Varicella Zoster Varicella Zoster Important It is possible that the main title of the report Varicella Zoster is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Synonyms Zoster Sine Herpete General Discussion Varicella-zoster is an infectious disease caused by a common virus known as herpes virus, also known as the varicella-zoster virus (VZV). During childhood, the virus causes chickenpox (varicella), while, during adulthood, it causes shingles (herpes zoster). Chickenpox is a highly contagious disease characterized by an itchy skin rash and fever. Chickenpox usually begins with mild constitutional symptoms such as a mild headache , moderate fever and discomfort followed by an eruption appearing in itchy groups of flat or elevated spots and blisters , which form crusts. The virus lies dormant in individuals who have had chickenpox as children. Shingles is a painful localized recurrence of the skin rash during adulthood. Shingles occur because the virus is reactivated.

Resources Centers for Disease Control and Prevention 1600 Clifton Road NE NIH/National Institute of Allergy and Infectious Diseases Office of Communications and Government Relations 6610 Rockledge Drive, MSC 6612 Bethesda, MD 20892-6612 Genetic and Rare Diseases (GARD) Information Center PO Box 8126 5841 South Maryland Ave, MC 2030 Chicago, IL 60637 Internet: For a Complete Report This is an abstract of a report from the National Organization for Rare Disorders (NORD). A copy of the complete report can be downloaded free from the NORD website for registered users. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational therapies (if available), and references from medical literature. For a full-text version of this topic, go to and click on Rare Disease Database under "Rare Disease Information". The information provided in this report is not intended for diagnostic purposes. It is provided for informational purposes only. NORD recommends that affected individuals seek the advice or counsel of their own personal physicians. It is possible that the title of this topic is not the name you selected.

Please check the Synonyms listing to find the alternate name(s) and Disorder Subdivision(s) covered by this report This disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. For additional information and assistance about rare disorders, please contact the National Organization for Rare Disorders at P.O. Box 1968, Danbury, CT 06813-1968; phone (203) 744-0100; web site or email orphan@rarediseases.org Last Updated: 4/10/2009 Varicella-zoster virus | University of Maryland Medical Center Introduction The varicella-zoster virus (VZV) can cause two diseases: chickenpox (varicella) and shingles (herpes zoster). Before a vaccine was developed in 1994, chickenpox was a common contagious childhood disease that produced itchy blisters, but rarely caused serious problems.

However, if adults who did not have the disease as children contract it, it could cause more serious complications. Shingles is caused by the same virus that causes chickenpox. Once you have had chickenpox, the varicella-zoster virus lies dormant in your nerves and can re-emerge as shingles. Shingles, which is characterized by a rash of blisters, can be very painful. But it is not life threatening. Some people who develop shingles also develop a condition caused postherpetic neuralgia, which causes the skin to remain painful even after the rash is gone. Shingles is most common in people over age 60, or in those with weakened immune systems. There is a vaccine that reduces your risk of getting shingles. Signs and Symptoms Chickenpox The typical rash of chickenpox is made up of groups of small, itchy blisters surrounded by inflamed skin. The rash usually starts on the face, scalp, or chest, and quickly spreads throughout the body. It usually appears a few days after you have been exposed. Over 4 days, each blister tends to dry out and form a scab, which then falls off 9 to 13 days later.

The rash may be preceded or accompanied by: Fever, usually low grade Flu-like symptoms Shingles The typical shingles rash starts as redness followed by blisters that usually cover only one side of your body. The rash follows the path of the nerve where the virus has lain dormant. About 50 to 60% of people with shingles have the rash on their trunk. The next most common site is one side of the face, which may even include the tongue, eye, or ear. Before the rash appears, you will have warning symptoms of pain, usually a sharp, aching, piercing, tearing, or burning sensation, on the part of your body where the rash appears 1 to 5 days later. That area may also feel itchy, numb, and unbearably sensitive to touch, even just from your clothes touching your skin. Other symptoms may include: Causes Chickenpox Both chickenpox and shingles are caused by the varicella-zoster virus (VZV), a type of herpes virus. The virus is spread when you come into contact with the rash, or by sneezing, coughing, and breathing.

In other words, when someone with chickenpox sneezes or coughs, there are droplets with the VZV virus in the air. The person is contagious from 2 days before the rash appears until all of the blisters have crusted over. Shingles While shingles is caused by the same virus that leads to chickenpox, the way you develop this painful skin condition is different. After you have had chickenpox, the virus lives in a dormant state, as if it is hibernating, in nerve cells along your spine. Later in life, when it "wakes up", usually from a weakened immune system, aging, or other risk factor, the virus travels down the path of the particular nerve where it was "hibernating," causing pain followed by the rash. About 30% of people who have had chickenpox will develop shingles. Getting vaccinated can reduce your risk.

Risk Factors Exposure to the virus if you have not had chickenpox nor received the vaccine Being under 10 years of age Time of year: late winter and early spring is the most common time that the virus is spread Shingles Age (most common in people over 60) Stress Weakened immune system (for example, people with HIV/AIDS, or those taking drugs to suppress the immune system due to autoimmune diseases or organ transplants) Having had chickenpox before age 1 Diagnosis Your doctor can usually diagnose chickenpox easily because of its characteristic rash. However, if there is any doubt, the doctor may view a scraping from one of the blisters under the microscope. If you have shingles, your doctor can usually make a diagnosis from the history of pain and other symptoms and the rash itself. He or she may take a scraping from one of the blisters for a laboratory test. Preventive Care Chickenpox The chickenpox vaccine (Varivax) is given to children over 1 year old. If a person receives the vaccine before age 13, then he or she only needs one dose.

If a person receives the vaccine when he or she is older than 13, a second dose is needed 1 to 2 months later. If you have never had chickenpox or the vaccine, avoid contact with anyone who has chickenpox. Children with chickenpox should be kept out of school or daycare until their doctor says otherwise to avoid spreading the virus. Shingles If you have never had chickenpox, the chickenpox vaccine can reduce your risk of getting chickenpox and shingles. Even if you do get the disease, having had the vaccine reduces the risk of complications. The shingles vaccine (Zostavax) can reduce the risk of getting shingles among people who are over 60 and have had chickenpox. It does not completely ensure you will not get shingles. If you do develop shingles, being vaccinated reduces the severity and the risk of postherpetic neuralgia.

The shingles vaccine is not recommended for people who: Have ever had a reaction to gelatin or neomycin Have a weakened immune system Take drugs to suppress the immune system (such as corticosteroids) Have tuberculosis Have a history of lymphatic or bone marrow cancer One study found that older adults who regularly practice tai chi had a better immune response to the varicella virus, and their immunity increased even more when they had the shingles vaccine. Treatment Approach Both chickenpox and shingles generally get better by themselves, unless you are at high risk for complications. The goal of treatment is to reduce pain and itching. Lifestyle You can reduce symptoms of chickenpox and shingles with some simple steps: Apply cool water compresses to your skin or soak in a bathtub filled with cool water Add finely ground oatmeal (there are special brands sold in drugstores) to the bathtub Apply calamine or an over-the-counter hydrocortisone lotion to the affected areas Trim your fingernails to avoid infection For small children with chickenpox, cover hands with loose fitting, soft cotton or flannel mittens to prevent scratching Medications Chickenpox Antihistamine.

