Case and Research Letter
Herpes Zoster in Children Vaccinated Against Varicella-Zoster Virus: Experience in our Hospital
Herpes zóster en niños vacunados contra el virus varicela zóster: experiencia en nuestro hospital
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Caro-Gutiérrez, J.L. López-Estebaranz, E. Naz-Villalba, L. Ayala-Bernaldo de Quiros" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Caro-Gutiérrez" "email" => array:2 [ 0 => "carogutierrezd@gmail.com" 1 => "mdcaro@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Naz-Villalba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Ayala-Bernaldo de Quiros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Herpes zóster en niños vacunados contra el virus varicela zóster: experiencia en nuestro hospital" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 884 "Ancho" => 1600 "Tamanyo" => 182550 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of the herpes zoster lesions in 4 of the patients in our series.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The introduction of the varicella zoster virus (VZV) vaccine was expected to eliminate herpes zoster (HZ) in vaccinated children. However, several years later we continue to treat cases of HZ in children. We describe 8 cases of pediatric HZ that were recorded between 2010 and 2013 during duty shifts at the dermatology service of Hospital Universitario Fundación Alcorcón. During this period the population living in the catchment area of the hospital corresponded to 247 000 inhabitants. The clinical and epidemiological characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>. A slight male predominance was observed, with a male to female ratio of 6:2. Ages ranged from 18 months to 5 years (mean, 3.5 years). All the patients had been vaccinated with a single dose between 15 and 17 months of age. The mean time from vaccination to HZ onset was 2.2 years, with the earliest case detected only 3 months after vaccination. Polymerase chain reaction (PCR) for VZV was performed in 2 cases, both of which were positive. The necessary technique for differentiation between the vaccine and wild strain was unavailable in our hospital. The most frequently affected dermatomes were those of the lower limbs. Treatment varied depending on the extent and duration of the lesions, and the discomfort reported by the patients. Treatment with oral acyclovir was required in 5 of the 8 cases; the remaining patients received topical treatments consisting of astringent soaks and antibiotic ointments. None of the patients had risk factors for immunosuppression or associated comorbidities. Just 3 patients had atopic dermatitis, but none of them had required oral corticosteroid therapy in the preceding year. Six of the 8 patients had undergone laboratory testing in the preceding month, with no abnormalities detected. A favorable clinical course was observed with the prescribed treatments. Subsequent follow-up revealed no complications such as scarring and postherpetic neuralgia or recurrences.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The VZV vaccine is a live attenuated vaccine derived from the Oka strain of VZV. Its use in children under 12 years was approved in 2003 (Varivax). Although the latest guidelines of the Spanish Association of Pediatrics recommend administering 2 doses (the first at 12-15 months and the second at 2-3 years), this dosing schedule is used by only 3 autonomous communities (Ceuta, Melilla, and Navarra). The general trend is to administer a single dose at 11 to 12 years. Between 2010 and 2013 children in Madrid received a single dose at 15 months, and vaccination was recommended for children aged 11 who were seronegative and had not been previously vaccinated. These recommendations were recently changed, and as of January 1, 2014, vaccination is only recommended for 12-year-olds who have not been previously vaccinated and have not contracted HZ.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total absence of HZ in vaccinated children was expected with the introduction of the VZV vaccine, but several years later HZ cases continue to be recorded in both vaccinated and healthy children. PCR was performed in some of these cases, and was positive for the Oka strain.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–4</span></a> This strain may be reactivated, causing disseminated zoster (which occurs if antibody titers are low, and is often mistaken for wild-type infection) or metameric zoster.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> The latter condition is probably underdiagnosed owing to the belief that the vaccine strain is incapable of reactivating, the rarity of HZ in children, and the fact that postvaccination HZ is relatively mild and thus may account for fewer consultations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Reactivation may be more frequent if titers of anti-VZV are low<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> and if a rash develops after vaccination, as it is postulated that skin lesions enable the passage of VZV to the nerves and the establishment of latent infection.