[Pulmonary manifestations of chickenpox during primary tuberculous infection in infants: general data on chickenpox lung].
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Chickenpox↗
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My granddaughter was recently visiting and she had chickenpox. I've already had chickenpox, but I'm concerned about getting shingles because I know the two diseases are related. Can I catch shingles from her?
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Chickenpox↗
[Seroepidemiology of chickenpox, measles and parotitis in the Republic of Mexico. III. Chickenpox].
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Age Factors↗
[Complications and costs associated with chickenpox in immunocompetent children].
OBJECTIVES: Chickenpox is a common infection of childhood in countries that have not included the corresponding vaccination in their immunization schedules. Chickenpox is usually benign in immunocompetent children, and treatment is not needed. The objectives of this study were to investigate the frequency and characteristics of chickenpox complications that require hospital treatment in immunocompetent children and the clinical progression in children of mothers with perinatal chickenpox. In addition, the hospital costs associated with chickenpox in the studied children were calculated. METHODS: This was a retrospective study using the clinical records of children with chickenpox hospitalized at the Children's Hospital of Panama, from January 1991 through December 2000. We analyzed the types of complications, the clinical progression, and the hospital costs of the chickenpox patients. RESULTS: Of 5 203 children seen in outpatient consultations, 568 of them (11%) were hospitalized. We included 513 children in our study: 381 (74%) with chickenpox acquired in the community, 92 (18%) the children of mothers with chickenpox, and 40 (8%) with nosocomial chickenpox. The most frequent complications were cutaneous and subcutaneous infections (45%), respiratory infections (25%), and neurological changes (7%). The respiratory and cutaneous complications occurred sooner and among younger patients than did the neurological changes. Overall, 13 of the children (2.5%) died. The case fatality rate was 8% for chickenpox with respiratory and neurological complications and 0% for chickenpox with cutaneous complications. Of the 92 children with a mother with chickenpox, 60 of them (65%) did not develop the disease, and none of the 92 died. In contrast, 2 of the 32 neonates (6%) with perinatal chickenpox died. The mean length of hospitalization was 8.9 days (standard deviation, +/- 17.4 days). Parenteral pharmacotherapy was used with the great majority of the children, particularly antibiotics (54%), acyclovir (17%), and intravenous immunoglobulin (14%). The mean per-patient cost of hospitalization was US$ 1 209. CONCLUSIONS: Our results show that chickenpox is associated with a sizable number of expensive complications and a not-insignificant case fatality rate in immunocompetent children. Routine vaccination against chickenpox could reduce the impact of this disease on the health of children in Panama
Acyclovir↗
Chickenpox vaccines: new drugs. A favourable risk-benefit balance in some situations.
(1) Chickenpox is generally mild. Most severe cases of chickenpox occur in immunocompromised patients, adults, and pregnant women (and their foetuses). (2) Two live attenuated chickenpox vaccines derived from the same strain of varicella virus (Oka) are marketed in France, under the trade names Varilrix and Varivax. (3) They have not been adequately evaluated in immunocompromised children. (4) The impact of routine vaccination of women of child-bearing age on complications of chickenpox during pregnancy has not been studied. (5) Immunogenicity studies in several thousand immunocompetent children aged from 1 to 12 years show that the vaccine is almost always immunogenic after a single injection. Other comparative studies in adolescents and adults show that two injections are needed, at least two months apart. (6) A double-blind placebo-controlled trial including 513 immunocompetent children showed that Varilrix prevented 88% of cases of chickenpox after a median follow-up of 29 months, but no data on severe chickenpox were reported. A study that followed up 9202 children aged 1 to 12 years for more than 13 years showed that vaccination with Varivax failed to prevent chickenpox in 12.5% of cases and that 1.7% of these cases were severe. (7) Immunocompetent children vaccinated within three days after exposure to the virus are partially protected, according to one study of Varilrix (104 children) and two small studies of Varivax (10 and 42 children). There are no equivalent studies in adults. (8) Local adverse effects such as fever and rash are common in immunocompetent vaccinees. The rash is sometimes varicella-like and is due to infection by the vaccine strain. Pharmacovigilance studies of Varivax have shown no serious adverse effects. (9) Disseminated and/or persistent infection caused by the vaccine strain has been reported in immunocompromised patients. (10) Vaccination of immunocompetent subjects does not appear to result in a risk of chickenpox transmission to subsequent contacts. There seems to be no increase in the risk of herpes zoster in vaccinated children nor is there any firm evidence that chickenpox vaccination increases the incidence of herpes zoster in the general population. (11) Little information is available on vaccination during pregnancy. As a precaution, however, pregnant women should not be vaccinated. (12) Mass vaccination does not appear to be justified: chickenpox is generally mild during childhood, and several questions concerning the effects of the vaccine remain unanswered. (13) Chickenpox vaccination should be restricted to specific groups of non immune immunocompetent adults who are in a position to transmit chickenpox to immunodeficient contacts (e.g. health care personnel and kindergarten staff); adults who have been in contact with a case of chickenpox within the past three days; and children awaiting transplantation. The potential benefits and risks of vaccinating immunocompromised patients should be assessed on a case by case basis.
