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PubMed2005

Chickenpox complications in Saudi Arabia: Is it time for routine varicella vaccination?

INTRODUCTION: Varicella zoster (chickenpox) infection is a common and benign disease of childhood. The predominance of uncomplicated cases in children tends to overshadow the morbidity associated with severe cases and the resultant hospitalization. OBJECTIVE: The objective was to establish the complication rate of chickenpox in the Saudi National Guard population over a 2(1/2)-year period. METHODS: All reported cases of chickenpox at the King Abdulaziz Medical City, Riyadh were prospectively followed for development of complications during the period between 1 June 2001 and 30 December 2003. RESULTS: A total of 3802 cases of chickenpox were reported and followed during the acute illness phase. The majority of cases, 2984 (78%), occurred in children less than 15 years of age. Among all chickenpox cases, 78 (2%) required hospitalization, and 50 patients developed 58 (1.5%) complications. Skin and soft tissue infections were the most common complications, 20 (34%), followed by pneumonia in 16 (28%), bacteremia in six (10%), encephalitis in four (7%) and necrotizing fasciitis in four (7%). Complications were less common in children (36/2984, 1.2%) as compared to adults (14/818, 1.7%) (p = 0.26). However, pneumonia (p = 0.03) and hospitalization (p = 0.004) were more common in adults as compared to children. The overall fatality rate was 0.05%; two patients died, one aged two months the other 28 years. CONCLUSION: These data provide a baseline for morbidity and mortality from chickenpox, and further support the inclusion of varicella vaccine in the routine childhood immunization program in Saudi Arabia.

Adolescent↗

PubMed2005

The changing epidemiology of chickenpox in Alberta.

BACKGROUND: Varicella vaccine was licensed in Canada in 1998. The province of Alberta introduced a universal publicly funded varicella vaccination program in 2001. PURPOSE: To describe the epidemiology of non-fatal cases of chickenpox for which publicly funded health services were utilized for the period 1986-2002. METHODS: We used the records of Alberta's universal, publicly funded health care insurance system to identify cases of chickenpox for the period 1986-2002. The earliest dated utilization of a health service for which there was an ICD9-CM code of 052.xx or an IC10-CA code of B01.xx was used as the date of illness onset. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Registry. Age-specific rates were estimated for each year. RESULTS: The crude incidence of chickenpox significantly declined over the period 1994-2002, most steeply after the year 2000. The incidence of chickenpox varied by age group and year and there was evidence of age-group-year interaction. Among those aged 5-19 years, chickenpox incidence began to decline prior to vaccine licensure in Canada. Among those aged less than one year and those aged 1-4 years, the incidence increased until 1999 when a decline began. Over the period 0.8% of cases were hospitalized. CONCLUSION: Chickenpox rates began to decline prior to the introduction of the publicly funded vaccination program; however the declines in rates among the youngest age-groups are consistent with a vaccination program effect.

Adolescent↗

PubMed1991

A controlled trial of acyclovir for chickenpox in normal children.

BACKGROUND: Chickenpox, the primary infection caused by the varicella-zoster virus, affects more than 3 million children a year in the United States. Although usually self-limited, chickenpox can cause prolonged discomfort and is associated with infrequent but serious complications. METHODS: To evaluate the effectiveness of acyclovir for the treatment of chickenpox, we conducted a multicenter, double-blind, placebo-controlled study involving 815 healthy children 2 to 12 years old who contracted chickenpox. Treatment with acyclovir was begun within the first 24 hours of rash and was administered by the oral route in a dose of 20 mg per kilogram of body weight four times daily for five days. RESULTS: The children treated with acyclovir had fewer varicella lesions than those given placebo (mean number, 294 vs 347; P less than 0.001), and a smaller proportion of them had more than 500 lesions (21 percent, as compared with 38 percent with placebo; P less than 0.001). In over 95 percent of the recipients of acyclovir no new lesions formed after day 3, whereas new lesions were forming in 20 percent of the placebo recipients on day 6 or later. The recipients of acyclovir also had accelerated progression to the crusted and healed stages, less itching, and fewer residual lesions after 28 days. In the children treated with acyclovir the duration of fever and constitutional symptoms was limited to three to four days, whereas in 20 percent of the children given placebo illness lasted more than four days. There was no significant difference between groups in the distribution of 11 disease complications (10 bacterial skin infections and 1 case of transient cerebellar ataxia). Acyclovir was well tolerated, and there was no significant difference between groups in the titers of antibodies against varicella-zoster virus. CONCLUSIONS: Acyclovir is a safe treatment that reduces the duration and severity of chickenpox in normal children when therapy is initiated during the first 24 hours of rash. Whether treatment with acyclovir can reduce the rare, serious complications of chickenpox remains uncertain.

