成人水痘20例临床分析

目的探讨成人水痘的临床特点。方法分析20例成人水痘的临床特点，并与30例儿童水痘比较。结果患者出疹时间、皮疹分布区域、发热时间和并发症等，成人水痘都与儿童水痘不同。结论与儿童水痘相比较，成人水痘有自己的临床特点。     

Sensitive enzyme-linked immunosorbent assay for antibody to varicella-zoster virus using purified VZV glycoprotein antigen

The development of an ELISA of increased sensitivity has permitted a more critical evaluation of human humoral immune responses to the live attenuated varicella (Oka/Merck) vaccine. For use as a solid-phase antigen, the glycoprotein (gp) antigens are prepared by lectin-affinity chromatography from lysates of VZV-infected MRC-5 cells. The lot-to-lot variation in VZV gp content is controlled by standardization of antigen against a panel of human serum providing antigen-coated plates of consistent quality. The increased sensitivity of the gpELISA over the VAR ELISA is reflected in the greater seroconversion rate and prepositive rate specificity. These determinations have been shown to be specific for anti-VZV by absorption experiments using purified VZV gp antigens.     

2017—2021年扬州市宝应县水痘流行病学特征分析

目的 分析2017—2021年扬州市宝应县水痘的流行特征,为水痘防制工作提供参考依据。方法 通过查阅监测系统相关数据的方式,采用描述性流行病学方法对2017—2021年扬州市宝应县水痘发病情况进行流行病学特征分析。结果 2017—2021年扬州市宝应县累计报告水痘病例3 841例,年均发病率为105.74/10万,5年发病率总体呈逐年上升趋势(χ2=112.92,P<0.01);有2个发病高峰期,主要集中在5—7月及10月至次年的2月,报告发病数分别占总病例数的27.65%、51.54%;人群以15岁及以下学生及幼托儿童为主,占79.24%;男性发病率略高于女性;城区发病率高于乡镇地区;突发公共卫生事件的发生主要集中在水痘发生的高峰期;疫苗首针剂的接种率总体呈现逐年上升的趋势(χ2=37.37,P<0.01)。结论 扬州市宝应县水痘的发生情况有明显的季节、年龄、职业和地区差异,加强15岁及以下人群的水痘二针剂疫苗的接种及防护知识宣传,这是预防水痘疫情发生和扩散的关键。     

The Economic Value of Childhood Varicella Vaccination in France and Germany

OBJECTIVE: To determine the economic impact of childhood varicella vaccination in France and Germany. METHODS: A common methodology based on the use of a varicella transmission model was used for the two countries. Cost data (2002 per thousand) were derived from two previous studies. The analysis focused on a routine vaccination program for which three different coverage rates (CRs) were considered (90%, 70%, and 45%). Catch-up strategies were also analyzed. A societal perspective including both direct and indirect costs and a third-party payer perspective were considered (Social Security in France and Sickness Funds in Germany). RESULTS: A routine vaccination program has a clear positive impact on varicella-related morbidity in both countries. With a 90% CR, the number of varicella-related deaths was reduced by 87% in Germany and by 84% in France. In addition, with a CR of 90%, routine varicella vaccination induces savings in both countries from both societal (Germany 61%, France 60%) and third-party payer perspectives (Germany 51%, France 6.7%). For lower CRs, routine vaccination remains cost saving from a third-party payer perspective in Germany but not in France, where it is nevertheless cost-effective (cost per life-year gained of 6521 per thousand in the base case with a 45% CR). CONCLUSION: Considering the impact of vaccination on varicella morbidity and costs, a routine varicella vaccination program appears to be cost saving in Germany and France from both a societal and a third-party payer perspective. For France, routine varicella vaccination remains cost-effective in worst cases when a third-party payer perspective is adopted. Catch-up programs provide additional savings.     

儿童白血病合并暴发型水痘带状疱疹病毒感染临床分析

目的探讨白血病患儿合并水痘带状疱疹病毒感染的临床特点及防治措施.方法回顾性分析1995年1月～2003年2月某院收治的6例合并水痘带状疱疹病毒感染的白血病患儿病历情况.结果 6例患儿均有发热及典型皮损,其中4例为持续高热(39～40.4℃)达1周,皮疹均为全身性分布.6例患儿均治愈,无水痘并发症发生.结论白血病患儿合并水痘带状疱疹病毒感染多呈暴发性感染,临床症状较重,容易出现并发症,应采取积极有效的防治措施.大剂量静脉用免疫球蛋白联合抗病毒药物等综合治疗效果较好.     

