
1: Cutis. 2008 Dec;82(6):399-402.

Varicella pneumonia with immune thrombocytopenic purpura: a patient with multiple
complications.

Umstattd LJ, Reichenberg JS.

University of Texas Medical Branch, Austin, TX 78701, USA.

Viral syndromes can present with various cutaneous manifestations, from the
morbilliform eruption of measles to the papular lesions of molluscum. The
systemic manifestations of viral illness can be similarly varied, with different 
presentations in each individual. We describe a patient with recently diagnosed
AIDS who presented to the emergency department with hemorrhagic papules and
shortness of breath. She was found to be severely thrombocytopenic, and a Tzanck 
smear revealed multinucleate giant cells. She received a diagnosis of immune
thrombocytopenic purpura (ITP) and primary varicella pneumonia. Acyclovir and
intravenous immunoglobulin (IVIG) were initiated. Her respiratory status improved
after 5 days of treatment and her cutaneous lesions healed, with some scarring.
We believe the rapid resolution and benign outcome of this patient's varicella
infection may have been attributed to the concomitant initiation of IVIG with
antiviral therapy.

Publication Types: 
    Case Reports

PMID: 19181029 [PubMed - indexed for MEDLINE]

2: Pediatr Infect Dis J. 2008 Dec;27(12):1113-4.

Risk of varicella complications in children treated with inhaled steroids.

Hervás D, Osona B, Masip C, Yeste S, Figuerola J, Hervás JA.

Department of Pediatrics, Son Dureta University Hospital, Mallorca, Spain.
jhervashp@yahoo.es

We have studied the complications of varicella in children treated with inhaled
steroids. From 1995 to 2005, 3/213 (1.4%) children hospitalized on the island of 
Mallorca, Spain, for varicella had received inhaled steroids. The rate of
hospitalization for varicella complications in children receiving inhaled
steroids was 17/100,000 children taking inhaled steroids, a rate similar to the
rest of the children's population (18.2/100,000). Inhaled steroids did not
increase the risk of varicella complications (relative risk 0.94; 95% confidence 
interval: 0.3-2.89).

PMID: 19068518 [PubMed - indexed for MEDLINE]

3: Virology. 2009 Jan 20;383(2):216-25. Epub 2008 Nov 20.

Distribution of varicella-zoster virus (VZV) wild-type genotypes in northern and 
southern Europe: evidence for high conservation of circulating genotypes.

Loparev VN, Rubtcova EN, Bostik V, Tzaneva V, Sauerbrei A, Robo A,
Sattler-Dornbacher E, Hanovcova I, Stepanova V, Splino M, Eremin V, Koskiniemi M,
Vankova OE, Schmid DS.

National VZV Laboratory, Centers for Disease Control and Prevention, Coordinating
Center for Infectious Diseases, National Center for Preparedness, Detection, and 
Control of Infectious Diseases, Atlanta, GA, USA.

Phylogenetic analysis of 19 complete VZV genomic sequences resolves wild-type
strains into 5 genotypes (E1, E2, J, M1, and M2). Complete sequences for M3 and
M4 strains are unavailable, but targeted analyses of representative strains
suggest they are stable, circulating VZV genotypes. Sequence analysis of VZV
isolates identified both shared and specific markers for every genotype and
validated a unified VZV genotyping strategy. Despite high genotype diversity no
evidence for intra-genotypic recombination was observed. Five of seven VZV
genotypes were reliably discriminated using only four single nucleotide
polymorphisms (SNP) present in ORF22, and the E1 and E2 genotypes were resolved
using SNP located in ORF21, ORF22 or ORF50. Sequence analysis of 342 clinical
varicella and zoster specimens from 18 European countries identified the
following distribution of VZV genotypes: E1, 221 (65%); E2, 87 (25%); M1, 20
(6%); M2, 3 (1%); M4, 11 (3%). No M3 or J strains were observed.

PMID: 19019403 [PubMed - indexed for MEDLINE]

4: Pediatr Emerg Care. 2008 Nov;24(11):777-81.

Cardiac tamponade and pleural effusion complicating varicella: a case report.

Masood SA, Kiel E, Akingbola O, Green R, Hodges L, Petterway G.

Department of Pediatrics, Louisiana State University, Shreveport, LA 71103, USA. 
masoodsa@ihs.org

Varicella is a common infectious disease, usually benign and self-limited, and
complications are believed to be rare. Most cases occur in healthy children
younger than 14 years. Serious complications are uncommon, although high-risk
groups have been identified, such as immunosuppressed patients, neonates, and
adults. Cardiac tamponade after pericardial effusion occurring as a complication 
of varicella infection has been very infrequently reported. We describe an
8-month-old infant presenting with cardiac tamponade after varicella infection
secondary to purulent bacterial pericardial effusion. He required a pericardial
window formation. He also developed pleural empyema, another uncommon
complication requiring thoracostomy drainage. This illustrative case, management,
and unique features will be presented along with a review of all cases of
varicella complicated by pericarditis in the English literature.

Publication Types: 
    Case Reports

PMID: 19018223 [PubMed - indexed for MEDLINE]

5: BioDrugs. 2008;22(6):387-402. doi: 10.2165/0063030-200822060-00005.

Sixteen years of global experience with the first refrigerator-stable varicella
vaccine (Varilrix).

Kreth HW, Lee BW, Kosuwon P, Salazar J, Gloriani-Barzaga N, Bock HL, Meurice F.

Department of Pediatrics, University of Wuerzburg, Wuerzburg, Germany.

Without vaccination, chickenpox (varicella) will affect almost every person in
the world during their lifetime. The burden of disease due to varicella is often 
unrecognized. Varilrix is a varicella vaccine derived from the Oka strain of
varicella virus. The vaccine, as a frozen formulation, was licensed for use in
1984 and was the first commercially available varicella vaccine. It subsequently 
became the first refrigerator-stable varicella vaccine; its development commenced
in 1991 and it has been licensed for use since 1994. Varilrix is indicated for
use in high-risk groups, potentially immunocompromised individuals, and healthy
subjects in many countries. This article reviews data from extensive worldwide
experience with the refrigerator-stable version of the vaccine, including
information derived from its use in over 10,000 individuals participating in
clinical trials investigating its immunogenicity, efficacy, effectiveness, and
safety, as well as postmarketing data including its use in universal mass
vaccination programs. Sixteen years of clinical and postmarketing experience with
the same formulation represents the longest and most extensive experience with a 
refrigerator-stable varicella vaccine worldwide. Varilrix, in conjunction with
the trivalent measles-mumps-rubella vaccine Priorix, has also been the basis for 
clinical development of the tetravalent measles-mumps-rubella-varicella vaccine
(Priorix-Tetra).

Publication Types: 
    Review

PMID: 18998756 [PubMed - indexed for MEDLINE]

6: BMC Public Health. 2008 Oct 27;8:372.

The epidemiology of Varicella Zoster Virus infection in Italy.

Gabutti G, Rota MC, Guido M, De Donno A, Bella A, degli Atti ML, Crovari P;
Seroepidemiology Group.

Collaborators: Bassetti D, Bechini A, Boccalini S, Bonanni P, Caciagli P, Camper 
A, Campa AM, Caraccio W, Cavallaro A, Ciamarra E, Clerico L, Casentino L, de
Simone E, Favero A, Focà A, Genna L, Giammanco A, Giancotti A, Goglio A,
Grandesso S, Icardi GC, Lolli C, Marchetti D, Marsella M, Martelli P, Mucignat L,
Palladino D, Passerini C, Perani V, Piscione E, Rizza F, Rollo MC, Simula L,
Sforza R, Tagliatatela D, Tronci M, Villalta D.

Department of Clinical and Experimental Medicine, Section of Hygiene and
Occupational Health, University of Ferrara, Ferrara, Italy.
giovanni.gabutti@unife.it

BACKGROUND: The epidemiological importance of varicella and zoster and the
availability of an efficacious and safe vaccine have led to an important
international debate regarding the suitability of mass vaccination. The objective
of the study was to describe the epidemiology of varicella and zoster in Italy
and to determine whether there have been changes with respect to observations
provided by an analogous study conducted 8 years ago, in order to define the most
appropriate vaccination strategy. METHODS: A number of data sources were
evaluated, a cross-sectional population-based seroprevalence study was conducted 
on samples collected in 2004, and the results were compared with data obtained in
1996. RESULTS: The data from active and passive surveillance systems confirm that
varicella is a widespread infectious disease which mainly affects children. VZV
seroprevalence did not substantially differ from that found in the previous
study. The sero-epidemiological profile in Italy is different from that in other 
European countries. In particular, the percentage of susceptible adolescents is
at least nearly twice as high as in other European countries and in the age group
20-39 yrs, approximately 9% of individuals are susceptible to VZV. CONCLUSION:
The results of this study can contribute to evaluating the options for varicella 
vaccination. It is possible that in a few years, in all Italian Regions, there
will exist the conditions necessary for implementing a mass vaccination campaign 
and that the large-scale availability of MMRV tetravalent vaccines will
facilitate mass vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18954432 [PubMed - indexed for MEDLINE]

7: Infez Med. 2008 Sep;16(3):144-7.

Anti-varicella-zoster vaccination in contacts of children receiving
antineoplastic chemotherapy: a prospective pilot study.

Timitilli A, Bertoluzzo L, Micalizzi C, Faraci M, Hanau G, Ricci R, Giacchino R, 
Castagnola E.

Unit of Infectious Diseases, G. Gaslini Childrens Hospital, Genoa, Italy.

Varicella may be a severe infection in children with malignancy. Varicella
vaccination is either not recommended for immunocompromised children or it
requires temporary discontinuation of immunosuppression. We prospectively
evaluated the feasibility of a varicella vaccination programme of household
contacts of varicella-negative children receiving antineoplastic chemotherapy.
From April 2004 to April 2005, 207 children were evaluated; in 49 (24 percent)
the attending physicians collected no history about previous varicella and
performed no serological evaluation before any transfusion. Among the 158
patients with complete history and/or a screening test, 51 (32 percent) were
negative, with a total of 110 household contacts eligible for the study. Of
these, 13 (12 percent) subjects resulted negative for varicella. In three of them
vaccination was not performed due to parental refusal. This study demonstrates
the difficulties in implementing a varicella vaccination programme targeting
negative household contacts of immunocompromised children. The attitude of
paediatric oncologists and parental refusal currently represent the main
challenges against the complete success of this strategy in countries where VZV
vaccination is not inserted in the general vaccination programme.

PMID: 18843211 [PubMed - indexed for MEDLINE]

8: Am J Epidemiol. 2008 Nov 1;168(9):1082-90. Epub 2008 Sep 18.

Using time-use data to parameterize models for the spread of close-contact
infectious diseases.

Zagheni E, Billari FC, Manfredi P, Melegaro A, Mossong J, Edmunds WJ.

Department of Demography, University of California, Berkeley, 2232 Piedmont
Avenue, Berkeley, CA 94720-2120, USA. emilioz@demog.berkeley.edu

Social contact patterns are a critical explanatory factor of the spread of
close-contact infectious agents. Both indirect (via observed epidemiologic data) 
and direct (via diaries that record at-risk events) approaches to the measurement
of contacts by age have been proposed in the literature. In this paper, the
authors discuss the possibilities offered by time-use surveys to measure contact 
patterns and to explain observed seroprevalence profiles. The authors first
develop a methodology to estimate time-of-exposure matrices, and then they apply 
it to time-use data for the United States (1987-2003). Finally, the authors
estimate age-specific transmission parameters for varicella, commonly known as
"chickenpox," from age-specific time-of-exposure and seroprevalence data (United 
States, 1988-1994). The estimated time-of-exposure matrix reveals a strong
element of assortativeness by age. In addition, there are peaks of exposure
between people who were born one generation apart (i.e., parents and their
children). Models based on the estimated age-specific transmission parameters fit
the observed patterns of infection of endemically circulating varicella in a
satisfactory way. The availability of time-use data for a large number of
countries and their potential to supplement contact surveys make the methods
developed extremely valuable and suitable for implementation in several different
contexts.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18801889 [PubMed - indexed for MEDLINE]

9: Brain Dev. 2009 Jan;31(1):86-9. Epub 2008 Sep 14.

Bilateral middle cerebral artery infarctions following mild varicella infection: 
a case report.

Okanishi T, Kondo A, Inoue T, Maegaki Y, Ohno K, Togari H.

Division of Child Neurology, Institute of Neurological Sciences, Faculty of
Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
oknsoknsokns@yahoo.co.jp

We report a two-year and one-month-old immunocompetent boy who developed aphasia 
and right hemiparesis eight months after mild varicella with only a few vesicles.
Magnetic resonance images and angiography demonstrated mixed acute and old
infarctions of the bilateral middle cerebral arteries. VZV-DNA was detected on
polymerase chain reaction analysis of cerebral spinal fluid (CSF). He was treated
with intravenous acyclovir and edaravone, and his speech and motor functions had 
almost recovered after two months. Cerebral lesions of the bilateral middle
cerebral artery territories and virus DNA detection from CSF are rare in
VZV-related vasculopathy and suggest incomplete immunoresponse to varicella in
this patient.

