scholarly journals Common Features Between Stroke Following Varicella in Children and Stroke Following Herpes Zoster in Adults

2021 ◽  
Author(s):  
Charles Grose ◽  
Amir Shaban ◽  
Heather J. Fullerton
Keyword(s):  
Ischemic Stroke ◽  
Herpes Zoster ◽  
Trigeminal Ganglion ◽  
Cerebral Arteries ◽  
Varicella Vaccine ◽  
Arterial Ischemic Stroke ◽  
Varicella Zoster ◽  
Common Features ◽  
Afferent Fibers ◽  
Cervical Ganglion

AbstractThe cerebral arteries are innervated by afferent fibers from the trigeminal ganglia. Varicella-zoster virus (VZV) frequently resides in the trigeminal ganglion. Reports of arterial ischemic stroke due to VZV cerebral vasculopathy in adults after herpes zoster have been described for decades. Reports of arterial ischemic stroke due to post-varicella cerebral arteriopathy in children have also been described for decades. One rationale for this review has been post-licensure studies that have shown an apparent protective effect from stroke in both adults who have received live zoster vaccine and children who have received live varicella vaccine. In this review, we define common features between stroke following varicella in children and stroke following herpes zoster in adults. The trigeminal ganglion and to a lesser extent the superior cervical ganglion are central to the stroke pathogenesis pathway because afferent fibers from these two ganglia provide the circuitry by which the virus can travel to the anterior and posterior circulations of the brain. Based on studies in pseudorabies virus (PRV) models, it is likely that VZV is carried to the cerebral arteries on a kinesin motor via gE, gI and the homolog of PRV US9. The gE product is an essential VZV protein.

scholarly journals 2767. Variation in Incidence of Pediatric Herpes Zoster by First- and Second-Dose Varicella Vaccine Formulations

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S975-S976
Author(s):  
Sheila Weinmann ◽  
Stephanie Irving ◽  
Padma Koppolu ◽  
Allison Naleway ◽  
Edward Belongia ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Varicella Vaccine ◽  
Vaccine Dose ◽  
Varicella Vaccination ◽  
Vaccine Formulation ◽  
Wild Type ◽  
Varicella Zoster ◽  
Dose Formulation ◽  
Using Data ◽  
Rate Ratios

Abstract Background Varicella (VAR) and measles-mumps-rubella (MMR) vaccines are recommended for children at ages 12–15 months and 4–6 years. These are administered as separate MMR and VAR vaccines (MMR+VAR) or as combined measles-mumps-rubella-varicella (MMRV) vaccine. Herpes zoster (HZ), caused by wild-type or vaccine-strain varicella-zoster virus, can occur in children after varicella vaccination. It is unknown whether HZ incidence after varicella vaccination varies by vaccine formulation or simultaneous receipt of MMR. Methods Using data from six integrated health systems, we examined HZ incidence among children who turned 12 months old during 2003–2008 and received varicella and MMR vaccines according to routine recommendations. All HZ cases ≥ 21 days after first varicella vaccination were identified using ICD-9 codes from inpatient, outpatient, emergency room encounters, and claims data, through 2014. HZ incidence was examined by vaccine formulation (MMR+VAR, MMRV, or VAR without same-day MMR) and doses received and compared using incidence rate ratios (IRR). Results Among 199,797 children, we identified 601 HZ cases. Crude HZ incidence after first-dose MMR+VAR (18.6 [95% CI 11.1–29.2] cases/100,000 person-years) was similar to the rate after first-dose MMRV (17.9 [95% CI 10.6–28.3] cases/100,000 person-years), but approximately double the rate among those with first-dose VAR without same-day MMR (7.5 [95% CI 3.1–15.0] cases/100,000 person-years); see Table 1. The IRR for HZ after first-dose MMR+VAR or MMRV, compared with VAR, was 2.5 (95% CI 1.4–4.4; P = 0.002). When examining any first or second dose formulation, crude HZ incidence was lower after the second varicella vaccine dose (13.9 cases/100,000 person-years), than in the period before the second dose (i.e., between first and second doses or after the first dose in children with only one dose; 21.8 cases/100,000 person-years, P < 0.0001). HZ incidence was also lower after two varicella vaccine doses in each of the three first-dose formulation groups. Conclusion HZ incidence among children varied by first-dose varicella vaccine formulation and number of varicella vaccine doses. Regardless of the first-dose varicella vaccine formulation, children who received two vaccine doses had lower HZ incidence after the second dose. Disclosures All authors: No reported disclosures.

