Clinical Features And Genotype Of Varicella-zoster Virus In Xinjiang

Objective:To explore the epidemiology and characteristics of varicella or herpes in Xinjiang. The study was designed to explore the factors related to acute pain and CD3+, CD4+, CD8+ T cell subsets in peripheral blood of herpes zoster, so as to understand cellular immune function in patients with herpes of different types, which can help to early intervent and rehabilitate pain from disease. By the analysis of epidemic situation and genotype of varicella-zoster virus in Xinjiang, we can find the effect of live attenuated vaccine study (Oka vaccine, vOka) and the relationship between different clinical variables and VZV gene subtypes, which will provide a theoretical basis and reference for clinical preventing of varicella or herpes in the Xinjiang.Methods:This study collected 125 cases clinically diagnosed varicella or herpes from 2012 April to 2013 January in outpatient department of dermatology or in hospital, including 6 cases of varicella and 119 cases of herpes zoster. The age, gender, nationality, skin lesions in acute stage location, degree of pain (acute herpetic pain, AHP), combined with fever or other internal medicine diseases were recorded. Acquire 2 ml venous blood in tubes with heparin and collect blister fluid of herpes zoster from skin lesions. Analyze the characteristics of varicella or herpes and the differences among different ages, different nationalities, different gender, different complications of herpes zoster in patients with acute pain phase. Flow measurement technique was used to detect CD3+, CD4+, CD8+ T cell subsets and CD4+/CD8+ ratio to detect the change of immune function. Detect DNA of VZV from blister fluid. And ORF22,38,54,62 fragment was amplified by PCR and sequenced using nucleic acid sequence analysis DNAMAN software. According to six SNPs of ORF22 fragment on mutation combinations and ORF38 (Pst I), ORF54 (Bgl I) restriction site analysis, VZV genotypes were determined. Sma I restriction site of VZV ORF62 was amplified to distinguish wild strains and vaccine strains. A retrospective survey of patients was carried on prevention vaccination history and clinical symptoms, to understand "breakthrough" infection incidence and clinical features in Xinjiang, and finally analyze the relationship between clinical variables and different subtypes of VZV.Results: ① Clinical data analysis showed that the average age of 6 cases of varicella was (16.83±10.30) years, while the average age of 119 cases of herpes zoster patients was (53.88±17.61) years; rash of herpes showed concentric distribution. In 119 cases with herpes,32 cases occured in the head, face and neck, accounting for 27%; 43 cases of chest and back,3 accounting for 6%; waist and abdomen in 24 cases, accounting for 20%; hip limbs in 19 cases, accounting for 16%; multiple sites in 1 case, accounting 1%. For different ages, different genders, different nationalities, different complications in patients with herpes zoster AHP statistical analysis, levels of AHP was statistically different in different ages and complications (P<0.05), but not found in ethnic and genders(P>0.05). ② through inter-group analysis of variance and LSD-t method pairwise comparison of different ages, different genders, different complications, degrees of AHP in peripheral blood T cell subsets were analyzed, the results showed CD3+, CD4+, CD4+/CD8+T cell subsets of patients≥56 years old decreased, compared those<25 years and 26-55 years old while CD8+ T cell subsets decreased; CD4+, CD4+/CD8+ T cell subsets of patients≤25 years old patient decreased compared with 26-55 years (P<0.05); and no differences between genders in CD3+, CD4+, CD8+and CD4+/CD8+ yet; CD3+, CD4+, CD8+and CD4+/CD8+ decreased significantly in patients with different complications or immunocompromised patients, such as type 2 diabetes (P<0.05), while little change in patients combined cardiovascular or cerebrovascular disease or no complications, the difference was not statistically significant (P>0.05); T cell subsets in pain analysis showed that CD3+, CD4+, CD8+and CD4+/CD8+ n patients with severe AHP decreased significantly compared mild to moderate group, the difference was statistically significant (P<0.05). ③ In this study,125 cases of blister fluid specimens, including six cases of chickenpox four cases of nucleic acid testing positive,119 cases of herpes zoster in 116 cases of nucleic acid testing positive for a total of 120 cases of positive samples of nucleic acid, the positive rate of 96%. For 120 clinical isolates of VZV ORF22 PCR products sequenced reference strain contrast gene sequences are published in Genbank shows that there are 79 J genotype, genotype Ml has 40, there is a genotype E; analysis ORF38 (Pst I), ORF54 (Bgl I) restriction sites, show 119 cases of PstI+ BglI + type, a type of PstI+BglI-. By ORF62 the Sma I restriction site analysis of 120 clinical isolates of VZV are wild strains, vaccination history and clinical manifestations prevention retrospective survey of patients, showing four cases of chickenpox patients, 2 patients had a clear history of varicella vaccine, suggesting that varicella vaccine does not provide 100% protection for vaccinated. Finally, the chi-square test for different genders, different ethnic groups, the situation VZV genotype infected patients of different ages were analyzed that different gender, genotyping patient age difference was not statistically significant (P>0.05), but different ethnic the significant difference in the composition of VZV genotypes (P<0.05), J-type gene in a high proportion of Han Chinese, the proportion of M1 and El in other ethnic was higher than Han Chinese.Conclusions: ① varicella is common in children and adolescent population, as a whole rash showed concentric distribution; zoster occurs mainly in the elderly over 50 years of age, chest and back are the most common site of predilection. ② acute phase of herpes zoster pain and age, comorbidity, whereas no correlation with gender, ethnicity, elderly, but degree of acute pain in diabetic or immunocompromised patients with herpes zoster is more severe. It should be paid more attention to specific populations and publicize knowledge of herpes zoster. ③ CD3+, CD4+, CD8+and CD4+/CD8+can be used as indicators for monitoring cellular immune function, when the indexes decrease significantly, it should be actively looked for reasons or the underlying disease and give early intervention to avoid sequelae of herpes zoster. ④ VZV in Xinjiang is highly conserved in the genetic characteristics and also polymorphic. VZV genotype is geographically relevant, but also has ethnic specificity, there may be differences between different ethnic susceptibility to VZV different genotypes. ⑤ varicella vaccine does not provide 100% protection to vaccine recipients, there has been a breakthrough in patients infected with the vaccine in Xinjiang; the clinical symptoms are similar with unvaccinated patients.