008 birth cohort; χ²= 162.80, P < 0.001 for 2009 birth cohort; χ²= 100.01, P < 0.001 for 2010 birth cohort). The vaccine effectiveness for 4-year birth cohorts was 89.33% (95% CI: 86.7%-92.1%) and for each birth corhort was 84.78% (95% CI: 77.94%-89.50%), 86.82% (95% CI: 77.82%-92.95%), 93.99% (95% CI: 89.27%-96.81%) and 95.60% (95% CI: 89.18%-98.21%), respectively. The effectiveness of each birth cohort declinedgradually from 2008 to 2013 and the 2009 birth cohort of it decreased fastest from 98.86% in 2010 to 66.83% in 2013.

CONCLUSIONSThe 1-dose varicella vaccine effectiveness was good, but breakthrough varicella infection rate was on the rise with time and the VE declined gradually from 2008 to 2013.

Objective: To understand the knowledge, attitude, and current status of vaccination of herpes zoster vaccination among urban residents aged 25 years and above in China. Methods: In August to October 2022, a convenience sampling method was used to survey residents aged 25 years and above at 36 community centers in 9 cities across China. Questionnaires were used to collect basic information, knowledge, and attitude toward herpes zoster and its vaccination, as well as vaccination status and reasons for non-vaccination among residents. Results: A total of 2 864 urban residents were included in the study. The total score of residents' cognition of herpes zoster and its vaccine was 3.01±2.08, and the total score of their attitude was 18.25±2.76. Factors such as being male (β=-0.45, P<0.001), older than 40-59 years (β=-0.34, P=0.023) or ≥60 years (β=-0.68, P<0.001), married (β=-0.69, P=0.002) were negatively associated with knowledge score. The educational level of high school or secondary school (β=0.44, P=0.036), college (β=0.65, P=0.006), bachelor's degree and above (β=1.20, P<0.001), annual net household income ≥120 000 Yuan in 2021 (β=0.42, P=0.020), having urban employee medical insurance (β=0.62, P=0.030), having public or commercial medical insurance (β=0.65, P=0.033), and having a history of chickenpox (β=0.29, P=0.025) were positively associated with knowledge scores. Being male (β=-0.38, P=0.008) and not remembering a history of chickenpox (β=-0.49, P=0.012) were negatively associated with attitude scores. Annual net household income in 2021 was between 40 000-80 000 Yuan (β=0.44, P=0.032) or between 80 000-120 000 Yuan (β=0.62, P=0.002) or ≥120 000 Yuan (β=0.93, P<0.001), and a history of herpes zoster (β=0.59, P=0.004) were positively associated with attitude scores. Of the 2 864 residents surveyed, only 29 (1.01%) had received the herpes zoster vaccine, with a vaccination rate of 1.70% for those aged 50 years and above, with the main reason for non-vaccination being lack of knowledge about the herpes zoster vaccine, followed by the high price. 42.67% of the population said they would consider getting the herpes zoster vaccine in the future. Conclusion: Low knowledge of herpes zoster and its vaccine, positive attitudes towards the preventive effects of herpes zoster and its vaccine, and extremely low vaccination rates among the urban population in China call for multiple measures to strengthen health education and vaccination recommendations for residents, especially for the elderly, low-education and low-income populations.
Aged ; Male ; Humans ; Female ; Herpes Zoster Vaccine ; Chickenpox ; Health Knowledge, Attitudes, Practice ; Urban Population ; Herpes Zoster/prevention & control* ; China

