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. 2001 Oct;54(10):743–747. doi: 10.1136/jcp.54.10.743

Vaccination to prevent varicella and shingles

J Breuer 1
PMCID: PMC1731286  PMID: 11577118

Abstract

Vaccination of healthy children against varicella using the live attenuated Oka vaccine has been available in Japan and south Korea for several years. In 1996, a programme of universal vaccination of children to prevent varicella was introduced in the USA and other countries, including Canada, Germany, and Sweden, have licensed the vaccine for use in healthy children. This article reviews the origin of the Oka vaccine and the evidence for vaccine safety and efficacy in children and adults. Universal vaccination of children and targeted vaccination of groups at risk of severe varicella are discussed. The possible use of the Oka vaccine to prevent zoster is reviewed, and initiatives to develop new varicella zoster virus vaccines are outlined.

Key Words: chickenpox • varicella zoster • herpes zoster • vaccination • leukaemia

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Selected References

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  1. Abendroth A., Slobedman B., Springer M. L., Blau H. M., Arvin A. M. Analysis of immune responses to varicella zoster viral proteins induced by DNA vaccination. Antiviral Res. 1999 Dec 31;44(3):179–192. doi: 10.1016/s0166-3542(99)00066-2. [DOI] [PubMed] [Google Scholar]
  2. Arbeter A. M., Baker L., Starr S. E., Levine B. L., Books E., Plotkin S. A. Combination measles, mumps, rubella and varicella vaccine. Pediatrics. 1986 Oct;78(4 Pt 2):742–747. [PubMed] [Google Scholar]
  3. Argaw T., Cohen J. I., Klutch M., Lekstrom K., Yoshikawa T., Asano Y., Krause P. R. Nucleotide sequences that distinguish Oka vaccine from parental Oka and other varicella-zoster virus isolates. J Infect Dis. 2000 Mar;181(3):1153–1157. doi: 10.1086/315335. [DOI] [PubMed] [Google Scholar]
  4. Arvin A. M., Gershon A. A. Live attenuated varicella vaccine. Annu Rev Microbiol. 1996;50:59–100. doi: 10.1146/annurev.micro.50.1.59. [DOI] [PubMed] [Google Scholar]
  5. Arvin A. M., Koropchak C. M., Williams B. R., Grumet F. C., Foung S. K. Early immune response in healthy and immunocompromised subjects with primary varicella-zoster virus infection. J Infect Dis. 1986 Sep;154(3):422–429. doi: 10.1093/infdis/154.3.422. [DOI] [PubMed] [Google Scholar]
  6. Arvin A. M., Koropchak C. M., Wittek A. E. Immunologic evidence of reinfection with varicella-zoster virus. J Infect Dis. 1983 Aug;148(2):200–205. doi: 10.1093/infdis/148.2.200. [DOI] [PubMed] [Google Scholar]
  7. Asano Y., Suga S., Yoshikawa T., Kobayashi I., Yazaki T., Shibata M., Tsuzuki K., Ito S. Experience and reason: twenty-year follow-up of protective immunity of the Oka strain live varicella vaccine. Pediatrics. 1994 Oct;94(4 Pt 1):524–526. [PubMed] [Google Scholar]
  8. Bergen R. E., Diaz P. S., Arvin A. M. The immunogenicity of the Oka/Merck varicella vaccine in relation to infectious varicella-zoster virus and relative viral antigen content. J Infect Dis. 1990 Nov;162(5):1049–1054. doi: 10.1093/infdis/162.5.1049. [DOI] [PubMed] [Google Scholar]
  9. Berger R., Trannoy E., Holländer G., Bailleux F., Rudin C., Creusvaux H. A dose-response study of a live attenuated varicella-zoster virus (Oka strain) vaccine administered to adults 55 years of age and older. J Infect Dis. 1998 Nov;178 (Suppl 1):S99–103. doi: 10.1086/514265. [DOI] [PubMed] [Google Scholar]