Successful differentiation of herpes zoster‐associated erythema multiforme from generalized extension of herpes by rapid polymerase chain reaction analysis

The polymerase chain reaction (PCR) assay for varicella zoster virus (VZV), herpes simplex virus (HSV)‐1 and HSV‐2 is available for use. Sometimes the differential diagnosis of the generalized herpes zoster (HZ), HSV1/2, and drug eruption is difficult. We report a case of HZ followed by the vesicular erythema multiforme (EM)‐like lesion. In this case the use of PCR was of great assistance. A 78‐year‐old Japanese man without any significant previous history of disease was admitted to our hospital complaining of zosteriform vesicle on an erythematous base from his right shoulder to the upper arm. We diagnosed him with HZ at the level of right Th2. In spite of the prompt start of antiviral therapy, a secondary new vesiculous erythema developed on his trunk. Clinically, it was quite difficult to differentiate the lesion from the generalized HZ. Rapid PCR assay of effusion and crust for VZV was performed. A PCR assay of VZV was positive for the crust taken from the primary lesion, while it was negative for the effusion and crust of the secondary widespread lesion. We diagnosed the secondary widespread lesion as an EM‐type drug eruption induced by acyclovir, or an EM associated with herpes zoster. We then stopped the use of acyclovir and applied steroid ointment of a very strong class for the secondary lesions, which improved after a few days. A PCR assay for VZV was useful for ruling out the generalized HZ in our case with secondary developed vesiculous lesions.     

Varicella vaccination in Japan: necessity of implementing a routine vaccination program

Varicella-zoster virus (VZV) is the causative agent of varicella (chickenpox). It shows extremely high infectivity and is spread by airborne, droplet, and contact transmission. After a person is infected with VZV, the virus remains dormant in the dorsal root ganglia, but can be reactivated under circumstances where specific immunity declines, leading to the development of herpes zoster (shingles). Although varicella is a disease that usually resolves after about 1 week, it can cause various complications such as secondary bacterial skin infection, pneumonia, and encephalitis. In addition, varicella can become severe in immunocompromised persons, whereas VZV infection transmitted from an infected mother can cause the congenital varicella syndrome or serious neonatal varicella. In 1974, a live varicella vaccine (Oka strain) was developed in Japan for the prevention of varicella, and clinical trials performed during the development were mainly focused on high-risk children. In 1985, the Oka strain was recognized as the best varicella vaccine strain by the World Health Organization (WHO). Today, all the varicella vaccines used worldwide to immunize approximately 32 million people annually contain the Oka strain. In Japan, it has been commercially available since 1987 for the voluntary vaccination program, in which children over the age of 1 year with no history of previous varicella infection receive a single dose. In addition to healthy children, this vaccine can be used for immunocompromised children, and vaccination of elderly persons can also be done to enhance their immunity against VZV. Varicella vaccine is a highly safe vaccine with sufficient immunogenicity. The preventive effect of single-dose vaccination is believed to be approximately 80 % for all types of varicella, including mild cases; it is 95 % or greater for moderate to severe disease. Implementation of a two-dose vaccination schedule has proved to be effective against breakthrough varicella, which is observed in approximately 20–30 % of children vaccinated with a single dose. Because it is administered as part of the voluntary vaccination program, the varicella vaccination coverage rate in Japan has remained low until recently at around 20–30 %, with no sign of a decrease in the number of varicella patients. It is necessary to maintain a vaccination rate of 90 % or higher to prevent varicella epidemics. To achieve this goal, implementation of a routine vaccination program for varicella and introduction of a two-dose vaccination schedule, which is more effective than a single-dose schedule, would be highly desirable.     

Antiviral Therapies for Herpesviruses: Current Agents and New Directions

Purpose

The objective of this review was to summarize the recent literature describing the current burden of disease due to herpesviruses in the antiviral and transplant era; describe mechanisms of action of antiviral agents and the development of resistance; summarize the literature of recent antiviral agents brought to market as well as agents under development; and to present literature on future strategies for herpesvirus therapeutics.