考虑重组带状疱疹疫苗用于脆弱的儿科患者：一个新的机会

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2025-04-07 DOI:10.1016/j.vaccine.2025.127072

A. Mollo , M. Peri , L. Lodi , A. Gissi , P. Lionetti , E. Marrani , M.V. Mastrolia , A. Tondo , V. Tintori , I. Sardi , G. Indolfi , S. Trapani , L. Galli , E. Venturini , V. Astorino , C. Azzari , S. Ricci

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引用次数: 0

摘要

一种重组疫苗被批准用于预防≥50岁的成人和≥19岁的免疫功能低下个体的带状疱疹（HZ）。然而，在儿童中，减毒活疫苗仍然是预防水痘带状疱疹病毒（VZV）的唯一策略，只有一项试验评估了葛兰素史克（GlaxoSmithKline）的HZ亚基候选疫苗在免疫功能低下儿童中的安全性和免疫原性。目的了解我院三级儿科医院的VZV负担，确定其发生和并发症的高危儿童群体，探讨灭活疫苗的必要性。方法回顾2018年1月至2023年5月梅耶儿童医院VZV/HZ出院代码和VZV阳性分子检测。我们根据患者的疫苗接种状况将其分类为未接种疫苗、部分接种疫苗（单剂量）或完全接种疫苗（完整的两剂量方案）。还包括来自同一部门和时期的96个对照，以评估VZV疫苗的有效性。结果48例VZV患者中，52%为女性；中位年龄：11.6岁[IQR: 7-14.2])， 10例水痘，38例HZ；2/48（4.2%）接种2剂疫苗，10/48（20.8%）接种1剂疫苗，36/48（75%）未接种疫苗。48例患者中有20例（42%）存在免疫相关合并症，在需要住院治疗的HZ患者中，合并症强烈预测住院(OR 4.71；95% ci, 1.23-20.39；p = 0.028)。完全疫苗接种在对照组（43/96,45%）比病例（2/48,4.2%）更频繁；p & lt;0.001)。结论在我们的队列中，许多病例有合并症，禁止使用减毒活疫苗。如果证实安全有效，重组HZ疫苗可以为不适合接种活病毒疫苗的免疫功能低下儿童提供一种预防性选择。

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Considering recombinant herpes zoster vaccine for fragile pediatric patients: A new opportunity

Background

A recombinant vaccine is approved to prevent herpes zoster (HZ) in adults ≥50 years and immunocompromised individuals ≥19 years. However, in children, the live attenuated vaccine remains the only prevention strategy against varicella zoster virus (VZV), with only one trial evaluating the safety and immunogenicity of GlaxoSmithKline's HZ subunit candidate vaccine in immunocompromised children.

Objectives

To estimate VZV burden in our third level pediatric hospital and identify high-risk pediatric groups for its occurrence and complications to explore the need for an inactivated vaccine.

Methods

We reviewed VZV/HZ hospital discharge codes and positive VZV molecular tests at Meyer Children's Hospital from January 2018 to May 2023. We categorized patients based on their vaccination status as unvaccinated, partially vaccinated (single dose), or fully vaccinated (complete two-dose regimen). 96 controls from the same Departments and period were also included to assess VZV vaccine effectiveness.

Results

Of 48 patients with VZV (52 % female; median age: 11.6 years [IQR: 7–14.2]), 10 had chickenpox and 38 HZ; 2/48 (4.2 %) received 2 doses of vaccination, 10/48 (20.8 %) were immunized with 1 dose and 36/48 (75 %) were unvaccinated. Immune-related comorbidities were present in 20/48 (42 %) patients, and among those with HZ requiring hospitalization, comorbidities strongly predicted admission (OR 4.71; 95 % CI, 1.23–20.39; p = 0.028). Full vaccination was more frequent in controls (43/96, 45 %) than in cases (2/48, 4.2 %; p < 0.001).

Conclusions

In our cohort, many cases had comorbidities contraindicating the live attenuated vaccine. If proven safe and effective, the recombinant HZ vaccine could offer a preventive option for immunocompromised children ineligible for live viral vaccines.

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

期刊介绍： Vaccine is unique in publishing the highest quality science across all disciplines relevant to the field of vaccinology - all original article submissions across basic and clinical research, vaccine manufacturing, history, public policy, behavioral science and ethics, social sciences, safety, and many other related areas are welcomed. The submission categories as given in the Guide for Authors indicate where we receive the most papers. Papers outside these major areas are also welcome and authors are encouraged to contact us with specific questions.