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PubMed2002

Immunity to chickenpox among school adolescents in Lebanon and options for vaccination.

Varicella infections cause substantial morbidity and mortality in adolescents and adults. The primary infection, chickenpox, results in lifelong immunity to chickenpox. A seroprevalence study carried on adolescents 15-18 years of age attending schools in Lebanon showed 96.6% immunity to varicella. The positive predictive value for immunity to chickenpox based on history alone was 97.4%, whereas the negative predictive value was 4.5%. Coming from a bigger family was a statistically significant predictor of immunity to chickenpox. In a developing country like Lebanon the merits and limitations of implementing universal varicella vaccination is discussed in relation to seroprevalence and socioeconomic factors.

Adolescent↗

PubMed2006

[Update on chickenpox].

Primary infection by varicella-zoster virus causes chickenpox and herpes zoster. At 14 years of age, 91% of the population have already suffered the illness and after 30 years, more than 95% have done so. In 1999, the hospitalization rate was 2.4 per 1,000 chickenpox cases in those under 14 and 15.5 per 1,000 cases in those over 14. A total of 73% of deaths recorded during the period 1991-2000 were in the older than 14 year old group. Efficacy of varicella vaccine after a 7-8 years period is 87%; a milder case of chickenpox (breakthrough) can appear in vaccinated people 42 days after vaccination. The introduction of the vaccine may be proposed to stop or decrease virus circulation among the population or to decrease complications and mortality from chickenpox. According to the objective proposed, different strategies that imply risks and benefits should be conducted.

Adolescent↗

PubMed1994

Varicella-zoster virus antibody avidity and IgG-subclass patterns in children with recurrent chickenpox.

The normal immune response after primary varicella-zoster virus (VZV) infection includes IgG subclass evolution to predominantly IgG1-type antibodies, and maturation from low to high avidity antibodies which are maintained for life. Twenty-three healthy and apparently immunocompetent children with a history of 2-5 episodes of chickenpox were studied after repeat disease. Serial sera were tested for VZV-IgG subclass patterns and VZV IgG and G-subclass antibody avidity by urea elution enzyme linked immunoassay (ELISA). Of 11 patients studied within 8 weeks of repeat chickenpox (Early Group), mean antibody avidity was significantly lower (31.3 +/- 26.81) than control (65.1 +/- 12.38) (P < .001). Seven had low avidity antibody (< 30 percent) and an abundance of IgG3 which was a pattern like primary chickenpox, and 2/11 had high avidity antibody characteristic of anamnestic responses. Early Group patients and 12 others studied over 8 weeks after repeat disease (Late Group) showed avidity maturation and attrition of IgG subclass antibodies other than IgG1. At least nine children failed to show VZV-specific secondary (memory) immune responses early in the course of repeat disease. It is possible that failure to maintain or evoke a secondary immune response could explain their susceptibility to repeat chickenpox.

Adolescent↗

PubMed1995

Chickenpox outbreak among the staff of a large, urban adult hospital: costs of monitoring and control.

Chickenpox is a highly infectious disease of childhood, but there are increasing reports of occurrence in adults. A recent community epidemic of chickenpox resulted in 20 documented cases of adult chickenpox in a large metropolitan hospital. Nine of these cases resulted from direct exposure to an index patient and four were in tertiary contacts of the three index patients associated with the nosocomial outbreak. A total of 165.6 person-days of work were lost (estimated $18,000 cost) as a result of this outbreak, and 70 infection control unit person-hours were required during the investigation and control. This article reports a nosocomial epidemic and reviews guidelines for identification and control of adult chickenpox in a large hospital complex.

Adult↗

PubMed2005

T-lymphocyte subsets and eosinophil counts in acute and convalescence chickenpox infection: a household study in Guinea-Bissau.