Adolescent↗
Varicella serology among school age children with a negative or uncertain history of chickenpox.
BACKGROUND: Clinicians who offer varicella vaccination to school age children face the dilemma of whether to serotest or vaccinate presumptively. Varicella seroprevalence among 7- to 12-year-old children with negative or uncertain histories has not previously been studied. Our main objective was to describe varicella seroprevalence among children ages 7 to 12 years with a negative or uncertain history of chickenpox. METHODS: This was a cross-sectional study of children whose clinicians had ordered varicella serotesting. Guidelines from the medical group's regional pediatric infectious disease specialists recommended obtaining varicella serology on all children 7 to 12 years old with a negative or uncertain history. Parents were interviewed by telephone about the child's history of chickenpox before test results were completed. RESULTS: Varicella seroprevalence ranged from 9% among 7-year-olds whose parents said they had definitely not had chickenpox to 68% among 11-year-olds whose parents were not sure whether they had had chickenpox. Among children whose parents were uncertain about their chickenpox history, almost one-half (48%) were seropositive. Twenty-five percent of children whose parents said they definitely had not and 32% of children whose parents said they had probably not had chickenpox were seropositive. Of parents whose children had experienced serotesting, 73% said they would prefer to have the blood test first rather than presumptive vaccination. For a large health maintenance organization, it was projected to be most cost-effective (in terms of cost per chickenpox case prevented) to recommend testing for children 9 to 12 years old with uncertain histories of chickenpox. CONCLUSIONS: We conclude that among children 7 to 12 years old with negative or uncertain histories of chickenpox, varicella seroprevalence ranges from 9 to 68% depending on age and clinical history. Parents are generally receptive to serotesting, although individual preferences vary. In the population we studied it would be most cost-effective to recommend testing before deciding about vaccination for children 9 to 12 years old with uncertain histories of chickenpox.
Chickenpox↗
Chickenpox outbreak in a highly vaccinated school population.
OBJECTIVE: We investigated a chickenpox outbreak that started in an Oregon elementary school in October 2001, after public schools began phasing in a varicella vaccination requirement for enrollment. We sought to determine the rate of varicella vaccination and effectiveness and risk factors for breakthrough disease. METHODS: A chickenpox case was defined as an acute maculopapulovesicular rash without other explanation occurring from October 30, 2001 through January 27, 2002 in a student without a prior history of chickenpox. We reviewed varicella vaccination records and history of prior chickenpox, and we calculated vaccine effectiveness. We evaluated the effects of age, gender, age at vaccination, and time since vaccination on risk of breakthrough disease (ie, chickenpox occurring >42 days after vaccination). RESULTS: Of 422 students, 218 (52%) had no prior chickenpox. Of these, 211 (97%) had been vaccinated before the outbreak. Twenty-one cases occurred in 9 of 16 classrooms. In these 9 classrooms, 18 of 152 (12%) vaccinated students developed chickenpox, compared with 3 of 7 (43%) unvaccinated students. Vaccine effectiveness was 72% (95% confidence interval: 3%-87%). Students vaccinated >5 years before the outbreak were 6.7 times (95% confidence interval: 2.2-22.9) as likely to develop breakthrough disease as those vaccinated </=5 years before the outbreak (15 of 65 [23%] vs 3 of 87 [3%]). CONCLUSIONS: A chickenpox outbreak occurred in a school in which 97% of students without a prior history of chickenpox were vaccinated. Students vaccinated >5 years before the outbreak were at risk for breakthrough disease. Booster vaccination may deserve additional consideration.