Acyclovir↗

PubMed1991

Assessment of a school exclusion policy during a chickenpox outbreak.

Two Ohio schools experienced an outbreak of over 200 cases of chickenpox during the period from October 5 to December 21, 1988, despite adherence to the 1986 American Academy of Pediatrics' recommendation that children be excluded from school for 1 week or until all lesions have crusted. In grades kindergarten through four, the attack rate for susceptibles was 51% (167/329). With the use of person-time analysis, classmates of a child with chickenpox in grades kindergarten through four were 3.6 times more likely to become a case 12-17 days (the range of one incubation period) after the last day the child with subsequent chickenpox was in class than at any other time during the 2.5-month study period (95% confidence interval (Cl) 2.4-5.4). This was even more pronounced during the first half of the outbreak (relative risk (RR), 10.8; 95% Cl 4.4-26.5). Cases were not more likely to aggregate 12-17 days after a child returned to school after having chickenpox (RR, 0.9; 95% Cl 0.5-1.5). No cases occurred in classmates 12-17 days after the 15 children absent less than 5 days returned to class. Because substantial chickenpox transmission may occur before rash onset, exclusion practices may have a limited effect on outbreak control and increase the indirect costs associated with chickenpox.

Chickenpox↗

PubMed1978

[Several epidemiologic features of the spread of chickenpox and herpes zoster].

Epidemiological and statistical data of herpes zoster and chickenpox by such indices as morbidity level, periodicity and month-by-month changes in the incidence of these diseases were compared. The study included 2345 herpes zoster and 11116 chickenpox cases in the course of 5 years (1972--1976). In comparison with herpes zoster, the intensity of chickenpox spread among the population was on the average 4.7 times greater. Of the total number of chickenpox cases the percentage of herpes zoster contituted 21.0. Chickenpox morbidity had marked seasonal cyclic nature with the amplitude of seasonal variations of about 8; as to herpes zoster--there was no annual or seasonal cyclicity. Thus, in the development of chickenpox and herpes zoster epidemic process there was revealed a peculiar tendency inherent to each of these infections; no common epidemiological and statistical regularities in the spread intensity, annual periodicity and seasonal cyclicity were detected.

Chickenpox↗

PubMed2000

Cost effectiveness of vaccination strategies in adults without a history of chickenpox.

PURPOSE: Some authorities recommend varicella antibody testing or vaccination for adults without a history of chickenpox, but the cost effectiveness of these interventions is uncertain. SUBJECTS AND METHODS: Using a Markov decision model, we estimated the cost effectiveness of three strategies for adults with no history of chickenpox: no vaccination, varicella antibody testing followed by vaccination for those without antibody, and vaccinating all. Societal and third-party payer perspectives were taken, with costs and benefits discounted at 3% per year. Assumptions for the baseline analysis were chosen to bias against no vaccination. RESULTS: In the baseline analysis for 20- to 29-year-old patients, testing followed by vaccination compared with no vaccination is cost saving from a societal perspective and costs $6,670 per quality-adjusted life-year (QALY) gained from a third-party payer perspective. When less favorable assumptions are used, results are sensitive to the rates of compliance with vaccination follow-up; testing followed by vaccination costs more than $50,000 per QALY if <75% comply. For patients 30 years of age and older, the incremental cost of testing followed by vaccination is at least $97,100 per QALY compared with no vaccination, with costs greater than $50,000 per QALY unless testing costs less than $7.73, the chickenpox case-fatality rate is >0.067% (baseline 0.025%), or immunity with no chickenpox history is <25% (baseline 71%). In either age group, vaccinating all has an incremental cost of $2 to $16 million per QALY gained compared with testing followed by vaccination. CONCLUSION: Testing followed by vaccination for varicella in US adults aged 20 to 29 years may be cost effective by conventional criteria but is sensitive to rates of compliance with vaccination protocols. Testing or vaccination of older adults is expensive but may be cost effective in patients with lower probabilities of immunity or in those who have a greater risk of complications from chickenpox.