Abstract 389: Gestational Inflammation and Perinatal Arterial Ischemic Stroke: A Causal Connection?

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Clemence Guiraut ◽  
Nicole Cauchon ◽  
Martin Lepage ◽  
Guillaume Sebire
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Arteries ◽  
Arterial Occlusion ◽  
Carotid Bifurcation ◽  
Causal Connection ◽  
Arterial Ischemic Stroke ◽  
Motor Impairments ◽  
Perinatal Stroke ◽  
Clinical Model ◽  
Hemiplegic Cerebral Palsy

Introduction: Perinatal arterial ischemic strokes affect about 1/3,000 newborn and are the main cause of hemiplegic cerebral palsy. The large cerebral arteries from the anterior system, namely the intra-cranial carotid bifurcation, are the most affected, ischemic stroke being located in its territory in 85% of cases. The classic, but unproven, pathophysiological hypothesis postulated that arterial occlusion was caused by emboli from placental origin. This remains controversial due to the major unbalance of brain infarcts between anterior and posterior distribution, and to the absence of associated extra-cerebral infarcts. A new pathophysiological perspective emerged from the epidemiological association between gestational inflammation and perinatal stroke. Our hypothesis is that materno-foetal inflammation, induced by gestational exposure to pathogens, leads to a site-specific vasculitis affecting the carotid bifurcation and then triggering a focal thrombosis. Material and methods: Dams were injected with saline or lipopolysaccharide (LPS) from Escherichia coli (200 μg/kg/12h) between gestational day (G) 21 and 22. Brains were harvested at G21, G22 and postnatal day 1 (P1). At P1, a prothrombotic stress (transcutaneous photothrombosis) was applied on middle cerebral arteries to compare its susceptibility to thrombosis between LPS-exposed or unexposed pups. Immunohistochemistry and ELISA detected maternal, placental and fetal/neonatal inflammatory markers. Results: Our results showed a maternal, placental and fetal inflammation mediated by IL-1β, TNF-α and MCP-1 as well as an arterial inflammation in relation with the clinical pattern of perinatal arterial ischemic strokes. LPS+photothrombosis pups presented ischemic strokes and motor impairments, which were not detected when photothrombosis was applied without prior treatment with LPS. Conclusion: Preliminary results from our new pre-clinical model support our hypothesis of increased susceptibility of anterior cerebral arteries to gestational inflammation, and open a new vasculitic pathophysiological avenue to understand perinatal stroke.

scholarly journals Microparticle-mediated VZV propagation and endothelial activation

Neurology ◽  
2019 ◽  
Vol 94 (5) ◽  
pp. e474-e480 ◽  
Author(s):  
Despina Eleftheriou ◽  
Elena Moraitis ◽  
Ying Hong ◽  
Mark Turmaine ◽  
Cristina Venturini ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Vascular Remodeling ◽  
In Vitro Model ◽  
Cerebral Arteries ◽  
Virus Transmission ◽  
Endothelial Activation ◽  
Arterial Ischemic Stroke ◽  
Varicella Zoster ◽  
Vitro Model

ObjectiveVaricella zoster virus (VZV) can spread anterogradely and infect cerebral arteries causing VZV vasculopathy and arterial ischemic stroke. In this study, we tested the hypothesis that virus-infected cerebrovascular fibroblasts undergo phenotypic changes that promote vascular remodeling and facilitate virus transmission in an in vitro model of VZV vasculopathy. The aims of this project were therefore to examine the changes that virus-infected human brain adventitial vascular fibroblasts (HBVAFs) undergo in an in vitro model of VZV vasculopathy and to identify disease biomarkers relating to VZV-related vasculopathy.MethodsHBVAFs were infected with VZV, and their ability to migrate, proliferate, transdifferentiate, and interact with endothelial cells was studied with flow cytometry. Microparticles (MPs) released from these cells were isolated and imaged with transmission electron microscopy, and their protein content was analyzed with mass spectrometry. Circulating MP profiles were also studied in children with VZV and non-VZV vasculopathy and compared with controls.ResultsVZV-infected HBVAFs transdifferentiated into myofibroblasts with enhanced proliferative and migratory capacity. Interaction of VZV-infected HBVAFs with endothelial cells resulted in endothelial dysfunction. These effects were, in part, mediated by the release of MPs from VZV-infected HBVAFs. These MPs contained VZV virions that could transmit VZV to neighboring cells, highlighting a novel model of VZV cell-to-cell viral dissemination. MPs positive for VZV were significantly higher in children with VZV-related vasculopathy compared to children with non-VZV vasculopathy (p = 0.01) and controls (p = 0.007).ConclusionsVZV-infected HBVAFs promote vascular remodeling and facilitate virus transmission. These effects were mediated by the release of apoptotic MPs that could transmit VZV infection to neighboring cells through a Trojan horse means of productive viral infection. VZV+ MPs may represent a disease biomarker worthy of further study.