If itching is severe, your doctor may suggest an antihistamine (such as Benadryl). Acyclovir (Zovirax). An antiviral drug prescribed for children who are at high risk of complications from chickenpox, or for adults who have chickenpox. Pain relievers. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help reduce pain. DO NOT give aspirin to children under 19 because of the risk of a rare but serious illness called Reye syndrome. Shingles Antiviral drugs. Most effective when started within 72 hours of the first sign of a rash, these drugs are often given to people who are at risk of postherpetic neuralgia. They include: Acyclovir (Zovirax) Valacyclovir (Valtrex) Corticosteroids. Used with Zovirax to reduce inflammation. Pain relievers. For pain associated with shingles, an over-the-counter pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be effective.

For severe pain, or pain associated with postherpetic neuralgia, your doctor may prescribe a narcotic (opioid) pain reliever. For postherpetic neuralgia Capsaicin. Contains a pain reliever derived from chili peppers that produces a burning sensation when applied to the skin. It is available as an ointment (Zostrix) or a patch. A 2003 study reported that the patch reduced pain by 33% in about half of people with postherpetic neuralgia. Lidocaine patch (Lidoderm). Applied to the skin to reduce pain. Tricyclic antidepressants. Low doses of tricyclics, especially nortiptyline (Pamelor), may help reduce pain. Gabapentin (Neurontin). An anticonvulsant (antiseizure) medication that may also help reduce pain. Nutrition and Dietary Supplements Since supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Adenosine monophosphate (AMP).

An early study looked at injections of AMP, a compound that is made by the body, for treating the initial symptoms of shingles, as well as preventing postherpetic neuralgia. Researches gave people with shingles injections of either 100 mg of AMP or placebo. At the end of 4 weeks, 88% of those who got AMP were pain free compared to 43% who got placebo. The study used injections of AMP, so researchers do not know if taking AMP orally would have any effect. People who take dipyridamole (Persatine) or carbamazepine (Tegretol) should not take AMP. People with heart disease or gout should not take AMP. Vitamins B-12 and E. A few studies suggest that vitamin E (1,200 to 1,600 mg per day) and injections of B-12 (but not oral B-12) might help reduce symptoms of postherpetic neuralgia. But the studies were not good quality, and more research is needed. Herbs The use of herbs is a time-honored approach to strengthening the body and treating disease.

However, herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. Cayenne (Capsicum frutescens/Capsicum spp.). Capsaicin cream made from cayenne pepper can relieve pain when applied to the skin. Capsaicin may help relieve the pain of post herpetic neuralgia, and an over-the-counter ointment is approved for this treatment (see Medications). Capsaicin causes burning when applied to the skin, so use sparingly and do not use around eyes, nose, or mouth. German Chamomile (Matricaria recutita). Traditionally, this herb has been used topically to treat skin conditions and childhood illnesses like chickenpox. However, no scientific studies have examined whether chamomile is helpful in treating chickenpox. Chamomile interacts with a number of medications, so ask your doctor before taking it. People who are allergic to ragweed, chrysanthemums, daisies, and other members of the aster family, should not take chamomile. Licorice (Glycyrrhiza glabra).

Traditionally, licorice gel has been used topically (applied to the skin) to treat shingles and postherpetic neuralgia. In test tubes, one of the constituents of licorice, called glycyrrhizin, stops the varicella zoster virus from reproducing. However, no scientific studies have examined whether licorice gel is helpful in treating either shingles or postherpetic neuralgia. Licorice, if absorbed systemically, interacts with a number of medications, and can potentially aggravate certain medical conditions, such as hypertension. Ask your doctor before using it. Acupuncture Although the results of scientific studies have been mixed, acupuncture may help relieve the nerve pain associated with shingles, especially when combined with traditional medications. Acupuncturists treat people based on an individualized assessment of the excesses and deficiencies of qi (or energy) located in various meridians. In the case of shingles, a qi deficiency is usually detected in the liver meridian and an excess in the gallbladder meridian. Acupuncturists will often provide needle or moxibustion treatment (a technique in which the herb mugwort is burned over specific acupuncture points) around painful areas.

Homeopathy Few studies have examined the effectiveness of specific homeopathic therapies, however, professional homeopaths may consider the following remedies for the treatment of chickenpox and shingles based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. Your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Chickenpox: Antimonium crudum. For irritable children who are extremely sensitive to touch and may have a thick white coating on the tongue. Antimonium tartaricum. For large, slowly-appearing pox lesions accompanied by cough. Mercurius. For large, pus-filled pox which may ooze; this remedy is most appropriate for individuals who sweat profusely and may have enlarged lymph nodes. Pulsatilla. For fever associated with chicken pox; children who tend to be whiny, clingy, and weepy but have little thirst despite the fever. Rhus toxicodendron. For severe itching that worsens at night and improves with warm compresses or a bath; this remedy is the most commonly prescribed. Sulphur.

For extremely itchy lesions that worsen with heat or bathing, and which children will often scratch to the point of bleeding. Shingles: Arsenicum. For intense burning sensation that improves with warmth and worsens with cold. Lachesis. For particularly dark, sometimes purple, lesions on the left side of the body. Mezereum. For burning, sharp pains that worsen with touch; this remedy is most appropriate for individuals who are naturally chilly and sensitive to cold. Ranunculus bolbosus. For lesions located on the chest or back; pain worsens with touch and movement. Rhus toxicodendron. For intense itching and pain that may be relieved by touch. Mind-Body Medicine The following relaxation techniques may help reduce the pain and stress associated with shingles and postherpetic neuralgia: Meditation People with post herpetic neuralgia have reported some relief from using hypnosis. Other Considerations If you get chickenpox when you are pregnant, the infection may spread to the baby. Special Populations If you have a weakened immune system, shingles blisters may spread to other parts of your body and it will likely take longer for the symptoms to heal, maybe lasting for months.

Conditions that weaken your immune function include: HIV or AIDS Cancer, especially leukemia, Hodgkin's disease and other lymphomas, or undergoing chemotherapy Having an autoimmune disease (such as rheumatoid arthritis, lupus, multiple sclerosis, and Crohn's disease) Taking drugs that suppress your immune system Warnings and Precautions Do not give aspirin to children under 19 due to the risk of a rare but serious illness called Reye's syndrome. Call your doctor if you experience confusion, vomiting, or weakness, even paralysis, of the arms, legs, trunk, or face during or soon after a chickenpox or shingles infection. Prognosis and Complications While chickenpox usually goes away on its own, severe and sometimes fatal infections may occur, particularly in newborn infants, adults, and people whose immune systems are weakened. Potential infections include: Encephalitis, a brain infection Myocarditis, an infection of the heart muscle Pneumonia Secondary bacterial skin infection Shingles usually clears up in 2 - 3 weeks. Your chance of getting another bout of shingles is only 1 - 5% if you have a healthy immune system.