Adult↗

PubMed2004

Declining incidence of chickenpox in the absence of universal childhood immunisation.

OBJECTIVE: To examine the epidemiology of chickenpox in Wales from 1986 to 2001. DESIGN: Descriptive analysis of chickenpox consultations reported by the Welsh general practice sentinel surveillance scheme for infectious diseases, compared with annual shingles consultation rates from the same scheme to exclude reporting fatigue and data from a general practice morbidity database to validate results. SETTING: A total of 226,884 patients registered with one of 30 volunteer general practices participating in the sentinel surveillance scheme. MAIN OUTCOME MEASURES: Age standardised and age specific incidence of chickenpox. RESULTS: Crude and age standardised consultation rates for chickenpox declined from 1986 to 2001, with loss of epidemic cycling. Rates remained stable in 0-4 year olds but declined in all older age groups, particularly those aged 5-14 years. Shingles consultation rates remained constant over the same period. Data from the morbidity database displayed similar trends. CONCLUSION: General practitioner consultation rates for chickenpox are declining in Wales except in pre-school children. These findings are unlikely to be a reporting artefact but may be explained either by an overall decline in transmission or increased social mixing in those under 5 years old, through formal child care and earlier school entry, and associated increasing rates of mild or subclinical infection in this age group. Further investigation, particularly by serological surveillance, is necessary before universal varicella immunisation can be considered in the UK.

Adolescent↗

PubMedDate not supplied

Age-specific incidence of chickenpox.

Because licensure of a chickenpox (varicella) vaccine is likely soon, it is important to ascertain the age-specific incidence of chickenpox. Increasing vaccine coverage and a resulting decrease in transmission may result in an accumulation of susceptible adults, followed by a shift of incidence into those older age groups in future years. Valid baseline age-specific incidence will make it possible to detect this phenomenon. Two studies were conducted in Kentucky to assess age-specific incidence of chickenpox. The first assessed chickenpox occurrence in two consecutive school-year cohorts of children from a geographically representative sample of Kentucky primary schools. The second gathered information from household members of those persons interviewed in the Behavioral Risk Factor Surveillance System telephone survey. The age-specific rates are remarkably similar between studies. Rates peak during the preschool and kindergarten years (ages 3-6). Approximately 20 percent of children remain susceptible to chickenpox after age 8 in both studies. The results from these two surveys will be valuable baselines for comparison with findings in incidence studies that will be performed after vaccine licensure.

Adolescent↗

PubMed1996

Alteration of T cells and natural killer cells during chickenpox in infancy.

To determine the reasons for the low immune response and the mild morbidity of chickenpox in infancy, we investigated alteration of T cells and natural killer (NK) cells during chickenpox in children < 1 year and > or = 2 years old using flow cytometry. The CD4/CD8 ratio decreased only in the < 1-year-old group from the acute to the convalescent phase (P < 0.05). The CD3-CD16+CD56+ and CD57-CD16+ counts increased in the < 1-year-old group, but those in the > or = 2-year-old group did not increase from the acute to the convalescent phase. The CD3-CD16+CD56+ counts and the CD57-CD16+ counts and percentage were larger in the < 1-year-old group than those in the > or = 2-year-old group (P = 0.001, P = 0.002, and P < 0.05) in the convalescent phase. These results seem to indicate that the low immune response in infancy after chickenpox are related to the small number of CD8 in contrast with CD4 and that increased subsets of NK cells during chickenpox may correlate to the mild morbidity of chickenpox in infancy.

