Current topics in human varicella infection: Pearls and challenges
Abstract
Varicella zoster virus (VZV), an alphaherpesvirus, is a highly contagious and neurotropic virus infecting the majority of the adult and pediatric population worldwide. Varicella zoster virus is the only human herpesvirus for which a licensed live attenuated vaccine has been developed. It can be considered that additional study on VZV is superfluous given the significant success of the VZV vaccines. This has been the case for other viruses including rubella and measles, for which effective vaccinations are widely available. Contrarily, much regarding VZV, a complex and chronic human disease due to its latency, still needs to be uncovered. Over the past two decades, our understanding of the molecular biology of VZV and its pathogenicity has expanded. In this review, we discussed our recent understanding of VZV biology, pathogenesis as well as its clinical aspect, including diagnosis, clinical management, and vaccine development.
References
Davison AJ. Evolution of the herpesviruses. Vet Microbiol 2002; 86(1-2): 69-88.
https://doi.org/10.1016/s0378-1135(01)00492-8
Pawaskar M, Meroc E, Samant S, Flem E, Bencina G, Riera-Montes M, et al. Economic burden of varicella in Europe in the absence of universal varicella vaccination. BMC Public Health 2021; 21(1):2312.
https://doi.org/10.1186/s12889-021-12343-x
Huang J, Wu Y, Wang M, Jiang J, Zhu Y, Kumar R, et al. The global disease burden of varicella-zoster virus infection from 1990 to 2019. J Med Virol 2022; 94(6):2736-46.
https://doi.org/10.1002/jmv.27538
Laing KJ, Ouwendijk WJD, Koelle DM, Verjans G. Immunobiology of varicella-zoster virus infection. J Infect Dis 2018; 218(suppl_2): S68-S74.
https://doi.org/10.1093/infdis/jiy403
Arvin AM. Varicella-zoster virus. Clin Microbiol Rev 1996; 9(3):361-81.
https://doi.org/10.1128/CMR.9.3.361
Walz-Cicconi MA, Rose RM, Dammin GJ, Weller TH. Inoculation of guinea pigs with varicella-zoster virus via the respiratory route. Arch Virol 1986; 88(3-4):265-77.
https://doi.org/10.1007/BF01310880
Meyer C, Kerns A, Barron A, Kreklywich C, Streblow DN, Messaoudi I. Simian varicella virus gene expression during acute and latent infection of rhesus macaques. J Neurovirol 2011; 17(6):600-12.
https://doi.org/10.1007/s13365-011-0057-y
Mahalingam R, Gershon A, Gershon M, Cohen JI, Arvin A, Zerboni L, et al. Current in vivo models of varicella-zoster virus neurotropism. Viruses 2019; 11(6):502.
https://doi.org/10.3390/v11060502
Gershon A, Takahashi M, Seward J. In: Plotkin S, Orenstein W, Offit P, eds. Vaccines: Saunders Elsevier; 2011: 915-58.
Breuer J, Grose C, Norberg P, Tipples G, Schmid DS. A proposal for a common nomenclature for viral clades that form the species varicella-zoster virus: summary of VZV Nomenclature Meeting 2008, Barts and the London School of Medicine and Dentistry, 24-25 July 2008. J Gen Virol 2010; 91(Pt 4):821-8.
https://doi.org/10.1099/vir.0.017814-0
Kujur A, Kiran KA, Kujur M. An epidemiological study of outbreak investigation of chickenpox in remote hamlets of a tribal state in India. Cureus 2022; 14(6):e26454.
https://doi.org/10.7759/cureus.26454
Juffrie M, Graham RR, Tan RI, Widjaja S, Mulyadi S, Weil J, et al. Seroprevalence of hepatitis A virus and varicella zoster antibodies in a Javanese community (Yogyakarta, Indonesia). Southeast Asian J Trop Med Public Health 2000; 31(1):21-4.
Lolekha S, Tanthiphabha W, Sornchai P, Kosuwan P, Sutra S, Warachit B, Chup Upprakarn S, et al. Effect of climatic factors and population density on varicella zoster virus epidemiology within a tropical country. Am J Trop Med Hyg 2001; 64(3-4):131-6.
https://doi.org/10.4269/ajtmh.2001.64.131
Dinkes ungkap penyebab belasan siswa SD di Bantul terkena cacar air October 2023.