  10. Beutels P., Clara R., Tormans G., Van Doorslaer E., Van Damme P. Costs and benefits of routine varicella vaccination in German children. J Infect Dis. 1996 Nov;174 (Suppl 3):S335–S341. doi: 10.1093/infdis/174.supplement_3.s335. [DOI] [PubMed] [Google Scholar]
  11. Black S., Shinefield H., Ray P., Lewis E., Hansen J., Schwalbe J., Coplan P., Sharrar R., Guess H. Postmarketing evaluation of the safety and effectiveness of varicella vaccine. Pediatr Infect Dis J. 1999 Dec;18(12):1041–1046. doi: 10.1097/00006454-199912000-00003. [DOI] [PubMed] [Google Scholar]
  12. Brunell P. A., Taylor-Wiedeman J., Geiser C. F., Frierson L., Lydick E. Risk of herpes zoster in children with leukemia: varicella vaccine compared with history of chickenpox. Pediatrics. 1986 Jan;77(1):53–56. [PubMed] [Google Scholar]
  13. Burke B. L., Steele R. W., Beard O. W., Wood J. S., Cain T. D., Marmer D. J. Immune responses to varicella-zoster in the aged. Arch Intern Med. 1982 Feb;142(2):291–293. [PubMed] [Google Scholar]
  14. D'Hondt E., Berge E., Colinet G., Duchene M., Peetermans J. Production and quality control of the Oka-strain live varicella vaccine. Postgrad Med J. 1985;61 (Suppl 4):53–56. [PubMed] [Google Scholar]
  15. Garnett G. P., Grenfell B. T. The epidemiology of varicella-zoster virus infections: a mathematical model. Epidemiol Infect. 1992 Jun;108(3):495–511. doi: 10.1017/s0950268800050007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gershon A. A., LaRussa P., Hardy I., Steinberg S., Silverstein S. Varicella vaccine: the American experience. J Infect Dis. 1992 Aug;166 (Suppl 1):S63–S68. doi: 10.1093/infdis/166.supplement_1.s63. [DOI] [PubMed] [Google Scholar]
  17. Gershon A. A., LaRussa P., Steinberg S., Mervish N., Lo S. H., Meier P. The protective effect of immunologic boosting against zoster: an analysis in leukemic children who were vaccinated against chickenpox. J Infect Dis. 1996 Feb;173(2):450–453. doi: 10.1093/infdis/173.2.450. [DOI] [PubMed] [Google Scholar]
  18. Gershon A. A. Varicella-zoster virus: prospects for control. Adv Pediatr Infect Dis. 1995;10:93–124. [PubMed] [Google Scholar]
  19. Hammerschlag M. R., Gershon A. A., Steinberg S. P., Clarke L., Gelb L. D. Herpes zoster in an adult recipient of live attenuated varicella vaccine. J Infect Dis. 1989 Sep;160(3):535–537. doi: 10.1093/infdis/160.3.535. [DOI] [PubMed] [Google Scholar]
  20. Hardy I., Gershon A. A., Steinberg S. P., LaRussa P. The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. Varicella Vaccine Collaborative Study Group. N Engl J Med. 1991 Nov 28;325(22):1545–1550. doi: 10.1056/NEJM199111283252204. [DOI] [PubMed] [Google Scholar]
  21. Hasan U. A., Harper D. R., Argent S., Layton G., Wren B. W., Morrow W. J. Immunization with a DNA expression vector encoding the varicella zoster virus glycoprotein E (gE) gene via intramuscular and subcutaneous routes. Vaccine. 2000 Feb 14;18(15):1506–1514. doi: 10.1016/s0264-410x(99)00428-4. [DOI] [PubMed] [Google Scholar]
  22. Hawrami K., Breuer J. Analysis of United Kingdom wild-type strains of varicella-zoster virus: differentiation from the Oka vaccine strain. J Med Virol. 1997 Sep;53(1):60–62. doi: 10.1002/(sici)1096-9071(199709)53:1<60::aid-jmv10>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  23. Hayakawa Y., Torigoe S., Shiraki K., Yamanishi K., Takahashi M. Biologic and biophysical markers of a live varicella vaccine strain (Oka): identification of clinical isolates from vaccine recipients. J Infect Dis. 1984 Jun;149(6):956–963. doi: 10.1093/infdis/149.6.956. [DOI] [PubMed] [Google Scholar]