Acute Disease↗

PubMedDate not supplied

[Chickenpox outbreak in Herrera del Duque, Badajoz, Spain].

INTRODUCTION: Chickenpox is a worldwide disease with high morbidity but few complications, although complications can be sevre in immunocompromised individuals and healthy adults. The annual chickenpox rate declared to the National Notification Disease Surveillance System is approximately 5 cases per 1,000 inhabitants in Extremadura (Spain). The aim of this study was to identify and describe the characteristics and cost of an epidemic outbreak of chickenpox in Extremadura. METHODS: Between November 2000 and March 2001, a descriptive study was performed. Cases of chickenpox were actively sought in a cohort of schoolchildren in Herrera del Duque (Badajoz). The protocols of the Monitoring Network of the Autonomous Community of Extremadura was used for case definition. Microbiological confirmation was performed by isolation of the virus and the presence of IgM and IgG markers in serum. We analyzed the direct and indirect tangible costs as well as the intangible costs of the outbreak. RESULTS: Seventy-five cases were identified, of which 94.7% occurred in children aged between 1-9 years, mainly boys. The attack rate was 18.5 cases per 1,000 inhabitants and 68.2% occurred in children aged less than 10 years charing a home. The clinical course was benign, without hospital admissions or complications. A total of 71.6% of children aged between 3 and 8 years were susceptible. A possible temporary aggregation of cases in the school was analyzed and a relative risk of 5.01 (p < 0.0001) was obtained. The virus was isolated in the 4 vesicle samples studied and serology was positive (IgM) in the 9 serum samples studied. The total cost of the outbreak was of 927,21 e, with a mean of 12,53 e per case and 205 school days lost. CONCLUSION: A chickenpox outbreack was confirmed in Herrera del Duque, with person-to-person transmission, affecting children aged between 1 and 9 years. The high susceptibility of the pupils, the characteristics of teaching, and the meetings prior to the carnivals played a determining role in the transmission of the epidemic. The estimated cost of this outbreak was 76% less than the cost that would have been generated by single-dose vaccination of the 75 individuals who contracted the disease.

Chickenpox↗

PubMed1993

Social epidemiology of chickenpox in two British national cohorts.

STUDY OBJECTIVE: To provide a quantitative description of factors independently predictive of reported chickenpox infections in two national cohorts of British children. DESIGN: Longitudinal cohort study design employing logistic regression analysis of data obtained in the 1970 British Births Survey (later to become the Child Health and Education Study, CHES), and the 1958 British Perinatal Mortality Survey (later to become the National Child Development Survey, NCDS). SETTINGS: One-week birth cohorts covering the whole of the United Kingdom. PARTICIPANTS: Data were obtained from questionnaires administered to the carers of 10,196 children born in the UK between 5 and 11 April 1970 (CHES) and 10,927 children born in the UK between 3 and 9 March 1958 (NCDS). These numbers consist of the whole of the surviving cohorts excluding those for whom data were incomplete. MEASUREMENTS: Biological, social, and medical factors in the parents and children, as recorded by the child's principle carer or from clinical notes. MAIN RESULTS: Chickenpox by the age of 10 years was reported to be more common in the children of advantaged families (higher social class, higher parental education levels), with a higher prevalence in those parts of the United Kingdom normally associated with affluence, such as the South East and South West of England, and lower rates in Wales and Scotland. Chickenpox by 10 years was also associated with more crowding in the home. A similar but less marked pattern occurred for chickenpox by the age of 11 years in the 1958 NCDS cohort. This social distribution apparently reflected overall rather than age-specific susceptibility. CONCLUSIONS: The national and international pattern of chickenpox epidemiology indicate that both social and climatological factors may be important in defining groups at risk. Further research is indicated if a vaccination service is to be implemented in this country.