Marin M, Seward JF, Gershon AA. 25 years of varicella vaccination in the United States. J Infect Dis 2022; 226(Suppl 4):S375-9.
https://doi.org/10.1093/infdis/jiac251
Elam-Evans LD, Valier MR, Fredua B, Zell E, Murthu BP, Sterrett N, et al. Celebrating 25 years of varicella vaccination coverage for children and adolescents in the United States: a success story. J Infect Dis 2022; 226(Suppl 4):S416-24.
https://doi.org/10.1093/infdis/jiac337
Dooling K, Marin M, Gershon AA. Clinical manifestations of varicella: disease is largely forgotten, but it's not gone. J Infect Dis 2022; 226(Suppl 4):S380-4.
https://doi.org/10.1093/infdis/jiac390
Goh AEN, Choi EH, Chokephaibulkit K, Choudhury J, Kuter B, Lee PI, et al. Burden of varicella in the Asia-Pacific region: a systematic literature review. Expert Rev Vaccines 2019; 18(5):475-93.
https://doi.org/10.1080/14760584.2019.1594781
Zerboni L, Sen N, Oliver SL, Arvin AM. Molecular mechanisms of varicella zoster virus pathogenesis. Nat Rev Microbiol 2014; 12(3):197-210.
https://doi.org/10.1038/nrmicro3215
Depledge DP, Sadaoka T, Ouwendijk WJD. Molecular aspects of varicella-zoster virus latency. Viruses 2018; 10(7):349.
https://doi.org/10.3390/v10070349
Hatsushika Y, Nii I, Taniguchi T. Varicella caused by airborne transmission of a localised herpes zoster infection in a family. BMJ Case Rep 2021; 14(9):e243217.
https://doi.org/10.1136/bcr-2021-243217
Marziano V, Poletti P, Beraud G, Boelle PY, Merler S, Colizza V. Modeling the impact of changes in day-care contact patterns on the dynamics of varicella transmission in France between 1991 and 2015. PLoS Comput Biol 2018; 14(8):e1006334.
https://doi.org/10.1371/journal.pcbi.1006334
Lachiewicz AM, Srinivas ML. Varicella-zoster virus post-exposure management and prophylaxis: A review. Prev Med Rep 2019; 16:101016.
https://doi.org/10.1016/j.pmedr.2019.101016
Newman AM, Jhaveri R. Myths and misconceptions: Varicella-zoster virus exposure, infection risks, complications, and treatments. Clin Ther 2019; 41(9):1816-22.
https://doi.org/10.1016/j.clinthera.2019.06.009
Viner K, Perella D, Lopez A, Bialek S, Newbern C, Pierre R, et al. Transmission of varicella zoster virus from individuals with herpes zoster or varicella in school and day care settings. J Infect Dis 2012; 205(9):1336-41.
https://doi.org/10.1093/infdis/jis207
Sawyer MH, Wu YN, Chamberlin CJ, Burgos C, Brodine SK, Bowler WA, et al. Detection of varicella-zoster virus DNA in the oropharynx and blood of patients with varicella. J Infect Dis 1992; 166(4):885-8.
https://doi.org/10.1093/infdis/166.4.885
Haberthur K, Meyer C, Arnold N, Engelmann F, Jeske DR, Messaoudi I. Intrabronchial infection of rhesus macaques with simian varicella virus results in a robust immune response in the lungs. J Virol 2014; 88(21):12777-92.
https://doi.org/10.1128/JVI.01814-14
Ma H, Fontaine R. Varicella outbreak among primary school students--Beijing, China, 2004. MMWR Suppl 2006; 55(1):39-43.
