{"doi":"10.1093/cid/ciaa222","title":"High Incidence of Herpes Zoster After Cord Blood Hematopoietic Cell Transplant Despite Longer Duration of Antiviral Prophylaxis","abstract":"BACKGROUND: Cord blood transplant (CBT) recipients have a high incidence of herpes zoster (HZ) in the context of short-term peritransplant antiviral prophylaxis. In 2009, international guidelines recommended HZ prophylaxis for at least 1 year after hematopoietic cell transplant. The impact of longer-term antiviral prophylaxis on HZ incidence after CBT is unknown. METHODS: We retrospectively analyzed varicella zoster virus (VZV)-seropositive CBT recipients who were transplanted between 2006 and 2016. We abstracted HZ events and other variables for up to 5 years post-CBT. We calculated the cumulative incidence of HZ and used Cox proportional hazards regression to identify variables associated with HZ. RESULTS: The study cohort consisted of 227 patients. Among 1-year survivors, 91% were still receiving prophylaxis, for a median duration of 20.6 months. HZ occurred in 44 patients (19%) at a median of 23.6 months. The cumulative incidence of HZ by 1 year after CBT was 1.8% (95% confidence interval [CI], .1%-4%), but increased to 26% (95% CI, 19%-33%) by 5 years. In a multivariable analysis, acute graft-vs-host disease was associated with increased risk, whereas antiviral prophylaxis was associated with reduced risk for HZ (adjusted hazard ratio, 0.19 [95% CI, .09-.4]). There was no association between CD4+ T-cell counts at 1 year post-CBT and subsequent risk for HZ. CONCLUSIONS: We found a high incidence of HZ after CBT despite antiviral prophylaxis for > 1 year. Based on these findings, we suggest longer duration of prophylaxis for HZ after CBT. Compliance with antiviral prophylaxis, VZV-specific immune monitoring, and vaccination to mitigate HZ after CBT also require further study.","journal":"Clinical Infectious Diseases","year":2020,"id":76279,"datarank":0.4636563680037475,"base_score":3.091042453358316,"endowment":3.091042453358316,"self_citation_contribution":0.4636563680037475,"citation_network_contribution":0.0,"self_endowment_contribution":0.4636563680037475,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":21,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9569,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":345766,"name":"Hu Xie","orcid":"0000-0003-0556-6591","position":1,"is_corresponding":false},{"id":230926,"name":"Wendy M. Leisenring","orcid":"0000-0001-7405-0906","position":2,"is_corresponding":false},{"id":234539,"name":"Louise E. Kimball","orcid":null,"position":3,"is_corresponding":false},{"id":398808,"name":"Sonia Goyal","orcid":null,"position":4,"is_corresponding":false},{"id":397774,"name":"E Chung","orcid":"0000-0001-6224-6549","position":5,"is_corresponding":false},{"id":398809,"name":"Rachel Blazevic","orcid":null,"position":6,"is_corresponding":false},{"id":398810,"name":"Byron Maltez","orcid":null,"position":7,"is_corresponding":false},{"id":397775,"name":"A. S. Edwards","orcid":"0000-0003-0747-0454","position":8,"is_corresponding":false},{"id":397776,"name":"Ann Dahlberg","orcid":"0000-0003-2460-1911","position":9,"is_corresponding":false},{"id":397777,"name":"Rachel B. Salit","orcid":"0000-0002-4060-9393","position":10,"is_corresponding":false},{"id":397778,"name":"Colleen Delaney","orcid":"0000-0002-1044-2801","position":11,"is_corresponding":false},{"id":236731,"name":"Steven A. Pergam","orcid":"0000-0002-6333-5196","position":12,"is_corresponding":false},{"id":233082,"name":"Michael Boeckh","orcid":"0000-0003-1538-7984","position":13,"is_corresponding":false},{"id":345767,"name":"Filippo Milano","orcid":"0000-0003-3573-2159","position":14,"is_corresponding":false},{"id":277654,"name":"Joshua A. Hill","orcid":"0000-0002-7665-7100","position":15,"is_corresponding":false},{"id":397773,"name":"Elisabetta Xue","orcid":"0000-0002-1963-9555","position":0,"is_corresponding":true}],"reference_count":44,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T21:47:46.469293Z","pmid":"32150265","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}