Varicella zoster vaccine (V210 / Varivax / Varivax ISF)

Rashless varicella-zoster virus encephalitis diagnosed by metagenomic next-generation sequencing: two case reports.

Guo Wei-Meng WM, Zhang Xue-Hao XH, Yang Xin X, Chen Fang F et al.

Varicella-zoster virus (VZV) can cause a range of central nervous system (CNS) infections, but early diagnosis is difficult when typical skin rash is absent. Rashless VZV encephalitis may present with nonspecific clinical, cerebrospinal fluid (CSF), and neuroimaging findings and can mimic autoimmune encephalitis, primary central nervous system lymphoma, or other disorders. We report two cases of rashless VZV encephalitis diagnosed by CSF metagenomic next-generation sequencing (mNGS), with subsequent neurological complications. Case 1 was a 68-year-old man admitted with fever, seizures, and impaired consciousness. Brain magnetic resonance imaging (MRI) showed multifocal abnormal signals. CSF analysis revealed marked pleocytosis and elevated protein levels, and CSF cytology showed suspected atypical lymphocytes, leading to early consideration of autoimmune encephalitis and primary central nervous system lymphoma. CSF mNGS detected VZV, and rashless VZV encephalitis was diagnosed. The patient improved after intravenous acyclovir combined with a short course of dexamethasone. On day 45 after disease onset, follow-up MRI showed a new acute cerebral infarction adjacent to the posterior horn of the left lateral ventricle. Recurrent CSF pleocytosis and persistent protein elevation suggested possible VZV-associated vasculopathy. After repeated antiviral treatment, he improved again, and no recurrence was observed during more than 3 years of follow-up. Case 2 was a 74-year-old man admitted with fever, low back pain, vomiting, and impaired consciousness. Brain MRI showed multifocal abnormal signals, and CSF analysis revealed marked inflammatory changes. CSF mNGS detected VZV, supporting the etiological diagnosis of rashless VZV encephalitis. The patient improved after intravenous acyclovir combined with a short course of dexamethasone. On day 14 after disease onset, he developed urinary retention, impaired defecation sensation, and bilateral lower-limb weakness, suggesting possible lumbosacral nerve root or cauda equina involvement. Suspected VZV-related Elsberg syndrome was considered. His urinary and bowel dysfunction recovered at 2 months after disease onset. Rashless VZV encephalitis may be diagnostically challenging because early clinical, CSF, and neuroimaging findings are nonspecific. CSF mNGS can support etiological diagnosis, and careful follow-up is needed to detect delayed vascular and lumbosacral nerve root complications.

CT-guided pulsed radiofrequency of sacral and pudendal nerves for herpes zoster-related neurogenic lower urinary tract dysfunction in male patients: a retrospective study.

Li Haojia H, Liu Jingyu J, Liao Hongsen H, Wang Dianjun D et al.

To evaluate the efficacy of CT-guided pulsed radiofrequency (PRF) neuromodulation targeting the sacral nerves (S2-S4) and the pudendal nerve in male patients with herpes zoster-related neurogenic lower urinary tract dysfunction (NLUTD), a condition lacking effective treatment and significantly impairing quality of life. A retrospective analysis was conducted on 15 male patients with herpes zoster-related NLUTD who underwent CT-guided PRF treatment between 2024 and 2025. PRF was applied to the sacral nerve roots (S2-S4) and the pudendal nerve. Clinical outcomes were assessed using residual urine volume and Visual Analog Scale (VAS) scores for pain. Most patients received two to three treatment sessions. A 12-week follow-up was conducted, and quality of life was evaluated using the 36-Item Short Form Health Survey (SF-36). PRF treatment resulted in significant and sustained improvements in both urinary function and pain. Residual urine volume decreased markedly from 174.7 ± 43.1 mL at baseline to 29.3 ± 42.2 mL at 12 weeks, while VAS scores declined from 5.8 ± 1.0 to 0.9 ± 1.1. Health-related quality of life also improved significantly, as reflected by reductions in KHQ (73.47 ± 7.17 to 27.27 ± 12.79) and IIQ-7 scores (17.40 ± 1.72 to 5.07 ± 3.01; p < 0.05). Clinical benefits were evident after the first session and further enhanced with repeated treatments, with most patients achieving near-complete symptom resolution at 12 weeks and no recurrence of urinary retention. CT-guided PRF neuromodulation of the sacral and pudendal nerves demonstrates significant therapeutic value for male NLUTD secondary to herpes zoster, providing durable improvements in pain relief, urinary function, and quality of life (SF-36) over a 12-week observation period. The dual neuromodulatory approach is safe and warrants further prospective validation.

Therapeutic melanoma vaccines: Platforms, neoantigen strategies, and emerging combination immunotherapies.

Mhanna Daniel D, Salman Bilal B, El Hakim Rawad R, Aridi Lea L et al.

Melanoma has emerged as a major focus of cancer immunotherapy research because of its highly immunogenic nature and responsiveness to immune-based treatments. Therapeutic melanoma vaccines are designed to stimulate tumor-specific immune responses through the delivery of Tumor-Associated Antigens (TAAs), Tumor-Specific Antigens (TSAs), and personalized neoantigens. This narrative review provides an overview of current melanoma vaccine strategies, including peptide-based vaccines, dendritic cell vaccines, nucleic acid-based platforms such as mRNA, DNA, and viral vector vaccines. Recent advances in vaccine engineering and tumor genomics have accelerated the development of personalized neoantigen vaccines capable of targeting mutations unique to individual tumors. In parallel, Artificial Intelligence (AI) and Machine Learning (ML) are increasingly being incorporated into neoantigen identification pipelines to improve epitope prediction and optimize vaccine design. Combination strategies involving Immune Checkpoint Inhibitors (ICIs), particularly anti-PD-1 and anti-CTLA-4 therapies, have further enhanced interest in melanoma vaccines by helping overcome tumor-induced immune suppression and augment T-cell activation. In addition to reviewing vaccine mechanisms and emerging technologies, this manuscript examines the evolving clinical trial landscape through analysis of melanoma vaccine studies registered on ClinicalTrials.gov. Although many studies have reported encouraging safety and immunogenicity findings, challenges related to tumor heterogeneity, immune evasion, biomarker selection, and manufacturing complexity continue to limit widespread clinical implementation. Ongoing advances in computational immunology, biomaterial engineering, and precision oncology are expected to further refine melanoma vaccine development and improve therapeutic efficacy. Collectively, these innovations may help establish melanoma vaccines as an increasingly important component of future personalized cancer immunotherapy strategies.

Moderna flu vaccine wins FDA approval.