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. 2011 Feb 1;203(3):316-23.
doi: 10.1093/infdis/jiq066. Epub 2010 Dec 21.

Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine

Barbara A Pahud  1 , Carol A Glaser, Cornelia L Dekker, Ann M Arvin, D Scott Schmid
Affiliations

Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine

Barbara A Pahud et al. J Infect Dis. .

Abstract

Background: Since the introduction of live attenuated varicella zoster virus (VZV) vaccine in 1995 there has been a significant reduction in varicella incidence and its associated complications, but the impact on VZV-associated central nervous system (CNS) disease has not been assessed.

Methods: In this descriptive study we evaluated patients referred to the California Encephalitis Project from 1998 to 2009 with VZV PCR-positive cerebrospinal fluid (CSF). Epidemiological, clinical, and laboratory data were collected using a standardized case form. Specimens were genotyped using multi-single nucleotide polymorphism (SNP) analysis.

Results: Twenty-six specimens were genotyped from patients 12-85 years of age (median, 46 years). Clinical presentations included meningitis (50%), encephalitis (42%), and acute disseminated encephalomyelitis (ADEM) (8%). Only 11 patients (42%) had a concomitant herpes zoster rash. Genotype analysis identified 20 European Group (Clade1, Clade 3) strains; 4 Asian (Clade 2) strains, and 2 Mosaic Group (Clade 4, Clade VI) strains. One specimen was recognized as vaccine strain by identifying vaccine-associated SNPs.

Conclusions: VZV continues to be associated with CNS disease, with meningitis being the most frequent clinical presentation. CNS VZV disease often presented without accompanying zoster rash. Sequencing data revealed multiple genotypes, including 1 vaccine strain detected in the CSF of a young patient with meningitis.

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Figures

Figure 1.
Figure 1.
Single nucleotide polymorphism (SNP) profiles for the VZV genotypes identified in this study. The base positions for the SNP are based on the published sequence for the Dumas strain (GenBank accession no. XO4370). The principle reference strain for each clade is indicated in parentheses. Clade VI is provisional; no complete genome sequences are currently available.
Figure 2.
Figure 2.
Distribution of VZV genotypes identified in this study. The vaccine strain was differentiated from other clade 2 viruses by evaluating vaccine specific SNP at positions 106262 and 107252 (ORF62), and genotyping SNP at ORF38 (PstI site), ORF54 (BglI site) and sequence analysis of targeted regions in ORF21, ORF22, and ORF50. Clade 1/Clade 3 indicates European group isolates that could not be further characterized due to failure to amplify the regions in ORF21 and ORF50.
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References

    1. Centers for Disease Control Prevention. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. MMWR Recomm Rep. 1996;45:1–36. - PubMed
    1. Lopez AS, Kolasa MS, Seward JF. Status of school entry requirements for varicella vaccination and vaccination coverage 11 years after implementation of the varicella vaccination program. J Infect Dis. 2008;197(suppl 2):S76–81. - PubMed
    1. Marin M, Guris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2007;56:1–40. - PubMed
    1. Koskiniemi M, Rantalaiho T, Piiparinen H, et al. Infections of the central nervous system of suspected viral origin: A collaborative study from Finland. J Neurovirol. 2001;7:400–8. - PubMed
    1. Seward JF, Watson BM, Peterson CL, et al. Varicella disease after introduction of varicella vaccine in the United States, 1995–2000. JAMA. 2002;287:606–11. - PubMed

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