Publication Types: 
    Case Reports

PMID: 18793825 [PubMed - indexed for MEDLINE]

10: Pediatr Dermatol. 2008 Jul-Aug;25(4):484-6.

Disseminated varicella infection in a child receiving short-term steroids for
asthma.

Wu CT, Tsai SC, Lin JJ, Hsia SH.

Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University
College of Medicine, Tauyuan, Taiwan. wct0722@yahoo.com.tw

An 8-year-old boy, treated with a short course of steroids for asthma, developed 
a fever with abdominal pain and a generalized vesicular rash after contact with
varicella-infected classmates. The clinical presentation was disseminated
varicella infection with multiple organ involvement. We confirmed varicella
zoster virus using a direct fluorescent antibody test. This report demonstrates
the increased risk of complicated varicella associated with the use of
corticosteroids, even for a short period of time.

Publication Types: 
    Case Reports

PMID: 18789098 [PubMed - indexed for MEDLINE]

11: Aust N Z J Public Health. 2008 Aug;32(4):367-71.

Healthcare workers and immunity to infectious diseases.

Vagholkar S, Ng J, Chan RC, Bunker JM, Zwar NA.

General Practice Unit, Sydney South West Area Health Service, School of Public
Health & Community Medicine, University of New South Wales.
sanjyot.vagholkar@sswahs.nsw.gov.au

OBJECTIVE: In 2002, New South Wales (NSW) Health introduced an updated policy for
occupational screening and vaccination against infectious diseases. This study
describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps,
rubella (MMR) and varicella based on serological screening, following
introduction of this policy. METHODS: HCW screening serology performed at two
healthcare facilities in south western Sydney (Bankstown and Fairfield) was
extracted for the period September 2003 to September 2005. Immunity to hepatitis 
B, MMR and varicella was quantitated and cross-tabulated against age, sex and
staff risk category. RESULTS: A total of 1,320 HCWs were screened. Almost two
thirds were immune to hepatitis B while immunity to MMR and varicella ranged from
88% to 94%. Age stratification showed lower levels of measles immunity in those
born after 1965. CONCLUSIONS: Despite availability of vaccination for over two
decades, a significant proportion of HCWs at these two facilities were non-immune
to hepatitis B. This is of concern for those non-immune staff involved in direct 
clinical care, who are at risk of blood and body fluid exposures. The small group
of HCWs non-immune to MMR and varicella pose a risk to themselves and others in
the event of an outbreak. IMPLICATIONS: There is a need for improved
implementation of the occupational screening and vaccination policy, including
better education of HCWs about the risks of non-immunity to vaccine preventable
diseases. The revised 2007 NSW Health policy may assist this process and will
need evaluation to determine whether HCW immunity improves in the coming years.

PMID: 18782402 [PubMed - indexed for MEDLINE]

12: Pediatr Infect Dis J. 2008 Oct;27(10):946-8.

Acyclovir-resistant chronic verrucous vaccine strain varicella in a patient with 
neuroblastoma.

Bryan CJ, Prichard MN, Daily S, Jefferson G, Hartline C, Cassady KA, Hilliard L, 
Shimamura M.

Division of Pediatric Hematology/Oncology, University of Alabama at Birmingham,
Birmingham, AL, USA. Coleman.Bryan@med.navy.mil

A 21-month-old girl with neuroblastoma developed chronic verrucous Oka strain
varicella-zoster infection during chemotherapy. Virus isolated from the patient
demonstrated high-level acyclovir resistance, and its thymidine kinase had no in 
vitro enzymatic activity. After foscarnet therapy, she underwent stem cell
transplantation without varicella reactivation. This is only the second reported 
case of resistant varicella zoster virus caused by Oka strain virus.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural

PMID: 18776818 [PubMed - indexed for MEDLINE]

13: Pediatrics. 2008 Sep;122(3):e744-51.

Varicella prevention in the United States: a review of successes and challenges.

Marin M, Meissner HC, Seward JF.

Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS A-47,
Atlanta, GA 30333, USA. mmarin@cdc.gov

OBJECTIVE: In 1995, the United States was the first country to introduce a
universal 1-dose childhood varicella vaccination program. In 2006, the US
varicella vaccine policy was changed to a routine 2-dose childhood program, with 
catchup vaccination for older children. The objective of this review was to
summarize the US experience with the 1-dose varicella vaccination program,
present the evidence considered for the policy change, and outline future
challenges of the program. METHODS: We conducted a review of publications
identified by searching PubMed for the terms "varicella," "varicella vaccine,"
and "herpes zoster." The search was limited to US publications except for herpes 
zoster; we reviewed all published literature on herpes zoster incidence. RESULTS:
A single dose of varicella vaccine was 80% to 85% effective in preventing disease
of any severity and >95% effective in preventing severe varicella and had an
excellent safety profile. The vaccination program reduced disease incidence by
57% to 90%, hospitalizations by 75% to 88%, deaths by >74%, and direct inpatient 
and outpatient medical expenditures by 74%. The decline of cases plateaued
between 2003 and 2006, and outbreaks continued to occur, even among highly
vaccinated school populations. Compared with children who received 1 dose, in 1
clinical trial, 2-dose vaccine recipients developed in a larger proportion
antibody titers that were more likely to protect against breakthrough disease and
had a 3.3-fold lower risk for breakthrough disease and higher vaccine efficacy.
Two studies showed no increase in overall herpes zoster incidence, whereas 2
others showed an increase. CONCLUSIONS: A decade of varicella prevention in the
United States has resulted in a dramatic decline in disease; however, even with
high vaccination coverage, the effectiveness of 1 dose of vaccine did not
generate sufficient population immunity to prevent community transmission. A
2-dose varicella vaccine schedule, therefore, was recommended for children in
2006. Data are inconclusive regarding an effect of the varicella vaccination
program on herpes zoster epidemiology.

Publication Types: 
    Review

PMID: 18762511 [PubMed - indexed for MEDLINE]

14: Vaccine. 2008 Nov 5;26(47):6006-12. Epub 2008 Aug 30.

Impact of varicella vaccination on health care outcomes in Ontario, Canada:
effect of a publicly funded program?

Kwong JC, Tanuseputro P, Zagorski B, Moineddin R, Chan KJ.

Institute for Clinical Evaluative Sciences, Toronto, Canada.
jeff.kwong@utoronto.ca

Varicella vaccines have been available for private purchase in Canada since 1998.
Ontario introduced publicly funded varicella vaccination in 2004. We assessed the
effects of private availability of varicella vaccines and subsequent
implementation of a publicly funded vaccination program on varicella-related
hospitalizations, emergency department (ED) use, and visits to physicians'
offices in Ontario. Rates of hospitalizations, ED use, and office visits
decreased 53% (95% CI, 48-58%), 43% (95% CI, 41-44%), and 45% (95% CI, 44-45%)
after publicly funded vaccination, compared to only 9% (95% CI, 4-14%), 23% (95% 
CI, 22-24%), and 29% (95% CI, 28-29%) after private availability. Varicella
vaccination is effective at reducing varicella-related health care use, with
benefits extending beyond those who receive the vaccine. Publicly funded
vaccination programs may be more effective than private vaccine availability.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18761386 [PubMed - indexed for MEDLINE]

15: Wien Klin Wochenschr. 2008;120(13-14):422-6.

High seroprevalence of varicella, measles, mumps, rubella and pertussis
antibodies in first-grade medical students.

Socan M, Berginc N.

Communicable Diseases Center, Institute of Public Health, Ljubljana, Slovenia.
maja.socan@ivz-rs.si

OBJECTIVE: The aim of the study was to investigate seropositivity for five
vaccine-preventable communicable diseases - varicella, measles, mumps, rubella
and pertussis - in a sample of first-grade medical students. METHODS: A total of 
256 students were tested for varicella IgG antibodies. In addition, 138 of the
students were serologically screened for measles, mumps, rubella and pertussis
antibodies. Data on vaccination and history of measles, mumps, rubella and
pertussis were collected. RESULTS: Immunity to varicella, measles, mumps and
rubella was established in 97.6%, 96.4%, 97.8% and 99.3% participants,
respectively. Anti-pertussis toxin antibodies were detected in 81.2% of the
students. CONCLUSIONS: The rates of varicella, measles, mumps and rubella
immunity in first-grade medical students are very high. To identify those
students who need vaccination before commencing practical work in healthcare
facilities, a meticulous disease and vaccination history should be taken and
medical records should be reviewed. Medical students providing no written
evidence of adequate vaccination status should be serologically tested and
vaccinated if necessary.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18726668 [PubMed - indexed for MEDLINE]

16: Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. 2008;14(2):125-6.

[Severe thrombocytopenia in a child with type 1 diabetes]

Khadwal A, Deepthi N.

Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of
Medical Education and Research, Chandigarh, India. devbijaya@yahoo.co.in

We describe here a young girl who developed severe thrombocytopenia following
Varicella infection. She was previously diagnosed with diabetes. In addition she 
demonstrated anti-nuclear factor positivity. Immune thrombocytopenic purpura
induced by varicella is rare in children with diabetes.

PMID: 18721501 [PubMed - indexed for MEDLINE]

17: Scand J Infect Dis. 2008;40(11-12):943-5.

Epidemiological investigation of a varicella outbreak in an Italian prison.

Valdarchi C, Farchi F, Dorrucci M, De Michetti F, Paparella C, Babudieri S, Spano
A, Starnini G, Rezza G.

Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di
Sanita, Rome, Italy.

Five cases of varicella occurred in a women's prison in Rome. A serosurvey
conducted in the prison found that 14.5% of the inmates were susceptible. The
sensitivity and positive predictive value of a history of varicella were high,
whereas specificity was rather low. The attack rate among susceptible inmates was
approximately 22%. Preventive measures probably contributed to reduce infection
spread.

PMID: 18720259 [PubMed - indexed for MEDLINE]

18: Ocul Immunol Inflamm. 2008 Jul-Aug;16(4):199-201.

Ocular manifestation of primary VZV infection in a splenectomized patient.

Wolf AH, Thurau SR, Kook D, Haritoglou C.

Department of Ophthalmolgy, Ludwig-Maximilians-University, München, Germany.
armin.wolf@med.uni-muenchen.de

PURPOSE: To report a rare case of primary varicella zoster virus (VZV)-associated
retinal vasculitis in a splenectomized patient. DESIGN: Case report. RESULTS:
After manifestation of VZV-associated retinal vasculitis, a splenectomized
patient experienced binocular loss of vision. CONCLUSIONS: For the development of
VZV-associated uveitis, the presence of specific T cells are necessary. Here, the
authors present a rare case of VZV-associated retinal vasculitis in a
splenectomized patient.

Publication Types: 
    Case Reports

PMID: 18716958 [PubMed - indexed for MEDLINE]

19: Vaccine. 2008 Oct 16;26(44):5627-32. Epub 2008 Aug 14.

DNA sequence analysis of varicella-zoster virus gene 62 from subclinical
infections in healthy children immunized with the Oka varicella vaccine.

Gomi Y, Ozaki T, Nishimura N, Narita A, Suzuki M, Ahn J, Watanabe N, Koyama N,
Ushida H, Yasuda N, Nakane K, Funahashi K, Fuke I, Takamizawa A, Ishikawa T,
Yamanishi K, Takahashi M.

Kanonji Institute, Research Foundation for Microbial Diseases of Osaka
University, 2-9-41, Yahata-cho, Kanonji, Kagawa, Japan. ygomi@mail.biken.or.jp

A live attenuated varicella vaccine, the Oka vaccine strain (vOka), is routinely 
administered to children in Japan and other countries, including the United
States. vOka consists of a mixture of genotypically distinct variants, but little
is known about the growth potential of each variants in vivo. We isolated
varicella-zoster virus (VZV) DNA sequences from the peripheral blood mononuclear 
cells (PBMCs) of asymptomatic healthy children immunized with the Oka varicella
vaccine. VZV gene 62 DNA fragments were detected in 5 of 166 (3.0%) PBMC samples 
by nested PCR within 5 weeks of the vaccination. Sequence analysis of VZV DNA
from these five PBMC samples indicated that multiple viral clones in the vaccine 
could infect vaccinees and replicate in vivo. We also provide evidence that a
nonsynonymous substitution at position 105356 may affect viral replication in
vivo.

PMID: 18706951 [PubMed - indexed for MEDLINE]

20: Dermatol Online J. 2008 Feb 28;14(2):24.

Persistent varicella as the initial manifestation of systemic lymphoma.

Ferreira M, Sanches M, Teixeira M, Guerra M, Selores M.

Service of Dermatology, Hospital Geral de Santo António, Porto, Portugal.
marcia_ferreira@hotmail.com

Varicella is a common benign childhood disease that often presents in adolescents
and adults in a more severe form. We report a previously healthy 50-year-old man 
who developed multiple necrotic cutaneous ulcers associated with fever, asthenia 
and anorexia. Physical examination revealed few tense hemorrhagic vesicles on the
trunk and necrotic cutaneous ulcers scattered over the entire cutaneous surface. 
After the diagnosis of varicella with varicella pneumonia was established,
treatment with acyclovir was instituted. His poor response to treatment was
indicative of immune compromise; an underlying peripheral T-cell lymphoma was
discovered.