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,5</span></a> Postvaccination HZ is distinguished from HZ after primary infection mainly based on the associated lesions. Postvaccination HZ lesions are generally smaller, less painful, and contain fewer vesicles. Moreover, these lesions predominantly develop on lumbosacral rather than thoracic dermatomes, given the greater proximity of the former to the site of vaccine administration.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, we have presented 8 cases of HZ; all patients were under 5 years of age, healthy, and had been vaccinated for VZV. Although cases of reactivation of the Oka strain of VZV have been reported, recent studies found no increase in the incidence of HZ in vaccinated children.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> However, no epidemiological studies have assessed the true incidence of HZ in children since the introduction of routine vaccination in Spain. Molecular characterization of the virus could provide more information on the incidence of HZ after VZV vaccination.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Caro-Gutiérrez D, López-Estebaranz J, Naz-Villalba E, Ayala-Bernaldo de Quiros L. Herpes zóster en niños vacunados contra el virus varicela zóster: experiencia en nuestro hospital. Actas Dermosifiliogr. 2015;106:329–331.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 884 "Ancho" => 1600 "Tamanyo" => 182550 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of the herpes zoster lesions in 4 of the patients in our series.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: →→, months from vaccination to onset of herpes zoster infection; AD, atopic dermatitis; PCR, polymerase chain reaction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AD/Asthma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immunosuppression \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hemogram \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age at Vaccination, mo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">→→ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, mo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PCR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Second Episode \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Girl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Boy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Boy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Boy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Face \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Boy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ankle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Girl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Boy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">DA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Boy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab785733.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical and Epidemiological Characteristics of Patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Herpes zoster after varicella immunization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.G. Liang" 1 => "K.A. Heidelberg" 2 => "R.M. Jacobson" 3 => "M.T. McEvoy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1998" "volumen" => "38" "paginaInicial" => "761" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9591823" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Herpes zoster by reactivated vaccine varicella zoster virus in a healthy child" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Uebe" 1 => "A. Sauerbrei" 2 => "S. Burdach" 3 => "G. 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Klinman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/74715" "Revista" => array:6 [ "tituloSerie" => "Nat Med" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "451" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10742154" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Herpes zoster after varicella-zoster vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Fahlbush" 1 => "U. Wesselmann" 2 => "P. Lehmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00105-012-2477-x" "Revista" => array:6 [ "tituloSerie" => "Hautarzt" "fecha" => "2013" "volumen" => "64" "paginaInicial" => "107" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23358727" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The postmarketing safety profile of varicella vaccine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Sharrar" 1 => "P. LaRussa" 2 => "S.A. Galea" 3 => "S.P. Steinberg" 4 => "A.R. Sweet" 5 => "R.M. Keatley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Vaccine" "fecha" => "2000" "volumen" => "19" "paginaInicial" => "916" "paginaFinal" => "923" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11115716" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence a clinical characteristics of HZ among children and adolescents after implementation of varicella vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Civen" 1 => "S.S. Chaves" 2 => "A. Jumaan" 3 => "H. Wu" 4 => "L. Mascola" 5 => "P. Gargiullo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/INF.0b013e3181a90b16" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "954" "paginaFinal" => "959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19536039" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effectiveness of varicella vaccine: A 14-year, prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Baxter" 1 => "P. Ray" 2 => "T.N. Tran" 3 => "S. Black" 4 => "H.R. Shinefield" 5 => "P.M. Coplan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2012-3303" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2013" "volumen" => "131" "paginaInicial" => "e1389" "paginaFinal" => "e1396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23545380" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000004/v2_201505051007/S1578219015000621/v2_201505051007/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000004/v2_201505051007/S1578219015000621/v2_201505051007/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000621?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 6 | 17 |
| 2024 Octubre | 112 | 43 | 155 |
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| 2024 Agosto | 132 | 61 | 193 |
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| 2024 Junio | 128 | 60 | 188 |
| 2024 Mayo | 111 | 44 | 155 |
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| 2024 Marzo | 115 | 53 | 168 |
| 2024 Febrero | 103 | 40 | 143 |
| 2024 Enero | 103 | 40 | 143 |
| 2023 Diciembre | 139 | 44 | 183 |
| 2023 Noviembre | 168 | 43 | 211 |
| 2023 Octubre | 155 | 39 | 194 |
| 2023 Septiembre | 140 | 57 | 197 |
| 2023 Agosto | 99 | 28 | 127 |
| 2023 Julio | 116 | 60 | 176 |
| 2023 Junio | 95 | 31 | 126 |
| 2023 Mayo | 96 | 37 | 133 |
| 2023 Abril | 69 | 34 | 103 |
| 2023 Marzo | 106 | 44 | 150 |
| 2023 Febrero | 103 | 39 | 142 |
| 2023 Enero | 112 | 62 | 174 |
| 2022 Diciembre | 107 | 49 | 156 |
| 2022 Noviembre | 111 | 30 | 141 |
| 2022 Octubre | 84 | 29 | 113 |
| 2022 Septiembre | 75 | 39 | 114 |
| 2022 Agosto | 91 | 40 | 131 |
| 2022 Julio | 68 | 40 | 108 |
| 2022 Junio | 70 | 19 | 89 |
| 2022 Mayo | 101 | 35 | 136 |
| 2022 Abril | 118 | 31 | 149 |
| 2022 Marzo | 75 | 45 | 120 |
| 2022 Febrero | 107 | 40 | 147 |
| 2022 Enero | 142 | 40 | 182 |
| 2021 Diciembre | 92 | 31 | 123 |
| 2021 Noviembre | 72 | 42 | 114 |
| 2021 Octubre | 55 | 52 | 107 |
| 2021 Septiembre | 52 | 37 | 89 |
| 2021 Agosto | 56 | 21 | 77 |
| 2021 Julio | 50 | 24 | 74 |
| 2021 Junio | 78 | 37 | 115 |
| 2021 Mayo | 54 | 25 | 79 |
| 2021 Abril | 177 | 50 | 227 |
| 2021 Marzo | 82 | 30 | 112 |
| 2021 Febrero | 79 | 27 | 106 |
| 2021 Enero | 41 | 13 | 54 |
| 2020 Diciembre | 53 | 21 | 74 |
| 2020 Noviembre | 22 | 15 | 37 |
| 2020 Octubre | 21 | 12 | 33 |
| 2020 Septiembre | 26 | 13 | 39 |
| 2020 Agosto | 19 | 19 | 38 |
| 2020 Julio | 16 | 16 | 32 |
| 2020 Junio | 43 | 29 | 72 |
| 2020 Mayo | 32 | 19 | 51 |
| 2020 Abril | 40 | 22 | 62 |
| 2020 Marzo | 49 | 13 | 62 |
| 2020 Febrero | 8 | 2 | 10 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 4 | 6 | 10 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Septiembre | 1 | 2 | 3 |
| 2019 Agosto | 9 | 0 | 9 |
| 2019 Julio | 4 | 3 | 7 |
| 2019 Junio | 4 | 5 | 9 |
| 2019 Mayo | 4 | 21 | 25 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Enero | 6 | 0 | 6 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 9 | 0 | 9 |
| 2018 Febrero | 63 | 2 | 65 |
| 2018 Enero | 151 | 6 | 157 |
| 2017 Diciembre | 114 | 10 | 124 |
| 2017 Noviembre | 52 | 3 | 55 |
| 2017 Octubre | 29 | 5 | 34 |
| 2017 Septiembre | 37 | 3 | 40 |
| 2017 Agosto | 59 | 5 | 64 |
| 2017 Julio | 47 | 2 | 49 |
| 2017 Junio | 68 | 8 | 76 |
| 2017 Mayo | 72 | 8 | 80 |
| 2017 Abril | 58 | 15 | 73 |
| 2017 Marzo | 45 | 7 | 52 |
| 2017 Febrero | 41 | 13 | 54 |
| 2017 Enero | 35 | 5 | 40 |
| 2016 Diciembre | 43 | 10 | 53 |
| 2016 Noviembre | 48 | 17 | 65 |
| 2016 Octubre | 52 | 12 | 64 |
| 2016 Septiembre | 0 | 7 | 7 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 9 | 1 | 10 |
| 2016 Junio | 12 | 1 | 13 |
| 2016 Mayo | 8 | 1 | 9 |
| 2016 Abril | 14 | 1 | 15 |
| 2016 Marzo | 7 | 0 | 7 |
| 2016 Febrero | 8 | 3 | 11 |
| 2016 Enero | 9 | 4 | 13 |
| 2015 Diciembre | 9 | 1 | 10 |
| 2015 Noviembre | 10 | 5 | 15 |
| 2015 Septiembre | 0 | 3 | 3 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 24 | 1 | 25 |
| 2015 Junio | 31 | 8 | 39 |
| 2015 Mayo | 36 | 6 | 42 |
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