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Postexposure Prophylaxis Against Varicella Zoster Virus Infection Among Hematopoietic Stem Cell Transplant Recipients

Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Biology of Blood and Marrow Transplantation (Impact Factor: 3.4). 11/2006; 12(10):1096-7. DOI: 10.1016/j.bbmt.2006.06.005
Source: PubMed

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    • "Besides, vaccination of VZV-seronegative individuals who may be in contact with the patients during transplantation should be done [25]. Zoster immune globulin (ZIG) and varicella-zoster immune globulin (VZIG) are passive antibody prophylaxis in seronegative recipients after exposure to varicella [113]. Acyclovir and valacyclovir prophylaxis were proven effective in several trials [9,114-117]. "
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    ABSTRACT: Viral infections are important causes of morbidity and mortality after allogeneic stem cell hematopoietic transplantation (allo-HSCT). Although most viral infections present with asymptomatic or subclinical manifestations, viruses may result in fatal complications in severe immunocompromised recipients. Reactivation of latent viruses, such as herpesviruses, is frequent during the immunosuppression that occurs with allo-HSCT. Viruses acquired from community, such as the respiratory and gastrointestinal viruses, are also important pathogens of post-transplant viral diseases. Currently, molecular diagnostic methods have replaced or supplemented traditional methods, such as viral culture and antigen detection, in diagnosis of viral infections. The utilization of polymerase chain reaction facilitates the early diagnosis. In view of lacking efficacious agents for treatment of viral diseases, prevention of viral infections is extremely valuable. Application of prophylactic strategies including preemptive therapy reduces viral infections and diseases. Adoptive cellular therapy for restoring virus-specific immunity is a promising method in the treatment of viral diseases.
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    ABSTRACT: Antiviral agents play a key role in the prevention and treatment of varicella zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show that aciclovir is effective in preventing VZV reactivation disease; however, no consensus exists on dose, duration and patient population for its use. The recent shortage of VZV-specific immunoglobulin has generated renewed interest in the use of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for post-exposure prophylaxis is not supported by randomized trials, but uncontrolled experience suggests that it might be a reasonable alternative if varicella-specific immunoglobulin is not available. Current evidence on the use of antiviral agents in the prevention of reactivation disease and management of exposure to VZV is discussed.
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    ABSTRACT: Evidence-based Pediatric Infectious Diseases is a practical guide to the diagnosis and management of childhood infections in clinical practice. Renowned Clinical Professor of Pediatric Infectious Diseases, David Isaacs, and an expert consultant editor team, bring you the first book to critically look at the evidence for decision making in pediatric infections. Based around illustrative case studies, each chapter presents and analyzes current evidence on the management of different pediatric infections and provides firm treatment recommendations based on evidence of: Efficacy and safety Antibiotic resistance. Cost. Adverse effects. Ethical considerations. Clear summaries and specific guidance allow you to assess the evidence for yourself and make rapid but informed management decisions based on the strength of evidence available. Antibiotic doses are presented clearly and simply, enabling you to select appropriate treatment at a glance. This book uses a case-based approach that focuses on the most common disease areas affecting children in industrialized countries, developing countries, travelers and refugees. It is an up-to-date, relevant and widely applicable text that carefully examines the evidence for antibiotics and other interventions whilst encouraging a conservative and responsible approach to antibiotic use. Evidence-based Pediatric Infectious Diseases is an indispensable resource for any practitioner who strives to provide the best evidence-based care for childhood infections.
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