Age Factors↗

PubMed1976

Chromosome damage in Down's syndrome induced by chickenpox infection.

Chromosomes were studied in 74-hr lymphocyte cultures from seven patients with Down's syndrome and from 12 hematologically and karyotypically normal control subjects. Six were studied before and six after chickenpox infection. In Down's syndrome, the number of breaks per cell was 0.083 +/- 0.036 immediately after chickenpox infection; this was significantly greater than the number of breaks before infection, 0.03 +/- 0.008, and also significantly greater than the number of breaks, 0.046 +/- 0.023, observed in control children with chickenpox. Therefore, chromosomes from patients with Down's syndrome were significantly more sensitive to breakage after chickenpox infection than those from control subjects. The incidence of chromosome breaks in Down's syndrome 1 month after chickenpox infection fell to the level observed in the preinfection range. The present results showed that the difference between the observed and the expected values for breakage in special regions of chromosome was not significant, but that chromosome breakage was random.

Chickenpox↗

PubMed1998

Cost effectiveness of early treatment with oral aciclovir in adult chickenpox.

Treatment of adult chickenpox with aciclovir is controversial because of the relatively high cost of medication and small proven benefits of therapy. A decision-tree model was used to estimate the cost effectiveness of aciclovir, from third-party payer and societal perspectives: the incremental cost per quality-adjusted life-year (QALY) gained was calculated for aciclovir treatment of chickenpox compared with no antiviral therapy in immunocompetent adults who presented within 24 hours of the onset of chickenpox rash. Incremental costs for aciclovir compared with no antiviral treatment were 42,900 US dollars per QALY gained, when viewed from a third-party payer perspective; however, results are sensitive to variation of clinical parameters. From a societal perspective, aciclovir therapy was cost saving compared with no antiviral treatment; aciclovir remained cost saving or cost effective (less than 50,000 US dollars per QALY gained) when probabilities, quality-of-life utility values and costs were varied within clinically plausible ranges, and when other scenarios for chickenpox severity and aciclovir effectiveness were examined. From a societal perspective, oral aciclovir is cost effective, and perhaps cost saving, when given within 24 hours of rash onset in adult chickenpox. The argument for antiviral use may be less strong when viewed from the perspective of a third-party payer.

Acyclovir↗

PubMed1993

Osteomyelitis in hospitalized children with chickenpox: imaging findings in four cases.

OBJECTIVE: The most common complications of chickenpox are skin and soft-tissue infections. Pneumonia and CNS involvement occur less often, and skeletal complications are considered rare. The purpose of this study was to evaluate the imaging findings of osteomyelitis in children after chickenpox. MATERIALS AND METHODS: We retrospectively reviewed the records of children admitted to our institution because of chickenpox and analyzed the imaging findings in those who had skeletal involvement. Ninety-seven patients were admitted between January 1991 and January 1993 because of chickenpox or a complication thereof. Four previously healthy patients, three boys and one girl, between 1 and 6 years old had osteomyelitis. Staphylococcus aureus was isolated from bone in one patient, and group A beta-hemolytic streptococcus was isolated from blood cultures in another. No organism was grown in the other two; necrotic bone was recovered from one lesion and the other healed with periosteal formation of new bone typical of osteomyelitis. All patients were treated with IV antibiotics, and their recoveries were uncomplicated. RESULTS: Conventional radiographs showed loss of fat planes in three patients and destruction of bone in two. Bone scintigraphy showed increased uptake of radionuclide in early and late phases in three patients. Uptake in one case was extensive, with a central area of relatively little uptake corresponding to a subperiosteal fluid collection. CT in two and MR imaging in one showed subperiosteal fluid collections surrounding the involved bones in association with bone and marrow changes. CONCLUSION: Osteomyelitis was the fourth most common complication of chickenpox in our series. The appearances on conventional radiographs and scintigrams are indistinguishable from those of typical bacterial osteomyelitis. However, CT and MR imaging showed subperiosteal fluid collections in three of four patients, an appearance only occasionally seen with typical osteomyelitis.