If you have a weakened immune system (see Special Populations), your risk for recurrence is higher. Potential complications from shingles include: Shingles lesions involving the mouth or eye; the latter may lead to blindness if not treated. Postherpetic neuralgia, persistent pain for months to years even after the skin lesions have cleared up. Secondary bacterial skin infections. Encephalitis (a brain infection) or sepsis (an infection in your blood stream, affecting many organs in the body). A growing body of research suggests that VZV may lead to a variety of neurologic complications, including encephalitis and meningitis. Supporting Research Arvin A. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012. Betts RF. Vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S143-S147. Black: Obstetric and Gynecologic Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2008. Cohen J.

Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011. Davies SJ, Harding LM, Baranowski AP. A novel treatment of postherpetic neuralgia using peppermint oil. Clin J Pain. 2002;18(3):200-2. Frisch S, Guo A. Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster. Clinics in Geriatric Medicine. Philadelphia, PA: W.B. Saunders Company. 2013;29(2). Gould D. Varicella zoster virus: chickenpox and shingles. Nurs Stand. 2014;28(33):52-8. Hu J. Acupuncture treatment of herpes zoster. J Tradit Chin Med. 2001;21(1):78-80. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc.

2007 Apr;55(4):511-7. Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother. 2004 Mar;5(3):551-9. Review. Lamont RF, Sobel JD, Carrington D, et al. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG. 2011;118(10):1155-62. Nagel MA. Varicella zoster virus vasculopathy: clinical features and pathogenesis. J Neurovirol. 2014;20(2):157-63. Nagel MA, Gilden D. Neurological complications of varicella zoster virus reactivation. Curr Opin Neurol. 2014;27(3):356-60. Niv D, Maltsman-Tseikhin A. Postherpetic neuralgia: the never-ending challenge. Pain Pract. 2005 Dec;5(4):327-40.

Pieroni A. Medicinal plants and food medicines in the folk traditions of the upper Lucca Province, Italy. J Etnopharmacol. 2000;70(3):235-73. Powell DR, Patel S, Franco-Paredes C. Varicella-Zoster Virus Vasculopathy: The Growing Association Between Herpes Zoster and Strokes. Am J Med Sci. 2015;350(3):243-5. Reilly MP. Clinical applications of acupuncture in anesthesia practice. CRNA. 2000;11(4):173-9. Roxas M. Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations. Altern Med Rev. 2006 Jun;11(2):102-13. Review. Silver B, Zhu H. Varicella zoster virus vaccines: potential complications and possible improvements. Virol Sin. 2014;29(5):265-73. Stankus SJ, Dlugopolski M, Packer D.

Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61(8):2437-8. Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S136-S142. Review. Wu J, Guo Z. Twenty-three cases of postherpetic neuralgia treated by acupuncture. J Tradit Chin Med. 2000;20(1):36-37. Young MK, Wood M, Jean-Noel N. Postherpetic neuralgia in older adults: culture, quality of life, and the use of alternative/complementary therapies. Holist Nurs Pract. 2007 May-Jun;21(3):124-34. Review. Alternative Names Varicella CDC's Healthcare Infection Control Guidelines at Varicella U.S.

Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Prevention Services Publication date: 12/01/1992 Varicella History -- Varicella (chickenpox) was not reliably distinguished from smallpox until the end of the 19th century. Herpes zoster (shingles) has been recognized since ancient times and was described in the early medical literature. Clinical observations of the relationship between varicella and herpes zoster were made in 1888 by Von Bokay, when susceptible children acquired varicella after contact with herpes zoster. Varicella virus (VZV) was isolated from vesicular fluid of both chickenpox and zoster lesions in cell culture by Weller in 1954. Subsequent laboratory studies of the virus have led to the development of a live attenuated varicella vaccine, Oka strain, in Japan in the 1970s. The vaccine has been shown to be safe and effective in healthy and immunocompromised children, and healthy adults. It will soon be licensed in the U.S., probably for use in healthy children.

Varicella Zoster Virus VZV is a member of the herpes virus group, (alpha) herpes virus 3. It is a DNA virus. VZV has the capacity to persist as a latent infection in dorsal root or extra medullary cranial ganglia. Epidemiology Infectiousness -- Varicella is highly contagious (less so than measles, but more so than mumps and rubella), with secondary attack rates in susceptible household contacts of up to 90%. Virtually all persons in the U.S. acquire varicella by adulthood; thus, the number of cases occurring annually should approximate the U.S. birth cohort (3.5 to 4 million). Epidemiologic Characteristics -- Varicella is endemic in the U.S. and has a seasonal fluctuation, with the highest incidence occurring in winter and early spring. Between 150,000 to 200,000 cases of varicella are reported annually to the Centers for Disease Control and Prevention (CDC), representing 4%-6% of all cases. Varicella is notifiable in approximately 33 reporting areas in the U.S.

The majority of cases, approximately 90%, occur in children less than 15 years of age. The highest attack rates are in children 5 to 9 years of age, who represent 60% of all cases. By adulthood, 90%-95% of the U.S. population have antibodies to varicella. In the tropics, varicella occurs more often in adults; thus, immigrants from these areas are more likely to be susceptible than the remainder of the population at comparable ages. Morbidity and Mortality -- Normal children usually have a relatively benign course. Complications are most likely to occur in the immunocompromised, newborns whose mothers develop rash close to the time of delivery, and adults. Approximately 40 to 90 deaths due to varicella are reported each year. The majority of these are in normal persons. Herpes Zoster -- Reflects reactivation of latent VZV infection. Reactivation is associated with aging, immunosuppression, in utero exposure to varicella, and postnatal varicella occurring before 18 months of age.

Approximately 300,000 cases are estimated to occur annually, and 5% are recurrences. No seasonal variation is known. Herpes zoster is not a notifiable condition. In the immunocompromised, zoster can disseminate, causing generalized skin lesions, and central nervous system (CNS), pulmonary, and hepatic involvement. Pathogenesis and Spread Mode of Transmission Person to person - Via direct contact with vesicular fluid or via droplets from respiratory tract secretions. Airborne - Via aerosolized droplet nuclei. Indirect contact - For example, via articles containing fresh discharges of vesicular lesions. Reservoir: Humans Incubation Period The average length is 14 to 16 days from exposure, with a range of 10 to 21 days. This may be prolonged in immunocompromised patients and those who have received varicella zoster immune globulin (VZIG). The incubation period may be up to 28 days after VZIG. Period of Communicability Extends from 1 to 2 days before the onset of rash through the first 5 to 6 days after rash onset.

Immunocompromised patients with progressive varicella are probably contagious during the entire period new lesions are appearing. The virus has not been isolated from crusted lesions. Mild and inapparent infections occur rarely (<5% of infections) Immunity following primary infection is considered long-lasting However, reexposure may lead to reinfection with boosts in antibody titers, usually without clinically apparent illness or detectable viremia. Path of entry of the virus into the susceptible host is assumed to be the upper respiratory tract Clinical Manifestations Prodrome - Adults may have 1 to 2 days of fever and malaise prior to rash onset, but in children the rash is often the first sign of disease. Rash - The rash is generalized, pruritic, and rapidly progresses from macules to papules to vesicular lesions before crusting. Lesions are usually 1 to 4 mm in diameter; the vesicles contain clear fluid on a erythematous base that may rupture or become purulent before they dry and crust. Successive crops appear over several days, with lesions present in several stages of maturity. The rash begins on the scalp, moves to the trunk, and then the extremities.

