{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:10:22Z","timestamp":1790795422392,"version":"4.1.0"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"\n CONTEXT:<\/jats:title>\n Live vaccines usually provide robust immunity but can transmit the vaccine virus.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE:<\/jats:title>\n To assess the characteristics of secondary transmission of the vaccine-strain varicella-zoster virus (Oka strain; vOka) on the basis of the published experience with use of live varicella and zoster vaccines.<\/jats:p>\n <\/jats:sec>\n \n DATA SOURCES:<\/jats:title>\n Systematic review of Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases for articles published through 2018.<\/jats:p>\n <\/jats:sec>\n \n STUDY SELECTION:<\/jats:title>\n Articles that reported original data on vOka transmission from persons who received vaccines containing the live attenuated varicella-zoster virus.<\/jats:p>\n <\/jats:sec>\n \n DATA EXTRACTION:<\/jats:title>\n We abstracted data to describe vOka transmission by index patient\u2019s immune status, type (varicella or herpes zoster) and severity of illness, and whether transmission was laboratory confirmed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Twenty articles were included. We identified 13 patients with vOka varicella after transmission from 11 immunocompetent varicella vaccine recipients. In all instances, the vaccine recipient had a rash: 6 varicella-like and 5 herpes zoster. Transmission occurred mostly to household contacts. One additional case was not considered direct transmission from a vaccine recipient, but the mechanism was uncertain. Transmission from vaccinated immunocompromised children also occurred only if the vaccine recipient developed a rash postvaccination. Secondary cases of varicella caused by vOka were mild.<\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS:<\/jats:title>\n It is likely that other vOka transmission cases remain unpublished.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Healthy, vaccinated persons have minimal risk for transmitting vOka to contacts and only if a rash is present. Our findings support the existing recommendations for routine varicella vaccination and the guidance that persons with vaccine-related rash avoid contact with susceptible persons at high risk for severe varicella complications.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2019-1305","type":"journal-article","created":{"date-parts":[[2019,8,30]],"date-time":"2019-08-30T08:26:31Z","timestamp":1567153591000},"source":"Crossref","is-referenced-by-count":44,"title":["Transmission of Vaccine-Strain Varicella-Zoster Virus: A Systematic Review"],"prefix":"10.1542","volume":"144","author":[{"given":"Mona","family":"Marin","sequence":"first","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Leung","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for 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