[Seroepidemiology of chickenpox, measles and parotitis in the Republic of Mexico. III. Chickenpox].
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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↗
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↗
[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↗
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↗
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↗
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↗
Human monkeypox: confusion with chickenpox.
Human monkeypox is a zoonosis occurring sporadically in the tropical rain forest of western and central Africa. The exact incidence and geographical distribution are unknown, since many cases are not recognized. Special surveillance was established in three regions in Zaire in 1981 that led to a substantial increase in reported cases. The question arose as to the possibility that clinical diagnostic errors cause some cases of monkeypox to be misdiagnosed as other eruptive diseases. This paper presents the results of a study assessing the extent of and reasons for these clinical diagnostic errors in areas where health staff as well as the general public are aware of human monkeypox. In Zaire in the period 1981-1986, 977 persons with skin eruption not clinically diagnosed as human monkeypox were laboratory tested. 3.3% of human monkeypox cases were found among 730 patients diagnosed as cases of chickenpox, 7.3% among cases diagnosed as "atypical chickenpox" and 6.1% among cases with skin rash for which clinical diagnosis could not be established. The diagnostic difficulties were mainly based on clinical features characteristic of chickenpox: regional pleomorphism (in 46% of misdiagnosed cases), indefinite body-distribution of skin eruptions (49%), and centripetal distribution of skin lesions (17%). Lymph-node enlargement was observed in 76% of misdiagnosed patients. In the absence of smallpox, the main clinical diagnostic problem is the differentiation of human monkeypox from chickenpox. The presence of lymphadenopathy, pre-eruptive fever and slower maturation of skin lesions are the most important clinical signs supporting correct diagnosis of monkeypox.
Adolescent↗
Low antibody avidity in elderly chickenpox patients.
A small outbreak of chickenpox confirmed serologically in 3 elderly patients from a geriatric home is described. Disease was probably due to exogenous reinfection, yet nevertheless the avidity of specific antibodies measured by the urea denaturation test was even lower than in primary chickenpox controls, which themselves were, as expected, significantly lower than zoster controls. In elderly individuals susceptibility to reinfection with varicella-zoster virus (VZV) with clinical manifestation such as chickenpox may well be associated with the decay of specific humoral immunity detectable by antibodies of particularly low avidity, in contrast to reactivation of latent VZV presenting clinically as zoster, which is related to deficiencies in specific cellular immunity.
Aged↗
Acute retinal necrosis as a novel complication of chickenpox in adults.
Three patients in their 20s suffered from chickenpox while in an immunocompromised state: one in pregnancy, one during a long course of corticosteroid for severe nephrotic syndrome, and the third with repeated upper airway infection due to bronchiectasis. They developed acute retinal necrosis about three weeks after the onset of chickenpox. Since acute retinal necrosis threatens sight, this unusual complication of chickenpox in adults needs serious consideration.
Acute Disease↗
IgM and IgG responses to varicella-zoster virus p32/p36 complex after chickenpox and zoster, congenital and subclinical infections, and vaccination.
Varicella-zoster virus (VZV) directs the synthesis of a nonglycosylated polypeptide complex with two prominent species with relative molecular masses of 32,000 and 36,000; the p32/p36 complex is present in both the viral nucleocapsid and the nuclear matrix of the infected cell. We have now further characterized the humoral immune response of VZV-infected humans to this complex and established that it is a major viral antigen. Antibodies to VZV p32/p36 were detected in sera from patients with both primary VZV infection (chickenpox) and VZV reactivation (zoster); the response after zoster was more pronounced. When the IgM and IgG components of the immune response were distinguished, IgM to the viral nucleoproteins was observed following chickenpox and zoster and, to a lesser extent, in recipients of VZV vaccine. An IgM response to VZV p32 also was detected during intrauterine VZV infection and subclinical VZV infection.
Antibodies, Viral↗
Antibody response to varicella-zoster virus surface glycoproteins in chickenpox and shingles.
Varicella-zoster virus (VZV)-infected cell surface proteins were investigated using extrinsic radiolabelling of the cell surface, immunoprecipitation of detergent-solubilized extract of the same cell surface and fractionation of the immunoprecipitates using SDS-PAGE. Glycosylated proteins were identified by their affinity for Ricinus communis lectin. Six glycoproteins with apparent mol. wt. of 170K, 105K, 93K, 81K, 53K and 45K were identified. The 170K glycoprotein was shown to be disulphide-linked since under reducing conditions for SDS-PAGE it was cleaved to a protein of 63K mol. wt. The IgG responses to these glycoproteins during various clinical circumstances are described. In acute sera from all chickenpox patients and in the majority of acute shingles sera, antibodies reactive with glycoproteins could not be detected. In chickenpox convalescence, antibodies reactive with glycoproteins of mol. wt. 170K, 105K, 53K and 45K were identified, whilst during zoster convalescence antibodies to all six were prominent. Antibodies to the disulphide-linked glycoprotein persisted for many years following both the primary disease and its reactivation. Disseminated zoster was associated with significantly low levels of antibodies to these surface glycoproteins.