OBJECTIVE: To investigate changes in T-lymphocyte subsets, CD4+ and CD8+ lymphocytes, WBC, lymphocytes and eosinophil granulocytes during the acute and the convalescence phase of chickenpox infection. METHODS: During an epidemic of chickenpox, a household study was performed in a semi-urban area of Bissau, Guinea-Bissau. Varicella antibodies were determined to assess diagnostic certainty. To determine the timing of changes, haematological markers and T-cell subsets (immunocytochemical method) were analysed in the acute phase, 0-9 days after the rash, and in the convalescence phase, 35-45 days after the rash. RESULTS: In the acute phase, the CD4 percentage, CD4/CD8 ratio, and neutrophil percentage declined, whereas the CD8 percentage, WBC, CD4 and CD8 counts, and the lymphocyte percentage increased over the same period, most markedly for the CD8 count. The eosinophil percentage increased significantly with time from onset of rash. Between acute and convalescence samples there was an increase in CD4 percentage, CD4/CD8 ratio, and CD4 count, and a marked decrease in CD8 percentage and CD8 count. The changes were not significant for WBC, lymphocyte percentage, neutrophil percentage, and monocyte percentage, but eosinophil percentage was significantly increased 5-7 weeks after the onset of rash. The haematological changes were related to number of pox and intensity of exposure; a high eosinophil percentage was associated with less severe disease, i.e. less pox. CONCLUSION: We report significant changes in T-lymphocyte subsets during the acute phase of chickenpox infection, including a suppression of CD4+ T-cells and an augmentation of CD8+ T-cells. The levels were normalized 1 month later except for eosinophils, and we found no persistent CD4 suppression after chickenpox. An increased number of eosinophils in the peripheral blood was demonstrated early in the acute phase of the disease, and remained elevated in the convalescence phase.

Acute Disease↗

PubMed2006

Panuveitis as presenting sign of chickenpox in a young child.

CASE REPORT: A previously healthy 2-year-old girl presented with severe panuveitis in her left eye. She developed chickenpox rash several days later. DNA particles of varicella-zoster virus (VZV) were detected by polymerase chain reaction (PCR) in the aqueous humor. No antiviral regimen was administered. The uveitis resolved completely after 1 week. COMMENTS: Patients with chickenpox should undergo a thorough ophthalmologic examination at the onset of visual symptoms. Clinicians should be aware of the rare occurrence of chickenpox when evaluating a uveitis patient. If there is suspicion of chickenpox, the clinician may consider ordering serology or PCR tests.

Chickenpox↗

PubMed1997

Outcome of chickenpox in 66 pediatric renal transplant recipients.

Although chickenpox can cause severe morbidity and mortality in pediatric renal transplant recipients, published reports describing treatment of these patients are few, especially in the cyclosporine era. Sixty-nine episodes of chickenpox occurring in 66 patients were diagnosed in our transplant population between January 1984 and May 1996. Immunosuppression consisted of prednisone and azathioprine (30 cases); prednisone, azathioprine, and cyclosporine (38 cases); or prednisone alone (1 case). Azathioprine was temporarily discontinued in 66 of 68 cases. Cyclosporine was continued at the preexisting dose in 36 of 38 cases. Acyclovir was administered parenterally in 62 of 69 cases. Sixty-five of 66 patients survived. Cyclosporine use did not increase the incidence of severe disease (p > 0.1). Acute allograft rejection occurred in three patients and responded to prednisone. Chickenpox in children with renal transplants can be successfully treated with intravenous acyclovir and temporary withdrawal of azathioprine. Allograft rejection is uncommon with this approach. Patients receiving cyclosporine do not appear to experience increased morbidity or mortality with chickenpox.

Acyclovir↗

PubMed1998

Review of 26 years' hospital admissions for chickenpox in North London.

The epidemiology of chickenpox admissions to an Infectious Diseases Unit was studied over 26 years. Risk factors, markers of disease severity, and complications were analysed in patients admitted during the last 5 years. Some 613 patients were admitted with chickenpox over three 5-year periods between 1968 and 1993. There was a 2.23-fold increase in the number of adults admitted from home between the first and last period. Patients of European origin showed a three-fold increase. The mean age of adults rose from 26.2 to 34.3 years. Some 23% of adults had varicella pneumonitis. Smokers were six times more susceptible to pneumonitis than were non-smokers. Adult asthmatics were not at increased risk, whereas 42% of asthmatic children had chest complications. Seventeen of the 18 immunocompromised patients had a relatively uncomplicated course. Of the children, 32% had secondary skin infections, with no excess complications among those with eczema. Thrombocytopenia and elevated aspartate transaminases were four times and twice, more frequent in adults than children, respectively. These features occurred mostly in males. The male-to-female admission ratio was 2:1 in adults, and 1.2:1 in children. Males in both age groups showed a trend to more severe disease and more primary complications than did females. Our data showed an increase in adult chickenpox admissions. We have identified asthma as a risk factor for pulmonary complications in children, but not adults, and male gender as an independent risk factor for severe chickenpox.

Adolescent↗

PubMed1997

[Leukoencephalitis with hemiplegia during chickenpox].