  24. Hayward A. R., Buda K., Jones M., White C. J., Levin M. J. Varicella zoster virus-specific cytotoxicity following secondary immunization with live or killed vaccine. Viral Immunol. 1996;9(4):241–245. doi: 10.1089/vim.1996.9.241. [DOI] [PubMed] [Google Scholar]
  25. Hayward A., Villanueba E., Cosyns M., Levin M. Varicella-zoster virus (VZV)-specific cytotoxicity after immunization of nonimmune adults with Oka strain attenuated VZV vaccine. J Infect Dis. 1992 Aug;166(2):260–264. doi: 10.1093/infdis/166.2.260. [DOI] [PubMed] [Google Scholar]
  26. Holmes S. J. Review of recommendations of the Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, on varicella vaccine. J Infect Dis. 1996 Nov;174 (Suppl 3):S342–S344. doi: 10.1093/infdis/174.supplement_3.s342. [DOI] [PubMed] [Google Scholar]
  27. Huse D. M., Meissner H. C., Lacey M. J., Oster G. Childhood vaccination against chickenpox: an analysis of benefits and costs. J Pediatr. 1994 Jun;124(6):869–874. doi: 10.1016/s0022-3476(05)83173-7. [DOI] [PubMed] [Google Scholar]
  28. Jones E. M., Reeves D. S. Controlling chickenpox in hospitals. BMJ. 1997 Jan 4;314(7073):4–5. doi: 10.1136/bmj.314.7073.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Kappagoda C., Shaw P., Burgess M., Botham S., Cramer L. Varicella vaccine in non-immune household contacts of children with cancer or leukaemia. J Paediatr Child Health. 1999 Aug;35(4):341–345. [PubMed] [Google Scholar]
  30. Krause P. R., Klinman D. M. Efficacy, immunogenicity, safety, and use of live attenuated chickenpox vaccine. J Pediatr. 1995 Oct;127(4):518–525. doi: 10.1016/s0022-3476(95)70106-0. [DOI] [PubMed] [Google Scholar]
  31. Krause P. R., Klinman D. M. Varicella vaccination: evidence for frequent reactivation of the vaccine strain in healthy children. Nat Med. 2000 Apr;6(4):451–454. doi: 10.1038/74715. [DOI] [PubMed] [Google Scholar]
  32. Kuter B. J., Weibel R. E., Guess H. A., Matthews H., Morton D. H., Neff B. J., Provost P. J., Watson B. A., Starr S. E., Plotkin S. A. Oka/Merck varicella vaccine in healthy children: final report of a 2-year efficacy study and 7-year follow-up studies. Vaccine. 1991 Sep;9(9):643–647. doi: 10.1016/0264-410x(91)90189-d. [DOI] [PubMed] [Google Scholar]
  33. LaRussa P., Lungu O., Hardy I., Gershon A., Steinberg S. P., Silverstein S. Restriction fragment length polymorphism of polymerase chain reaction products from vaccine and wild-type varicella-zoster virus isolates. J Virol. 1992 Feb;66(2):1016–1020. doi: 10.1128/jvi.66.2.1016-1020.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. LaRussa P., Steinberg S., Gershon A. A. Varicella vaccine for immunocompromised children: results of collaborative studies in the United States and Canada. J Infect Dis. 1996 Nov;174 (Suppl 3):S320–S323. doi: 10.1093/infdis/174.supplement_3.s320. [DOI] [PubMed] [Google Scholar]
  35. Levin M. J., Murray M., Rotbart H. A., Zerbe G. O., White C. J., Hayward A. R. Immune response of elderly individuals to a live attenuated varicella vaccine. J Infect Dis. 1992 Aug;166(2):253–259. doi: 10.1093/infdis/166.2.253. [DOI] [PubMed] [Google Scholar]