Publication Types: 
    Case Reports

PMID: 18700127 [PubMed - indexed for MEDLINE]

21: Vaccine. 2008 Nov 25;26(50):6487-90. Epub 2008 Aug 9.

Clinicopathologic understanding and control of varicella-zoster virus infection.

Asano Y.

Department of Pediatrics, Fujita Health University, School of Medicine, Toyoake, 
Aichi 470-1192, Japan. yasano@fujita-hu.ac.jp

As reflections by the recipient for the Japanese society for vaccinology
Takahashi award, clinicopathologic understanding and control of varicella-zoster 
virus (VZV) infection was briefly reviewed. In 1974, a live varicella vaccine was
developed by attenuating the Oka strain of VZV after the passages in non-human
cells at a low temperature. The vaccine was immunogenic, well tolerated, and
effective, and distributed worldwide so far. For post-exposure prophylaxis of
varicella, the vaccine and acyclovir is effectively used in the incubation period
of varicella. The delayed type hypersensitivity to VZV skin test antigen was
applied for evaluation of cell-mediated immunity to VZV which is commercially
available in Japan. The biphasic viremia during incubation period of varicella
and airborne spread of VZV from varicella patients and from herpes zoster
patients with localized lesions were shown by the virus isolation or by detection
of the virus DNA.

Publication Types: 
    Review

PMID: 18694794 [PubMed - indexed for MEDLINE]

22: Infect Control Hosp Epidemiol. 2008 Sep;29(9):866-70.

An outbreak of varicella with likely breakthrough disease in a population of
pediatric cancer patients.

Adler AL, Casper C, Boeckh M, Heath J, Zerr DM.

Department of Pediatrics, University of Washington, Children's Hospital and
Regional Medical Center, Seattle, Washington 98105, USA.

BACKGROUND: Varicella is highly contagious, and immunocompromised patients are at
increased risk of severe illness, including disseminated disease, pneumonia, and 
encephalitis. We describe an outbreak of varicella with likely breakthrough
disease in a population of pediatric cancer patients in October 2004. SETTING: A 
250-bed tertiary care pediatric facility with a 33-bed oncology unit, outpatient 
clinics, and affiliated group housing and schoolroom spaces. METHODS: We defined 
varicella as an acute illness with a maculopapulovesicular rash, without other
apparent cause. We defined breakthrough disease as varicella with onset more than
42 days after vaccination. Cancer patients were considered to be nonimmune if
serologic test results were negative for varicella-zoster virus. Family members
were considered to be nonimmune if they had no history of infection with
wild-type varicella-zoster virus or of varicella vaccination. RESULTS: In a
period of approximately 16 days, varicella was detected in 7 children (the index 
case, 5 secondary cases, and 1 tertiary case). Of the 7 identified cases, 4
appeared to be cases of breakthrough disease in previously vaccinated children.
The outbreak resulted in the exposure of 82 families at a pediatric group housing
facility; 28 children at the schoolroom; and 77 patients, 150 family members, and
9 staff members at 3 outpatient clinics. CONCLUSIONS: This outbreak highlights
the important role that breakthrough varicella can play in healthcare centers
with affiliated group housing. Formal recommendations on the management of
exposed individuals who have been vaccinated should be made in such settings,
especially if immunocompromised hosts are present.

PMID: 18681813 [PubMed - indexed for MEDLINE]

23: Am J Infect Control. 2008 Aug;36(6):436-8.

Varicella zoster virus in health care workers in northern Israel: seroprevalence 
and predictive value of history of varicella infection.

Chazan B, Colodner R, Teitler N, Chen Y, Raz R.

Infectious Diseases Unit, Ha'Emek Medical Center, Afula, Israel.
chazan_b@clalit.org.il

Health care workers (HCWs) are susceptible to hospital acquired varicella zoster 
virus (VZV). We evaluated seroprevalence and predictive value of a history of
varicella disease (VD) with VZV serology in HCWs in northern Israel. A total of
200 HCWs were enrolled. A high rate of seropositivity for VZV-IgG was found:
98.5% seropositive and only 1.5% seronegative. A positive history of VD was an
excellent predictor for the presence of VZV-IgG; however, a negative history of
VD does not rule out the presence of VZV-IgG.

PMID: 18675150 [PubMed - indexed for MEDLINE]

24: Vaccine. 2008 Nov 18;26(49):6281-91. Epub 2008 Jul 30.

Cost-effectiveness analysis of universal childhood vaccination against varicella 
in Brazil.

Valentim J, Sartori AM, de Soárez PC, Amaku M, Azevedo RS, Novaes HM.

Department of Preventive Medicine, University of São Paulo School of Medicine,
Av. Dr. Arnaldo, 455 - 2 degrees andar Cerqueira César, São Paulo 01246-903,
Brazil. joicevalentim@yahoo.com.br

This study conducts a cost-effectiveness analysis of a childhood universal
varicella vaccination program in Brazil. An age and time-dependent dynamic model 
was developed to estimate the incidence of varicella for 30 years. Assuming a
single-dose schedule; vaccine efficacy of 85% and coverage of 80%, the program
could prevent 74,422,058 cases and 2905 deaths. It would cost R$ 3,178,396,110
and save R$ 660,076,410 to the society and R$ 365,602,305 to the healthcare
system. The program is cost-effective (R$ 14,749 and R$ 16,582 per life-year
saved under the societal and the healthcare system's perspective, respectively). 
The program's cost-effectiveness is highly sensitive to the vaccine price and
number of doses.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18674582 [PubMed - indexed for MEDLINE]

25: Expert Rev Vaccines. 2008 Aug;7(6):753-82.

Cost-effectiveness of varicella vaccination programs: an update of the
literature.

Rozenbaum MH, van Hoek AJ, Vegter S, Postma MJ.

Groningen Research Institute of Pharmacy (GRIP), University of Groningen,
Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. m.h.rozenbaum@rug.nl

Varicella is one of the most common infectious diseases in childhood, caused by
the varicella zoster virus. Although vaccines are available, there are only a few
countries with an early-childhood vaccination program. Most countries mainly
focus on vaccination of high-risk groups, such as susceptible healthcare workers.
One of the main concerns with a routine early-childhood vaccination program is a 
potential (temporal) increase of the incidence of herpes zoster among elderly
adults. In this review, we focus on the cost-effectiveness of varicella
vaccination and on the methodology used in the health-economic studies. In
particular, we focus on the perspective adopted, type of model used, the modeled 
effect on herpes zoster, the vaccine efficacy and price, and on the value of time
lost by infection. The vast majority of studies show vaccination of high-risk
groups - including susceptible adolescents - to be cost saving. Routine
early-childhood vaccination programs are always cost saving if indirect costs of 
production losses are included, or cost effective, as long as the potential
negative effects on zoster are not taken into account. We note that most studies 
included in the review used old vaccine prices and a single dose of the varicella
vaccine, whereas multiple doses are now becoming the standard. Despite that,
those aspects limit the timeliness of our review and we believe that the current 
work does provide useful insights in the cost-effectiveness of varicella
vaccination.

Publication Types: 
    Review

PMID: 18665775 [PubMed - indexed for MEDLINE]

26: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001833.

Comment in:
    Indian Pediatr. 2008 Sep;45(9):765-6.

Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children
and adults.

Macartney K, McIntyre P.

National Centre for Immunisation Research (NCIRS), Children's Hospital at
Westmead, Locked Bag 4001, Westmead, Sydney, NSW, Australia, 2145.
kristinm@chw.edu.au

BACKGROUND: Live attenuated varicella vaccines for the prevention of varicella
(chickenpox) has been demonstrated both in randomised controlled trials (RCTs)
and in population-based immunisation programmes in countries such as the United
States. However, many countries do not routinely immunise children against
varicella, and exposures continue to occur. Although the disease is often mild,
complications such as secondary bacterial infection, pneumonitis and encephalitis
occur in about 1% of cases, usually leading to hospitalisation. The use of
varicella vaccine in persons who have recently been exposed to the varicella
zoster virus has been studied as a form of post-exposure prophylaxis (PEP).
OBJECTIVES: To assess the efficacy and safety of vaccines for use as PEP for the 
prevention of varicella in children and adults. SEARCH STRATEGY: We searched the 
Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library,
2008, Issue 1); MEDLINE (1966 to February 2008); and EMBASE (January 1990 to
February 2008). SELECTION CRITERIA: RCTs and quasi-RCTs of varicella vaccine for 
PEP compared with placebo or no intervention. The outcome measures were efficacy 
in prevention of clinical cases and/or laboratory-confirmed clinical cases and
adverse effects following vaccination. DATA COLLECTION AND ANALYSIS: Two review
authors independently extracted and analysed data using Review Manager software. 
MAIN RESULTS: Three studies involving 110 healthy children who were siblings of
household contacts were identified as suitable for inclusion. The studies varied 
in quality, study design, vaccine used, and outcomes measured and, as such, were 
not suitable for meta-analysis. Overall, 13 out of 56 vaccine recipients (18%)
developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients
(78%). Of the vaccine recipients who developed varicella, the majority only had
mild disease (with less than 50 skin lesions). In the three studies, most
subjects received PEP within three days following exposure; too few subjects were
vaccinated four to five days post exposure to ascertain the efficacy of vaccine
given more than three days after exposure. No included studies reported on
adverse events following immunisation. AUTHORS' CONCLUSIONS: These small trials
suggest varicella vaccine administered within three days to children following
household contact with a varicella case reduces infection rates and severity of
cases. No RCTs for adolescents or adults were identified. However safety was not 
adequately addressed.

Publication Types: 
    Review

PMID: 18646079 [PubMed - indexed for MEDLINE]

27: Pediatr Infect Dis J. 2008 Aug;27(8):724-30.

Immunogenicity and safety assessments after one and two doses of a
refrigerator-stable tetravalent measles-mumps-rubella-varicella vaccine in
healthy children during the second year of life.

Schuster V, Otto W, Maurer L, Tcherepnine P, Pfletschinger U, Kindler K,
Soemantri P, Walther U, Macholdt U, Douha M, Pierson P, Willems P.

Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
volker.schuster@medizin.uni-leipzig.de

BACKGROUND: Measles, mumps, and rubella (MMR) and varicella (V) vaccines are
often coadministered at 1 clinic visit. This study (104389/NCT00127023) was
undertaken to assess the immunogenicity and safety of a new refrigerator-stable
tetravalent MMRV vaccine after 1 dose and after 2 doses administered during the
second year of life. METHODS: Nine hundred seventy healthy children aged 10-21
months received 2 doses of MMRV vaccine (Priorix-Tetra; GlaxoSmithKline
Biologicals, Rixensart, Belgium) 42 days apart (MMRV group; N = 732) or 1 dose of
MMR vaccine (Priorix) coadministered with varicella vaccine (Varilrix) followed
by a second dose of only MMR vaccine 42 days later (MMR + V group; N = 238).
RESULTS: Observed seroconversion rates for measles, mumps, rubella, and varicella
antibodies 42 days postdose 1 were 94.5%, 96.1%, 99.7%, 95.5% in the MMRV group
and 93.4%, 93.6%, 98.1%, 95.6% in the MMR + V group. Respective seroconversion
rates postdose 2 were 98.3%, 99.4%, 99.7%, 99.7% in the MMRV group and 97.6%,
99.5%, 100%, 97.5% in the MMR + V group. Observed antimeasles and antimumps
geometric mean titers (GMTs) were higher after each dose in the MMRV group than
in the MMR + V group. Antivaricella GMT increased 21-fold in the MMRV group
postdose 2, and was markedly higher than in the MMR + V group who did not receive
a second dose of varicella (1903.3 and 80.3 dilution, respectively). Both vaccine
regimens were generally well-tolerated in terms of local reactions, fever >39.5
degrees C, and vaccine-related rashes. CONCLUSIONS: Both after 1 dose and after 2
doses, the MMRV vaccine was at least as immunogenic as concomitant MMR and
varicella vaccination suggesting that it could be suitable for use according to
current vaccination schedules.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18600190 [PubMed - indexed for MEDLINE]

28: Pediatr Infect Dis J. 2008 Aug;27(8):757-9.

Large injection site reactions after a second dose of varicella vaccine.

Walter EB, Snyder MA, Clements DA, Katz SL.

Department of Pediatrics, Duke University Medical Center, Durham, NC 27704, USA. 
walte002@mc.duke.edu

A second dose of varicella vaccine is routinely recommended. We report 2 cases of
large local reactions after receipt of a second dose of varicella vaccine
administered in the thigh. The reactions resolved with symptomatic therapy.
Clinicians should continue to administer the second dose of varicella vaccine,
but should use the preferred site in the arm.