BACKGROUND: Chickenpox encephalitis is usually mild and often presents as an acute cerebellar ataxia. Seizures and coma are uncommon. CASE REPORT: A 4-year old girl presented generalized seizures. Two days after the onset of chickenpox, she developed ataxia and left hemiparesis on day 3, followed by left hemiplegia after 24 hours. The cerebral scan showed areas of subcortical hypodensity compatible with leuko-encephalitis. The EEG showed lesions of acute leuko-encephalitis located in the right sub-cortical temporo-fronto-parietal area. The patient was given cortico-steroid and recovered slowly but completely. CONCLUSIONS: Hemiplegia, an exceptional event during the course of chickenpox, makes the diagnosis of chickenpox leuko-encephalitis difficult; IRM appears to be a contributing factor.

Brain↗

PubMed2001

The magnitude of variation in temperature within a year has an effect on the seasonal variations of chickenpox incidence in Japan.

We investigated the epidemic pattern of chickenpox incidence among 47 prefectures in Japan. There were two peaks in chickenpox incidence in all prefectures. The first peaks appear at almost the same time in a year, while the second peaks occur at different times with relatively different types of size and shape. The feature of the second peak might characterize the epidemic pattern of chickenpox. We first introduced the second peak index, that is, the ratio of the difference between the incidence at the point of the second peak and the minimum incidence between the first and second peaks to the difference between the incidence at the point of the second peak and the minimum incidence in the year. There was a close correlation between the second peak index and the magnitude of variation in temperature within a year corresponding to the difference between the maximum and the minimum of the monthly mean of the highest daily temperature. This is the first article focusing on the close relationship between the second peak of epidemic pattern of chickenpox incidence and the variation of temperature within a year.

Chickenpox↗

PubMed1998

Direct and indirect costs of chickenpox in young children.

OBJECTIVE: To estimate the medical and economic or societal costs of chickenpox in young children using a descriptive study METHODS: Children under 5 years of age attending 124 Sydney childcare centres who were reported as having chickenpox were studied to assess the costs of medication use and medical consultations, days of care missed, and parental costs resulting from lost time from work and alternate childcare costs. RESULTS: There were 174 children (92 girls and 79 boys; in three the sex was not stated) who missed a mean of 5.5 days of care because of chickenpox, currently valued at $154. Medical costs were valued at $33 per child, based on 0.97 medical visits, and topical and oral medication. Labour costs resulting from parental work absenteeism were valued at $160 or $345 depending on the method of calculation, whilst direct economic costs of $24 were incurred through use of alternate childcare arrangements. Total costs including those incurred by secondary cases and by rare hospitalisations were in the range of $393-$578 per affected child. CONCLUSIONS: Medical costs of chickenpox in children are small relative to costs incurred as a result of parental work absenteeism and to costs of foregone childcare. Ascribing precise work-related costs should take into account some capacity to make up lost work time. Such data will be required when determining the cost-benefit of childhood varicella immunisation.

Absenteeism↗

PubMed2001

General practice survey of the management of chickenpox: appropriate targeting of antiviral therapy.

BACKGROUND: A working party of specialists and GPs recently published their consensus on recommended treatments for chickenpox. These are the closest to recommended guidelines available in the UK. They offer a rational basis for targeting those groups most at risk of complications with antiviral treatment. OBJECTIVES: The aim of the present study was to compare current practice by GPs in the management of chickenpox, particularly in targeting of antiviral therapy, with the working party recommendations. METHOD: A questionnaire survey was conducted of all GP principals within a single London Health Authority Responses to nine chickenpox clinical scenarios were compared with the working party recommendations. RESULTS: The response rate was (69.2%) 227/328. In five of the nine scenarios, fewer than 70% of GPs selected the correct response according to the recommendations. There was both underuse and overuse of antivirals according to the recommendations, with only 42% (96/227) advising oral antivirals or referral for an asthmatic treated with oral steroids 1 month previously, and 24% (53/221) advising oral antivirals 3 days after the chickenpox rash appeared. CONCLUSIONS: The results suggest some high risk groups may be being undertreated with oral antivirals and there may be considerable use of oral antivirals in situations where they are of no proven benefit.

Adult↗

PubMed1994

The cost of childhood chickenpox: parents' perspective.

The development of a varicella vaccine has raised questions about the cost effectiveness of vaccination, but little information on the costs of chickenpox exists. The purpose of this study was to evaluate medical costs and the value of work loss among families whose children had chickenpox. Interviews were conducted with 179 families who made advice nurse calls or urgent care clinic visits to three clinics in the Northern California Kaiser Permanente Medical Care Plan. Two-thirds of working mothers and one-third of working fathers missed work to care for children with chickenpox. The mean value of the work lost because of chickenpox was $293/family or $183/chickenpox case. The estimated costs of nonprescription medications were $20/family or $12.50/chickenpox case. Children were sick enough to need to stay home for only one-third as many days as chicken actually stayed home because of school exclusion policies. These empiric results differ from previous estimates of the medical and work loss costs of varicella and should be included in analyses of the cost effectiveness of proposed vaccination programs.