Chickenpox↗
Growth, morbidity and mortality after chickenpox infection in young children in Guinea-Bissau.
OBJECTIVE: To examine whether chickenpox in children below 2 years of age is associated with post-infection changes in growth, morbidity or mortality. METHODS: An outbreak of chickenpox was investigated in Guinea-Bissau. An examination, interview and anthropometry were performed 6 months after the epidemic for a group of children and matched controls whose weight had been measured at the time of the chickenpox episode. All children diagnosed with chickenpox before 2 years of age were followed for survival and hospitalisations to the age of 3 years and compared with all other children in the community. RESULTS: At the 6-month follow-up, skin infections tended to be more frequent in cases (p<0.06) and more cases had used antibiotics within the last month (p<0.03). Although there had been no difference before chickenpox infection, girls with chickenpox infection had significantly higher weight, height and larger arm-circumferences than controls (all p<0.01). After chickenpox infection, the incidence of hospitalisation and long-term mortality was the same for cases and other children in the community (respectively, incidence rate ratio=1.16 (0.77-1.74) and mortality ratio=0.74 (0.39-1.41)). CONCLUSION: Though chickenpox may be associated with increased short-term morbidity, it does not appear to have any negative long-term effect on growth, severe morbidity and survival of young children.
Body Height↗
Modified chickenpox in children immunized with the Oka/Merck varicella vaccine.
Oka/Merck varicella vaccine has been studied in this institution since 1981. Persistence of antibody for 6 to 8 years has been demonstrated; however, cases of chickenpox have been seen in immunized children. The severity of chickenpox in healthy children who have received Oka/Merck varicella vaccine since 1981 is described. All vaccinees who developed chickenpox-like rashes more than 6 weeks postimmunization were examined. Of 2163 vaccinees, 164 were examined, of whom 114 had rashes consistent with chickenpox. When sera were available (46%), antibody studies uniformly confirmed varicella-zoster virus infection. Chickenpox occurred 2 to 96 months (median of 44 months) postimmunization. The range for the number of skin lesions was 1 to 285 (median 18) in seroconverters. Symptoms included itching in 39%, fever in 9%, headaches in 7%, lymphadenopathy in 3%, and malaise in 2%; 54% were asymptomatic, except for the rash. The median time to total healing was 5 days. The median time lost from school was 2 days. Thirteen of the children in whom infections developed had failed to seroconvert after immunization. Their infections were similar in severity to those of children who had seroconverted originally. When varicella was introduced into families as a result of chickenpox in an immunized family member (index case), the rate of secondary chickenpox among immunized siblings was 12.2%. Eleven such secondary cases were similar in severity to the 9 index cases. It is concluded that chickenpox is generally mild in previously immunized children.
Adolescent↗
Chickenpox or smallpox: the use of the febrile prodrome as a distinguishing characteristic.