scholarly journals Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

2020 ◽  
Vol 35 (13) ◽  
pp. 889-895 ◽  
Author(s):  
Veena Ramachandran ◽  
Stephen C. Elliott ◽  
Kathie L. Rogers ◽  
Randall J. Cohrs ◽  
Miles Weinberger ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
The United States ◽  
Vaccine Virus ◽  
Virus Reactivation ◽  
Wild Type ◽  
Varicella Zoster ◽  
Intravenous Acyclovir

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

scholarly journals Prevention & Management of Herpes Zoster- an Update

2014 ◽  
Vol 41 (3) ◽  
pp. 53-56
Author(s):  
AKM Rejaul Haque ◽  
A Sultana ◽  
A Habib ◽  
ASM Zakaria
Keyword(s):  
Herpes Zoster ◽  
Virus Infection ◽  
Varicella Zoster Virus ◽  
Age Factors ◽  
Varicella Vaccine ◽  
Varicella Zoster Virus Infection ◽  
Post Herpetic Neuralgia ◽  
Varicella Zoster ◽  
Burning Pain ◽  
Chronic Corticosteroid

Herpes zoster (commonly referred to as "shingles") results .from reactivation of the varicella-zoster virus infection, or chickenpox. Were as varicella is generally a disease of childhood, herpes zoster becomes more common with increasing age Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapv, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible.for lhe classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With post herpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Although the diagnosis of the conditions is generally straightforward, treatment can be frustrating for the patient and physician. Approaches to management include treatment of the herpes zoster infection and associated pain, prevention of post herpetic neuralgia, and control of the neuropathic pain until the condition resolves. Herpes zoster is contagious to those who have not had varicella or have not received the varicella vaccine. The role of the varicella vaccine in preventing herpes zoster is uncertain, but is being studied. The management of herpes zoster is challenging because many patients develop troublesome complication. So, appropriate management o/'herpes zoster is very important to avoid complication. On the other hand prevention is better than cure. Immunization with varicella zoster virus vaccine may boost humoral and cell mediated and decrease the incidence of zoster in population. So effectiveness of a vaccination program need to be evaluated. immunity DOI: http://dx.doi.org/10.3329/bmj.v41i3.18961 Bangladesh Medical Journal 2012 Vol.41(3): 53-56

Abstract 38: Herpes Viruses in Childhood Arterial Ischemic Stroke: Interim Results of the VIPS Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Heather J Fullerton ◽  
Mitchell S Elkind ◽  
Carol A Glaser ◽  
Nancy K Hills ◽  
Jorge Luna ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
A Priori ◽  
Acute Infection ◽  
Multivariable Logistic Regression Analysis ◽  
Herpes Viruses ◽  
Arterial Ischemic Stroke ◽  
Vascular Effects ◽  
Recent Infection ◽  
Varicella Zoster ◽  
Hsv 1

