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Immunity to varicella-zoster virus in immunocompromised patients

PhD ceremony:dr. C. Rondaan
When:March 19, 2018
Supervisor:prof. dr. N.A. (Nico) Bos
Co-supervisors:dr. J. (Hannie) Westra, dr. S. van Assen
Where:Academy building RUG
Faculty:Medical Sciences / UMCG

Immunity to varicella-zoster virus in immunocompromised patients

After a primary infection with the varicella-zoster virus (VZV), known as varicella or chickenpox, the virus remains latently present in the body for life. Reactivation causes herpes zoster (shingles)Immunocompromised patients are at increased risk of herpes zoster and its complications, compared to the general population. The research described in the first part of the thesis focuses on increasing the knowledge on the immunity to VZV in immunocompromised patient groups. With this information, we hope to be able to contribute to better prevention of herpes zoster in these patients in the future. Multiple groups of immunocompromised patients were included in our studies: patients with different autoimmune diseases, patients in need of long term renal replacement therapy and transplant recipients.

In most of the investigated groups, we showed a decreased cellular immunity to the VZV compared to healthy controls, while VZV humoral immunity was similar. In patients on long term renal replacement therapy we showed that increased age and a history of transplantation were associated with a lower cellular immunity to VZV. Interestingly, in patients with systemic lupus erythematosus (SLE) we found VZV humoral immunity (antibody levels of the IgG class) to be increased compared to controls.

However, we did not find evidence of (subclinical) reactivations of VZV in a longitudinal study in SLE patients, which might have been an explanation for this finding. The second part of the thesis is about vaccination in patients with autoimmune inflammatory rheumatic diseases. A literature review and a proposal for recommendations are presented.