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Dialysis Discussion => Dialysis: Transplant Discussion => Topic started by: okarol on August 18, 2007, 12:20:13 PM
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If you are on the wait-list or planning a living donor transplant, you should read this regarding immunizations for chicken pox and shingles.
There are also links for Cytomegalovirus (CMV) and Epstein-Barre Virus (EBV.)
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This is from: http://adam.about.com/reports/Shingles-and-chickenpox-Varicella-zoster-virus.htm?once=true&
Shingles and chickenpox (Varicella-zoster virus)
New Chickenpox Immunization Schedule
In 2007, the U.S. Centers for Disease Control (CDC) updated the immunization schedule for the chickenpox vaccine. The CDC now recommends that children receive two doses of the vaccine. Children should receive:
* The first dose when they are 12 15 months old
* The second dose when they are 4 6 years old
If your child has been previously vaccinated, make sure that the pediatrician administers a second catch-up dose. It is clear that one dose of chickenpox vaccine does not provide complete protection against chickenpox. Adults who are at high risk of contracting chickenpox should also receive two doses of the chickenpox vaccine.
Shingles Vaccine
In 2006, the FDA approved the first shingles vaccine (Zostavax). The CDC now recommends that all adults with intact immune systems who are age 60 years and older receive this vaccine to help prevent herpes zoster (shingles). This includes adults who have previously had a shingles attack. Evidence indicates that Zostavax can help prevent the occurrence of shingles by about 50%. The vaccine can also help prevent the development of post-herpetic neuralgia (the nerve pain that can follow shingles) by 67%.
Scientists Identify Varicella-Mediating Protein
The varicella-zoster virus causes both chickenpox and shingles. After a chickenpox attack, the virus can lie dormant in the body for many years. Once reactivated, the virus quickly travels through nerve cells, causing rash and nerve pain. In 2006, scientists at the U.S. National Institutes of Health identified a specific protein that causes the virus to spread throughout cells in the body. Researchers hope that this important discovery may lead to new drug treatments for shingles.
Investigational Treatments for Postherpetic Neuralgia
Intravenous antiviral drug treatment, followed by oral antiviral drugs, may help reduce postherpetic neuralgia pain, according to a small study published in the Archives of Neurology.
Introduction
Shingles and chickenpox were once considered separate disorders. Researchers now know that they are both caused by a single virus of the herpes family known as varicella-zoster virus (VZV). The word herpes is derived from the Greek word "herpein," which means "to creep," a reference to a characteristic pattern of skin eruptions. VZV is still referred to by separate terms:
* Varicella: The primary infection that causes chickenpox
* Herpes zoster: The reactivation of the virus that causes shingles
Varicella (Chickenpox). When patients with chickenpox cough or sneeze, they expel tiny droplets that carry the virus. If a person who has never had chickenpox or been vaccinated inhales these particles, the virus enters the lungs. From here it passes into the bloodstream. When it is carried to the skin it produces the typical rash of chickenpox.
Herpes Zoster (Shingles). The varicella virus also travels to nerve cells called dorsal root ganglia. These are bundles of nerves that transmit sensory information from the skin to the brain. Here, the virus can hide from the immune system for years, often for a lifetime. This inactivity is called latency.
If the virus becomes active after being latent, it causes the disorder known as shingles. The virus in this later form is referred to as herpes zoster. The virus spreads in the ganglion and to the nerves connecting to it. Nerves most often affected are those in the face or the trunk. The virus can also spread to the spinal cord and into the bloodstream. In 2006, scientists at the U.S. Institutes of National Health identified a specific protein, called insulin-degrading enzyme, which causes the varicella-zoster virus to spread throughout cells in the body. The scientists hope that this discovery may eventually help in developing new drug therapies for treating shingles.
It is not clear why the varicella virus reactivates in some people but not in others. In many cases, the immune system has become impaired or suppressed from certain conditions such as AIDS, other immunodeficient diseases, or certain cancers or drugs that suppress the immune system. Aging itself increases the risk for shingles.
