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Intervention Review

Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults

  1. Kristine Macartney1,*,
  2. Peter McIntyre2

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 27 FEB 2008

DOI: 10.1002/14651858.CD001833.pub2

How to Cite

Macartney K, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001833. DOI: 10.1002/14651858.CD001833.pub2.

Author Information

  1. 1

    The Children's Hospital at Westmead, The National Centre for Immunisation Research (NCIRS), Sydney, NSW, Australia

  2. 2

    Children's Hospital at Westmead and University of Sydney, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia

*Kristine Macartney, The National Centre for Immunisation Research (NCIRS), The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. kristinm@chw.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Live attenuated varicella vaccines for the prevention of varicella (chickenpox) has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States. However, many countries do not routinely immunise children against varicella, and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP).

Objectives

To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, Issue 1); MEDLINE (1966 to February 2008); and EMBASE (January 1990 to February 2008).

Selection criteria

RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse effects following vaccination.

Data collection and analysis

Two review authors independently extracted and analysed data using Review Manager software.

Main results

Three studies involving 110 healthy children who were siblings of household contacts were identified as suitable for inclusion. The studies varied in quality, study design, vaccine used, and outcomes measured and, as such, were not suitable for meta-analysis. Overall, 13 out of 56 vaccine recipients (18%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with less than 50 skin lesions). In the three studies, most subjects received PEP within three days following exposure; too few subjects were vaccinated four to five days post exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included studies reported on adverse events following immunisation.

Authors' conclusions

These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. No RCTs for adolescents or adults were identified. However safety was not adequately addressed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Post-exposure prophylaxis vaccine to prevent varicella (chickenpox)

This review assessed how useful the varicella (also known as chickenpox) vaccine is in preventing chickenpox when given to children or adults who have never been immunised or had chickenpox before, but who receive the vaccine within a short time following exposure to a person with chickenpox. Varicella is a highly contagious viral infection characterised by a widespread pustular rash, fever and generally feeling unwell.

Although many cases of chickenpox are mild, complications such as secondary bacterial infection, neurological complications, and other problems occur in at least 1% of cases, usually resulting in hospitalisation. The virus that causes chickenpox also remains dormant in sensory nerve roots after infection, and can reactivate later in life as a painful blistering rash known as herpes zoster or shingles.

Chickenpox can be prevented by vaccination with live attenuated varicella vaccine, however, many countries have not yet funded routine population-based immunisation programmes, and exposure to chickenpox remains commonplace.

The question of how to prevent chickenpox occurring in an adult or child who has been in contact with a person with the disease has led to trials of varicella vaccines in this setting. This review found that three separate trials support giving varicella vaccine to a child, particularly if given within three days of contact with a chickenpox case. Although in some cases, mild chickenpox may still occur, the vaccine is likely to prevent moderate to severe cases of chickenpox. The number of participants in these three trials was small and is a limitation of this review. There have been no trials of this type undertaken in adults, and none of the trials commented on adverse events following immunisation, such as fever or injection site symptoms.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

疫苗用於預防暴露後兒童和成人水痘(chickenpox)的發生

活性減毒水痘疫苗用於預防水痘的效用,已經過隨機對照試驗(RCTs)及某些國家的免疫接種計劃(如美國)的証實;即使如此,仍有許多國家並未常規為兒童接種水痘疫苗,因此暴露於疾病的可能性依舊存在。雖然水痘的症狀通常很輕微,但嚴重的併發症,如發生率約為1%的繼發性細菌感染、肺炎以及腦炎等,都有可能導致病人住院。因此我們研究了將水痘疫苗用於最近接觸Varicella zoster病毒後的暴露後預防(postexposure prophylaxis,PEP)。

目標

評估水痘疫苗用於兒童和成人暴露後預防的有效性和安全性。

搜尋策略

我們檢索了Cochrane Central Register of Controlled Trials(CENTRAL)(Cochrane圖書館,2008年第1期)、MEDLINE(1966年至2008年2月)和EMBASE(1990年1月至2008年2月)。

選擇標準

我們收錄了比較水痘疫苗、安慰劑與不經治療三組之間,對於暴露後預防的成效之隨機(randomised)與半隨機(quasirandomised)對照試驗。結果的評估包括對於臨床病例或實驗室確診病例預防的有效性,以及接種後的不良反應。

資料收集與分析

由兩位作者各自利用Review Manager software來擷取及分析數據。

主要結論

我們共收錄了3篇研究,其中包含了110位曾與兄弟姐妹間接觸過的健康兒童。這些研究之間的品質、研究設計、使用疫苗的種類以及結果衡量的方法差異甚大,因此並不適合進行統合分析。整體而言,56位接受疫苗的人當中有13位產生水痘(18%),而54位使用安慰劑(或未經治療) 的人當中則有42位產生水痘(78%);大多數接種後仍發病的人僅有輕微的症狀(少於50處的皮膚損傷)。在這3篇研究當中,大多數的受試者會在接觸後3天內施打疫苗,僅有極少數人是在接觸後的4、5天內接種,以至樣本數過少,而於無法判斷3天以上施打是否有效。沒有任何研究提及施打疫苗之後的不良反應。

作者結論

這些小規模試驗發現,兒童在家中接觸到患者後的3天內施打水痘疫苗,將有效降低水痘接觸後的感染率和疾病嚴重度。並沒有關於青少年或成年人的隨機對照試驗。安全性的問題仍未被解決。

翻譯人

本摘要由慈濟醫院陳迪詠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

暴露後預防接種以防止水痘發生這篇回顧文章評估了未曾接種水痘疫苗或未曾發病的兒童與成人,於接觸病患後的短時間內接種水痘疫苗,是否得以預防水痘暴露後的發病。水痘是一種高傳染性的病毒感染,其特色是廣泛的膿皰皮疹、發燒與全身不適。雖然大多數的發病都很輕微,但嚴重併發症,如發生率至少1%的繼發性細菌感染、肺炎、腦炎等,都會導致病患住院。水痘病毒也會在感染後潛伏於感覺神經根,並於日後復發,造成帶狀皰疹(herpes zoster)而導致疼痛。水痘可藉由接種活性減毒疫苗來預防,然而許多國家仍未有全民接種計劃,而疾病的暴露依舊普遍。及因如此,而產生了許多關於如何防止成人或兒童暴露後發病之研究。我們的結果發現,3篇不同的研究都支持給予兒童接觸後的水痘疫苗接種,特別是在接觸後的3天之內;雖然在某些情況之下仍有輕度發病,但疫苗似乎能預防中至重度的疾病產生。這篇回顧文章的最大限制,主要來自於參與者人數規模過小,且缺乏關於青少年或成年人的隨機對照試驗。沒有任何研究提及接種後的不良反應,如發燒或施打部位所產生的的症狀。