Lesions also can occur on mucous membranes of the oropharynx, respiratory tract, vagina, conjunctiva, and the cornea. Other - The clinical course in normal children is typically benign, with mild malaise, pruritus, and fever up to 102 F for 2 to 3 days. Adults may have more marked systemic symptoms and they have a higher incidence of complications. Zoster - The vesicular eruption of zoster generally occurs unilaterally in the distribution of the dermatomes supplied by a dorsal root or extramedullary cranial nerve sensory ganglion. Most often, this involves the trunk or the area of cranial nerve V. Two to four days prior to the eruption there may be pain and paresthesia in the segment involved. There are few systemic symptoms. Post-herpetic neuralgia is a distressing complication of zoster, with no adequate therapy currently available. Ocular nerve and other organ involvement with zoster can occur, often with severe sequelae. Maternal varicella infection during pregnancy can lead to herpes zoster in the first year of life. Complications Varicella in Normal Children Low risk of complications.

Accounts for >90% of cases, 75% of all varicella hospitalizations, 70% of cases of encephalitis, 40% to 60% of all deaths, and virtually 100% of Reye Syndrome cases. Most common complication is secondary bacterial infection of cutaneous lesions. CNS Complications: Encephalitis (estimated rate = 1.7/100,000): Cerebellar ataxia is most common, and is associated with a good outcome; diffuse cerebral involvement is less common in children. Reye Syndrome: Recent dramatic decrease in the incidence has occurred, presumably related to decreased use of aspirin in children. Rare: Aseptic meningitis, transverse myelitis, and Guillain-Barre syndrome. Pneumonia: Viral or bacterial, more frequent in adults. Infrequent complications: Thrombocytopenia, hemorrhagic varicella, purpura fulminans, glomerulonephritis, myocarditis, arthritis, orchitis, uveitis, iritis, and clinical hepatitis. Normal Adults Have a higher risk of complications than normal children.

Less than 2% of reported cases are in persons > or equal to 20 years of age, but account for approximately 25% of mortality. Pneumonia: Case fatality rates of up to 30%. Diffuse cerebral encephalitis is more likely to affect adults than children, and has a case fatality rate of up to 37%. Hospitalization rate approximately 14-18/1,000 cases compared with 1-2/1,000 cases in normal children. Immunocompromised persons (i.e., persons with congenital or acquired immune deficiencies, malignancies, or on immunosuppressive therapy). Immunocompromised persons have a high risk of serious varicella infection. Immunocompromised persons have a high risk of disseminated disease (up to 36% in one report), resulting in multiple organ system involvement, often becoming fulminant and hemorrhagic. Most frequent complications include pneumonia and encephalitis. Increased risk of death; 7% in one report, however, this preceded the widespread use of VZIG and acyclovir and may not reflect current experience.

Congenital Infection Primary varicella infection in the first 16 weeks of gestation is rarely associated with a recognized constellation of abnormalities: low birth weight, hypoplasia of an extremity, cicatricial skin scarring, localized muscular atrophy, encephalitis, cortical atrophy, chorioretinitis, and microcephaly. Risk of congenital birth defects from primary maternal varicella infection during the first trimester is felt to be very low (1%-2%). Rare reports of congenital birth defects following maternal zoster exist; however, virologic confirmation of maternal lesions was lacking. Infection in utero with varicella, particularly after 20 weeks gestation, is associated with zoster in those infants at an earlier age; the exact risk is unknown. Neonatal Infection Due to Maternal Chickenpox Close to Time of Delivery The onset of maternal varicella from 5 days before to 2 days after delivery may result in severe infection of the neonate (in an estimated 17% to 30%) and an estimated case fatality rate of 31% in the first 5 to 10 days of life.

Fetal exposure to varicella virus without protection from sufficient maternal antibody results in severe disease. Infants born to mothers with onset of maternal varicella 5 days or more prior to delivery usually have a benign course, presumably due to passive transfer of sufficient maternal antibody. Infants After Postnatal Exposure Normal full-term infants with normal birthweight are unlikely to develop serious complications. Premature infants may have medical conditions that put them at increased risk for serious varicella illness and those born before 28 weeks of gestation may not have received adequate maternal antibody. Pregnancy - There is growing evidence that infection during pregnancy carries increased risk for serious varicella. Further study is needed. Death Risk in normal children: approximately 1/100,000; in normal infants: approximately 6/100,000. Risk in normal adults: approximately 12/100,000. Risk in leukemics is higher than in normal children and has been reported at 7%. Risk for newborns (who do not receive VZIG) from maternal chickenpox close to time of delivery is estimated at 31%. Majority of deaths occur in normal individuals.

Differential Diagnosis Chickenpox is associated with a very characteristic vesicular rash illness -- "Your grandmother could diagnose it" (Fehrs, 1990). A history of chickenpox has been shown to be a reliable indicator of immunity; however, a lack of such history is not as reliable and does not always correlate with lack of immunity. The differential diagnosis for chickenpox includes: Herpes Simplex Disseminated infection in the immunocompromised or neonate. Eczema herpeticum, vesicular lesions occur in the areas of eczematous involvement. Zoster-like lesions. Enteroviral Infections - Papulovesicular lesions occur on palms and soles, with vesicular lesions on the buccal mucosa; usually self limited. Impetigo - Erythematous macules progress to vesiculopustular lesions that dry and crust. The infection can spread. Exposed areas such as the face, neck, and limbs are often involved. Skin breaks serve as the portal of entry. Group A Streptococcus is usually the etiologic agent, but superinfection by staphylococci often occurs.

Rickettsialpox Generalized erythematous papulovesicular lesions occur on the palms, soles, and mucous membranes after the bite of a house mouse mite, Liponyssoides sanguineus (the vector). A black scab occurs at the bite. Systemic disease consists of chills, fever, headache, myalgia, photophobia, and adenopathy. It is self-limited, nonfatal, and noncommunicable. Laboratory Diagnosis Not routinely required, but useful if confirmation of diagnosis or determination of susceptibility is necessary. Viral Isolation -- Source - Vesicular fluid; difficult to isolate from the respiratory tract. Tissue culture isolation. Vesicular scrapings (Tzanck smear) can identify multi-nucleated giant cells, consistent with VZV and herpes simplex virus (HSV) infection. In some instances, stains of vesicular scrapings may be tested using a fluorescent monoclonal antibody test which is very sensitive and specific. Serologic Testing -- Complement fixation (CF): Commercially available, but lacks sensitivity. Neutralization test (NT): Sensitive and specific; time consuming and difficult to perform; not readily available.

Immunofluorescence assay for antibody to VZV-induced membrane antigen (FAMA): sensitive, time consuming, not readily available. Immune adherence hemagglutination (IAHA) sensitive; not readily available. Enzyme-linked immunosorbent assay (ELISA): Sensitive, simple, and commercially available; may be useful for routine testing. Cell Mediated Immunity Lymphocyte proliferative response to VZV antigen. Skin test antigen: Not commercially available. In normal individuals, the presence of detectable antibody can be considered evidence of immunity to VZV. Antibody levels in immunocompromised persons may be unreliable predictors of immunity, as they may reflect passively acquired antibody from blood products. Clinical varicella has developed in these persons. Laboratory tests must be interpreted cautiously in this population. History of prior chickenpox may be a more important indicator of immunity. Current Methods of Control and Prevention VZIG Prepared from plasma of normal blood donors with high antibody titers to VZV. Available from the American Red Cross. If administered within 96 hours of exposure, can modify or prevent clinical varicella and prevent complications or death, especially in susceptible immunocompromised individuals.

