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A new form of shingles vaccine reduces epidemics of painful rashes in patients transplanted with their own stem cells, according to a study by a Duke Health researcher and published today in JAMA.
The vaccine appears to offer protection against one of the most common and painful side effects of cell therapy, and it looks promising for patients whose immune status is compromised.
By using a non-living form of the herpes zoster virus that causes shingles, researchers have tested vaccination in people whose immune system is destroyed during hematopoietic stem cell transplantation (HSCT). HSCT patients are particularly prone to episodes of shingles, caused by the reactivation of the latent virus of chicken pox and shingles, also responsible for chickenpox.
The outbreak results in blisters and red rashes, painful and painful, usually on one side of the body, and often occurs in the elderly or people whose immune system is weakened. In some cases, shingles cause severe and persistent neurological pain.
"This trial is important because it demonstrates that the vaccine works in severely immunocompromised patients," said oncologist Keith Sullivan, MD, professor of medicine James B. Wyngaarden at Duke. "This suggests that it could also work with others whose immune system is not normal, including HIV-infected patients, bad cancer and autoimmune disorders."
Sullivan and colleagues from 167 centers in 28 countries recruited more than 1,800 transplant recipients. Half of the patients were randomized to receive two doses of vaccine shortly after the transplant and the other half a placebo.
After a median follow-up of 21 months, the vaccinated group had 30 cases of shingles per 1,000 person-years, compared to 94 cases per 1,000 person-years in patients receiving placebo injections.
The vaccine has also apparently reduced the incidence of painful post-therapeutic neuralgia, hospitalizations and complications related to shingles, as well as the duration of the pain.
Among HSCT patients, an outbreak of shingles is often more feared than the transplant itself, and patients have said that they had undergone two transplants before facing a new episode of shingles. It is extremely gratifying, and a good surprise, to see such a strong immune response among this study population. "
Keith Sullivan, M.D
Source:
Duke University Medical Center
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