Varicella vaccine has been included in the national immunization program for children since 2005 and zoster vaccine has been released since 2012 in Korea. Even though both varicella and zoster are caused by varicella-zoster virus (VZV), pathogeneses are different. In varicella, neutralizing antibody is very important to protect disease because VZV spreads via blood or lymph. In contrast, cell-mediated immunity is more important in zoster because of the neuronal spread of VZV. Therefore, the measurement methods of the immunogenicity against varicella and zoster vaccines are different. Fluorescent antibody to membrane antigen (FAMA) assay is the gold standard method to detect the protective antibody against VZV. It is still used as a reference test for the other methods. However, the fastidious nature required to perform the FAMA assay limits its use as a routine assay for the evaluation of vaccine immunogenicity. Nowadays, glycoprotein ELISA (gpEIA) is used as an alternative method for FAMA assay. However, there is no agreement over the protective level of gpEIA antibody titer with WHO standard international unit. The immunogenicity of zoster vaccine has been evaluated by responder cell frequency assay and IFN-gamma ELISpot assay. Nevertheless, skin test is considered to be a more accurate biomarker for cell-mediated immunity against zoster. For the evaluation of varicella vaccine, it is necessary to standardize the FAMA assay and to set the cut-off value for the gpEIA antibody titer through long-term follow-up study. For zoster vaccine, the evaluation of cell-mediated immunity in Korean adults is urgently needed.
Adult ; Antibodies, Neutralizing ; Chickenpox Vaccine ; Chickenpox* ; Child ; Enzyme-Linked Immunosorbent Assay ; Enzyme-Linked Immunospot Assay ; Follow-Up Studies ; Glycoproteins ; Herpes Zoster Vaccine ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Immunization Programs ; Korea ; Membranes ; Methods* ; Neurons ; Skin Tests ; Vaccines*

Objective: To investigate the genetic characteristics of varicella zoster virus (VZV) in Shandong province from 2020 to 2021. Methods: From April 2020 to December 2021, 85 herpes fluid samples from suspected varicella patients in Shandong province were collected. The qPCR was used to detect viral DNA and screen suspected samples. Six single nucleotide polymorphisms (SNPs) of ORF22 fragment and ORF38 fragment in positive samples were examined via PCR and Sanger sequencing to identify the viral genotypes. Four SNPs of ORF38 and ORF62 were examined to identify the vaccine and wild-type strains. The sequences were analyzed with Sequencher and MEGA7 software, using the VZV reference strain sequences from GenBank. Results: In the 85 samples suspected of varicella, 80 were VZV positive and wild-type strains belonging to Clade 2. Compared with clade 2 representative strains, the nucleotide and amino acid similarities of ORF22 fragment were 99.5%-100% and 98.5%-100%, respectively. SD20-1, SD20-5, SD20-6, SD20-8, SD20-9, SD20-10, SD20-11, SD20-12, SD20-13, SD20-30 and SD20-31 had a A➝G nucleotide mutation at 37990, causing amino acid change from glutamine to arginine. SD21-1 had a C➝A nucleotide mutation at 38059, causing threonine to asparagine during coding. Conclusions: From 2020 to 2021, all VZV strains in Shandong province are the wild-type strains belonging to Clade 2.
Amino Acids/genetics* ; Chickenpox ; Chickenpox Vaccine/genetics* ; Herpes Zoster ; Herpesvirus 3, Human/genetics* ; Humans ; Nucleotides ; Polymorphism, Single Nucleotide ; Real-Time Polymerase Chain Reaction

Varicella (chickenpox) is a highly contagious airborne disease caused by primary infection with the varicella zoster virus (VZV). Following the resolution of chickenpox, the virus can remain dormant in the dorsal sensory and cranial ganglion for decades. Shingles (herpes zoster [HZ]) is a neurocutaneous disease caused by reactivation of latent VZV and may progress to postherpetic neuralgia (PHN), which is characterized by dermatomal pain persisting for more than 120 days after the onset of HZ rash, or "well-established PHN", which persist for more than 180 days. Vaccination with an attenuated form of VZV activates specific T-cell production, thereby avoiding viral reactivation and development of HZ. It has been demonstrated to reduce the occurrence by approximately 50-70%, the duration of pain of HZ, and the frequency of subsequent PHN in individuals aged > or = 50 years in clinical studies. However, it has not proved efficacious in preventing repeat episodes of HZ and reducing the severity of PHN, nor has its long-term efficacy been demonstrated. The most frequent adverse reactions reported for HZ vaccination were injection site pain and/or swelling and headache. In addition, it should not be administrated to children, pregnant women, and immunocompromised persons or those allergic to neomycin or any component of the vaccine.
Aged ; Chickenpox ; Child ; Exanthema ; Female ; Ganglion Cysts ; Headache ; Herpes Zoster ; Herpes Zoster Vaccine ; Herpesvirus 3, Human ; Humans ; Neomycin ; Neuralgia, Postherpetic ; Pregnant Women ; T-Lymphocytes ; Vaccination ; Viruses