Background: Varicella zoster virus (VZV) is a known cause of cerebral arteriopathy and arterial ischemic stroke (AIS) in children, and scant evidence suggests other herpes viruses may also play a role. An objective of the Vascular effects of Infection in Pediatric Stroke (VIPS) study was to determine whether recent infection with herpes viruses_as measured by serologies_is associated with childhood AIS. Methods: VIPS is an international prospective 35-center case-control study enrolling 350 children (28 days-18 years) with AIS and 120 unmatched trauma controls. Case confirmation and vascular imaging review are performed centrally. Acute blood samples are collected ≤3 weeks after stroke/trauma; convalescent samples 7-28 days after the acute draw in cases only. Samples were tested for IgG and IgM antibodies to herpes simplex virus (HSV) 1 and 2, cytomegalovirus (CMV), Epstein Barr virus (EBV), and VZV. An algorithm developed a priori by a pediatric infectious disease expert (C.A.G.) classified acute infection as a dichotomous variable. Results: Of 310 cases enrolled thus far, 141 cases with paired samples and 44 controls underwent serologic analysis. Median age (IQR) was 7.0 years (2.9, 14.3) for cases and 8.3 (3.3, 13.3) for controls (P=0.90). Evidence of an acute herpes infection was found in 41% of cases versus 9% of controls (P<0.0001; Table). The most commonly identified virus was HSV-1. After adjusting for age in a multivariable logistic regression analysis, herpes exposure remained a significant predictor of AIS (OR 9.0, 95% CI 3.1, 38.7; P=0.0004). Of the 58 cases positive for herpes, 36% had a definite arteriopathy, and 33% a possible arteriopathy, compared to 34% and 24%, respectively, of 83 negative cases. Conclusions: In this interim analysis, acute exposure to a herpes virus appears associated with childhood AIS, present in 41% of cases that were tested.

scholarly journals Varicella-zoster virus.

1996 ◽  
Vol 9 (3) ◽  
pp. 361-381 ◽  
Author(s):  
A M Arvin
Keyword(s):  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
Viral Proteins ◽  
Childhood Immunization ◽  
Varicella Zoster ◽  
Double Stranded Dna ◽  
Laboratory Confirmation ◽  
Vesicular Rash ◽  
Risk Patients

Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization.

Live Attenuated Varicella Vaccine Use in Immunocompromised Children and Adults

PEDIATRICS ◽  
1986 ◽  
Vol 78 (4) ◽  
pp. 757-762
Author(s):  
Anne A. Gershon ◽  
Sharon P. Steinberg ◽  
Lawrence Geib ◽  
Keyword(s):  
Herpes Zoster ◽  
High Risk ◽  
Varicella Zoster Virus ◽  
Side Effect ◽  
Attack Rate ◽  
Varicella Vaccine ◽  
Healthy Adults ◽  
Maintenance Chemotherapy ◽  
Major Side Effect ◽  
Varicella Zoster

Live attenuated varicella vaccine has been administered to 307 children with leukemia in remission and to 86 healthy adults. The vaccine was well tolerated and immunogenic. The major side effect in leukemic children receiving maintenance chemotherapy was development of a vaccine-associated rash. Vaccinees in whom a rash developed were potentially somewhat infectious to others about 1 month after immunization. Vaccination was not associated with an increase in the incidence of herpes zoster or in relapse of leukemia. Vaccination provided excellent protection against severe varicella. It was associated with a significantg decrease in the attack rate of chickenpox following an intimate exposure to varicella-zoster virus, conferring about 80% protection in leukemic children. The cases of breakthrough varicella that occurred were mild. Thus, the vaccine may either prevent or modify varicella in high-risk individuals. It may also have use for prevention of nosocomial varicella.

scholarly journals Herpes Zoster Onset 9 Years After First Varicella Zoster Vaccination in an 11-year-old Child - A Case Report

2019 ◽  
Vol 15 (4) ◽  
pp. 265-267
Author(s):  
Kerasia-Maria Plachouri ◽  
Despoina Gkentzi ◽  
Anastasia Varvarigou ◽  
Sophia Georgiou ◽  
Gabriel Dimitriou
Keyword(s):  
Herpes Zoster ◽  
Elderly Population ◽  
Pediatric Patients ◽  
Varicella Vaccine ◽  
The Elderly ◽  
Published Data ◽  
Healthy Children ◽  
Case Presentation ◽  
Varicella Zoster ◽  
National Immunization

Background: Herpes zoster (HZ) tends to affect the elderly population and immunocompromised younger patients. However, HZ cases in healthy children have also been reported. Objective: This paper is a reminder to physicians, that Herpes Zoster can still be present in children, even in the era after the development of the varicella vaccine and its introduction in the national immunization programs globally. Methods: We present the case of an immunocompetent 11-year old vaccinated male patient, who developed a HZ infection. The child had received two doses of the VZV vaccination (Varivax®), nine years (first dose) and six years (second dose) prior to the infection. Results: Together with the case presentation, we summarize in this report the most recent published data, concerning the HZ prevalence in healthy varicella zoster vaccinated children. Conclusion: Vaccinated pediatric patients are not completely free of risk concerning HZ. Physicians, especially pediatricians and dermatologists, should be alert in order to recognize and treat HZ early, so as to avoid further complications.

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