Jones D, Como CN, Jing L, Blackmon A, Neff CP, Krueger O, et al. Varicella zoster virus productively infects human peripheral blood mononuclear cells to modulate expression of immunoinhibitory proteins and blocking PD-L1 enhances virus-specific CD8+ T cell effector function. PLoS Pathog 2019; 15(3):e1007650.
https://doi.org/10.1371/journal.ppat.1007650
Ku CC, Zerboni L, Ito H, Graham BS, Wallace M, Arvin AM. Varicella-zoster virus transfer to skin by T Cells and modulation of viral replication by epidermal cell interferon-alpha. J Exp Med 2004; 200(7):917-25.
https://doi.org/10.1084/jem.20040634
Kennedy PGE, Gershon AA. Clinical features of varicella-zoster virus infection. Viruses 2018; 10(11):609.
https://doi.org/10.3390/v10110609
Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, et al. Varicella zoster virus infection. Nat Rev Dis Primers 2015; 1:15016.
https://doi.org/10.1038/nrdp.2015.16
Islam B, Islam Z, GeurtsvanKessel CH, Jahan I, Endtz HP, Mohammad QD, et al. Guillain-Barre syndrome following varicella-zoster virus infection. Eur J Clin Microbiol Infect Dis 2018; 37(3):511-8.
https://doi.org/10.1007/s10096-018-3199-5
Yan Y, Yuan Y, Wang J, Zhang Y, Liu H, Zhang Z. Meningitis/meningoencephalitis caused by varicella zoster virus reactivation: a retrospective single-center case series study. Am J Transl Res 2022; 14(1):491-500.
Masih I, Boyle R, Donnelly A, Soye A, Kidney J. Varicella pneumonitis in an immunocompetent patient. BMJ Case Rep 2011; 201:(bcr0820103259.
https://doi.org/10.1136/bcr.08.2010.3259
Leung J, Broder KR, Marin M. Severe varicella in persons vaccinated with varicella vaccine (breakthrough varicella): a systematic literature review. Expert Rev Vaccines 2017; 16(4):391-400.
https://doi.org/10.1080/14760584.2017.1294069
Gershon M, Gershon A. Varicella-zoster virus and the enteric nervous system. J Infect Dis 2018; 218(suppl_2):S113-9.
https://doi.org/ 10.1093/infdis/jiy407
Asada H. VZV-specific cell-mediated immunity, but not humoral immunity, correlates inversely with the incidence of herpes zoster and the severity of skin symptoms and zoster-associated pain: The SHEZ study. Vaccine 2019; 37(44):6776-81.
https://doi.org/10.1016/j.vaccine.2019.09.031
Kwon DE, Lee HS, Lee KH, La Y, Han SH, Song YG. Incidence of herpes zoster in adult solid organ transplant recipients: A meta-analysis and comprehensive review. Transpl Infect Dis 2021; 23(4):e13674.
https://doi.org/10.1111/tid.13674
McKay SL, Guo A, Pergam SA, Dooling K. Herpes zoster risk in immunocompromised adults in the United States: A systematic review. Clin Infect Dis 2020; 71(7):e125-e34.
https://doi.org/10.1093/cid/ciz1090
Sauerbrei A. Varicella-zoster virus infections - antiviral therapy and diagnosis. GMS Infect Dis 2016; 4:Doc01.
https://doi.org/10.3205/id000019.
Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis 2016; 35(5):723-34.
https://doi.org/10.1007/s10096-016-2605-0
Choi RY, Lauer A, Rosenbaum JT. Molecular diagnosis and ocular imaging of varicella zoster virus associated neuroretinitis. Am J Ophthalmol Case Rep 2018; 11:146-8.
https://doi.org/10.1016/j.ajoc.2018.07.002
Wilson DA, Yen-Lieberman B, Schindler S, Asamoto K, Schold JD, Procop GW. Should varicella-zoster virus culture be eliminated? A comparison of direct immunofluorescence antigen detection, culture, and PCR, with a historical review. J Clin Microbiol 2012; 50(12):4120-2.
https://doi.org/10.1128/JCM.06753-11
Schmutzhard J, Merete Riedel H, Zweygberg Wirgart B, Grillner L. Detection of herpes simplex virus type 1, herpes simplex virus type 2 and varicella-zoster virus in skin lesions. Comparison of real-time PCR, nested PCR and virus isolation. J Clin Virol 2004; 29(2):120-6.
https://doi.org/10.1016/s1386-6532(03)00113-6
Wong AA, Pabbaraju K, Wong S, Tellier R. Development of a multiplex real-time PCR for the simultaneous detection of herpes simplex and varicella zoster viruses in cerebrospinal fluid and lesion swab specimens. J Virol Methods 2016; 229:16-23.