BACKGROUND: The ability to differentiate chickenpox from smallpox is important for early recognition of bioterrorism events and prevention of false alarms. The febrile prodrome is a clinical feature used to differentiate these conditions. However, the prevalence of prodromal manifestations in chickenpox has not been well established. METHODS: We evaluated prodrome characteristics of all chickenpox cases identified through an active varicella surveillance program over a 21-month period. The frequencies of various prodromal manifestations among vaccinated and unvaccinated case patients were assessed, and the impact of other demographic features on these manifestations was evaluated. Data were analyzed to determine what proportion met the smallpox febrile prodrome criteria as elaborated in the Centers for Disease Control and Prevention algorithm for evaluating patients suspected of having smallpox. Finally, we compared our data with historical data on smallpox prodromes. RESULTS: Data on prodrome characteristics were available for 932 chickenpox cases. Prodromal fever was present in 37% of unvaccinated chickenpox case patients and in 25% of vaccinated case patients. Among unvaccinated case patients, adults were 70% more likely than children to have fever in the prodrome period. We found that prodromes are less common and less severe in chickenpox than in smallpox. Nevertheless, 7%-17% of unvaccinated chickenpox case patients meet the smallpox febrile prodrome criteria. CONCLUSIONS: Febrile prodromes occur in a significant proportion of patients with chickenpox, particularly among unvaccinated case patients and adults. Therefore, the febrile prodrome alone is not a sufficient marker of smallpox risk. All major and minor smallpox criteria should be considered together in assessing the likelihood of smallpox.
Adolescent↗
Cost of chickenpox in Canada: part II. Cost of complicated cases and total economic impact. The Immunization Monitoring Program-Active (IMPACT).
OBJECTIVE: Primarily, to determine the direct medical costs and productivity losses associated with complicated chickenpox (hospitalized cases) and, secondarily, to quantify the overall economic burden of chickenpox in Canada. METHODS: Direct medical resource consumption patterns were determined by chart review of 160 otherwise healthy children and 40 children with leukemia hospitalized for chickenpox. Children were selected from the database of the Immunization Monitoring Program Active (IMPACT), a network of 11 tertiary-care hospitals in Canada that collected information at the time of hospitalization from January 1991 to March 1996. An additional 26 healthy children hospitalized were recruited prospectively by IMPACT. Productivity losses (time lost from work and daily activities) were assessed by caregiver interviews. Treatment costs were determined from the patient, Ministry of Health, and societal perspectives. RESULTS: The average societal per case cost for complicated chickenpox in healthy children was $7060 and $8398, respectively, from the retrospective and prospective assessments. For children with leukemia, the direct medical cost was estimated at $7228. These costs were combined with a cost established previously for uncomplicated chickenpox. The estimated yearly overall economic impact of chickenpox in Canada was $122.4 million, with $24.0 million attributable to Ministry of Health costs, assuming an estimated yearly incidence of 346 527 cases and a 0.54% rate of hospitalization for healthy children. CONCLUSIONS: Direct medical costs are the major cost driver in the care of complicated chickenpox. However, in the context of the overall economic burden of the disease, uncomplicated chickenpox is the major cost driver, contributing 89% to the total cost.
Canada↗
Fatal outbreak of chickenpox (varicella-zoster virus infection) among institutionalised adults with learning difficulties.
Most adults are not susceptible to chickenpox. We present a report of an outbreak of chickenpox among institutionalised adults with learning difficulties. An inventory of exposed and possible affected residents was done after three adult males were diagnosed with chickenpox following a case of zoster. Individuals with a recent history of chickenpox rash or herpes zoster were included as cases. Medical files were used to derive background information. Serum samples of the first two patients were tested for IgM varicella-zoster virus (VZV) antibodies. Eventually ten cases of chickenpox (eight residents and one group leader and her partner) and two residents with herpes zoster were registered over a period of four months in 2001. The first two patients tested positive in serum. One resident with chickenpox died. This outbreak suggests a higher risk from chickenpox for institutionalised adults with learning difficulties in comparison with the general Dutch population, probably due to limited contacts with the general population. Further research into varicella-zoster seroprevalence, preferably with low-invasive diagnostic methods, is necessary to determine if this potential risk is present elsewhere, since the risk of life-threatening chickenpox in adults could be reduced by the now available live attenuated VZV vaccine.
Adult↗
Prevention of chickenpox in reproductive-age women: cost-effectiveness of routine prenatal screening with postpartum vaccination of susceptibles.