  36. Levin M. J., Murray M., Zerbe G. O., White C. J., Hayward A. R. Immune responses of elderly persons 4 years after receiving a live attenuated varicella vaccine. J Infect Dis. 1994 Sep;170(3):522–526. doi: 10.1093/infdis/170.3.522. [DOI] [PubMed] [Google Scholar]
  37. Lieu T. A., Cochi S. L., Black S. B., Halloran M. E., Shinefield H. R., Holmes S. J., Wharton M., Washington A. E. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA. 1994 Feb 2;271(5):375–381. [PubMed] [Google Scholar]
  38. Lieu T. A., Finkler L. J., Sorel M. E., Black S. B., Shinefield H. R. Cost-effectiveness of varicella serotesting versus presumptive vaccination of school-age children and adolescents. Pediatrics. 1995 May;95(5):632–638. [PubMed] [Google Scholar]
  39. Lim Y. J., Chew F. T., Tan A. Y., Lee B. W. Risk factors for breakthrough varicella in healthy children. Arch Dis Child. 1998 Dec;79(6):478–480. doi: 10.1136/adc.79.6.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Moffat J. F., Zerboni L., Kinchington P. R., Grose C., Kaneshima H., Arvin A. M. Attenuation of the vaccine Oka strain of varicella-zoster virus and role of glycoprotein C in alphaherpesvirus virulence demonstrated in the SCID-hu mouse. J Virol. 1998 Feb;72(2):965–974. doi: 10.1128/jvi.72.2.965-974.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Oxman M. N. Immunization to reduce the frequency and severity of herpes zoster and its complications. Neurology. 1995 Dec;45(12 Suppl 8):S41–S46. doi: 10.1212/wnl.45.12_suppl_8.s41. [DOI] [PubMed] [Google Scholar]
  42. Pastuszak A. L., Levy M., Schick B., Zuber C., Feldkamp M., Gladstone J., Bar-Levy F., Jackson E., Donnenfeld A., Meschino W. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med. 1994 Mar 31;330(13):901–905. doi: 10.1056/NEJM199403313301305. [DOI] [PubMed] [Google Scholar]
  43. Preblud S. R., Orenstein W. A., Koplan J. P., Bart K. J., Hinman A. R. A benefit-cost analysis of a childhood varicella vaccination programme. Postgrad Med J. 1985;61 (Suppl 4):17–22. [PubMed] [Google Scholar]
  44. Preblud S. R. Varicella: complications and costs. Pediatrics. 1986 Oct;78(4 Pt 2):728–735. [PubMed] [Google Scholar]
  45. Provost P. J., Krah D. L., Kuter B. J., Morton D. H., Schofield T. L., Wasmuth E. H., White C. J., Miller W. J., Ellis R. W. Antibody assays suitable for assessing immune responses to live varicella vaccine. Vaccine. 1991 Feb;9(2):111–116. doi: 10.1016/0264-410x(91)90266-9. [DOI] [PubMed] [Google Scholar]
  46. Seidman D. S., Stevenson D. K., Arvin A. M. Varicella vaccine in pregnancy. BMJ. 1996 Sep 21;313(7059):701–702. doi: 10.1136/bmj.313.7059.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Sharp M., Terada K., Wilson A., Nader S., Kinchington P. E., Ruyechan W. T., Hay J., Arvin A. M. Kinetics and viral protein specificity of the cytotoxic T lymphocyte response in healthy adults immunized with live attenuated varicella vaccine. J Infect Dis. 1992 May;165(5):852–858. doi: 10.1093/infdis/165.5.852. [DOI] [PubMed] [Google Scholar]
  48. Soong W., Schultz J. C., Patera A. C., Sommer M. H., Cohen J. I. Infection of human T lymphocytes with varicella-zoster virus: an analysis with viral mutants and clinical isolates. J Virol. 2000 Feb;74(4):1864–1870. doi: 10.1128/jvi.74.4.1864-1870.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Sperber S. J., Smith B. V., Hayden F. G. Serologic response and reactogenicity to booster immunization of healthy seropositive adults with live or inactivated varicella vaccine. Antiviral Res. 1992 Mar;17(3):213–222. doi: 10.1016/0166-3542(92)90042-4. [DOI] [PubMed] [Google Scholar]
