OBJECTIVE:To review the varicella-zoster virus (VZV) and herpes zoster disease and to summarize published reports on the use of the live-attenuated varicella zoster vaccine to enhance cell-mediated immunity in elderly individuals. DATA SOURCE:A MEDLINE search (1966-August 1999) for English-language clinical studies and review articles pertaining to VZV and the live-attenuated varicella vaccine was conducted; references obtained from these publications were subsequently reviewed for additional relevant articles. STUDY SELECTION AND DATA EXTRACTION:Representative clinical trials were summarized and relevant information was selected to assist in the understanding of VZV, the subsequent immune response, and the live-attenuated varicella vaccine. DATA SYNTHESIS:The physiologic, age-related decline in VZV cell-mediated immunity has been shown to be restored on administration of live-attenuated varicella vaccine. Various studies report serum anti-VZV antibody concentrations, and production of interferon-gamma were increased following vaccination. Concentrations subsequently returned to baseline one year after vaccination. Increase in responder cell frequency, a measure of cell-mediated immunity, has been reported to last up to four years after vaccination, at concentrations similar or superior to those observed following herpes zoster. CONCLUSIONS:Enhancement of cell-mediated immune response in elderly individuals through vaccination with live-attenuated varicella vaccine is a possible measure to protect this population from herpes zoster and to attenuate its complications. A summary of immunogenicity studies to identify the immune response to live-attenuated varicella vaccine in the elderly is presented. The absolute clinical significance, as well as appropriate administration guidelines of this prophylactic intervention, will become evident following forthcoming large, masked, placebo-controlled trials.

译文

目的:回顾水痘带状疱疹病毒(VZV)和带状疱疹疾病,并总结有关使用减毒水痘带状疱疹活疫苗增强老年人细胞介导的免疫力的已发表报告。
资料来源:MEDLINE搜索(1966年8月至1999年8月)进行英语临床研究,并复习了有关VZV和减毒活水痘疫苗的文章;随后对从这些出版物中获得的参考文献进行了审查,以获取其他相关文章。
研究的选择和数据提取:总结了代表性的临床试验,并选择了相关的信息以帮助理解VZV,随后的免疫反应和减毒的水痘活疫苗。
数据合成:已证明,减毒水痘活疫苗的接种可以恢复生理性,与年龄相关的VZV细胞介导的免疫力下降。各种研究报告了血清抗VZV抗体的浓度,接种疫苗后γ干扰素的产生增加。疫苗接种一年后,浓度随后恢复到基线。据报道,接种细胞后反应细胞频率的增加(一种衡量细胞介导的免疫力的方法)可持续长达四年,其浓度与带状疱疹后观察到的浓度相似或更高。
结论:通过减毒活水痘疫苗接种来增强老年人的细胞介导的免疫反应是保护该人群免受带状疱疹和减轻其并发症的可能措施。概述了免疫原性研究,以鉴定老年人对减毒活水痘疫苗的免疫应答。在即将进行的大型的,有掩盖的,安慰剂对照的试验之后,这种预防性干预措施的绝对临床意义以及适当的给药指南将变得显而易见。

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