Indications for use: Individuals with significant exposure: Continuous household contact; playmate contact of over an hour; hospital contact in the same 2- to 4-bed room, or prolonged direct contact; newborn of mother who had onset of varicella 5 days before to 2 days after delivery. Individuals at risk for complications: Immunocompromised children: Those with immune deficiencies, neoplastic disease, or on immunosuppressive therapy. Newborns of mothers with varicella onset 5 days before to 2 days after delivery. Premature infants with postnatal exposure: Those born > or equal to 28 weeks gestation and up to term, and > or equal to 1,000 grams; mother not immune. Those born < 28 weeks or < 1000 grams birth-weight, regardless of maternal history. Immunocompromised adults: If susceptible and have a history of significant exposure. Normal adults and pregnant females: Consider the type of exposure, susceptibility, risks for complications, and cost. No evidence that VZIG will prevent congenital varicella.

Dose: 125 units/I0 kg, up to a maximum of 625 units (five vials), IM. Volume 125 units per 1.25 ml (one vial). (Higher doses can be considered for immunosuppressed persons). Should be given within 96 hours of exposure, preferably as soon as possible. The administration of VZIG may prolong the incubation period of varicella to as long as 28 days post-exposure. Special Varicella Zoster Exposure Situations -- Hospital personnel - If susceptible, with significant exposure, workers should be relieved from direct patient contact from day 10 to day 21 after exposure. If workers develop chickenpox, varicella lesions must be crusted before they should return to direct patient contact. Receipt of VZIG does not change this recommendation for reassignment. Since VZIG can prolong the incubation period, the period of removal from direct patient contact should be lengthened to 28 days after exposure.

Newborn with maternal rash onset 5 days before to 2 days after delivery Since about 50% of infants who receive VZIG will develop varicella, if these infants remain hospitalized beyond age 10 days, they should be kept in strict isolation until age 21 days. Antiviral Therapy Acyclovir - The Advisory Committee on Immunization Practices (ACIP) has not set policy concerning acyclovir. The policy of the American Academy of Pediatrics (AAP) includes: Not routinely recommended for uncomplicated varicella in healthy children. Should be considered in individuals at high risk for severe varicella or complications. Healthy nonpregnant individuals 13 years of age or older. Children over 12 months of age with a chronic cutaneous or pulmonary disorder, or salicylate therapy. Children receiving short, intermittent or aerosolized courses of corticosteroids. If immunocompromised, intravenous administration is indicated. Corticosteroids should be discontinued, if possible, after exposure. Dosage: Should be started within the first 24 hours of onset of rash, 20 mg/kg four times a day for 5 days, maximum 800 mg four times per day.

Adequate fluid intake should be maintained. Intravenous acyclovir is recommended for primary varicella or recurrent zoster in immunocompromised children and for viral-mediated complications of varicella in normal individuals. Oral acyclovir is not recommended for pregnant women with uncomplicated varicella. Intravenous acyclovir should be considered in pregnant women with serious viral-mediated complications of varicella. Acyclovir should not be used prophylactically in normal children exposed to varicella to prevent infection or illness. Adenine Arabinoside (ara-A). Vaccine virus isolated from vesicular fluid from a healthy child. Attenuated by passage 30 to 33 times in human diploid cells and guinea pig fibroblasts. Live attenuated vaccine developed in Japan in the early 1970s. Licensed for general use in Japan and Korea and in high-risk individuals in a number of European countries. Vaccine has been administered to over 15,000 people in Japan and the U.S., including healthy children, healthy adults, children with acute lymphocytic leukemia (ALL), and other immunocompromised patients.

Table 1; Efficacy in Children Seroconversion only 82% with one dose, 94% with two doses. Effective vaccination may require two doses. Efficacy of two doses only approximately 65%-70% after household exposure. Breakthrough infectious are mild, with few skin lesions, and do not result in dissemination of serious illness. Adverse Events Following Varicella Vaccination Normal Children/Adults. Rash. (1) 4%-10%. (2) Usually <50 lesions. (3) Often maculopapular rather than vesicular. Injection site lesions, swelling, pain. System reactions rare. Adults: 1/302 @ 3 years (wild-type virus isolated). Normal children: 1.4/10,000 person-years (vs. 8/10,000 following natural disease). No virus isolated. Children with acute lymphoblastic leukemia (ALL). Rash more frequent. Occurs in up to 40%. More frequent in patients: With no suspension of chemotherapy. Reactivation (zoster).

May be less frequent than following natural disease (Hardy I, Gershon AA, Steinberg SP, LaRussa P, Varicella Vaccine Collaborative Study Group. The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. N Engl J Med 1991; 325[22]:1545-50.) No severe illness or dissemination reported. More common in those with initial vaccine-related rash. Vaccine virus isolated. Transmission of Varicella Vaccine Virus Transmission from normal recent vaccinees. No secondary clinical illnesses reported. <1% asymptomatic seroconversion documented in susceptible contacts (Weibel). Transmission from children with ALL. Only from recent vaccinees with rash. Transmission rate from those with post-vaccination rash is 9%-28%. Vaccine virus isolated from secondary cases. One case of tertiary transmission. Transmission has been documented from persons who initially seroconverted after vaccination but nevertheless developed mild breakthrough infection later. Summary The vaccine appears to be safe and effective. Vaccination prevents illness in normal individuals. Vaccination prevents serious complications in the immunocompromised. Persistent immunity is produced in almost all normal vaccinees.

Immunocompromised persons and adults may require two doses of vaccine. The risk for zoster appears to be less than the risk following natural varicella. Antibody levels following simultaneous administration of the vaccine with measles-mumps-rubella (MMR) at 15 months of age are similar to those detected when the vaccines are given alone. Cost/Benefit analysis: Annual cost of caring for normal children estimated to be $400 million; 95% of costs are associated with wages lost when parents must provide home care of an ill child. Vaccine given with MMR at 15 months could reduce costs by 66%; benefit to cost ratio 6.9:1.

Varicella-Zoster Immune Globulin: Regional Distribution Centers Service Area Regional Center and 24-Hour Telephone United States and territories ------------------------------------------------------------------------ Alabama American Red Cross Blood Services Alabama Region (205) 322-5661 Alaska (see Oregon) Arizona American Red Cross Blood Services Southern Arizona Region (602) 623-0541 Arkansas (see Missouri) California, northern American Red Cross Blood Services L.A.-Orange Counties Region (213) 739-5200 Colorado (see N.