  50. Takada M., Suzutani T., Yoshida I., Matoba M., Azuma M. Identification of varicella-zoster virus strains by PCR analysis of three repeat elements and a PstI-site-less region. J Clin Microbiol. 1995 Mar;33(3):658–660. doi: 10.1128/jcm.33.3.658-660.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Takahashi M., Otsuka T., Okuno Y., Asano Y., Yazaki T. Live vaccine used to prevent the spread of varicella in children in hospital. Lancet. 1974 Nov 30;2(7892):1288–1290. doi: 10.1016/s0140-6736(74)90144-5. [DOI] [PubMed] [Google Scholar]
  52. Watson B. M., Laufer D. S., Kuter B. J., Staehle B., White C. J., Starr S. E. Safety and immunogenicity of a combined live attenuated measles, mumps, rubella, and varicella vaccine (MMR(II)V) in healthy children. J Infect Dis. 1996 Mar;173(3):731–734. doi: 10.1093/infdis/173.3.731. [DOI] [PubMed] [Google Scholar]
  53. Watson B., Piercy S., Soppas D., Browngoehl K., Warner M., Isganitis K., White C. J., Kuter B., Chua J., Starr S. The effect of decreasing amounts of live virus, while antigen content remains constant, on immunogenicity of Oka/Merck varicella vaccine. J Infect Dis. 1993 Dec;168(6):1356–1360. doi: 10.1093/infdis/168.6.1356. [DOI] [PubMed] [Google Scholar]
  54. Watson B., Rothstein E., Bernstein H., Arbeter A., Arvin A., Chartrand S., Clements D., Kumar M. L., Reisinger K., Blatter M. Safety and cellular and humoral immune responses of a booster dose of varicella vaccine 6 years after primary immunization. J Infect Dis. 1995 Jul;172(1):217–219. doi: 10.1093/infdis/172.1.217. [DOI] [PubMed] [Google Scholar]
  55. Weibel R. E., Neff B. J., Kuter B. J., Guess H. A., Rothenberger C. A., Fitzgerald A. J., Connor K. A., McLean A. A., Hilleman M. R., Buynak E. B. Live attenuated varicella virus vaccine. Efficacy trial in healthy children. N Engl J Med. 1984 May 31;310(22):1409–1415. doi: 10.1056/NEJM198405313102201. [DOI] [PubMed] [Google Scholar]
  56. Welsh M. D., Harper D. R., Garcia-Valcarcel M., Fowler W. J., Aitken C., Jeffries D. J., Layton G. T. Ability of yeast Ty-VLPs (virus-like particles) containing varicella-zoster virus (VZV)gE and assembly protein fragments to induce in vitro proliferation of human lymphocytes from VZV immune patients. J Med Virol. 1999 Sep;59(1):78–83. [PubMed] [Google Scholar]
  57. White C. J., Kuter B. J., Hildebrand C. S., Isganitis K. L., Matthews H., Miller W. J., Provost P. J., Ellis R. W., Gerety R. J., Calandra G. B. Varicella vaccine (VARIVAX) in healthy children and adolescents: results from clinical trials, 1987 to 1989. Pediatrics. 1991 May;87(5):604–610. [PubMed] [Google Scholar]
  58. White C. J., Kuter B. J., Ngai A., Hildebrand C. S., Isganitis K. L., Patterson C. M., Capra A., Miller W. J., Krah D. L., Provost P. J. Modified cases of chickenpox after varicella vaccination: correlation of protection with antibody response. Pediatr Infect Dis J. 1992 Jan;11(1):19–23. doi: 10.1097/00006454-199201000-00006. [DOI] [PubMed] [Google Scholar]
  59. Wilson A., Sharp M., Koropchak C. M., Ting S. F., Arvin A. M. Subclinical varicella-zoster virus viremia, herpes zoster, and T lymphocyte immunity to varicella-zoster viral antigens after bone marrow transplantation. J Infect Dis. 1992 Jan;165(1):119–126. doi: 10.1093/infdis/165.1.119. [DOI] [PubMed] [Google Scholar]

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