Publication Types: 
    Case Reports

PMID: 18574438 [PubMed - indexed for MEDLINE]

29: J Infect. 2008 Aug;57(2):95-102. Epub 2008 Jun 13.

Chickenpox in adults - clinical management.

Tunbridge AJ, Breuer J, Jeffery KJ; British Infection Society.

Department of Infection and Tropical Medicine, Royal Hallamshire Hospital,
Glossop Road, Sheffield S10 2JF, UK. anne.tunbridge@sth.nhs.uk

Acute varicella zoster virus (VZV) infection, or chickenpox, is still perceived
by many as a mild infection of childhood. However, chickenpox is increasingly
common in adults and adolescents who together with immunosuppressed individuals
are at a higher risk of severe infection. Antiviral therapy is available which
both ameliorates symptoms and decreases the severity of chickenpox if
administered early in the course of the infection. Passive immunisation with
varicella zoster immunoglobulin (VZIG) may prevent or attenuate infection
following exposure to varicella of an immunocompromised or pregnant individual or
a neonate. Active immunisation is available and is universal in many developed
countries. This review reflects current best practice in management of chickenpox
in adults by specialist physicians in the UK. The accompanying flowchart has been
formulated to guide emergency physicians and general practitioners through the
decision-making process regarding treatment and admission for specialist care.

Publication Types: 
    Review

PMID: 18555533 [PubMed - indexed for MEDLINE]

30: J Clin Microbiol. 2008 Aug;46(8):2665-70. Epub 2008 Jun 11.

Discriminating between varicella-zoster virus vaccine and wild-type strains by
loop-mediated isothermal amplification.

Higashimoto Y, Ihira M, Ohta A, Inoue S, Usui C, Asano Y, Yoshikawa T.

Department of Clinical Immunology, Fujita Health University School of Health
Sciences, Toyoake, Aichi, Japan.

The loop-mediated isothermal amplification (LAMP) method was developed to
distinguish between the varicella-zoster virus (VZV) vaccine (vOka) strain and
wild-type strains. Two single nucleotide polymorphisms (SNPs) (nucleotide [nt]
105705 for VR-1 VZV LAMP and nt 106262 for VR-2 VZV LAMP) located in the open
reading frame 62 gene were selected as LAMP targets. Amplified vOka DNA
demonstrated a typical ladder pattern; however, no LAMP product was detected in
reactions performed with DNAs from other human herpesviruses by either VR-1 VZV
LAMP or VR-2 VZV LAMP. This result was confirmed by a turbidity assay. The
sensitivities of both VR-1 and VR-2 VZV LAMP determined by either the turbidity
assay or agarose gel electrophoresis were 100 copies per reaction. To
discriminate the vOka strain from wild-type strains, VR-1 and VR-2 VZV LAMP
products were digested with the appropriate restriction enzymes (SacII for VR-1
LAMP and SmaI for VR-2 LAMP). The digested products were clearly different in the
vOka strain and wild-type strains. To evaluate the utility of the LAMP methods
for rapid differentiation, viral DNA (without DNA extraction) in swab samples was
directly tested. Wild-type VZV DNA was detected in 20 swab samples by either VR-1
VZV LAMP or VR-2 VZV LAMP. Sequence analysis confirmed the expected SNPs in the
LAMP products amplified from the vOka strain and the five wild-type strains.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 18550736 [PubMed - indexed for MEDLINE]

31: J Coll Physicians Surg Pak. 2008 May;18(5):319-20.

Auto immune hemolytic anemia in a child precipitated by chicken pox.

Billoo SS, Jamalvi SW.

Department of Paediatrics, Jinnah Medical and Dental College, Karachi, Pakistan.

Auto Immune Hemolytic Anemia (AIHA) is a rare entity in children. We report a
case of an adolescent girl with AIHA, which was precipitated by chicken pox.
Clinical course over 3 years, till remission is described.

Publication Types: 
    Case Reports

PMID: 18541094 [PubMed - indexed for MEDLINE]

32: Drugs Today (Barc). 2008 Apr;44(4):279-92.

A combination vaccine against measles, mumps, rubella and varicella.

Knuf M, Faber J, Barth I, Habermehl P.

Pediatric University Hospital, Johannes Gutenberg University, Mainz, Germany.
knuf@kinder.klinik.uni-mainz.de

A new combination vaccine against measles, mumps, rubella and varicella (MMRV)
from GlaxoSmithKline Biologicals has recently been approved in Europe. It
combines the components from two well-established, live, attenuated vaccines
against measles, mumps and rubella. This review presents a summary of the
development of this MMRV vaccine from published clinical studies. Seroconversion 
rates and antibody titers after the first and second dose are similar to those
observed after concomitant administration of the MMR and varicella vaccines.
Furthermore, the clinical profile of this combination vaccine, in terms of
injection- site and general tolerability, is similar to that of the component
vaccines. A higher incidence of low-grade fever has been noted following the
first dose of MMRV vaccine, although it is no different from component vaccines
following the second dose. MMRV vaccines were recommended in Germany in 2006 for 
administration in two doses to children aged 11-14 months and 15-23 months. They 
offer a convenient way to implement varicella vaccination and to achieve high
vaccine coverage rates mirroring those of MMR vaccines. For other countries
considering introducing these vaccines, the advantages for children, parents and 
healthcare providers of protecting against four diseases in a single vaccine
should be noted. 2008 Prous Science, S.A.U. or its licensors

Publication Types: 
    Review

PMID: 18536786 [PubMed - indexed for MEDLINE]

33: Pediatrics. 2008 Jun;121(6):e1548-54.

Vaccine-era varicella epidemiology and vaccine effectiveness in a public
elementary school population, 2002-2007.

Lee LE, Ho H, Lorber E, Fratto J, Perkins S, Cieslak PR.

Oregon State Health, 800 NE Oregon St, Portland, OR 97211, USA.
lore.e.lee@state.or.us

OBJECTIVE: We conducted ongoing varicella surveillance of public elementary
school students to track changes in incidence from 2002 to 2007. In school year
2002-2003, we also conducted a retrospective cohort study to measure varicella
vaccine effectiveness, assess relationships between risk factors for varicella in
vaccine recipients (breakthrough varicella) identified in earlier studies, and
assess the ability of school nurse surveillance to detect varicella cases.
PATIENTS AND METHODS: Varicella was defined as acute illness with
maculo-papulo-vesicular rash without another apparent cause persisting >24 hours,
regardless of previous episodes of the same or a similar illness. Using case data
reported by school nurses, we described breakthrough varicella rates (percentage 
of vaccinated students with varicella), annual varicella-incidence rates
(varicella cases per 100 public elementary school students), vaccine
effectiveness, risk factors for breakthrough varicella, clinical characteristics 
of vaccinated and susceptible varicella patients, and sensitivity and positive
predictive value of school nurse surveillance. RESULTS: During school years
2002-2007, 502 elementary school students met the varicella case definition.
Breakthrough varicella rates among exposed students ranged from 6% to 8% per
school year; annual incidence rates ranged from 0.2% to 0.3% of public elementary
school students; and varicella was more severe and lasted longer in susceptible
than in vaccinated students. The positive predictive value of school nurse
surveillance was 94%, and sensitivity was 90%. Vaccine effectiveness was 81%.
CONCLUSIONS: School nurse surveillance has both high positive predictive value
and sensitivity and is a useful means of tracking varicella occurrence. Annual
incidence rates of varicella are low. Vaccine effectiveness and breakthrough
varicella rates are comparable to findings of other studies.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18519459 [PubMed - indexed for MEDLINE]

34: Epidemiol Infect. 2009 Jan;137(1):48-57. Epub 2008 May 9.

Contact patterns and their implied basic reproductive numbers: an illustration
for varicella-zoster virus.

Effelterre TV, Shkedy Z, Aerts M, Molenberghs G, Damme PV, Beutels P.

Hasselt University, Center for Statistics, Biostatistics, Diepenbeek, Belgium.
tvaneff@yahoo.com

The WAIFW matrix (Who Acquires Infection From Whom) is a central parameter in
modelling the spread of infectious diseases. The calculation of the basic
reproductive number (R0) depends on the assumptions made about the transmission
within and between age groups through the structure of the WAIFW matrix and
different structures might lead to different estimates for R0 and hence different
estimates for the minimal immunization coverage needed for the elimination of the
infection in the population. In this paper, we estimate R0 for varicella in
Belgium. The force of infection is estimated from seroprevalence data using
fractional polynomials and we show how the estimate of R0 is heavily influenced
by the structure of the WAIFW matrix.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18466660 [PubMed - indexed for MEDLINE]

35: Cent Eur J Public Health. 2008 Mar;16(1):41-4.

Seroprevalence of antibodies to varicella-zoster virus in Madrid (Spain) in the
absence of vaccination.

Perez-Farinos N, Garcia-Comas L, Ramirez-Fernandez R, Sanz JC, Barranco D,
Garcia-Fernandez C, Ordobas M.

Epidemiology Department, Madrid Public Health Institute, Madrid, Spain.
napo@napo.jazztel.es

OBJECTIVE: to ascertain the seroprevalence of antibodies to varicella-zoster
virus in the Madrid population prior to the introduction of vaccination. STUDY
DESIGN: Cross-sectional antibody seroprevalence study. METHODS: Population:
persons aged 2 to 40 years in Madrid. Field work: September 1999 to April 2000.
Data were collected on demographic and socio-economic variables and on a number
of exposures. IgG antibodies were determined using Enzyme Linked ImmunoSorbent
Assay (ELISA), and antibody prevalence broken down by age group. Logistic
regression was used to analyse the association between the presence of antibodies
and the respective study variables. The results were compared against those of an
earlier seroprevalence survey in Madrid (1993). RESULTS: A total of 2,131
subjects were included, with a non-response rate of 20.4%. Antibody prevalence
was estimated at 90.2%; the 90% mark was reached at 11 years of age and almost
100% of adults presented with antibodies. In the case of children, school
attendance associated with the presence of antibodies. No significant differences
were observed vis-à-vis the results of the earlier survey. CONCLUSIONS: The
seroprevalence profile coincides with those of other Spanish regions and European
countries, and remains stable over time. Antibody presence rises sharply in
children from aged 2 years to adolescence. Further seroprevalence studies are
called for to study the disease trend and assess preventive measures.

PMID: 18459480 [PubMed - indexed for MEDLINE]

36: Arch Dis Child. 2008 Oct;93(10):845-50. Epub 2008 May 2.

Impact of universal varicella vaccination on 1-year-olds in Uruguay: 1997-2005.

Quian J, Rüttimann R, Romero C, Dall'Orso P, Cerisola A, Breuer T, Greenberg M,
Verstraeten T.

Pediatric Department, Republic University, Montevideo, Uruguay.

OBJECTIVE: Varicella vaccination was introduced at the end of 1999 into the
Uruguayan immunisation schedule for children aged 12 months. Varilrix (Oka
strain; GlaxoSmithKline Biologicals) has been the only vaccine used since then
and coverage has been estimated to exceed 90% since the start of the universal
varicella vaccination programme. We assessed the impact of the Uruguayan
varicella vaccination programme during 2005, 6 years after its introduction.
METHODS: Information on hospitalisations was collected from the main paediatric
referral hospital and information on medical consultations for varicella was
collected from two private health insurance systems in Montevideo. The proportion
of hospitalisations due to varicella and the proportion of ambulatory visits for 
varicella since the introduction of the vaccine were compared between 1999 and
2005 and 1997 and 1999 in the following age groups: <1 year, 1-4 years, 5-9 years
and 10-14 years. RESULTS: By 2005, the proportion of hospitalisations due to
varicella among children, was reduced by 81% overall and by 63%, 94%, 73% and 62%
in the <1, 1-4, 5-9 and 10-14 years age groups, respectively. The incidence of
ambulatory visits for varicella among children was reduced by 87% overall and by 
80%, 97%, 81% and 65% in the <1, 1-4, 5-9 and 10-14 years age groups,
respectively. CONCLUSIONS: The burden of varicella has decreased substantially in
Uruguayan children since the introduction of the varicella vaccination, including
those groups outside the recommended vaccination age. It is expected to decrease 
further as more cohorts of children are vaccinated and herd immunity increases.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18456699 [PubMed - indexed for MEDLINE]

37: J Coll Physicians Surg Pak. 2008 Feb;18(2):95-7.

Onset of adult varicella in relation to rural or urban origin and its
complications.

Raza N, Tariq WU, Zaidi SK.