Mexico) Connecticut American Red Cross Blood Services Connecticut Region (203) 678-2730 Delaware (see Pennsylvania) Florida South Florida Blood Service (305) 326-8888 American Red Cross Blood Services Mid-Florida Region (904) 255-5444 Georgia American Red Cross Blood Services Atlanta Region (404) 881-9800 (404) 881-6752 (night) Hawaii (see California, Southern) Idaho American Red Cross Blood Services Mid-America region (312) 440-2222 Illinois, southern (see Missouri) Indiana American Red Cross Blood Services Fort Wayne Region (219) 482-3781 Iowa (see Wisconsin, S.E.) Kansas (see Missouri) Kentucky (see Missouri) Louisiana (See Texas [Gulf Coast]) Maine American Red Cross Blood Services Northeast Region (207) 775-2367 Maryland American Red Cross Blood Services (301) 764-4639 (also see Washington D.C.) Massachusetts Massachusetts Public Health United States Biologics

 Laboratories (617) 522-3700 Michigan American Red Cross Blood Services Southeastern Michigan Region (313) 494-2715 American Red Cross Blood Services Wolverine Region (313) 232-1176 American Red Cross Blood Services Great Lakes Region (517) 484-7461 Minnesota American Red Cross Blood Services St.

Paul Region (612) 291-6789 (612) 291 6767 (night) Mississippi (see Alabama) Missouri American Red Cross Blood Services (314) 658-2000 (314) 658-2136 (night) Montana (see Oregon) Nebraska American Red Cross Blood Services Midwest Region (402) 341-2723 Nevada (see California, northern) New Hampshire (see Vermont) New Jersey, northern (see Greater New York Blood Program) New Jersey, southern (see Pennsylvania) New Mexico United Blood Services (505) 247-9831 New York The Greater New York Blood Program (212) 468-2106 (212) 570-3068 (night) American Red Cross Blood Services Northeastern New York region (518) 449-5020 or (518)462-7461 (518) 462-6964 (night) American Red Cross Blood Services Northeastern New

 York Region (518) 449-5020 or (518) 462-7461 (518) 462-6964 (night) American Red Cross Blood Services Greater Buffalo Chapter (716) 886-6866 American Red Cross Blood Services Rochester Region (716) 461-9800 American Red Cross Blood Services Syracuse Region (315) 425-1647 North Carolina American Red Cross Blood Services Carolinas Region (704) 376-1661 North Dakota (see Wisconsin, S.E.) Ohio American Red Cross Blood Services Northern Ohio Region (216) 781-1800 American Red Cross Blood Services Central Ohio Region (614) 253-7981 Oklahoma (see Texas Gulf Coast) Oregon American Red Cross Blood Services Pacific Northwest Region (503) 243-5286 Puerto Rico American Red Cross Servicio de Sangre Capitulo (809) 759-7979 Pennsylvania American Red Cross Blood Services Penn-Jersey

 Region (215) 299-4126 Rhode Island Rhode Island Blood Center (401) 863-8368 South Carolina American Red Cross Blood Services South Carolina Region (803) 256-2301 South Dakota (see Wisconsin, S.E.) Tennessee American Red Cross Nashville Region (6154) 327-1931, ext.

315 Texas Gulf Coast Regional Blood Center (713) 791-6250 American Red Cross Blood Services Central Texas Region (817) 776-8754 American Red Cross Blood Services Reed River Region (817) 322-8686 Utah (see California, northern) Vermont American Red Cross Blood Services Vermont-New Hampshire Region (802) 658-6400, ext 217 Virginia (also see Washington, DC) American Red Cross Blood Services Tidewater Region (804) 446-7709 Richmond Metropolitan Blood Service (804) 359-5100 ARC Blood Services Appalachian region (703) 985-3595 Washington Puget Sound Blood Center (206) 292-6525 Washington, DC American Red Cross Blood Services Washington Region West Virginia (see Washington, DC) Wisconsin The Blood Center of S.E.

Wisconsin (414) 933-5000 American Red Cross Blood Services Badger Region (608) 255-0021 Wyoming (see California, northern) Other countries Canada Canadian Red Cross Blood Transfusion Service National Office (416) 923-6692 Central and South America South Florida Community Blood Center (305) 326-8888 All other countries American Red Cross Blood Services Northeast Region (617) 449-0773 American Red Cross Blood Services Blood Services (617) 731-2130 Varicella Workshop Which statement about varicella is not true? Varicella is highly contagious. Varicella is a notifiable disease in all states. Most adults are immune to varicella. Airborne transmission of vancella can occur. Which statement about herpes zoster or shingles is not true? Zoster represents reactivation of latent varicella infection. About 5% of zoster episodes are recurrences of zoster. No seasonal variation in zoster is known. CDC receives reports of herpes zoster from states.

What is the incubation period for chickenpox? If someone, such as a health care worker, is susceptible to varicella and is exposed to the disease, when should they be considered at risk for developing chickenpox and exposing others? In the case in question 4, if the exposed person received VZIG, what effect would this treatment have on the incubation period? On recommendations for preventing exposure of high-risk persons to this person? Which of the following is NOT true regarding vancella? The period of communicability (for normal persons) extends from 1 to 2 days before onset of the rash through the first 5 to 6 days after rash onset. Vancella zoster immune globulin (VZIG) is indicated for a healthy full-term infant who is exposed to chickenpox at home at age 2 weeks. Vancella vaccine is less immunogenic and effective in normal adults than in normal children, although it does prevent serious disease in this group. Herpes zoster is a reactivation of latent varicella infection. Normal adults have a higher risk of complications from the disease than do normal children.

Questions 7-16: Indicate whether the following persons should receive VZIG and why: The normal newborn whose mother develops a varicella rash on the day of delivery. ____ Yes The normal newborn whose mother developed a rash 10 days before delivery. ____ Yes ____ No ____ VZIG should be considered The 1500g infant born at 30 weeks gestation who is exposed in the nursery to chickenpox. ____ Yes ____ No ____ VZIG should be considered The infant born at 27 weeks gestation who is exposed to chickenpox in the nursery but whose mother is sure she had chickenpox several years ago, when she was in college. ____ Yes ____ No ____ VZIG should be considered The pregnant woman who is exposed to a household member with chickenpox and whose doctor wants to protect her against the risk of complications of varicella in pregnancy. ____ Yes ____ No ____ VZIG should be considered The pregnant woman who is exposed in the first trimester to a household member with varicella and who wants VZIG in order to protect her fetus against infection. ____ Yes What age group is currently most likely to develop chickenpox?

Name groups which have a higher risk for complications of varicella than do normal children. For which persons is Merck Sharp & Dohme seeking FDA licensure of varicella vaccine? Which of the following has not been observed following vaccination in trials of varicella vaccine in normal and immunocompromised children? Vaccine-associated rash associated with a low rate of transmission of vaccine virus Vaccine-associated fever Zoster due to reactivation of vaccine virus Severe complications Which statement about varicella is not true? Varicella is highly contagious. Varicella is a notifiable disease in all states. Most adults are immune to varicella. Airborne transmission of varicella can occur. Answer: B. - Varicella is a notifiable disease in fewer states (less than 70%) than are measles, mumps, or rubella. This fact and the fact that many cases of varicella are mild and never come to medical attention contribute to the low rate of reporting of varicella to the CDC -- only 4%-6% of the estimated annual total of U.S. cases. Which statement about herpes zoster or shingles is not true? Zoster represents reactivation of latent varicella infection.