Other Herpes Viruses
The varicella-zoster virus belongs to a group of herpes viruses that includes eight human viruses (it also includes animal viruses as well). Herpes viruses are similar in shape and size and reproduce within the structure of a cell. The particular cell depends upon the specific virus. The human herpes viruses are:
* Herpes Simplex Virus 1 (HSV-1; causes cold sores and sometimes genital herpes) - http://www.cdc.gov/std/Herpes/default.htm
* Herpes Simplex Virus 2 (HSV-2; causes genital herpes and sometimes cold sores) - http://www.cdc.gov/std/Herpes/default.htm
* Varicella-zoster Virus (VZV; causes chickenpox and shingles)
* Cytomegalovirus (CMV; causes mononucleosis and retinitis) - http://www.cdc.gov/cmv/
* Epstein-Barre Virus (EBV; causes mononucleosis - http://www.cdc.gov/ncidod/diseases/ebv.htm
* Human Herpesvirus 6 (HHV6; causes roseola)
* Human Herpesvirus 7 (HHV7; causes roseola)
* Human Herpesvirus 7 (HHV8; causes Kaposi's sarcoma)
All herpes viruses share some common properties, including a pattern of active symptoms followed by latent inactive periods that can last for months, years, or even for a lifetime.
Recommendations for the Chickenpox Vaccine in Adults
The U.S. Centers for Disease Control and Prevention (CDC) recommends that every healthy adult without a known history of chickenpox be vaccinated. Adults in the following groups should strongly consider vaccination:
* Those with high risk of exposure or transmission (hospital or day care workers, parents of young children)
* People in contact with those who have compromised immune systems
* Nonpregnant women of childbearing age
* International travelers
As with other live-virus vaccines, the chickenpox vaccine is not recommended for:
* Women who are pregnant or who may become pregnant within 30 days of vaccination.
* People whose immune systems are compromised by disease or drugs (such as after organ transplantation). Experts report that the vaccine is safe in children with acute lymphoblastic leukemia (ALL). Certain children who are HIV-positive may be candidates for the vaccine. An inactivated chickenpox vaccine may be safe for patients undergoing bone marrow transplants when given before and after the operation.
Patients who cannot be vaccinated but who are exposed to chickenpox receive immune globulin antibodies against varicella virus. This helps prevent complications of the disease if they become infected.
Side Effects of the Varicella (Chickenpox) Vaccine
* Discomfort at the Injection Site. About 20% of vaccine recipients have pain, swelling, or redness at the injection site.
* Severe Side Effects. Only about 5% of adverse reactions are serious. Such events include seizures, pneumonia, anaphylactic reaction, encephalitis, Stevens-Johnsons syndrome, neuropathy, herpes zoster, and blood abnormalities.
* Risk of Transmission. The vaccine may produce a mild rash within about a month of the vaccination, which can transmit chickenpox to others. Individuals who have recently been vaccinated should avoid close contact with anyone who might be susceptible to severe complications from chickenpox until the risk for a rash passes.
* Later Infection. Months or even years after the vaccination, some people develop a mild infection termed modified varicella-like syndrome (MVLS). The condition appears to be less contagious and has fewer complications than naturally acquired chickenpox.
Shingles Vaccine
In 2006, a shingles vaccine was approved for use in the United States. The zoster vaccine (Zostavax) is a stronger version of the chickenpox vaccine. Study results published in 2005 suggested that the zoster vaccine can prevent about half of all shingles cases and two-thirds of postherpetic neuralgia cases. The CDC recommends that all adults age 60 years and older who have intact immune systems should receive this vaccine
Varicella-Zoster Immune Globulin
Varicella-zoster immune globulin (VariZIG) is a substance that triggers an immune response against the varicella-zoster virus. It is used to protect high-risk patients who are exposed to chickenpox, or those who cannot receive a vaccination of the live virus. Such groups include:
* Pregnant women with no history of chickenpox
* Newborn infants whose mothers had signs or symptoms of chickenpox around the time of delivery (5 days before to 2 days after)
* Premature infants
* Immunocompromised children and adults with no antibodies to VZV
* Recipients of bone-marrow transplants (even if they have had chickenpox)
* Patients with a debilitating disease (even if they have had chickenpox)
For these patients, VariZIG should be given within 96 hours of exposure to someone with chickenpox. (Note: VariZIG is a new formulation of an older drug called VZIG, which is no longer being produced.)
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