Department of Dermatology, Combined Military Hospital, Abbottabad.
naeemraza561@hotmail.com

OBJECTIVES: To determine area of origin of adult varicella patients, whether
rural or urban, to compare the mean interval between leaving the area of origin
and onset of varicella in adults of rural origin in comparison with those of
urban origin and to observe its complications. STUDY DESIGN: A cross-sectional
study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Abbottabad, from 
January to December 2006. PATIENTS AND METHODS: All patients over the age of 18
years, presenting with acute illness clinically, suggestive of varicella were
included in the study. A specially designed proforma was filled for each patient 
separately, which included demographic features as well as area of origin,
whether rural or urban, and the age at which they left the area of origin. These 
patients were examined, treated and assessed clinically on regular basis for the 
progress of the disease as well as for its possible local or systemic
complications. Data analysis was done by using statistical programme SPSS-10.
RESULTS: Out of 9155 adult patients, 156 (1.70%) had varicella, including 128
(82.1%) males and 28 (17.9%) females. Origin was rural in 125 (80.1%) and urban
in 31 (19.9%) patients. Mean interval between leaving area of origin and
developing varicella in those of rural origin was 01.79+/-01.78 years and that in
patients of urban origin was 03.37+/-05.72 years (p+/-0.009). None of the
patients developed any complication of the disease. CONCLUSION: Varicella in
adults is generally a benign illness. It is more common among adult males of
rural origin and the interval between leaving the area of origin and onset of
varicella in these patients is significantly less as compared to that in adults
of urban origin.

Publication Types: 
    Comparative Study

PMID: 18454894 [PubMed - indexed for MEDLINE]

38: J Infect Dis. 2008 Mar 1;197 Suppl 2:S94-S100.

Varicella among adults: data from an active surveillance project, 1995-2005.

Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX, Perella D, Mascola
L, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
mmarin@cdc.gov

We report detailed population-based data on varicella among adults. In 2 US
varicella active surveillance sites with high vaccine coverage among young
children, the incidence of varicella among adults declined 74% during 1995-2005. 
A low proportion (3%) of adults with varicella had been vaccinated, with no
improvement over the decade of program implementation, suggesting that the
decline was likely secondary to herd-immunity effects. Compared with children,
adults had more severe varicella in terms of both clinical presentation and
frequency of complications. However, <30% of adults with varicella were treated
with acyclovir. Among adolescents, illness severity was intermediate between that
in children and adults. Varicella cases are preventable through vaccination. As
we enter the second decade of the varicella vaccination program in the United
States, we need to ensure that susceptible adolescents and adults are adequately 
protected from varicella by vaccination and that those who acquire varicella are 
appropriately treated with effective antiviral treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419417 [PubMed - indexed for MEDLINE]

39: J Infect Dis. 2008 Mar 1;197 Suppl 2:S90-3.

Epidemiology of varicella in Connecticut, 2001-2005.

Sosa LE, Hadler JL.

Epidemic Intelligence Service, Office of Workforce and Career Development,
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
lynn.sosa@ct.gov

We analyzed varicella surveillance data in Connecticut for 2001-2005, to describe
the epidemiology of varicella in a highly vaccinated population after the
introduction of varicella vaccine and to determine the number of preventable
cases that had occurred during school-related outbreaks. Overall, the incidence
of varicella did not change during the surveillance period. Vaccination rates
among reported case patients increased, and the severity of infection decreased. 
An annual median of 2.5 cases/outbreak was identified as being preventable, with 
a majority of these cases being preventable by revaccination of previously
vaccinated persons. Continued surveillance is needed in order to monitor changing
trends in varicella epidemiology.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18419416 [PubMed - indexed for MEDLINE]

40: J Infect Dis. 2008 Mar 1;197 Suppl 2:S82-9.

Varicella vaccine effectiveness in the US vaccination program: a review.

Seward JF, Marin M, Vázquez M.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
jseward@cdc.gov

Varicella vaccine (Varivax, Merck) has been available in the United States since 
1995. We reviewed published results of postlicensure studies of vaccine
effectiveness. Among 19 studies, 17 reported on the effectiveness of vaccine
received before exposure, and 2 reported on effectiveness after exposure. Studies
used retrospective and prospective cohort, case-control, and secondary attack
rate (household contact) designs. The majority of estimates assessed protection
against clinically diagnosed varicella. One dose of varicella vaccine was 84.5%
effective (median; range, 44%-100%) in preventing all varicella and 100%
effective (mean and median) in preventing severe varicella. When administered
after exposure, varicella vaccine was highly effective in preventing or modifying
varicella. Although 1 dose of varicella vaccine has provided excellent
protection, a higher degree of effectiveness is needed in order to interrupt
transmission and to prevent outbreaks in settings with high contact rates.
Monitoring the effectiveness of the newly recommended 2-dose childhood vaccine
schedule for varicella vaccine is a priority.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18419415 [PubMed - indexed for MEDLINE]

41: J Infect Dis. 2008 Mar 1;197 Suppl 2:S76-81.

Status of school entry requirements for varicella vaccination and vaccination
coverage 11 years after implementation of the varicella vaccination program.

Lopez AS, Kolasa MS, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
alopez@cdc.gov

We reviewed progress toward adoption of day care and school entry requirements in
each state and the District of Columbia (DC) and compared varicella vaccination
coverage by state to year of implementation of day care entry requirements. By
the start of the 2006-2007 school year, 46 states (92%) and DC had implemented
entry requirements for varicella vaccination. Between 1997 and 2005, national
varicella vaccination coverage among children 19-35 months of age increased from 
25.8% to 87.9%. Implementation of day care entry requirements in 2000 or earlier 
was associated with higher vaccination coverage (> or =90%; P=.002).
Implementation of day care and school entry requirements for varicella
vaccination is an important strategy for achieving and maintaining high
vaccination coverage among preschool- and school-aged children in the United
States. The newly adopted vaccine policy recommendation of 2 doses of varicella
vaccine for all school-aged children should be incorporated into the states'
school entry requirements.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419414 [PubMed - indexed for MEDLINE]

42: J Infect Dis. 2008 Mar 1;197 Suppl 2:S71-5.

Changing varicella epidemiology in active surveillance sites--United States,
1995-2005.

Guris D, Jumaan AO, Mascola L, Watson BM, Zhang JX, Chaves SS, Gargiullo P,
Perella D, Civen R, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Significant reductions in varicella incidence were reported from 1995 to 2000 in 
the varicella active surveillance sites of Antelope Valley (AV), California, and 
West Philadelphia (WP), Pennsylvania. We examined incidence rates, median age,
and vaccination status of case patients for 1995-2005. Coverage data were from
the National Immunization Survey. By 2005, coverage among children 19-35 months
of age reached 92% (AV) and 94% (WP); 57% and 64% of case patients in AV and WP, 
respectively, were vaccinated; and varicella incidence declined by 89.8% in AV
and 90.4% in WP. Incidence declined in all age groups, especially among children 
<10 years of age in both sites and among adolescents 10-14 years of age in WP. In
AV, since 2000, the incidence among adolescents 10-14 and 15-19 years of age
increased. Implementation of school requirements through 10th grade in WP may
explain the differences in the decline in incidence among adolescents. Continued 
surveillance will be important to monitor the impact that the 2-dose vaccine
policy in children has on varicella epidemiology.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419413 [PubMed - indexed for MEDLINE]

43: J Infect Dis. 2008 Mar 1;197 Suppl 2:S41-4.

Development of varicella vaccine.

Takahashi M, Asano Y, Kamiya H, Baba K, Ozaki T, Otsuka T, Yamanishi K.

Department of Virology, Research Institute for Microbial Diseases, Osaka
University, Suita, Osaka, Japan. mtakahashi@mail.biken.or.jp

The Oka strain of varicella-zoster virus (VZV) was first isolated from vesicles
of an otherwise healthy 3-year-old boy with typical varicella. The virus was
passaged 11 times in human embryonic lung fibroblasts at 34 degrees C and 12
times in guinea pig embryo fibroblasts (GPEFs) at 37 degrees C. GPEFs were the
only nonprimate cells tested in which some degree of viral replication occurred. 
The resultant virus was temperature sensitive and showed host dependency,
measured as better replication in GPEFs than that shown by the parental virus.
The passaged virus was used as a candidate varicella vaccine and proved safe and 
effective for healthy and immunocompromised children. During the follow-up of
vaccinated children with acute lymphocytic leukemia, the incidence of herpes
zoster (HZ) was significantly lower among children who did not have a rash after 
vaccination, compared with those who had a rash caused by VZV (6 [2.3%] of 260
vs. 12 [17.1%] of 70, respectively). Because of the pathogenesis of VZV, the
incidence of latency and of HZ is predicted to be lower among vaccine recipients 
than among individuals who have experienced varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419406 [PubMed - indexed for MEDLINE]

44: J Infect Dis. 2008 Mar 1;197 Suppl 2:S242-5.

Perspective on live varicella vaccine.

Gershon AA, Katz SL.

Department of Pediatrics, Columbia University College of Physicians and Surgeons,
New York, New York 10032, USA. aag1@columbia.edu

The attenuation of varicella-zoster virus (VZV) by Takahashi in 1974 was a
remarkable achievement. It swiftly led to development of a live vaccine against
chickenpox, which was initially tested in Japan. With its successful employment
in immunocompromised children to prevent morbidity and mortality due to
varicella, the vaccine began to be tested in healthy children in Japan and
elsewhere. In the United States, vaccine use progressed from extensive clinical
trials that demonstrated safety and efficacy to universal immunization of healthy
infants and children. In the past 10 years, >30 million healthy American
individuals, mostly children, have been vaccinated. With increasing use of
vaccine, there has been a concomitant decrease in the incidence of disease, along
with decreases in hospitalizations and deaths due to VZV. To improve protection, 
however, a 2-dose schedule of immunization was recommended for routine use in all
children by the Centers for Disease Control and Prevention in June 2006. At
roughly the same time, licensure of the combined measles-mumps-rubella-varicella 
vaccine was completed, which allowed harmonization of immunization against these 
4 viruses with 1 injection given twice in childhood. Concomitantly, a version of 
the varicella vaccine with 10 times the titer was developed for immunization of
healthy individuals >60 years of age against herpes zoster (HZ). Although
elimination of VZV from human populations may not yet be possible, the combined
approach of immunization against both varicella in childhood and HZ in adulthood 
in the developed world are predicted to dramatically increase our control of this
troublesome virus.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18419404 [PubMed - indexed for MEDLINE]

45: J Infect Dis. 2008 Mar 1;197 Suppl 2:S224-7.

The impact of the varicella vaccination program on herpes zoster epidemiology in 
the United States: a review.

Reynolds MA, Chaves SS, Harpaz R, Lopez AS, Seward JF.

Division of Viral Diseases, National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333,
USA. mtr6@cdc.gov

Speculation that a universal varicella vaccination program might lead to an
increase in herpes zoster (HZ) incidence has been supported by modeling studies
that assume that exposure to varicella boosts immunity and protects against
reactivation of varicella-zoster virus (VZV) as HZ. Such studies predict an
increase in HZ incidence until the adult population becomes predominantly
composed of individuals with vaccine-induced immunity who do not harbor wild-type
VZV. In the United States, a varicella vaccination program was implemented in
1995. Since then, studies monitoring HZ incidence have shown inconsistent
findings: 2 studies have shown no increase in overall incidence, whereas 1 study 
has shown an increase. Studies from Canada and the United Kingdom have shown
increasing rates of HZ incidence in the absence of a varicella vaccination
program. Data suggest that heretofore unidentified risk factors for HZ also are
changing over time. Further studies are needed to identify these factors, to
isolate possible additional effects from a varicella vaccination program.
Untangling the contribution of these different factors on HZ epidemiology will be
challenging.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18419401 [PubMed - indexed for MEDLINE]

46: J Infect Dis. 2008 Mar 1;197 Suppl 2:S200-6.

Varicella vaccination of immunocompromised children.

Levin MJ.

Department of Pediatrics, Section of Infectious Diseases, University of Colorado 
School of Medicine, Denver, USA. Myron.levin@uchsc.edu

BACKGROUND: Exposure of immunocompromised children to varicella often requires
postexposure prophylaxis. Exposures requiring this management are often not
recognized. Varicella can be a severe disease when it occurs in immunocompromised
children, in spite of antiviral therapy. Varicella exposure and varicella in
these children can also disrupt scheduled therapy for their underlying illness.
Both postexposure prophylaxis and treatment of varicella are likely to be
expensive and use significant medical resources. Numerous trials have been
undertaken to vaccinate children who are immunocompromised by a variety of
conditions and therapies that depress their immune function. METHODS: Clinical
trials of varicella vaccine administration to immunocompromised children that
were reported since 1975 were identified in the Ovid medical database. Reports
were selected for analysis and discussion on the basis of their completeness and 
the utility of their conclusions. RESULTS: Vaccination before immune compromise
is discussed as a strategy for some settings. The obstacles, potential
opportunities, and success in varicella vaccination for immunocompromised
children are separately analyzed for (1) children with leukemia and other
malignancies, (2) human immunodeficiency virus-infected children, and (3)
children with hematopoietic stem cell or solid-organ transplantation.
CONCLUSIONS: Vaccination before immune compromise is often successful, and the
vaccine-induced response is usually partially or fully protective. In many
treatment settings, it is possible to safely vaccinate once the level of immune
suppression has been reduced. Targets for future research are outlined. A
consensus conference should be undertaken to develop guidelines for the use of
varicella vaccine in immunocompromised children.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 18419398 [PubMed - indexed for MEDLINE]

47: J Infect Dis. 2008 Mar 1;197 Suppl 2:S196-9.

