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Varicella-zoster virus immunity in dermatological patients on systemic immunosuppressant treatment

Authors


  • Funding sources
    None.

  • Conflicts of interest
    B.K. is in receipt of unrestricted research grants from and/or has acted as a consultant for Abbott, Janssen-Cilag, Merck-Serono, Pfizer and Schering Plough. S.F.F. has received speaker honoraria from Pfizer, Astra-Zeneca and Leo. S.R. has acted as a consultant for Wyeth Pharmaceuticals, Schering Plough and Abbott.

Caitriona Hackett.
E-mail: c.hackett@svuh.ie

Summary

Background  Primary varicella infection is caused by varicella-zoster virus (VZV). It is a common childhood infection, which is usually benign but can occasionally cause morbidity and mortality. In immunosuppressed adults, atypical presentation and disseminated disease can occur with significant morbidity and mortality. A VZV vaccine is available.

Objectives  This study was designed to measure the prevalence of immunity to VZV and to determine the predictive value of a self-reported history of varicella infection in a population of dermatological patients receiving systemic immunosuppressant therapy. We sought to assess the need for routine serological testing for varicella-zoster immunity in this cohort.

Methods  Serological testing for VZV immunity was done on 228 patients receiving systemic immunosuppressive treatment for a dermatological condition. Information regarding a history of previous primary VZV infection was obtained from each patient.

Results  Two hundred and twenty-eight patients had VZV serology performed. The mean age of the patients was 49·6 years. The prevalence of VZV seropositivity in this cohort was 98·7%. One hundred and two patients (44·7%) reported having a definite history of primary VZV. The sensitivity of a self-reported history of VZV infection was 45·3% with a specificity of 100%. The positive and negative predictive values of a self-reported history of VZV for serologically confirmed immunity were 100% and 2·3%, respectively.

Conclusions  The prevalence of VZV IgG antibodies in our cohort of Irish dermatology patients receiving immunosuppressive therapy is 98·7%. A recalled history of varicella infection is a good predictor of serological immunity. This study has shown that there are VZV-susceptible individuals within our cohort. These patients did not have a clear history of previous infection. We recommend serological testing of patients without a clear history of infection prior to the commencement of immunosuppressive therapy and vaccination of patients with negative serology.

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