Absenteeism↗

PubMed2000

[Comparison of positivity rates for antibodies against measles, rubella, chickenpox and mumps by assays].

Our previous study found mistakes by some doctors in the choice of an assay for determining antibodies in Japan. To compare the positivity rates for antibodies by assays, we measured the antibodies of measles, rubella, chickenpox and mumps from the same sera using such methods as the EIA, HI and CF assays. The subjects were 175 nursing students. The positivity rates for measles, chickenpox and mumps by the EIA assay were 96.6%, 93.7%, and 83.3%, respectively. Those for rubella by the HI and CF assays were 92.0% and 10.1%. The sensitivity rates for measles, chickenpox and mumps by the HI and CF assays, based on the results of the EIA assay, were 75.1%, 102.4% and 69.2% in the HI assay, and 20.6%, 38.7% and 8.0% in the CF assay, respectively. Our previous study showed that the sensitivity of the HI assay for rubella antibody is same as that of the EIA assay in Japan. Currently an EIA assay should be chosen for these antibodies and the HI assay or IAHA assay should be possible selections for rubella and chickenpox. However, international comparison of the cutoff titers for these antibodies should be considered.

Antibodies, Viral↗

PubMed1988

Epidemiology of chickenpox in England and Wales, 1967-85.

Routine sources of data on chickenpox morbidity and mortality in England and Wales were reviewed for 1967-85. Only two epidemics occurred, one in 1967 and one in 1980, both of which were immediately followed by two to three years of low incidence. The age distribution of the disease appears to be changing, with more cases now being reported in children aged 0-4 years. The number of deaths in adults have, however, increased, particularly those deaths that are associated with pneumonia and immunosuppression. At present in England and Wales more deaths are attributed to chickenpox than to whooping cough and mumps. Widespread use of selective immunisation against chickenpox might be justified in England and Wales, but before routine immunisation of the child population can be considered special surveys to determine the incidence and severity of chickenpox and the effect of the vaccine on the subsequent development of herpes zoster are needed as well as cost-benefit studies of immunisation.

Adolescent↗

PubMed2005

Chickenpox, pregnancy and the newborn: a follow-up.

In September 2005, we published an article on Chickenpox, pregnancy and the newborn. One of the issues it considered was fetal varicella syndrome, an uncommon but potentially fatal consequence of in-utero chickenpox infection. We reported evidence suggesting that contracting maternal chickenpox within the first 28 weeks of pregnancy can lead to fetal varicella syndrome. This suggestion was questioned after publication since it was at odds with national guidance in the U.K. and elsewhere, which has indicated that fetal varicella syndrome occurs only where maternal chickenpox develops before 20 weeks of pregnancy. Here we discuss in more detail the basis for our conclusion and its implications.

Chickenpox↗

PubMed2005

Chickenpox, pregnancy and the newborn.

In the UK, chickenpox (primary varicella virus infection) is usually a mild, self-limiting disease of childhood. It is more severe in adults. For example, of every 100,000 people who contract chickenpox, around 4-9 die from it, of whom 81-85% are adults. Chickenpox infection in pregnant women can lead to a severe maternal illness and it appears five times more likely to be fatal than in non-pregnant women. Although most women who have chickenpox in pregnancy give birth to healthy children, in other cases, the baby is harmed by in-utero infection or severe varicella of the newborn. Here we review the risks and key aspects of diagnosis and further management of varicella infection in pregnancy and the neonatal period.

Acyclovir↗

PubMed2005

Case report: occupationally related recurrent varicella (chickenpox) in a hospital nurse.

Commonly accepted outcomes of varicella-zoster virus (VZV) infections include chickenpox (primary) and shingles (recurrence or latency), as well lifetime immunity against chickenpox. We report the case of a registered nurse who worked in a neurologic surgery ward in a general hospital in Taipei, Taiwan. While working there for approximately 1 year, she developed recurrent chickenpox after caring for a paraparesis patient, who had herpes zoster during hospitalization in August 2002. The varicella incubation period was 10 days, which matched the range (10-21 days). Recently negative specific serum IgM and positive specific serum IgG indicated a past VZV infection. The nurse did not get herpes zoster from the second episode of varicella on 9 August 2002 to 4 April 2005 and is now convalescing. We conclude that occupational VZV hazards exist in the health care environment and suggest testing for VZV antibody and a VZV vaccination program for susceptible health care workers. Key words: chickenpox, indirect fluroscent antibody, occupational exposure, polymerase chain reaction, shingles, Taiwan, varicella-zoster virus.

Adult↗