Chickenpox: Presentation, transmission, complications and prevention
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Varicella, commonly known as chickenpox is an acute and highly infectious disease, which is caused by the varicella zoster virus Varicella. The two chickenpox vaccines available in the UK are Varilrix and Varivax but are not included in the routine childhood vaccination scheme unless they are immunocompromised ( Gov.uk, 2018 ; PHE, 2019 ). The varicella vaccination has been associated with a dramatic reduction in chickenpox cases in countries such as the United States, where every child can be vaccinated ( Seward et al, 2002 ). Johnston et al (1997) ; however, suggest that approximately 2–3% of patients vaccinated per year can develop a mild form of chickenpox regardless of the vaccine given. The Joint Committee on Vaccination and Immunisation (2010) has not recommended it as part of the national immunisation programme but nearly a decade later perhaps it is time to revisit this topic.Keywords:
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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 exammined. 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.
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ABSTRACT Background Varicella (chickenpox) is a highly contagious disease caused by the varicella-zoster virus. Although typically a mild disease, varicella can cause complications leading to severe illness and even death. Safe and effective varicella vaccines are available. The Joint Committee on Vaccination and Immunisation is planning to review the evidence regarding the introduction of varicella vaccine into the UK’s routine childhood immunisation schedule. Objectives To explore UK healthcare professionals’ (HCPs) knowledge and attitudes towards varicella vaccination, its introduction to the UK routine childhood immunisation schedule, and their preferences for how it should be delivered. Design We conducted an online cross-sectional survey exploring HCPs’ attitudes towards varicella, varicella vaccine, and their preferences for delivery of the vaccine between August and September 2022. Participants 91 HCPs working in the UK (96.7% female, 3.3% male, mean age 48.7 years). Results General vaccine attitudes in this group were very positive. Gaps in knowledge about varicella were revealed: 21.0% of respondents disagreed or were unsure that chickenpox can cause serious complications, while 41.8% were unsure or did not believe chickenpox was serious enough to vaccinate against. After receiving some basic information about chickenpox and the vaccine, almost half of the HCPs (47.3%) in our survey would prefer to administer the varicella vaccine combined with MMR. Conclusions Given the positive influence of HCPs on parents’ decisions to vaccinate their children, it is important to understand HCPs’ views regarding the introduction of varicella vaccine into the routine schedule. Our findings highlighted areas for training and HCPs’ preferences which will have implications for policy and practice should the vaccine be introduced.
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Varicella–zoster virus is the cause of both varicella (chickenpox) and herpes zoster (shingles). A live attenuated varicella vaccine was developed in Japan in 1974, and in 1995 it was approved for use in the United States. The policy of universal vaccination of susceptible children and adults has had a profound effect on the epidemiology of varicella. Its effect on the epidemiology of zoster remains to be seen, in part because of the long delay between primary infection with varicella–zoster virus and the subsequent occurrence of zoster.Before varicella vaccine was introduced, chickenpox developed in approximately 4 million persons, most of . . .
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* Abbreviation:
VZV — : varicella zoster virus
The live attenuated varicella vaccine remains the only vaccine in use against a virus that has a latent form and therefore causes 2 illnesses: varicella and zoster (also known as shingles).1 Zoster occurs after latent infection with varicella zoster virus (VZV) reactivates, after either chickenpox or vaccination. Viral latency lasts a lifetime. In countries where the vaccine is not used, varicella is mainly a disease of children, and zoster is a disease of adults. Because of declining cell-mediated immunity in older individuals, the incidence of zoster increases sharply after age 50. However, zoster may occur at any age in individuals who have previously been infected with VZV, and children vaccinated against chickenpox are at risk. In addition to waning cellular immunity with age, other factors that may precipitate zoster include immunosuppression, other viral infections, and stress.1
The varicella vaccine was developed in Japan in 1974, after Takahashi et al2 successfully attenuated VZV that was obtained from an otherwise healthy child with chickenpox. When the varicella vaccine was initially tested in the United States in the late 1970s, children with leukemia were frequently on their way to being cured of …
Address correspondence to Anne A. Gershon, MD, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032. E-mail: aag1{at}cumc.columbia.edu
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Varicella, commonly known as chickenpox is an acute and highly infectious disease, which is caused by the varicella zoster virus Varicella. The two chickenpox vaccines available in the UK are Varilrix and Varivax but are not included in the routine childhood vaccination scheme unless they are immunocompromised ( Gov.uk, 2018 ; PHE, 2019 ). The varicella vaccination has been associated with a dramatic reduction in chickenpox cases in countries such as the United States, where every child can be vaccinated ( Seward et al, 2002 ). Johnston et al (1997) ; however, suggest that approximately 2–3% of patients vaccinated per year can develop a mild form of chickenpox regardless of the vaccine given. The Joint Committee on Vaccination and Immunisation (2010) has not recommended it as part of the national immunisation programme but nearly a decade later perhaps it is time to revisit this topic.
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A case of chickenpox in a 94-year-old female is described. Serological tests for Varicella zoster virus (VZV) performed on early and late serum samples confirmed primary VZV infection. The patient recovered but seventeen days after presentation she developed a stroke from which she subsequently died. Chickenpox in older people is relatively rare-this case may be the oldest case of laboratory-proven chickenpox described-but it is a life-threatening illness. The varicella vaccine is licensed for use in immunocompetent persons of 12 months of age or older but in the UK is only offered to susceptible healthcare workers and close contacts of immunocompromised patients. In the US, the vaccine is recommended for all susceptible adolescents and adults. The same recommendation should be made in the UK.
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