Risk of herpes zoster in adults immunized with varicella vaccine.

Hambleton S, Steinberg SP, Larussa PS, Shapiro ED, Gershon AA.

Department of Pediatrics, Columbia University College of Physicians and Surgeons,
New York, New York, USA. shambleton@doctors.org.uk

A program of routine varicella vaccination of children 12-18 months of age, begun
in the United States in 1995, has been very successful in reducing the incidence 
of varicella. Varicella-zoster virus (VZV), in both wild-type and live attenuated
forms, is notable for its ability to produce latent infection of sensory neurons 
from which it can later reactivate to cause herpes zoster (HZ). Therefore, the
effects of vaccination on this secondary VZV-related disease are important to
consider; in practice, however, such studies are complicated by the typically
long delay between acquisition of the virus and its reactivation. Studies of
immunocompromised children have shown that vaccination is relatively protective
against HZ in this highly vulnerable group. We now present long-term follow-up
data on a group of individuals who received varicella vaccine as healthy young
adults 10-26 years ago and who have been followed prospectively by means of
active surveillance. Among some 2000 person-years of follow-up, 2 cases of HZ
have occurred, for a rate of 1.00 case/1000 person-years. Overall, the incidence 
of HZ in this cohort, therefore, is similar to published data for the US
population in the prevaccine era.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18419397 [PubMed - indexed for MEDLINE]

48: J Infect Dis. 2008 Mar 1;197 Suppl 2:S191-5.

Varicella vaccination in Australia and New Zealand.

Macartney KK, Burgess MA.

National Centre for Immunisation Research and Surveillance, The Children's
Hospital at Westmead, Westmead, Australia. kristinm@chw.edu.au

Varicella-zoster virus has been responsible for a significant disease burden,
including hospitalizations and deaths in Australia and New Zealand. Varicella
vaccine has been available in Australia since 1999 and, since November 2005, has 
been funded under the National Immunisation Program for use in all children as a 
single dose at 18 months of age and in a school-based catch-up program at 10-13
years of age. Recent hospitalization data from Australia show a decline in
varicella hospitalizations in children 1-4 years of age, most likely related to
vaccination. In New Zealand, varicella vaccine has been available since 1999 but 
is currently not recommended or funded on the New Zealand national immunization
schedule. The anticipated licensure of combination
measles-mumps-rubella-varicella vaccines in both countries may lead to future
schedule changes.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419396 [PubMed - indexed for MEDLINE]

49: J Infect Dis. 2008 Mar 1;197 Suppl 2:S185-90.

Varicella vaccination in Japan, South Korea, and Europe.

Sadzot-Delvaux C, Rentier B, Wutzler P, Asano Y, Suga S, Yoshikawa T, Plotkin SA.

Unit of Fundamental Virology and Immunology, Department of Life Sciences,
University of Liege, Sart Tilman, Belgium.

The most extensive use of varicella vaccine has been in the United States and
Canada, where it is universally recommended. However, a number of other countries
now have recommendations for use of the vaccine, which has been expanding in
Europe and Latin America. In this article, we review information concerning
varicella vaccination in Japan, where the vaccine was first developed, and in
South Korea and parts of Europe. Despite the worldwide availability of an
efficient vaccine, varicella vaccination policy is highly variable from country
to country. The recent development of a tetravalent vaccine against measles,
mumps, rubella, and varicella could modify this variability in the future. It is 
evident that efforts to control varicella will spread gradually to all
continents.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419395 [PubMed - indexed for MEDLINE]

50: J Infect Dis. 2008 Mar 1;197 Suppl 2:S165-9.

The safety profile of varicella vaccine: a 10-year review.

Galea SA, Sweet A, Beninger P, Steinberg SP, Larussa PS, Gershon AA, Sharrar RG.

Merck Research Laboratories, Clinical Risk Management and Safety Surveillance,
North Wales, Pennsylvania 19454-1099, USA. susan_galea@merck.com

Varivax (varicella virus vaccine live [Oka/Merck]; Merck), a live attenuated
varicella vaccine, is indicated for vaccination against varicella in appropriate 
individuals > or =12 months of age. The 10-year safety profile for Varivax is
described using data submitted to Merck from routine global postmarketing
surveillance, combined with information from a Varicella Zoster Virus
Identification Program, which uses polymerase chain reaction (PCR) analysis to
identify the presence and strain of VZV in selected specimens. There were 16,683 
reports worldwide voluntarily submitted to Merck, for an overall reporting rate
of 3.4 reports/10,000 doses of vaccine distributed. PCR analysis of vesicular
rashes that occurred within the first 2 weeks after vaccination was more likely
to identify wild-type varicella-zoster virus (VZV), whereas the presence of Oka
VZV was generally associated with vesicular rashes that occurred 15-42 days after
vaccination. Reports of breakthrough varicella that occurred >42 days after
vaccination were associated with wild-type VZV. Among 697 herpes zoster reports, 
PCR analysis identified Oka VZV in 57 reports and wild-type VZV in 38 reports.
There were no primary neurologic adverse events associated with Oka VZV.
Secondary transmission of Oka VZV from vaccine recipients with postvaccination
vesicular rashes was identified in 3 susceptible household contacts. Disseminated
Oka VZV was identified in 6 immunocompromised patients and 1 patient with Down
syndrome. This review has shown that the vaccine is generally safe and well
tolerated.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18419392 [PubMed - indexed for MEDLINE]

51: J Infect Dis. 2008 Mar 1;197 Suppl 2:S156-64.

An economic analysis of the universal varicella vaccination program in the United
States.

Zhou F, Ortega-Sanchez IR, Guris D, Shefer A, Lieu T, Seward JF.

National Center for Immunization and Respiratory Diseases, Centers for Disease
Control and Prevention, Public Health Service, US Department of Health and Human 
Services, Atlanta, Georgia, USA. faz1@cdc.gov

Frequent varicella outbreaks with sizable impact on the US public health system
have continued to occur despite the success of the country's 1-dose varicella
vaccination program. The Advisory Committee on Immunization Practices recently
recommended adding a routine second dose of varicella vaccine and weighed
economic projections as well as public health goals in their deliberations. This 
decision-tree-based analysis was conducted to evaluate the economic impact of the
projected 2-dose varicella vaccination program as well as the existing 1-dose
program. The analysis used population-based vaccination coverage and disease
incidence data to make projections for a hypothetical US birth cohort of
4,100,000 infants born in 2006. Compared with no vaccination, both the 1-dose
program (societal benefit-cost ratio [BCR], 4.37) and 2-dose program (BCR, 2.73) 
were estimated to be cost saving from the societal perspective. Compared with the
1-dose program, the incremental second dose was not cost saving (societal
incremental BCR, 0.56). The incremental cost-effectiveness ratio for the second
dose was $343 per case prevented, or approximately $109,000 per quality-adjusted 
life-year saved, and these results were sensitive to assumptions about vaccine
effectiveness and prices.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419391 [PubMed - indexed for MEDLINE]

52: J Infect Dis. 2008 Mar 1;197 Suppl 2:S152-5.

Varicella immunogenicity with 1- and 2-dose regimens of
measles-mumps-rubella-varicella vaccine.

Shinefield HR, Black S, Kuter BJ.

Department of Pediatrics, University of California at San Francisco School of
Medicine, San Francisco, California, USA. Henryshinefield@aol.com

A quadrivalent vaccine combining measles, mumps, rubella, and varicella antigens 
(MMRV) was developed to increase the coverage of varicella vaccine and reduce the
number of injections children receive. Although the varicella antigen is as
immunogenic in the latest formulation of MMRV vaccine as when it is administered 
alone, up to 14% of vaccine recipients do not achieve protective levels of
anti-varicella antibodies after a single dose, which can result in breakthrough
varicella. A second dose of varicella vaccine raises response rates to 99% and
was recently recommended by the Advisory Committee on Immunization Practices.
Giving the second dose 3 months after the first (at approximately 15 months of
age) would provide more protection against varicella but would necessitate a
change in the childhood vaccination schedule, which currently calls for a second 
dose of MMRV vaccine between the ages of 4 and 6 years.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419390 [PubMed - indexed for MEDLINE]

53: J Infect Dis. 2008 Mar 1;197 Suppl 2:S147-51.

Use and limitations of varicella-zoster virus-specific serological testing to
evaluate breakthrough disease in vaccinees and to screen for susceptibility to
varicella.

Breuer J, Schmid DS, Gershon AA.

Skin Virus Laboratory, Centre for Infectious Disease, St. Bartholomew's and The
Royal London School of Medicine and Dentistry, Queen Mary College, London, United
Kingdom.

A plethora of tests for determining the presence of antibodies to
varicella-zoster virus (VZV) have been developed over the years, with a wide
range of performance standards. There is general agreement that the presence of
VZV antibodies in serum indicates immunity to varicella and protection from
chickenpox, although the role of specific antibody in mediating protection
remains unclear. Both antibodies and cellular immunity probably interact to
mediate immunity to the virus. In any case, VZV-specific serum antibody is a
useful indicator of protection against chickenpox in patients and persons at high
risk of exposure, whether they have been immunized or naturally infected.
Serological tests are also a useful implement for evaluating the length of time
that immunity to varicella persists after vaccination and whether waning of
vaccine-induced immunity occurs. The purpose of this review is to contrast the
strengths and weaknesses of currently available VZV antibody assays. Although
several of these methods are useful for various specific applications, simpler
and more accurate tests to measure antibodies to VZV are a high priority for
future research and development.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18419389 [PubMed - indexed for MEDLINE]

54: J Infect Dis. 2008 Mar 1;197 Suppl 2:S143-6.

Humoral and cell-mediated immune responses in children and adults after 1 and 2
doses of varicella vaccine.

Watson B.

Immunization Program Division of Disease Control, Philadelphia Department of
Public Health, Philadelphia, Pennsylvania 19146, USA. barbara.watson@phila.gov

Humoral and cell-mediated immune responses to varicella-zoster virus (VZV) have
been evaluated after 1 and 2 doses of live attenuated varicella vaccine, Oka
strain, in several studies. One dose of varicella vaccine, however, elicits
detectable immune responses that are low and, in some cases, may be insufficient 
for complete protection against the virus after the normal decline in humoral and
cell-mediated immunity with time. In contrast, immune responses after 2 doses are
significantly higher and approximate the levels seen after natural disease. These
investigations of vaccine-induced immunity suggest that 2 doses of VZV vaccine
will better achieve the goals of the VZV vaccination program, by reducing the VZV
burden of disease in childhood and preventing accumulation of young adults who
are susceptible to or only partially protected from varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18419388 [PubMed - indexed for MEDLINE]

55: J Infect Dis. 2008 Mar 1;197 Suppl 2:S139-42.

Lack of association between age at varicella vaccination and risk of breakthrough
varicella, within the Northern California Kaiser Permanente Medical Care Program.

Black S, Ray P, Shinefield H, Saddier P, Nikas A.

Department of Pediatric Infectious Diseases, Stanford University, Palo Alto,
California, USA.

BACKGROUND: Varicella vaccine currently is recommended for children between 12
and 18 months of age. However, rates of breakthrough varicella have been reported
to be higher among children vaccinated before 14 or 15 months of age and to
increase with time since vaccination. Methods: An ongoing study at the Northern
California Kaiser Permanente Medical Care Program is evaluating vaccine efficacy 
in 7585 children vaccinated with Varivax in 1995, when they were between 12 and
23 months of age. Cases of chickenpox are identified by telephone interviews with
each child's parent(s) every 6 months. Mean age at varicella onset and mean time 
from vaccination to onset were calculated on the basis of age, in months, at
vaccination. Logistic regression was used to test for trend, and the chi2 test
was used to test for differences in rates of breakthrough varicella by age.
RESULTS: Over the first 8 years of the study, a total of 1161 cases of
breakthrough varicella were reported, for an average rate of 21.7 cases/1000
person-years. Vaccine effectiveness was 83.6% at year 8. The rate of breakthrough
varicella did not change for each additional month of age at vaccination (P =
.864), and no difference in the rate of breakthrough varicella was found between 
children vaccinated at <15 months of age and those vaccinated at > or =15 months 
of age. CONCLUSIONS: Our data do not show a difference in vaccine effectiveness
with age at vaccination and thus support the current recommendations for initial 
vaccination between 12 and 18 months of age.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419387 [PubMed - indexed for MEDLINE]

56: J Infect Dis. 2008 Mar 1;197 Suppl 2:S132-8.

Laboratory diagnosis and characteristics of breakthrough varicella in children.

Weinmann S, Chun C, Mullooly JP, Riedlinger K, Houston H, Loparev VN, Schmid DS, 
Seward JF.

Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, 
USA. Sheila.Weinmann@kpchr.org

The atypical features of varicella in vaccinated persons (breakthrough varicella 
[BTV]) present diagnostic challenges. We examined varicella-zoster virus (VZV)
polymerase chain reaction (PCR) and immunoglobulin (Ig) M and IgG serologic test 
results for confirming BTV cases. Among 33 vaccinated children with
varicella-like rash, we identified wild-type VZV in 58% overall and in 76% of
those with adequate tissue specimens; no vaccine-type virus was found. Of the 12 
subjects with PCR-confirmed BTV and acute-phase serum samples, 9 had detectable
IgM, and all had highly elevated acute-phase IgG titers. Six subjects with
negative PCR results had lower IgG titers and negative IgM results. Although PCR 
is the preferred method for laboratory confirmation of BTV, a positive serum
varicella IgM test result should also be considered to be diagnostic in a
suspected BTV case; however, a negative IgM test result cannot be used to rule
out the diagnosis. The value of highly elevated IgG titers needs further
evaluation. Larger studies are needed to confirm these results.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18419386 [PubMed - indexed for MEDLINE]

57: J Infect Dis. 2008 Mar 1;197 Suppl 2:S127-31.

Varicella disease among vaccinated persons: clinical and epidemiological
characteristics, 1997-2005.

Chaves SS, Zhang J, Civen R, Watson BM, Carbajal T, Perella D, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30332, USA.
schaves@cdc.gov

Approximately 1 in every 5 children who receives 1 dose of varicella vaccine may 
develop varicella disease, also known as breakthrough disease, if exposed to
varicella-zoster virus. Currently, in communities with high vaccination coverage,
varicella cases mostly occur in vaccinated individuals. We report on the first
population-based description of the clinical and epidemiological characteristics 
of varicella in populations with increasing vaccine coverage between 1997 and
2005. In vaccinated children 1-14 years of age, varicella was most often mild and
modified; the atypical disease presentation may result in diagnostic challenges
to health care providers. However, despite the generally mild nature of these
cases, approximately 25% caused >50 lesions, and some resulted in serious
complications similar to those occurring in unvaccinated individuals. Continued
surveillance of the risk and characteristics of breakthrough disease will be
needed, to monitor the effect of the new 2-dose vaccine recommendation for
children.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18419385 [PubMed - indexed for MEDLINE]

58: J Infect Dis. 2008 Mar 1;197 Suppl 2:S120-6.

Epidemiology of varicella hospitalizations in the United States, 1995-2005.

Reynolds MA, Watson BM, Plott-Adams KK, Jumaan AO, Galil K, Maupin TJ, Zhang JX, 
Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
mtr6@cdc.gov

To describe the impact of the varicella vaccination program on varicella-related 
hospitalizations (VRHs) in the United States, data from the Varicella Active
Surveillance Project (VASP) were used to compare rates of hospitalization and
rates of complications among patients hospitalized for varicella-related
conditions from 1995 to 2005. Of the 26,290 varicella cases reported between 1995
and 2005, 170 cases resulted in VRHs, including 1 case that resulted in death.
Both VRH rates per 100,000 population and complications during VRH per 100,000
population decreased significantly between the early vaccination period
(1995-1998) and the middle/late vaccination period (1999-2005). Infants and
adults were at highest risk for VRH, and having been vaccinated against varicella
was a protective factor. Varicella vaccination may have prevented a significant
number of VRHs. The fact that 4 vaccinated children required hospitalization for 
varicella-related complications demonstrates that 1 dose of varicella vaccine
does not prevent serious disease in all cases, even among previously healthy
children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419384 [PubMed - indexed for MEDLINE]

59: J Infect Dis. 2008 Mar 1;197 Suppl 2:S114-9.

Varicella outbreak epidemiology in an active surveillance site, 1995-2005.

Civen R, Lopez AS, Zhang J, Garcia-Herrera J, Schmid DS, Chaves SS, Mascola L.

Los Angeles County Department of Public Health, Los Angeles, California 90012,
USA. rciven@ph.lacounty.gov

We describe trends and characteristics of varicella outbreaks identified in an
active surveillance site from 1995 to 2005. Cases of varicella were reported to
the active surveillance project, and outbreaks were defined retrospectively as > 
or =5 varicella cases epidemiologically linked to a common setting that occurred 
within 1 incubation period. Outbreaks were grouped by calendar year. From
1995-1998 to 2002-2005, varicella outbreaks significantly decreased in number,
from 236 to 46 (P< .001); in size, from a median of 15 cases/outbreak to 9
cases/outbreak (P< .001); and in duration, from 44.5 days to 30 days (P< .001).
The median age of case patients with outbreak-related varicella increased from 6 
to 9 years (P< .001). The 1-dose varicella vaccination program has been
successful in decreasing the number of outbreaks and cases; however, challenges
remain with regard to controlling outbreaks among vaccinated persons and
targeting vaccination efforts to susceptible persons in older age groups.

PMID: 18419383 [PubMed - indexed for MEDLINE]

60: J Infect Dis. 2008 Mar 1;197 Suppl 2:S108-13.

Varicella outbreak reporting, response, management, and national surveillance.

Leung J, Rue A, Lopez A, Ortega-Sanchez IR, Harpaz R, Guris D, Seward JF.

National Center for Immunization and Respiratory Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia 30333, USA. JLeung@cdc.gov

Two national surveys were conducted to evaluate the status of varicella
case-based surveillance and outbreak response. Although progress toward national 
surveillance has been significant, a large number of jurisdictions are still
without case-based surveillance. For jurisdictions beginning case-based
surveillance with limited resources, a staged approach is recommended. The
national outbreak survey showed that a significant number of varicella outbreaks 
continue to occur. The majority of jurisdictions respond to these outbreaks,
although the response varies considerably. Depending on the outbreak-response
approach, costs per outbreak ranged from $3000 for a typical, or passive,
response to $6000 for a more active response. As varicella surveillance and
outbreak control improves, jurisdictions may benefit from more-standardized
outbreak-control practices. The recent recommendation by the Advisory Committee
on Immunization Practices for a routine second dose of varicella vaccine should
lead to better varicella disease control, making case-based surveillance and
appropriate outbreak response even more feasible.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419382 [PubMed - indexed for MEDLINE]

61: J Infect Dis. 2008 Mar 1;197 Suppl 2:S101-7.

Challenges to implementing second-dose varicella vaccination during an outbreak
in the absence of a routine 2-dose vaccination requirement--Maine, 2006.

Parker AA, Reynolds MA, Leung J, Anderson M, Rey A, Ortega-Sanchez IR, Schmid DS,
Guris D, Gensheimer KF.

Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease
Control and Prevention (CDC), Atlanta, Georgia, USA. AParker@cdc.gov

In June 2005, the Advisory Committee on Immunization Practices (ACIP) recommended
administering a second dose of varicella vaccine during outbreaks, supplementing 
the routine 1-dose requirement. From October 2005 to January 2006, a varicella
outbreak occurred in Maine in a highly vaccinated elementary school population.
We investigated the outbreak, held a school-based vaccination clinic, and
assessed costs in implementing ACIP's outbreak-response recommendation. Parents
completed questionnaires and case investigation interviews. Personnel at the
Maine Center for Disease Control and Prevention, the school in which the outbreak
occurred ("school A"), and physician offices completed economic surveys.
Forty-eight cases occurred, with no hospitalizations or deaths. Vaccine
effectiveness was 86.6% (95% confidence interval, 82.0%-90.1%). Of 240 eligible
students, 132 (55.0%) received second-dose vaccination. Implementing ACIP's
outbreak-response recommendation was challenging and cost approximately $26,875. 
Additionally, the routine 1-dose varicella vaccination policy did not confer
adequate population immunity to prevent this outbreak. These findings support
ACIP's June 2007 recommendation for a routine 2-dose varicella vaccination
program.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419381 [PubMed - indexed for MEDLINE]

62: Can J Public Health. 2008 Jan-Feb;99(1):41-5.

Health disparities in chickenpox or shingles in Alberta?

Russell ML, Schopflocher DP, Svenson LW.

Department of Community Health Sciences, University of Calgary, Calgary, AB.
mlrussel@ucalgary.ca

OBJECTIVE: Exploring for evidence of socio-economic health disparities in
chickenpox and shingles in Alberta, Canada. METHODS: Chickenpox and shingles
cases were identified from administrative data from Alberta's universal health
care insurance system for 1994-2002. Incident cases were those with the earliest 
dated utilization of a health service (chickenpox: ICD9-CM 052/ICD10-CA B01;
shingles: ICD9-CM 053/ ICD10-CA B02). Crude and age-specific rates were estimated
for each year by an indicator of socio-demographic status based upon the nature
of the payer and eligibility for health care premium subsidy (SES-proxy) for the 
provincial health care insurance system. RESULTS: Among young children there is a
gradient of disparity in chickenpox rates prior to the year in which publicly
funded vaccination programs were implemented. After this point, disparities
decline but less so for First Nations children than for others. There was no
evidence of disparity by SES-proxy for shingles. CONCLUSION: Publicly funded
vaccination programs may effectively contribute to reduction in disease
disparities for vaccine-preventable diseases. Further study is required to
ascertain why disparities continue for First Nations children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18435390 [PubMed - indexed for MEDLINE]

63: Pediatr Hematol Oncol. 2008 Apr-May;25(3):237-42.

Fatal visceral varicella-zoster virus infection without skin involvement in a
child with acute lymphoblastic leukemia.

Matsuzaki A, Suminoe A, Koga Y, Kusuhara K, Hara T, Ogata R, Sata T, Hara T.

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University,
Fukuoka, Japan. matsuzaki@shs.kyushu-u.ac.jp

A 5-year-old girl with acute lymphoblastic leukemia in remission suffered from
fatal visceral varicella-zoster virus (VZV) infection after the oral
administration of a high-dose dexamethasone. She abruptly developed fulminant
hepatitis and disseminated intravascular coagulation, and died 3 days later. VZV 
DNA and antigens were detected in the peripheral blood (6 x 10(8) copies/mL) and 
a postmortem liver specimen, respectively. The exposure to VZV was not confirmed 
and no skin lesions were observed. VZV infection should be considered in patients
with unexplained liver dysfunction under severe immunosuppressive condition, even
in the absence of viral exposure and skin involvement.

Publication Types: 
    Case Reports

PMID: 18432508 [PubMed - indexed for MEDLINE]

64: Acta Paediatr. 2008 Jul;97(7):948-51.

Oxidant/antioxidant status and vitamin A levels in children infected with
varicella.

Avci Z, Avci A, Alioglu B, Malbora B, Bayraktar N, Derbent M, Ozbek N.

Baskent University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey.
zekaiavci@yahoo.com

AIM: Varicella is a childhood disease, with its highest incidence being found in 
children aged 1 to 9 years. The aim of this study was to investigate the plasma
oxidant and antioxidant status in Turkish children with varicella infection.
METHODS: The study population consisted of 29 children infected with varicella
recruited from the Department of Pediatrics at Baskent University Hospital in
Ankara, Turkey. The control group consisted of 20 age-matched children from the
same region who were apparently otherwise healthy. After overnight fasting,
venous blood samples were obtained and transferred to heparinized tubes. Plasma
malondialdehyde and vitamin A levels were measured in both groups. RESULTS: The
plasma malondialdehyde levels were higher in children in the infected group than 
they were in children in the control group. However, there were no statistically 
significant differences in plasma vitamin A levels between the groups.
CONCLUSION: This study suggests that oxidant stress causes significant
peroxidation, and the antioxidant defence system is affected in varicella
infection. Antioxidant supplementation may yield beneficial results in these
patients. Further studies are needed to determine the positive effects of vitamin
A supplementation in patients with varicella infections.

PMID: 18430072 [PubMed - indexed for MEDLINE]

65: J Med Virol. 2008 Jun;80(6):1123-30.

Genotypes of varicella-zoster virus wild-type strains in Germany.

Sauerbrei A, Zell R, Philipps A, Wutzler P.

Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of
Jena, Jena, Germany. andreas.sauerbrei@med.uni-jena.de

Surveillance of varicella-zoster virus (VZV) genotypes is indicated in Germany
after implementation of universal varicella vaccination. This article reports
genotyping data of 77 VZV strains obtained from 54 patients with varicella, 1
newborn with congenital varicella syndrome, 2 fetuses with intrauterine VZV
infection and 20 cases with zoster. Fragments of the open reading frames (ORF) 1,
21, 22, 37, 50, 54, and 60 were analyzed by sequencing. In addition, the PstI
polymorphism of the ORF 38 was characterized. Thirty strains, 22 from varicella
and 8 from zoster, had the genetic markers of genotype E2, 2 of them carried new 
single nucleotide polymorphisms (SNP). Twenty-nine VZV isolates, 17 from
varicella, and 12 from zoster, could be analyzed as E1 strains, 6 of them as E1
variants containing individual SNPs. Finally, 17 strains taken from primary VZV
infection were classified as genotype M1, 13 of which belonged to the M1 subtype 
1, 3 to the M1 subtype 2, and 1 to the M1 subtype 3. One strain was regarded as
potential E2/J recombinant. In conclusion, VZV genotypes E2, E1, and M1 can be
found in nearly equal incidence in varicella in Germany. The most frequent group 
is attributed to the genotype E2. Genotype M1 strains can only be detected after 
primary VZV infection and not in zoster cases. The possible recombinant could not
be classified definitely by the scattered SNP method used and, therefore, has to 
be confirmed by full-genome sequencing studies.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18428135 [PubMed - indexed for MEDLINE]

66: J Infect Dis. 2008 Apr 1;197(7):944-9.