About 5% of zoster episodes are recurrences of zoster. No seasonal variation in zoster is known. CDC receives reports of herpes zoster from states. Answer: D. - Unlike cases of primary varicella (or chickenpox), cases of herpes zoster are not tracked by the CDC through routine notifiable disease surveillance in States. What is the incubation period for chickenpox? Answer: An average of 14-16 days, with a range of 10-21 days. If someone, such as a health care worker, is susceptible to varicella and is exposed to the disease, when should they be considered at risk for developing chickenpox and exposing others? Answer: During the period of 10-21 days after exposure. This is the period during which they should not be in contact with susceptible persons at high risk for complications from varicella. In the case in question 4, if the exposed person received VZIG, what effect would this treatment have on the incubation period? On recommendations for preventing exposure of high-risk persons to this person? Answer: The incubation period could be lengthened to as long as 28 days.

Therefore, the exposed person should not be in contact with susceptible persons at high risk for varicella complications during the period from 10 to 28 days post-exposure. Which of the following is NOT true regarding varicella? The period of communicability (for normal persons) extends from 1 to 2 days before onset of the rash through the first 5 to 6 days after rash onset. Varicella zoster immune globulin (VZIG) is indicated for a healthy full-term infant who is exposed to chickenpox at home at age 2 weeks. Varicella vaccine is less immunogenic and effective in normal adults than in normal children, although it does prevent serious disease in this group. Herpes zoster is a reactivation of latent varicella infection. Normal adults have a higher risk of complications from the disease than do normal children. Answer: B. - Use of VZIG for infants and children is reserved primarily for susceptible, immunocompromised children after significant exposure. It is not indicated for healthy, normal-term infants, who are not known to be at any greater risk from complications of chickenpox than older c children.

Questions 7-16: Indicate whether the following persons should receive VZIG and why: The normal newborn whose mother develops a varicella rash the day of delivery. Answer: A - YES. This infant is likely to develop serious neonatal varicella because it was exposed in utero to varicella virus when the mother was viremic but was born before sufficient maternal antibody could be produced, transferred transplacentally, and moderate disease in the infant. The normal newborn whose mother developed a rash 10 days before delivery. Answer: B - NO. This infant should have received maternal anti-body in utero and should have mild or no disease. Only infants whose mothers develop rash 5 days before to 2 days after delivery are at high-risk for serious varicella. The 1500g infant born at 30 weeks gestation who is exposed in the nursery to chickenpox. Answer: C - VZIG should be considered.

Since this infant weighs > or equal to 1000g and was born at > or equal to 28 weeks gestation, VZIG does not need to be given if there is a good maternal history of chickenpox, even though this infant is premature. If the mother does not have a history of chickenpox, VZIG should be given. The infant born at 27 weeks gestation who is exposed to chickenpox in the nursery but whose mother is sure she had chickenpox several years ago, when she was in college. Answer: A - YES. Even though the mother should be immune to chickenpox, since the infant may have been born before maternal antibody was transferred transplacentally, the ACIP and AAP recommend that VZIG be given. The pregnant woman who is exposed to a household member with chickenpox and whose doctor wants to protect her against the risk of complications varicella in pregnancy. Answer: C - VZIG should be considered. It is unclear if pregnant women have a higher risk for complications from varicella than do non- pregnant adults; however, adults do have a higher risk of complications than do children.

Some obstetricians will administer VZIG to exposed pregnant women if adequate resources and time are available, especially if the exposure was high, as occurs within households. The pregnant woman who is exposed in the first trimester to a household member with varicella and who wants VZIG in order to protect her fetus against infection. Answer: B - NO. There is no evidence that the administration of VZIG will prevent fetal infection. However, some obstetricians will give VZIG for a different reason (see above). The pregnant exposed women should be reassured that congenital varicella syndrome is rare and results from exposure during the first 16 weeks of pregnancy only. The immunocompromised adult who is significantly exposed to varicella. Answer: C - VZIG should be considered. VZIG should be given if the adult does not have a carefully obtained history of varicella or has serologic evidence of lack of immunity. The normal adult who is exposed to chickenpox and has no memory of ever having had chickenpox. Answer: C - VZIG should be considered. VZIG is expensive and not routinely recommended by the ACIP for such adults.

However, since adults do have a higher rate of complications with varicella than do children, some physicians will offer adults the option of receiving VZIG. The high-risk patient who was exposed to varicella 8 days ago. Answer: B - NO. VZIG should be administered within 96 hours of exposure. In this case, the patient would probably be treated with an anti-viral agent, such as acyclovir, at the first sign of illness. The susceptible high-risk patient who was exposed to varicella 3 days ago and whose doctor is unsuccessful in reaching CDC to obtain VZIG. Answer: A - YES. VZIG is obtained from the local American Red Cross, not from CDC. What age group is currently most likely to develop chickenpox? Answer: School-aged children, especially children 5-9 years of age. Name groups which have a higher risk than do normal children for complications of varicella. Answer: - Immunocompromised patients (including persons with AIDS). Adults. Newborns whose mothers develop a varicella rash 5 days before to 2 days after delivery. Premature infants.

Normal infants under age 1 year (who have a lower risk than newborns with neonatal exposure but a higher risk than older children). Pregnant women, possibly. For which persons is Merck Sharp & Dohme seeking FDA licensure of varicella vaccine? Answer: Children over 12 months of age and adults. Which of the following have not been observed following vaccination in trials of varicella vaccine in normal and immunocompromised children? Vaccine-associated rash associated with a low rate of transmission of vaccine virus? Vaccine-associated fever. Zoster due to reactivation of vaccine virus. Severe complications. Answer: E - Severe complications. While a few immunocompromised vaccines have developed extensive rashes similar to wild-type infection, no reports of serious complications or death due to vaccine infection exist. For Additional Information U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. POINT OF CONTACT FOR THIS DOCUMENT: To request a copy of this document or for questions concerning this document, please contact the person or office listed below. If requesting a document, please specify the complete name of the document as well as the address to which you would like it mailed.

Note that if a name is listed with the address below, you may wish to contact this person via CDC WONDER/PC e-mail. DON H STENHOUSE Atlanta, GA 30333 Table 1 Table 1 Efficacy In Children =========================================================================== Normal Children Children With ALL ___________________________________________________________________________ 1. Immunologic Response ------------------------- Humoral (seroconversion One dose: 88% rate) 94%-100% Two doses: 98% Cellular >90% Data difficult to interpret 2. Clinical Efficacy _________________________ Pre-exposure 85%-95% 85% with 2 doses 3. Duration of Immunity _________________________ Antibody >90% (up to 3-10 years) 50%-80% Cellular Frequently lost (Cell mediated) 90% antibody Cellular (Positive skin testing) 90% 90% 4. Breakthrough infections (about 2%/year in first few years post vaccination) are generally mild, with few skin lesions, and do not result in dissemination or serious illness.

=========================================================================== This page last reviewed: Wednesday, January 27, 2016 This information is provided as technical reference material. Please contact us at cwus@cdc.gov to request a simple text version of this document. Chickenpox (Varicella)-Topic Overview Chickenpox (Varicella) Credits What is chickenpox? Chickenpox (varicella) is a contagious illness that causes an itchy rash and red spots or blisters (pox) all over the body. Chickenpox can cause problems for pregnant women, newborns, teens and adults, and people who have immune system problems that make it hard for the body to fight infection. Chickenpox usually isn't a serious health problem in healthy children. But a child with chickenpox needs to stay home from school. And you may need to miss work in order to care for your child. After you have had chickenpox, you aren't likely to get it again. But the virus stays in your body long after you get over the illness. If the virus becomes active again, it can cause a painful viral infection called shingles . What causes chickenpox, and how is it spread?