https://doi.org/10.1016/j.jviromet.2015.12.009
Meyberg-Solomayer GC, Fehm T, Muller-Hansen I, Enders G, Poets C, Wallwiener D, et al. Prenatal ultrasound diagnosis, follow-up, and outcome of congenital varicella syndrome. Fetal Diagn Ther 2006; 21(3):296-301.
https://doi.org/10.1159/000091360
Liu J, Ye X, Jia J, Zhu R, Wang L, Chen C, et al. Serological evaluation of immunity to the varicella-zoster virus based on a novel competitive enzyme-linked immunosorbent asay. Sci Rep 2016; 6:20577.
https://doi.org/10.1038/srep20577
Dollard S, Chen MH, Lindstrom S, Marin M, Rota PA. Diagnostic and immunologic testing for varicella in the era of high-impact varicella vaccination: An evolving problem. J Infect Dis 2022; 226(Suppl 4):S450-5.
https://doi.org/10.1093/infdis/jiac363
Gershon AA, Gershon MD. Pathogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev 2013; 26(4):728-43.
https://doi.org/10.1128/CMR.00052-13
Chickenpox (Varicella), For health care professionals. 2022.
https://www.cdc.gov/chickenpox/hcp/index.html.
Indonesia Ministry of Health. Peraturan Menteri Kesehatan Nomor 27 Tahun 2017 tentang Pedoman Pencegahan dan Pengendalian Infeksi di Fasilitas Pelayanan Kesehatan 2017.
Kim JE, Song YJ. Anti-varicella-zoster virus activity of cephalotaxine esters in vitro. J Microbiol 2019; 57(1):74-9.
https://doi.org/10.1007/s12275-019-8514-z
Park S, Kim NE, Park BJ, Kwon HC, Song YJ. Kaempferol interferes with varicella-zoster virus replication in human foreskin fibroblasts. Pharmaceuticals (Basel) 2022; 15(12):1582.
https://doi.org/10.3390/ph15121582
Agency UHS. Guidelines on post exposure prophylaxis (PEP) for varicella or shingles (January 2023). 2023.
Yamanishi K. Molecular analysis of the Oka vaccine strain of varicella-zoster virus. J Infect Dis 2008; 197 Suppl 2:S45-8.
https://doi.org/10.1086/522122
Varela FH, Pinto LA, Scotta MC. Global impact of varicella vaccination programs. Hum Vaccin Immunother 2019; 15(3):645-57.
https://doi.org/10.1080/21645515.2018.1546525
Cunningham AL, Levin MJ. Herpes zoster vaccines. J Infect Dis 2018; 218(suppl_2):S127-33.
https://doi.org/10.1093/infdis/jiy382
Hong K, Sohn S, Choe YJ, Rhie K, Lee JK, Ham MS, et al. Waning effectiveness of one-dose universal varicella vaccination in Korea, 2011-2018: a propensity score matched national population cohort. J Korean Med Sci 2021; 36(36):e222.
https://doi.org/10.3346/jkms.2021.36.e222
Levin MJ. Immune senescence and vaccines to prevent herpes zoster in older persons. Curr Opin Immunol 2012; 24(4):494-500.
https://doi.org/10.1016/j.coi.2012.06.002
Hertel M, Heiland M, Nahles S, Laffert MV, Mura C, Bourne PE, et al. Real-world evidence from over one million COVID-19 vaccinations is consistent with reactivation of the varicella-zoster virus. J Eur Acad Dermatol Venereol 2022; 36(8):1342-8.
https://doi.org/10.1111/jdv.18184
Gershon AA, Gershon MD, Shapiro ED. Live attenuated varicella vaccine: Prevention of varicella and of zoster. J Infect Dis 2021; 224(12 Suppl 2):S387-97.
https://doi.org/ 10.1093/infdis/jiaa573
Waye A, Jacobs P, Tan B. The impact of the universal infant varicella immunization strategy on Canadian varicella-related hospitalization rates. Vaccine 2013; 31(42):4744-8.
https://doi.org/10.1016/j.vaccine.2013.08.022
Shah RA, Limmer AL, Nwannunu CE, Patel RR, Mui UN, Tyring SK. Shingrix for herpes zoster: A review. Skin Therapy Lett 2019; 24(4):5-7.
