1251. Assessment of the accuracy of clinical diagnosis of herpes zoster by polymerase chain reaction
Session: Oral Abstract Session: Laboratory and Clinical Virology
Saturday, October 5, 2013: 10:45 AM
Room: The Moscone Center: 300
Background: While herpes zoster (HZ) is felt to be relatively a distinct clinical condition, it can be confused with zosteriform herpes simplex and other linear dermatoses. Molecular virologic techniques have revolutionized the diagnosis of diseases caused by varicella-zoster virus (VZV). By comparing the diagnosis with the findings of polymerase chain reaction (PCR) test, this study assessed the accuracy of clinical diagnosis of HZ in community practices and evaluated whether it varied by HZ vaccination status.

Methods: Clinically diagnosed HZ patients, both vaccinated with a zoster vaccine and unvaccinated, were identified within 1 day by daily automated review of the electronic health records of Kaiser Permanente, Southern California. A trained research associate contacted the subjects by phone and arranged a visit at their home. A minimum of two skin lesion specimens, as well as saliva, and urine samples were obtained within 4 days of diagnosis. Specimens and samples were sent to the National VZV Laboratory at CDC for VZV PCR testing, which was done blindly to vaccination statue. Test results from skin lesions were regarded as the criterion standard for HZ case confirmation, with beta-actin positive control. Vaccine strain VZV and wild type VZV were differentiated by genotyping. The proportion of positive PCR results was compared between vaccinated patients and the unvaccinated ones.

Results: From January 2012 to April, 2013, specimens were taken from 416 clinically diagnosed HZ patients (206 vaccinated and 210 unvaccinated). The average number of days from rash onset to specimen collection was 5.5 days (median: 5 days). HZ was confirmed by positive PCR from skin lesions in 175/206 (84.9%) vaccinated and 178/210 (84.8%) unvaccinated cases. All but one confirmed positive skin specimens were wild-type VZV. One vaccinated female patient had a positive Oka strain VZV. 

Conclusion: The accuracy of clinical diagnosis of HZ is considered adequate and is similar between the patients vaccinated with a zoster vaccine and the unvaccinated. Oka strain virus in HZ vaccine is first found to be capable of reactivating and causing clinical symptoms in an  immunocompetent individual.

Hung Fu Tseng, Ph.D., MPH1, Scott Schmid, PhD2, Rafael Harpaz, MD, MPH2, Phillip LaRussa, MD3, Kimberly Holmquist, MPHc1, Kay W. Radford4, Yi Luo, MS1 and Steven Jacobsen, MD, PhD1, (1)Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, (2)Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (3)Columbia University School of Medicine, New York, NY, (4)CDC, Atlanta, GA


H. F. Tseng, None

S. Schmid, None

R. Harpaz, None

P. LaRussa, None

K. Holmquist, None

K. W. Radford, None

Y. Luo, None

S. Jacobsen, None

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