LITERATURE UPDATE
outcomes. The authors also aim to reinforce the importance of immunisation, which would aid in reducing the incidence of vaccine-preventable diseases such as varicella and its life-threatening complications.
Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review Jordan Z, Rowland E. Vaccine. 2024 Jan 12;42(2):75-83.
doi: 10.1016/
j.vaccine.2023.12.045.
Skin scraping of a cutaneous lesion from a chickenpox patient, showing an early formative, multinucleated giant cell.
Structures of the Varicella Zoster Virus Glycoprotein E and Epitope Mapping of Vaccine-Elicited Antibodies Harshbarger WD, Holzapfel G, Seraj N et al. Vaccines (Basel). 2024 Sep 27; 12(10):1111.
doi: 10.3390/vaccines12101111.
Varicella zoster virus (VZV) is the causative agent for chickenpox and herpes zoster (HZ, shingles). HZ is a debilitating disease affecting elderly and immunocompromised populations. Glycoprotein E (gE) is indispensable for viral replication and cell-to-cell spread, and is the primary target for anti-VZV antibodies. Importantly, gE is the sole antigen in Shingrix, a highly efficacious, AS01B-adjuvanted vaccine approved in multiple countries for the prevention of HZ, yet the three-dimensional (3D) structure of gE remains elusive. Here, the authors sought to determine
the structure of VZV gE and to understand in detail its interactions with neutralising antibodies.
The study used X-ray crystallography and cryo-electron microscopy to elucidate structures of gE bound by recombinant Fabs of antibodies previously elicited through vaccination with Zostavax, a live, attenuated vaccine. The 3D structures resolve distinct central and C-terminal antigenic domains, presenting an array of diverse conformational epitopes. The central domain has two beta-sheets and two alpha helices, including an IgG-like fold. The C-terminal domain exhibits three beta-sheets and an Ig-like fold and high structural similarity to HSV1 gE. In conclusion, gE from VZV-infected cells elicits a human antibody response with a preference for the gI binding
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domain of gE. These results yield insights to VZV gE structure and immunogenicity, provide a framework for future studies, and may guide the design of additional herpesvirus vaccine antigens.
Varicella Pneumonia in Immunocompetent Adults: Symptomatic and Asymptomatic Cases
Qasem S, Almutairi R, Elhousiny M, Albazzali A. Cureus. 2024 Sep 7;16(9): e68891. doi: 10.7759/cureus.68891. eCollection 2024 Sep.
Varicella zoster virus (VZV) is an enveloped, linear double-stranded DNA virus. It belongs to the Herpesviridae family and can manifest as primary varicella infection or secondary infection, also known as herpes zoster. Varicella pneumonia is an uncommon but potentially life-threatening complication of primary varicella infection. It mainly affects adults, and, if left untreated, the mortality rate is high. Here, the authors report two cases involving adult male patients who presented with a generalised widespread vesicular rash compatible with primary varicella. Each patient had a different clinical
presentation; the first patient had respiratory symptoms, while the second patient did not. Chest radiographs of both patients showed bilateral infiltrates. Treatment was initiated with the administration of intravenous acyclovir with a very good response. This report of two cases highlights the importance of early detection and prompt treatment of varicella-related complications, especially in higher- risk patients, to reduce morbidity and mortality and improve overall clinical
In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness. This study aims to examine parental
perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns. Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Programme checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes. Twenty-two articles were included in
this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision-making, and vaccination is overwhelming perceived as a parental decision.
While some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule.
OCTOBER 2025
WWW.PATHOLOGYINPRACTICE.COM
CDC/Dorothy Reese
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