Persistence of immunity to varicella in children with leukemia immunized with live attenuated varicella vaccine.
Persistence of immunity to varicella in children with leukemia immunized with live attenuated varicella vaccine.
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接种水痘减毒活疫苗的白血病儿童对水痘免疫力的持续性。
DOI：
10.1056/nejm198904063201403
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Steinberg,SP
中科院分区：
文献类型：
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作者：
Gershon,AA;Steinberg,SP
为了确定水痘疫苗的安全性和有效性，我们研究了437名白血病缓解期儿童，他们接受了水痘减毒活病毒免疫。其中301名患者接种了两剂疫苗，136名患者接种了两个生产商10个批次中的1个批次的单剂疫苗。这些患者平均随访了三年（范围，一到六年），在437名儿童中，88%的人在第一剂疫苗接种后发生血清转换，98%的人在一剂或两剂疫苗接种后发生血清转换。1年、3年和5年后血清阴性的患者比例分别为20%、25%和30%，特异性抗体的几何平均滴度随时间变化很小（分别为6.3、6.5和5.7）。水痘已记录在36名接种疫苗的患者（8%）中，他们有3至640个囊泡（平均100个），病情轻微，无并发症。在83名接种过水痘疫苗的患者中，有11人患有水痘，发病率为14%（血清阳性患者为8%，血清阴性患者为29%）。自接种疫苗以来的时间与发病率或突破性疾病的严重程度之间没有关系。两剂疫苗似乎并不比一剂疫苗更有效。在372名接受维持化疗的患者中，149名（40%）在接种疫苗时出现皮疹，16名儿童（4%）接受了阿昔洛韦治疗，4名儿童成为严重的发热性疾病。这些反应都不是致命的，都与疫苗批次，使用已停止。我们的结论是，在儿童在缓解白血病，水痘疫苗是安全的，并诱导免疫水痘，持续三年以上。（N Engl J Med 1989; 320：892-7.）
To determine the safety and efficacy of varicella vaccine, we studied 437 children in remission from leukemia who were immunized with live attenuated varicella virus. Three hundred one of the patients received two doses of vaccine and 136 received a single dose of vaccine from 1 of 10 lots from two manufacturers. The patients have been followed for an average of three years (range, one to six).Seroconversion occurred in 88 percent of the 437 children after the first dose of vaccine and in 98 percent after one or two doses. The proportions of patients who were seronegative after one, three, and five years were 20, 25, and 30 percent, respectively, with little change over time in the geometric mean titers of specific antibody (6.3, 6.5, and 5.7, respectively). Chickenpox has been documented in 36 vaccinated patients (8 percent) who had 3 to 640 vesicles (mean, 100), mild illness, and no complications. Of the 83 vaccinated patients exposed to varicella within their families, 11 had chickenpox; the attack rate was 14 percent (8 percent among seropositive patients, 29 percent among seronegative patients). There was no relation between the time since vaccination and either the attack rate or the severity of the breakthrough illness. Two doses of vaccine appeared to be no more effective than a single dose.Of the 372 patients receiving maintenance chemotherapy when immunized, 149 (40 percent) had a rash, which was treated with acyclovir in 16 children (4 percent) and became a severe febrile illness in 4. These reactions were not fatal and were all associated with vaccine lots, the use of which has since been discontinued.We conclude that in children in remission from leukemia, varicella vaccine is safe and induces an immunity to chickenpox that persists for more than three years. (N Engl J Med 1989; 320:892–7.)