Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Two Cases of Herpes Zoster Following Varicella Vaccination in Immunocompetent Young Children: One Case Caused by Vaccine-Strain

건강한 어린 소아에서 수두 백신 접종 후 발생한 대상포진 2예: 백신주에 의한 1예

  • Kim, Da-Eun (Department of Pediatrics, Seoul Medical Center) ;
  • Kang, Hae Ji (Division of Viral Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency) ;
  • Han, Myung-Guk (Division of Viral Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency) ;
  • Yeom, Hye-young (Department of Pediatrics, Seoul Medical Center) ;
  • Chang, Sung Hee (Department of Pediatrics, Seoul Medical Center)
  • 김다은 (서울특별시 서울의료원 소아청소년과) ;
  • 강혜지 (질병관리청 감염병진단분석국 바이러스분석과) ;
  • 한명국 (질병관리청 감염병진단분석국 바이러스분석과) ;
  • 염혜영 (서울특별시 서울의료원 소아청소년과) ;
  • 장성희 (서울특별시 서울의료원 소아청소년과)
  • Received : 2022.01.30
  • Accepted : 2022.08.18
  • Published : 2022.08.25
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Abstract

Herpes zoster (HZ) has been reported in immunocompetent children who received the varicella vaccine. In vaccinated children, HZ can be caused by vaccine-strain or by wild-type varicella-zoster virus (VZV). Like wild-type VZV, varicella vaccine virus can establish latency and reactivate as HZ. We report two cases of HZ in otherwise healthy 16- and 14-month-old boys who received varicella vaccine at 12 months of age. They presented with a vesicular rash on their upper extremities three to four months after varicella vaccination. In one case, a swab was obtained by abrading skin vesicles and VZV was detected in skin specimens by polymerase chain reaction. The VZV open-reading frame 62 was sequenced and single nucleotide polymorphism analysis confirmed that the virus from skin specimen was vaccine-strain. This is the first HZ case following varicella vaccination confirmed to be caused by vaccine-strain VZV in the immunocompetent children in Korea. Pediatricians should be aware of the potential for varicella vaccine virus reactivation in vaccinated young children.

대상포진은 소아에서 흔하지 않은 질환이며, 국외의 자료에서는 수두 백신 접종 정책 시행 후 대상포진의 발생률이 감소되었다. 저자들은 건강한 어린 소아에서 수두 백신 접종 후 발생한 대상포진 2예를 경험하였다. 특히 이중 1예에서는 피부 검체를 검사하여 대상포진이 백신주 varicella-zoster virus (VZV)에 의한 것을 확인하였다. 2예 모두 발진이 번지는 양상이어서 항바이러스제를 투여하였고 호전되었다. 수두 백신을 접종 받은 어린 소아가, 수두에 이환 되거나 노출된 적이 없으며, 대상포진이 발병하였을 경우 백신주에 의한 대상포진의 가능성을 고려해야 한다.

Keywords

References

  1. Galea SA, Sweet A, Beninger P, Steinberg SP, Larussa PS, Gershon AA, et al. The safety profile of varicella vaccine: a 10-year review. J Infect Dis 2008;197 Suppl 2:S165-9. https://doi.org/10.1086/522125
  2. Weinmann S, Chun C, Schmid DS, Roberts M, Vandermeer M, Riedlinger K, et al. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009. J Infect Dis 2013;208:1859-68. https://doi.org/10.1093/infdis/jit405
  3. Na GY. Herpes zoster in three healthy children immunized with varicella vaccine (Oka/Biken); the causative virus differed from vaccine strain on PCR analysis of the IV variable region (R5) and of a PstI-site region. Br J Dermatol 1997;137:255-8. https://doi.org/10.1046/j.1365-2133.1997.18151926.x
  4. Kim SJ, Lee YS, Seo SR, Chun DK, Lee JR, Lee SC. Two cases of herpes zoster in healthy children after varicella vaccination. Korean J Dermatol 2001;39:250-2.
  5. Ahn SK, Song MS, Jeon SY, Park JJ. A case of Ramsay-Hunt syndrome in a 4-year-old normal child after varicella vaccination. J Clinical Otolaryngol 2004;15:290-3.
  6. Korea Disease Control and Prevention Agency. Standard Operating Procedure, The Detection of Varicella Zoster Virus gene using PCR (KDCA-S-GN-VZV-17-01). Cheongju: Korea Disease Control and Prevention Agency; 2019.
  7. Gomi Y, Ozaki T, Nishimura N, Narita A, Suzuki M, Ahn J, et al. DNA sequence analysis of varicella-zoster virus gene 62 from subclinical infections in healthy children immunized with the Oka varicella vaccine. Vaccine 2008;26:5627-32. https://doi.org/10.1016/j.vaccine.2008.07.069
  8. Takayama N, Takayama M, Takita J. Herpes zoster in healthy children immunized with varicella vaccine. Pediatr Infect Dis J 2000;19:169-70. https://doi.org/10.1097/00006454-200002000-00020
  9. Dreyer S, Hemarajata P, Hogeling M, Henderson GP. Pediatric vaccine-strain herpes zoster: a case series. Pediatr Dermatol 2017;34:665-7. https://doi.org/10.1111/pde.13265
  10. Kim KH, Choi YJ, Song KH, Park WB, Jeon JH, Park SW, et al. Genotype of varicella-zoster virus isolates in South Korea. J Clin Microbiol 2011;49:1913-6. https://doi.org/10.1128/JCM.02356-10
  11. Civen R, Chaves SS, Jumaan A, Wu H, Mascola L, Gargiullo P, et al. The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination. Pediatr Infect Dis J 2009;28:954-9. https://doi.org/10.1097/INF.0b013e3181a90b16
  12. Chun C, Weinmann S, Riedlinger K, Mullooly JP, Houston H, Schmid DS, et al. Laboratory characteristics of suspected herpes zoster in vaccinated children. Pediatr Infect Dis J 2011;30:719-21. https://doi.org/10.1097/INF.0b013e3182137e35
  13. Guess HA, Broughton DD, Melton LJ 3rd, Kurland LT. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics 1985;76:512-7. https://doi.org/10.1542/peds.76.4.512
  14. Baba K, Yabuuchi H, Takahashi M, Ogra PL. Increased incidence of herpes zoster in normal children infected with varicella zoster virus during infancy: community-based follow-up study. J Pediatr 1986;108:372-7. https://doi.org/10.1016/S0022-3476(86)80875-7
  15. Wutzler P, Casabona G, Cnops J, Akpo EI, Safadi MA. Herpes zoster in the context of varicella vaccination - an equation with several variables. Vaccine 2018;36:7072-82. https://doi.org/10.1016/j.vaccine.2018.09.013
  16. Harpaz R, Leung JW. The epidemiology of herpes zoster in the United States during the era of varicella and herpes zoster vaccines: changing patterns among children. Clin Infect Dis 2019;69:345-7. https://doi.org/10.1093/cid/ciy954
  17. Weinmann S, Naleway AL, Koppolu P, Baxter R, Belongia EA, Hambidge SJ, et al. Incidence of herpes zoster among children; 2003-2014. Pediatrics 2019;144:e20182917. https://doi.org/10.1542/peds.2018-2917
  18. Mok HR, Park SY, Lee SY, Choi SR, Jeong DC, Chung SY, et al. A recent 10-year clinical and epidemiological study on zoster under 20 years old. Korean J Pediatr Infect Dis 2005;12:195-201. https://doi.org/10.14776/kjpid.2005.12.2.195