건강한 어린 소아에서 수두 백신 접종 후 발생한 대상포진 2예: 백신주에 의한 1예
Two Cases of Herpes Zoster Following Varicella Vaccination in Immunocompetent Young Children: One Case Caused by Vaccine-Strain
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초록
대상포진은 소아에서 흔하지 않은 질환이며, 국외의 자료에서는 수두 백신 접종 정책 시행 후 대상포진의 발생률이 감소되었다. 저자들은 건강한 어린 소아에서 수두 백신 접종 후 발생한 대상포진 2예를 경험하였다. 특히 이중 1예에서는 피부 검체를 검사하여 대상포진이 백신주 varicella-zoster virus (VZV)에 의한 것을 확인하였다. 2예 모두 발진이 번지는 양상이어서 항바이러스제를 투여하였고 호전되었다. 수두 백신을 접종 받은 어린 소아가, 수두에 이환 되거나 노출된 적이 없으며, 대상포진이 발병하였을 경우 백신주에 의한 대상포진의 가능성을 고려해야 한다.
Abstract
Herpes zoster (HZ) has been reported in immunocompetent children who received the varicella vaccine. In vaccinated children, HZ can be caused by vaccine-strain or by wild-type varicella-zoster virus (VZV). Like wild-type VZV, varicella vaccine virus can establish latency and reactivate as HZ. We report two cases of HZ in otherwise healthy 16- and 14-month-old boys who received varicella vaccine at 12 months of age. They presented with a vesicular rash on their upper extremities three to four months after varicella vaccination. In one case, a swab was obtained by abrading skin vesicles and VZV was detected in skin specimens by polymerase chain reaction. The VZV open-reading frame 62 was sequenced and single nucleotide polymorphism analysis confirmed that the virus from skin specimen was vaccine-strain. This is the first HZ case following varicella vaccination confirmed to be caused by vaccine-strain VZV in the immunocompetent children in Korea. Pediatricians should be aware of the potential for varicella vaccine virus reactivation in vaccinated young children.
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