Adult↗
Central nervous system vasculitis after chickenpox--cause or coincidence?
A 7.5 year old boy, known to have a seizure disorder, presented with an infarct in the left middle cerebral artery territory, 10 weeks after severe chickenpox. Immunofluorescent antibody titre to the varicella zoster virus in the cerebrospinal fluid was 1:32. Cerebral angiography showed evidence of focal vasculitis. He presented again seven months later with an acute exacerbation of seizures. Magnetic resonance imaging of the brain showed an old posterior extension of the infarct, but a repeated angiography demonstrated an improvement in the vasculitic process. Cerebrospinal fluid antibody titre was again 1:32. Although this may have been an unfortunate coincidence, a possible association between chickenpox and vasculitis, similar to that reported with herpes zoster, and with potentially significant clinical implications, should be considered. As a definite proof can be obtained only by a brain biopsy, however, which is generally not indicated in such cases, only additional clinical reports can lead to delineation of this association as a definite entity.
Brain Diseases↗
Chickenpox pneumonia: experience with antiviral treatment.
Of 13 patients with chickenpox pneumonia (12 of them adults) treated during 1979-87, 10 received antiviral drugs--nine acyclovir and one vidarabine. Three died despite intensive treatment. Serious secondary infections occurred in six cases. There were no clear indications that antiviral treatment altered the natural history of the condition. Acyclovir may at present be used too late in the course of chickenpox pneumonia to alter its outcome.
Acyclovir↗
Abscess formation as a complication of chickenpox.
Chickenpox is a common infectious disease of childhood. Skin lesions may occasionally become secondarily infected with bacteria. Large abscess formation is reported complicating a mild case of chickenpox in a previously healthy patient.
Abscess↗
[Periodicity of chickenpox and epidemic parotitis].
The pattern of the dynamics of incidence of chickenpox and epidemic mumps in Leningrad for many years was studied. The application of mathematical methods of treatment of the incidence data revealed the main trends of the processes and the occurrence of three rhythms in each infection. The average values of the periods of these rhythms differ for chickenpox and epidemic mumps and are 11.0, 6.2, and 4.1 years and 8.2, 4.0, and 2.8 years, respectively. The study of the age incidence in comparison with the dynamics of the epidemic process for many years showed that periodicity of these infections could not be explained completely by variations of the herd immunity of the population.
Adolescent↗
A double blind, placebo controlled trial of efficacy and safety of oral acyclovir (Zovirax) in the treatment of chickenpox in adults.
A double-blind placebo controlled trial of oral acyclovir in otherwise healthy immune competent young adults with chickenpox was conducted. One hundred males were recruited into the trial, fifty were randomised to receive acyclovir at a dose of 800 mg five times daily for 5 days and fifty to receive matching placebo. Acyclovir recipients experienced itching and required anti-pruritic therapy for a significantly shorter period of time (p less than 0.05); no significant effects of acyclovir therapy on overall rash progression were observed. In patients with a mild rash on entry the maximum daily temperature recorded was significantly lower in the acyclovir group as compared with placebo recipients on day 1 of therapy (p less than 0.01). Acyclovir was extremely well tolerated and no adverse events were reported. Studies with early oral acyclovir therapy in otherwise healthy children with chickenpox has demonstrated significant benefits, particularly in rash progression. It is postulated that the partial benefits shown in this study in adults reflect the high proportion of patients with mild disease and enrollment of the majority of patients more than 24 hours after the rash onset.
Acyclovir↗
[The prevention of chickenpox in high risk children. Comparison of the effectiveness of specific immunoglobulins and of defibrinated convalescent plasma. 414 cases (author's transl)].
Comparison between 157 children treated with defibrinated convalescent plasma and 257 children treated with specific immunoglobulins revealed the improved effectiveness of the latter treatment in the prevention of chickenpox. Specific Herpes Zoster-Chickenpox immunoglobulins are prepared by caprylic acid fractionation of convalescent plasma. The prevention obtained in more than 90% of cases would appear to be clinically and biologically total as shown by serological surveillance of certain children with particularly severe immune depression.
Chickenpox↗