LITERATURE UPDATE
and temperate regions with infections occurring at an earlier age in temperate climates. Varicella is a vaccine-preventable disease and over 40 countries have a universal one-dose or two-dose paediatric immunisation programme, either administered alone or combined with the measles, mumps and rubella vaccination (MMRV). The UK’s Joint Committee on Vaccination and Immunisation recommended the introduction of MMRV in November 2024.
The vaccine, whether monovalent or
MMRV, is effective in reducing varicella cases and hospital admissions, and two-dose regimens have further reduced breakthrough infections of shingles, a recognised concern in varicella vaccination programmes. Long-term data on shingles incidence in later life are not yet available and may be mitigated through paired universal shingles vaccination programmes for adults. Cost-effectiveness studies in high-
resource settings support vaccination due to reduced hospitalisations and societal costs, such as missed caregiver employment. However, more research is needed for lower-resource regions to determine whether universal vaccination is feasible and cost-effective. While global varicella elimination is unlikely without sterilising immunity, vaccination can significantly reduce the disease burden, depending on regional epidemiology and available resources.
Varicella Zoster Virus Infection and Pregnancy: An Optimal Management Approach
Ion A, Orzan OA, Bălăceanu-Gurău B. Pathogens. 2025 Feb 5;14(2):151. doi: 10.3390/pathogens14020151.
Varicella-zoster virus is an α-herpes virus with a double-stranded DNA genome, which causes two main clinical pictures: varicella or chickenpox and herpes zoster. Chickenpox is the primary infection, predominantly affecting children, and it presents with fever and a cutaneous eruption consisting of a vesicular, pruritic, and painful rash. Herpes zoster is a viral infection that typically develops in adulthood as a result of the reactivation of the varicella-zoster virus. If acquired during pregnancy, chickenpox may be responsible for serious complications for the mother, the fetus, or the newborn. The most frequent complication of primary varicella-zoster virus infection in mothers is varicella pneumonia, while encephalitis and hepatitis are rare. The effects on the fetus due to chickenpox infection depend on the stage of pregnancy when the mother
52 Electron micrograph of a varicella zoster virion.
becomes infected. If the infection occurs during the first trimester, it does not increase the risk of miscarriage. However, if the infection occurs during the first or second trimester, it may cause fetal varicella syndrome or congenital varicella syndrome. During pregnancy, if the varicella- zoster virus reactivates, it usually does not cause harm to the fetus, or lead to any birth defects. However, it may increase maternal morbidity due to herpes zoster and its complications. In the case of primary varicella-zoster virus infection in pregnant women, about 20% of newborns may get neonatal or infantile herpes zoster without any complications. However, it is recommended to start early treatment of herpes zoster in pregnant women as it is believed to accelerate the healing process of skin lesions and alleviate pain, reducing both its duration and severity. Through this narrative review, the authors discuss the approach to the optimal management of varicella-zoster virus infection during pregnancy.
Exploring the Link between Varicella- Zoster Virus, Autoimmune Diseases, and the Role of Recombinant Zoster Vaccine.
Ishihara R, Watanabe R, Shiomi M et al. Biomolecules. 2024 Jun 22;14(7):739. doi: 10.3390/biom14070739.
The varicella-zoster virus (VZV) is a human neurotropic herpes virus responsible for varicella and herpes zoster (HZ). Following primary infection in childhood, VZV manifests as varicella (chickenpox) and enters a period of latency within the dorsal root ganglion. A compromised cellular immune response due to ageing or immunosuppression triggers viral reactivation and the development of HZ (shingles).
Patients with autoimmune diseases have a higher risk of developing HZ owing to the immunodeficiency associated with the disease itself and/
or the use of immunosuppressive agents. The introduction of new immunosuppressive agents with unique mechanisms has expanded the treatment options for autoimmune diseases but has also increased the risk of HZ. Specifically, Janus kinase (JAK) inhibitors and anifrolumab have raised concerns regarding HZ. Despite treatment advances, a substantial number of patients suffer from complications such as post-herpetic neuralgia for prolonged periods. The adjuvanted recombinant zoster vaccine (RZV) is considered safe and effective even in immunocompromised patients. The widespread adoption of RZV may reduce the health and socioeconomic burdens of HZ patients. This review covers the link between VZV and autoimmune diseases, assesses the risk of HZ associated with immunosuppressant use, and discusses the benefits and risks of using RZV in patients with autoimmune diseases.
Disseminated vaccine-strain varicella-zoster virus reactivation in an adolescent with secondary immunodeficiency: a case report and literature review Fashina OA, Chuang TM, Galardy PJ et al. BMC Infect Dis. 2024 Nov 14;24(1):1296. doi: 10.1186/s12879-024-09776-1.
Routine childhood immunisation against varicella-zoster virus has led to a dramatic reduction in the incidence of primary varicella. However, there are rare, yet significant cases reported of reactivated Oka-strain varicella, primarily in immunocompromised hosts. A 16-year-old female with Hodgkin’s lymphoma developed a vesicular rash shortly after completing all chemotherapy treatment. Swabs obtained from the vesicles were positive for varicella-zoster virus. By the time of hospitalisation, the patient developed a disseminated rash involving multiple dermatomes. Subsequent polymerase chain reaction (PCR) confirmed Oka vaccine-strain varicella-zoster virus. The patient had previously received a primary series of immunisations against varicella in 2008 and 2012, with her second dose given 11 years prior to her development of vaccine-strain herpes zoster and 10 years prior to her diagnosis of Hodgkin’s lymphoma, respectively. The patient was treated with parenteral acyclovir upon hospitalisation and monitored clinically for cutaneous disease progression as well as sequelae. After eight days of inpatient treatment, her rash had stopped spreading with no new lesions. All earlier lesions had crusted
OCTOBER 2025
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