Larson VZV Vaccines

What two diseases are caused by VZV?

• Chicken pox (varicella)

• Shingles (zoster)

Viral Latency

The virus is present in a cell but is not replicating

Pathogenesis of VZV

Widely distributed vesicular rash due to viral spread to lymph nodes and transport of virus from blood to skin through infected T cells

How does the presentation of VZV differ from measles and rubella?

The skin rash begins on the torso (centripetal distribution) and progresses outward to the arms, legs, and head

What effect does VZV infection have on T cells?

Enhances homing to skin

• VZV infected CD4 T cells express skin homing proteins, such as cutaneous leukocyte antigen (CLA) and CCR4

Once in the skin, VZV triggers _____

Innate immune response

• Type 1 IFNs - IFNα

• PML (Promyelocytic leukemia protein)

PML (promyelocytic leukemia protein)

Forms intranuclear cages to trap new virions

How does VZV establish latency?

By infecting sensory nerve bodies in the dorsal root ganglia (spine) and trigeminal ganglia (face)

Where in the body does zoster manifest?

In the dermatome that is innervated by the affected ganglion

What two things are needed to resolve VZV infection?

• Cell mediated immunity (CMI)

• Antibodies

What is needed to prevent reactivation of VZV?

Memory T cells (CD4 and CD8 T cells)

If you have shingles once, can you get it again?

Yes

Rates of recurrent infections are similar to rates of first occurrences

Why is the varicella vaccine given after 12 months?

Maternal antibodies are high the first year of life and will clear out virus

Antibodies against gE (glycoprotein E) are neutralizing, which means _____

Attachment and infection are blocked

What was added to the Shingrix vaccine to improve the immune response to gE (glycoprotein E)?

An adjuvant