OBJECTIVE: To evaluate economic and clinical outcomes of a program of routine prenatal serotesting for varicella and postpartum vaccination of seronegative women. METHODS: An analytic cost-effectiveness model was constructed to compare the current strategy of no serotesting with 1) selective serotesting of pregnant women without a prior history of chickenpox and 2) serotesting of all pregnant women. In both serotesting strategies, seronegative women were vaccinated postpartum. The model followed a hypothetical cohort of 4 million women over 20 years. Costs and chickenpox disease outcomes during and outside of subsequent pregnancies were considered. The incremental cost-effectiveness (cost per adult chickenpox case prevented) of selective serotesting compared with the current strategy was measured. RESULTS: Compared to no testing, selective serotesting would prevent 43% (48,577 of 112,654) of adult chickenpox cases, save $21.8 million in discounted medical and work loss costs from the societal perspective, and cost $1126 per case prevented from the health payer's perspective (medical costs only). The model was sensitive to varicella seroprevalence and incidence of chickenpox among susceptible women but was relatively insensitive to the cost of serologic testing and vaccination. Compared with selective serotesting, the serotest-all strategy would prevent an additional 15,645 cases, at a societal cost of $7653 per additional case prevented. CONCLUSION: The selective serotesting strategy could prevent nearly half of chickenpox cases among this cohort and is cost-saving from the societal perspective. From the health payer's perspective, it compares favorably with other generally accepted preventive practices. It should be considered for prevention of chickenpox among women of childbearing age.
Adult↗
[Vaccination against rubella, measles, chickenpox, and mumps in nursing students].
The past history of infection and vaccination, and serum antibodies against rubella, measles, chickenpox, and mumps were investigated, before vaccine was inoculated in the susceptible nursing students. The subjects were 221 nursing students (208 women, 13 men, the average age 18.4 +/- 1.8 years old) who entered Nagasaki University from 2001 to 2003. The positive rates of the past history of rubella, measles, chickenpox, and mumps were 49.8%, 28.1%, 86.4%, 50.7%, and that of previous vaccination were 31.7%, 69.2%, 10.9%, 5.3%, respectively. The serum antibody was measured with HI assay for rubella, or with EIA assay for measles, chickenpox, and mumps. The positive rates for the antibodies against rubella, measles, chickenpox, and mumps were 92.8%, 90.0%, 82.3%, and 85.0%, respectively. The rates for vaccine inoculation to the students without antibody were 92.8% in rubella, 100.0% in measles, 66.7% in chickenpox, 85.0% in mumps, and that to the low titer antibody (2.0 < or = EIA-IgG < 4.0) students were 70.6% in measles, 48.0% in chickenpox, 93.8% in mumps, respectively. Susceptible nursing students, as well as the medical stuff, should be vaccinated in order to prevent hospital infection of rubella, measles, chickenpox, and mumps.
Adolescent↗
Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data.
OBJECTIVE: To evaluate the epidemiology and impact of mortality from chickenpox in England and Wales. DESIGN: Review of death certificates from the Office for National Statistics on which codes for "chickenpox" or "varicella" were mentioned. Further information ascertained from certifying physician. PARTICIPANTS: Those certified as having died from chickenpox in England and Wales, 1995-7. MAIN OUTCOME MEASURES: Diagnosis and age and sex distributions of deaths from chickenpox. RESULTS: On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%). CONCLUSIONS: Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion.
Adolescent↗
Epidemiology of chickenpox in France (1991-1995).