Chickenpox is caused by the varicella- zoster virus . It can spread easily. You can get it from an infected person who sneezes, coughs , or shares food or drinks. You can also get it if you touch the fluid from a chickenpox blister. A person who has chickenpox can spread the virus even before he or she has any symptoms. Chickenpox is most easily spread from 2 to 3 days before the rash appears until all the blisters have crusted over. You are at risk for chickenpox if you have never had the illness and haven't had the chickenpox vaccine . If someone you live with gets chickenpox, your risk is even higher because of the close contact. What are the symptoms? The first symptoms of chickenpox usually develop about 14 to 16 days after contact with a person infected with the virus. Most people feel sick and have a fever, a decreased appetite, a headache , a cough , and a sore throat . The itchy chickenpox rash usually appears about 1 or 2 days after the first symptoms start.

After a chickenpox red spot appears, it usually takes about 1 or 2 days for the spot to go through all its stages. This includes blistering, bursting, drying, and crusting over. New red spots will appear every day for up to 5 to 7 days. It usually takes about 10 days after the first symptoms before all blisters have crusted over. This is when the person with chickenpox can return to day care , school, or work. Continued How is chickenpox diagnosed? Your doctor will ask you about your symptoms and will examine you. This usually gives your doctor enough information to find out if you have chickenpox. A healthy child with chickenpox symptoms may not need to visit a doctor. You may be able to describe your child's symptoms to the doctor over the phone. Teenagers, adults, pregnant women, and people with health problems need to see a doctor for chickenpox. This is especially important for pregnant women, since chickenpox during pregnancy can cause birth defects or serious newborn infection. How is it treated? Most healthy children and adults need only home treatment for chickenpox. Home treatment includes resting and taking medicines to reduce fever and itching .

You also can soak in oatmeal baths to help with itching . People with long-term diseases or other health problems may need more treatment for chickenpox. They may need immunoglobulin treatment (IG) or antiviral medicine. Your doctor can give you these soon after you are exposed to the virus to help you feel better sooner. How can you prevent chickenpox? You can prevent chickenpox with the chickenpox vaccine . Children get the chickenpox vaccine as part of their routine immunizations . If you have been around a person who has the virus and you have not had chickenpox or the vaccine , you still may be able to prevent the illness. Get a shot of chickenpox antibodies (immunoglobulin) or the vaccine right away. Frequently Asked Questions Varicella - National Library of Medicine - PubMed Health Post‐exposure prophylaxis vaccine to prevent varicella (chickenpox) This review assessed how useful the varicella (also known as chickenpox) vaccine is in preventing chickenpox when given to children or adults who have never been immunised or previously had chickenpox, but who receive the vaccine within a short time following exposure to a person infectious with chickenpox.

Varicella is a highly contagious viral infection characterised by a widespread pustular rash, fever and generally feeling unwell. We identified three trials involving 110 healthy children who were siblings of household contacts. Acyclovir can reduce the number of days with fever in otherwise healthy children with chickenpox, but its effect on sores and itching is not yet certain Chickenpox (varicella) is caused by a virus. It begins with a fever, followed by a rash of red pimples which become itchy sores that form scabs. Chickenpox usually affects children from one to 14 years. In young babies, adults or people with impaired immune system, chickenpox is more severe. Treatments include lotions to relieve itchiness, paracetamol (acetaminophen) for fever and the antiviral drug acyclovir. The review of trials found that acyclovir reduces the number of days of fever from chickenpox in otherwise healthy children, usually without adverse effects. It is not clear whether it improves sores and itching. Varicella and influenza vaccines may reduce morbidity in patients with blood cancers Viral infections cause significant disease and even death in patients with blood cancers.

In the current systematic review of randomized controlled trials (RCTs) we aimed to evaluate the efficacy and safety of viral vaccines in these patients. The pre‐defined primary outcome was incidence of the infection concerned. Secondary outcomes were mortality due to the viral infection, all‐cause mortality, incidence of complications, incidence of severe viral infection, hospitalization rate, in vitro immune response and frequency of adverse effects. Eight RCTs were included. They evaluated heat‐inactivated varicella zoster virus (VZV) vaccine (two trials), influenza vaccines (five trials) and inactivated poliovirus vaccine (one trial). There were no RCTs on other viral vaccines (hepatitis A, hepatitis B, measles, mumps, rubella). Only the two trials on VZV vaccine reported our pre‐defined primary outcome. All trials reported some of the pre‐defined secondary outcomes. We found that inactivated VZV vaccine might reduce the severity of herpes zoster when given before and after stem cell transplant in adults with lymphoma or leukemia. Inactivated influenza vaccine might reduce upper and lower respiratory infections and hospitalization in adults with multiple myeloma who are undergoing chemotherapy, or children with leukemia or lymphoma within two years post‐chemotherapy.

However, the quality of evidence is not high. Local adverse effects occur frequently with the vaccines, although serious adverse effects appear uncommon. Further high‐quality RCTs are needed to clarify the benefits and optimal regimens of viral vaccines for patients with blood cancers. Post‐exposure prophylaxis vaccine to prevent varicella (chickenpox) This review assessed how useful the varicella (also known as chickenpox) vaccine is in preventing chickenpox when given to children or adults who have never been immunised or previously had chickenpox, but who receive the vaccine within a short time following exposure to a person infectious with chickenpox. Varicella is a highly contagious viral infection characterised by a widespread pustular rash, fever and generally feeling unwell. We identified three trials involving 110 healthy children who were siblings of household contacts. How can you avoid getting chickenpox? Chickenpox is highly contagious. If you are not immunized and have never had chicken pox, contact with someone who has it will almost always leave you infected.

Early vaccination and being careful around those who already have chickenpox are the most important precautions you can take.Chickenpox is caused by the varicella-zoster virus, one of the herpes viruses. The German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends being vaccinated to lower your chances of infection. If you or someone in your family gets chickenpox there are several things you can do to avoid getting it yourself.Most importantly, people who have chickenpox should avoid contact with anyone who has not had it and who also may be more likely to develop more severe symptoms. This especially includes people with a weakened immune system, newborn babies, and non-vaccinated adults. The virus can harm the unborn child during pregnancy, and can be life-threatening for newborns. But although chickenpox is very unpleasant, it only rarely has serious consequences for otherwise healthy children. Acyclovir can reduce the number of days with fever in otherwise healthy children with chickenpox, but its effect on sores and itching is not yet certain Chickenpox (varicella) is caused by a virus. It begins with a fever, followed by a rash of red pimples which become itchy sores that form scabs.

Chickenpox usually affects children from one to 14 years. In young babies, adults or people with impaired immune system, chickenpox is more severe. Treatments include lotions to relieve itchiness, paracetamol (acetaminophen) for fever and the antiviral drug acyclovir. The review of trials found that acyclovir reduces the number of days of fever from chickenpox in otherwise healthy children, usually without adverse effects. It is not clear whether it improves sores and itching.

Question: 'Varicella' is better known as what?
Answer: CHICKEN POX