Chickenpox↗

PubMed1998

Seasonal variation of chickenpox, mumps and rubella in Taiwanese children estimated by pediatric clinics.

To determine the seasonal variation of childhood infectious diseases in Taiwan, the incidence rates of chickenpox, mumps and rubella were studied by analyzing patient's records collected from pediatric clinics in northern, central, southern and eastern Taiwan from January 1, 1993 to December 31, 1993. The study revealed that a chickenpox outbreak was most likely to occur in autumn, followed by a second peak in spring, and the lowest rate in summer. In this study, the highest monthly incidence of chickenpox was 540 cases per 100,000 population. The highest incidence of mumps occurred in the spring, the second highest in autumn, and the lowest during summer. Cases of rubella occurred in the spring, summer and autumn, but not in the winter. The data on chickenpox from this study revealed a similar seasonal pattern every year to that of the Department of Health of the National Quarantine Service on Taiwan. The chickenpox virus is known to be relatively sensitive to elevations in ambient temperature and is characterized by its occurrence mainly in slightly humid seasons.

Chickenpox↗

PubMed2000

Epidemiological features and economic evaluation of a potential chickenpox vaccination strategy in Slovak Republic.

Cost effectiveness and cost benefit of a potential chickenpox vaccination strategy in Slovakia have been evaluated. As a base for comparison with potential vaccination strategy, direct and indirect costs of chickenpox incidence in Slovakia in 1996 were evaluated, using the EPIS data (Epidemiological Information System in Slovak Republic), and official annual analyse of epidemiological situation in Slovakia. According to their estimates, the authors consider the potential chickenpox vaccination as highly cost effective. The results of their analysis show that as the saved costs mostly indirect costs participate. With respect to the prevailing social impact of chickenpox also the funding of the future chickenpox vaccination is supposed to be shared by social insurance system.

Chickenpox↗

PubMedDate not supplied

Acyclovir in the treatment of chickenpox.

Although chickenpox is a highly contagious disease affecting 90% of susceptible persons exposed, its morbidity and mortality in healthy patients is minimal. Treatment of chickenpox with oral acyclovir appears to decrease the number of pox lesions and shorten the duration of new lesion formation. Most importantly, children treated with acyclovir begin to feel better soon and had fewer systemic signs and symptoms of chickenpox (fever, fatigue, loss of appetite). However, the greatest mortality from chickenpox is seen in the immunocompromised patient, or in elderly patients with zoster (shingles) due to reactivation of latent varicella infection. Therefore, prevention of varicella is necessary to decrease mortality from the varicella-zoster virus. It is hopeful that the varicella vaccine will be licensed in the U.S. for routine immunization of healthy children within the next year. While its general use will not eliminate either chickenpox or zoster, there will be a considerable decrease in the morbidity and mortality caused by this agent as a result of routine immunization.

Acyclovir↗

PubMed1982

A cluster of cases of Reye syndrome associated with chickenpox.

In the spring of 1980, four confirmed, and three possible cases of Reye syndrome, each associated with a chickenpox prodromal illness, were identified in Las Cruces, NM. One patient, a 5-year-old girl, died. Cases tended to occur in one section of the community, among children attending two of the 16 elementary schools. A telephone survey of parents with school-aged children (6 to 9 years old) suggested that a significantly greater attack rate of chickenpox occurred in children attending those two schools. Based upon this survey and the expected distribution of chickenpox among children less than 15 years of age, the incidence of Reye syndrome following chickenpox infection in the county in which Las Cruces is located was estimated to be 2.5/10,000 cases of chickenpox; these data reveal a four- to ninefold greater incidence of Reye syndrome than that following influenza B infections, which was previously estimated based upon a cluster of five cases in a county in Michigan. Additional investigations of Reye syndrome clusters are needed in an effort to identify and study suspected risk factors and to better define the relationship between Reye syndrome and viral infections.

Chickenpox↗