STUDY OBJECTIVES: To decide whether a mass immunisation against chickenpox should be or should not be organised, it is important to have up to date data on the disease and to have baseline data to further assess a mass immunisation strategy, if any. DESIGN: Recent chickenpox epidemiology (age and sex distribution, seasonal dynamic and complications) in France are reviewed. SETTING: The system works with about 500 Sentinelle general practitioners (SGPs) and has provided surveillance of frequent communicable diseases in continental France since 1984. PARTICIPANTS: The data were collected by the computerised Sentinelle system. The Sentinelle system uses a videotex server that allows information exchange, data entry, and synthetic return of information. Chickenpox was defined as a sudden onset of typical skin eruption with pruritus, leaving scabs and associated with moderate fever. For each reported case, the SGP gave information on the age of the patient, sex, prevailing childcare for the children, contacts and complications (skin superinfections, lower and upper respiratory infections, conjunctivitis and corneal infections, nervous system injuries, stomatitis and others). Spectral analysis was used to detect cyclical patterns. MAIN RESULTS: Between 1991 and 1995, 15,817 cases of chickenpox were reported and provided the basis for the analysis. The yearly national incidence was 1.0-1.35 cases per 100 inhabitants. A pronounced annual periodicity of the incidence was observed and confirmed by spectral analysis. Ninety two per cent of chickenpox cases occurred in children under 14 years of age with about 5% being under one. Complications were reported in 2% of the cases. Common complications reported were skin superinfections, lower and upper respiratory tract infections. However, 21 cases out of 318 complications were nervous system injuries including six encephalitis or cerebellar ataxia. All these cases recovered completely. CONCLUSIONS: Chickenpox is usually a benign childhood disease. This study affords up to date observations on the disease in France. A large panel of complications has been reported. This paper provides the first attempt to describe the epidemiology of chickenpox in France.
Adolescent↗
Reported exposure to chickenpox: a predictor of positive anti-varicella-zoster antibodies in parturient women.
OBJECTIVE: To determine the positive and negative predictive values of recalled exposure to chickenpox for identifying anti-varicella-zoster virus (VZV) seropositive parturient women. METHODS: Blood samples were taken from laboring women during February 1998: All women completed questionnaires concerning a history of chickenpox in themselves and their children. Anti-VZV antibodies were determined by the immunofluorescent antibodies to membrane antigen (IFAMA) technique. RESULTS: Three hundred and twenty-seven women formed the study population; 239 women (73.1%) recalled chickenpox in themselves or their children, of which 229 (95.8%) were seropositive for anti-VZV antibodies. Of the 88 women who gave a negative/uncertain history of chickenpox 82 (93.2%) were seropositive and 6 (6.8%) were seronegative. All 87 mothers who were certain their children had had chickenpox were seropositive, including all 16 mothers who had a negative personal history. Thus, a woman with a history of chickenpox had a positive predictive value of 95.8%, and a woman with a lack of history had a negative predictive value of 6.8% (sensitivity 73.6%, specificity 37.5%), while a positive history of chickenpox in a child had a positive predictive value of 100%. CONCLUSIONS: Most women with no known history of VZV infection have evidence of prior exposure by serologic testing. Moreover, 100% of women with a negative history who were exposed to VZV in their children were protected from the disease. Therefore, mothers exposed to VZV during pregnancy can be reassured that most likely they are protected. However, the practice of testing all pregnant women exposed to the disease should be continued.
Adolescent↗
[Complications of chickenpox as reason for children's hospitalization].
Chickenpox is self limiting disease, with potentially dangerous course. Chickenpox complications can evoke the necessity of hospitalization. Assess the types and courses of chickenpox complications in child patients hospitalized in Provincial Hospital of Infectious Diseases in Bydogoszcz between 1999 and 2003. Cases of chickenpox complications being the reason of children hospitalization were retrospectively analyzed. The total number of children hospitalized because of chickenpox complication is 153. Patients age ranged from 18 days to 18 years, with average of 5,4 years. 62% of children were younger than 5 and, 1/3 children were younger than 1. The average period of hospitalization was 7 days. 17% of patients stayed in hospital longer than 10 days. 53% of patients were male. In 5 cases chronic diseases were diagnosed. The most common reason of hospitalization connected with chickenpox were symptoms of alimentary canal disorder (30%), respiratory tract inflammations, with pneumonia and bronchitis in the lead (30/47). Neurological complications during chickenpox occurred in 23 of 153 hospitalized (15%): febrile convulsions - 6/153, cerebellar ataxia - 9/153, meningitis and brain fever - 6/153, peripheral nerve - 2/153. Bacterial skin infection as the reason of hospitalization of 16 children, hepatitis of 3 and joints inflammation of 1 child.
Adolescent↗