A community-based survey of varicella-zoster virus-specific immune responses in the elderly

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Abstract

Background

In the USA, live attenuated varicella-zoster virus (VZV) vaccine is licensed for use in people 50 or older, to reduce the incidence and/or severity of herpes zoster. However, this vaccine is not yet available in Japan, and the immunity profile for VZV in older people has not been investigated in detail in Japan.

Objectives

The aim of this study was to conduct a detailed survey about the immunity profile for VZV in older people in Japan.

Study design

A panel of immunologic tests (skin test, ELISPOT, gpELISA, IAHA and NT) were used to analyze the immunity to VZV in the subjects. And an interview about zoster history was carried out with each of the subjects.

Results

Cellular immunity test (skin test and ELISPOT) results declined with increasing age; on the contrary, humoral immunity test (gpELISA, IAHA and NT) results increased with advancing age. In addition, strongly boosted humoral immunity was found in the subjects with zoster history, however relatively small increase was found in cellular immunity test results.

Conclusions

Cell-mediated immunity (CMI) to VZV decreased and humoral immunity increased with increasing age in this population.

Section snippets

Background

Varicella-zoster virus (VZV) causes varicella in children, and establishes lifelong latency in the sensory ganglia. Reactivation of the latent VZV causes herpes zoster (zoster).1 Many risk factors for the occurrence of zoster have been reported,2, 3, 4, 5 and increasing age is considered a key risk factor.2, 6, 7, 8 Antibody levels are reported to be relatively constant with increasing age,6, 7, 9 while a decline in VZV-specific cell-mediated immunity (CMI) with advancing age, and in

Objectives

The objective of this study was to conduct a detailed survey at large scale about VZV-immunity profile of older people in Japan. Therefore, here, we carried out a large-scale VZV-immune profile investigation in a population living in an island cluster in Japan where elder people have stayed for a long period without moving.

Volunteers

Epidemiological description of the Shozu Herpes Zoster (SHEZ) Study, a large cohort study, was recently reported,13 and this study has been done as a part of SHEZ Study. We enrolled 365 healthy volunteers from Shozu County, which consists of small islands in the middle of Japan, from December 2008 to October 2009. Shozu County, Kagawa Prefecture is an administrative division. All of the volunteers were continuous residents of the island and were age 60 or older: 121 volunteers were in their

Correlation among the immunologic tests results

The coefficient range from the Pearson correlation analysis was from 0.549 to 0.666 between all combinations of the humoral immunity tests, indicating strong correlations (Fig. 1A). A strong correlation was found between the edema and erythema in the skin test (Fig. 1B). Weak correlation (Pearson r from 0.231 to 0.251) was found between the ELISPOT and erythema, and between the ELISPOT and edema (Fig. 1B). No correlation was found between the cellular and humoral immunity results (Fig. 1C).

Decreased CMI to VZV with increasing age

We

Discussion

To investigate the immunity to VZV, a plethora of tests have been developed over the years. Advantage and disadvantage of each test have also been reported.17, 18 Since it is likely that more convincing data are obtained when combined tests are performed for an immunologic survey, here we used a panel of immunologic tests to investigate the detailed immunity profile of each subject. We enrolled healthy volunteers, 60 or older, from an island cluster and demonstrated that the CMI to VZV

Funding

This study is funded as “Epidemiological Research for the Development of Herpes Zoster Vaccine” (KHC1102) by a research grant from the Labour Sciences Research Grants at Research on Publicly Essential Drugs and Medical Devices of Health.

Competing interest

Authors (H.T., E.M., S.O., H.I., H.A., K.Y. and Y.M.) report no potential conflicts of interest. Y.O. belongs to Biken which produces skin test reaction and Oka vaccine.

Ethical approval

This study was approved by ethical committees of all the involved institutions. Written informed consent was obtained from each volunteer.

Acknowledgments

We thank the cooperating medical organizations belonging to the Shozu County Medical Society: 11 of the 13 medical organizations in Shozu County consisting of 6 private clinics, 2 municipal clinics, 1 private hospital and 2 municipal hospitals. Dermatology department exists only at the 2 municipal hospitals, where dermatological services are provided by part-time dermatologists on 3 days a week, Shodoshima Federation of Self-Government Bodies, Tonosho Town Autonomous Liaison Council, Shodoshima

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