Comment in:
    J Infect Dis. 2008 Apr 1;197(7):935-7.

Primary vaccine failure after 1 dose of varicella vaccine in healthy children.

Michalik DE, Steinberg SP, Larussa PS, Edwards KM, Wright PF, Arvin AM, Gans HA, 
Gershon AA.

Division of Pediatric Infectious Diseases, Columbia University Medical Center,
New York, New York 10032, USA.

Universal immunization of young children with 1 dose of varicella vaccine was
recommended in the United States in 1995, and it has significantly decreased the 
incidence of chickenpox. Outbreaks of varicella, however, are reported among
vaccinated children. Although vaccine effectiveness has usually been 85%, rates
as low as 44% have been observed. Whether this is from primary or secondary
vaccine failure-or both-is unclear. We tested serum samples from 148 healthy
children immunized against varicella in New York, Tennessee, and California to
determine their seroconversion rates, before and after 1 dose of Merck/Oka
varicella vaccine. The median age at vaccination was 12.5 months; postvaccination
serum samples were obtained on average 4 months later. Serum was tested for
antibodies against varicella-zoster virus (VZV) by use of the previously
validated sensitive and specific fluorescent antibody to membrane antigen (FAMA) 
assay. Of 148 healthy child vaccinees, 113 (76%) seroconverted, and 24% had no
detectable VZV FAMA antibodies. Our data contrast with reported seroconversion
rates of 86%-96% by other VZV antibody tests and suggest that many cases of
varicella in immunized children are due to primary vaccine failure. A second dose
of varicella vaccine is expected to increase seroconversion rates and vaccine
effectiveness.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18419532 [PubMed - indexed for MEDLINE]

67: Scand J Infect Dis. 2008;40(5):428-30.

Breakthrough VZV infection after immunization, presenting as herpes zoster.

Schade RP, Bakkers J, Cornelissen M, Koster-Kamphuis L, Melchers WJ, Galama JM.

Department of Medical Microbiology, Nijmegen, The Netherlands.
r.schade@mmb.umcn.nl

An immunocompromized, VZV-vaccinated child had a breakthrough infection with VZV,
acquired at a day-care centre during a chickenpox outbreak. Interestingly, the
infection manifested as herpes zoster of 1 dermatome. Typing showed wild-type
virus, which suggests that exogenous reinfection with a new strain may present as
herpes zoster.

Publication Types: 
    Case Reports

PMID: 18418805 [PubMed - indexed for MEDLINE]

68: J Egypt Public Health Assoc. 2007;82(3-4):283-97.

Seroprevalence of measles, mumps, rubella and varicella among staff of a hospital
in Riyadh, Saudi Arabia.

Abbas M, Atwa M, Emara A.

Department of Occupational and Community Medicine, Suez Canal University, Egypt. 
moustafafouad@yahoo.com

This study aimed at screening immune status of Health Care Workers (HCWs) against
measles, mumps, rubella, and varicella, and assessing the reliability of the
history of previous illness due to these infections or vaccination against them
as an indicator of the immune status, as checked by laboratory tests. Demographic
data, history of previous illnesses and previous vaccinations were collected
using a self-administered questionnaire. Also, serologic screening was done for
these infections. Antibodies tested using ELISA. Among tested hospital staff,
71.8%, 60.3%, 47.9% and 68.4% reported history of infection or vaccination
against measles, mumps, rubella and varicella respectively, while laboratory
results proved that 4.5%, 10.8%, 12.9% and 11.3% were susceptible respectively.
Susceptibility was most frequent among housekeeping staff against measles and
varicella, while administrative staff were the most susceptibles to mumps, and
nurses were the most susceptibles to rubella. Sensitivity of past history of
illness as an indicator of the immune status, was found to be (85%, 83%, 66%,
86%); Specificity was (81%, 81%, 89%, 87%); Positive Predictive value (PV) was
(99%, 98%, 98%, 98%) and Negative PV was (16%, 29%, 22%, 39%) for measles, mumps,
rubella and varicella respectively. Screening for measles, mumps, rubella and
varicella among hospital staff is mandatory to detect those who are susceptible
for infections and should be vaccinated, and so preventing transmission of these 
infections to their colleagues or patients.

PMID: 18410713 [PubMed - indexed for MEDLINE]

69: J Pediatr Ophthalmol Strabismus. 2008 Mar-Apr;45(2):116-7.

Ring corneal infiltrate and progressive ring thinning following primary varicella
infection.

Khan AO, Al-Assiri A, Wagoner MD.

Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh,
Saudi Arabia.

Unilateral stromal keratitis is a known rare sequela of primary varicella
infection. The authors describe a unique case of immunological (Wessely) ring
formation and progressive ring thinning following primary varicella infection in 
a 6-year-old girl.

Publication Types: 
    Case Reports

PMID: 18404961 [PubMed - indexed for MEDLINE]

70: Hum Vaccin. 2008 Jul-Aug;4(4):316-9. Epub 2008 Feb 19.

Protective immunity following vaccination: how is it defined?

Amanna IJ, Messaoudi I, Slifka MK.

Vaccine and Gene Therapy Institute, Oregon Health & Science University,
Beaverton, Oregon 97006, USA.

Vaccination represents an important medical breakthrough pioneered by Edward
Jenner over 200 years ago when he developed the world's first vaccine against
smallpox. To this day, vaccination remains the most effective means available for
combating infectious disease. There are currently over 20 vaccines licensed for
use within the US with many more vaccines in the R&D pipeline. Although vaccines 
must demonstrate clinical efficacy in order to receive FDA approval, the
correlates of immunity vary remarkably between different vaccines and may be
based primarily on animal studies, clinical evidence, or a combination of these
sources of information. Correlates of protection are critical for measuring
vaccine efficacy but researchers should know the history and limitations of these
values. As vaccine technologies advance, the way in which we measure and define
protective correlates may need to evolve as well. Here, we describe the
correlates of protective immunity for vaccines against smallpox, tetanus, yellow 
fever and measles and compare these to a more recently introduced vaccine against
varicella zoster virus, wherein a strict correlate of immunity has yet to be
fully defined.

PMID: 18398296 [PubMed - indexed for MEDLINE]

71: J Med Assoc Thai. 2008 Jan;91(1):110-6.

Maternal chickenpox in peripartum period: a case report and review.

Pattanasuttinont S.

Department of Obstetrics and Gynecology, HRH Maha Chakri Sirindhorn Medical
Center, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, Thailand. 
sumate@swu.ac.th

A 30-year-old pregnant woman had skin lesions at 38 weeks of gestation. She was
diagnosed as primary varicella zoster infection. Her clinical symptoms were high 
fever and generalized vesicles eruption. No serious maternal complication was
found. The patient delivered a male baby 4 days after she developed skin lesions.
The neonatal blood IgM against varicella zoster was negative. The baby was given 
Varicella zoster immunoglobulin within 24 hours and isolated in a neonatal care
unit. The baby developed skin lesions on day 11th post delivery. Intravenous
acyclovir was administered for 7 days. Finally, the baby was found to be free of 
severe neonatal varicella infection.

Publication Types: 
    Case Reports
    Review

PMID: 18386554 [PubMed - indexed for MEDLINE]

72: Int J Paediatr Dent. 2008 May;18(3):155-62.

Molar incisor hypomineralization: a study of aetiological factors in a group of
UK children.

Whatling R, Fearne JM.

Department of Paediatric Dentistry, Royal London Hospital, London, UK.
rosemary.whatling@bartsandthelondon.nhs.uk

OBJECTIVES: The objectives were to investigate the aetiology of molar incisor
hypomineralization (MIH), and to discuss previously published studies. SUBJECTS
AND METHODS: One hundred and nine children attending the Department of Paediatric
Dentistry at the Royal London Hospital were included in the study: 57 children
with MIH and 52 controls. Their mothers completed a medical history interview.
RESULTS: No significant associations were found with MIH and delivery and birth
complications, breastfeeding, immunization history, other illnesses and
allergies, general anaesthetics, fluoride history, and trauma or abscesses
affecting the primary predecessors. A family history of enamel defects was more
commonly reported for MIH children, but the association was not statistically
significant. However, MIH was significantly more common among those whose mothers
had experienced problems during pregnancy (P = 0.025), those who had chickenpox
between the ages of 3 and 3.99 (P = 0.047), and those for whom amoxycillin was
the only antibiotic they had received (P = 0.028). CONCLUSIONS: The aetiology of 
MIH remains unclear, and this study questions whether it is because of a lone
aetiological insult. This study recommends further research looking at the links 
with chickenpox occurring around the third year of life and amoxycillin.

PMID: 18384347 [PubMed - indexed for MEDLINE]

73: Infection. 2008 Mar;36(2):130-4. Epub 2008 Mar 31.

Immunity to varicella zoster virus among young adults: a decline prior to
widespread uptake of varicella vaccines.

Grotto I, Balicer RD, Smetana Z, Davidovitch N, Bar-Zeev Y, Mendelson E, Zarka S,
Huerta M.

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. grotto@bgu.ac.il

BACKGROUND: The epidemiology of chickenpox in Israel is changing, mainly due to
the increasing - but not universal - uptake of varicella vaccine. PATIENTS AND
METHODS: We conducted a seroprevalence study of varicella zoster virus (VZV)
antibodies among 536 Israeli military recruits 18 years of age, on the basis of a
representative sample of sera collected in 2003. RESULTS: The overall
seroprevalence rate was 94.6%, which was significantly lower than that observed
in a similar population in 1992 (98.4%, p < 0.001). The rate was lower among
subjects whose fathers had less than 12 years of schooling (89.8%, p = 0.033). No
statistically significant differences were observed when data were stratified by 
sex, subject's level of education, or origin. CONCLUSION: This decline in the
level of immunity must be considered when determining pre- and post-exposure
vaccination policy among young adults in crowded environments.

PMID: 18379727 [PubMed - indexed for MEDLINE]

74: J Infect. 2008 May;56(5):360-5. Epub 2008 Mar 21.

Varicella infection--evidence for peak activity in summer months.

Miller ER, Kelly HA.

Victorian Infectious Diseases Reference Laboratory, Locked Bag 815, Carlton South
3053, Australia. emma.miller@deakin.edu.au

This study aimed to identify seasonal variations in the presentation of primary
varicella infection in susceptible patients in Victoria (a temperate region in
south-east Australia) by analysing Victorian hospital admissions data and medical
locum service data from the years preceding the introduction of a universally
offered vaccination, complemented by available surveillance data from the
neighbouring state, of South Australia. Contrary to the conventional assumption, 
which is based on observations in temperate regions elsewhere in the world, we
found no consistent evidence of seasonal peaks during late winter and early
spring for varicella infection in Victoria. This finding may have implications
for prevention in temperate regions elsewhere in the world wherever estimations
of local seasonal trends have been based on international experiences.

PMID: 18359087 [PubMed - indexed for MEDLINE]

75: Int J Infect Dis. 2007 Nov;11 Suppl 2:S49-55.

A new challenge for Europe: introducing a pediatric quadrivalent vaccine for
measles, mumps, rubella, and varicella.

Ramet J.

Department of Pediatrics, Universitair Ziekenhuis Antwerpen, Antwerp Belgium.
jose.ramet@zna.be

BACKGROUND: Varicella is often considered to be a benign disease of childhood. In
fact, varicella is associated with serious complications and mortality even among
healthy individuals. DISCUSSION: Although the course of varicella can be
uncomplicated, it can also be associated with serious complications such as
pneumonia, fluid and electrolyte disturbances, skin and soft tissue infections
and central nervous system disturbances. Worldwide studies have confirmed the
high frequency of disease as well as the resultant morbidity, mortality and
medical resource use. A quadrivalent vaccine is now available in certain
countries to protect against measles, mumps, rubella and varicella (MMRV).
Countries that have initiated routine vaccination pro- grams have reported
substantial reductions in morbidity and mortality as well as improved health
outcomes. The MMRV vaccine facilitates coverage against all four diseases, and
would be expected to improve compliance as well as coverage of varicella.
CONCLUSIONS: Universal vaccination programs with MMRV should be considered as a
way to reduce the medical and economic impact of varicella. The MMRV vaccine
provides a means to achieve universal coverage.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18162247 [PubMed - indexed for MEDLINE]

76: Am J Infect Control. 2008 Mar;36(2):142-7.

Diphtheria, tetanus, and varicella immunity in health care workers in neonatal
units.

dos Santos AM, Ono E, Lobato RT, do Prado SI, Kopelman BI, Cavalcanti CM, Monomi 
MK, Weckx LY, de Moraes-Pinto MI.

Division of Neonatal Medicine, Department of Pediatrics, Federal University of
São Paulo, São Paulo, Brazil. ameliamiyashiro@yahoo.com.br

BACKGROUND: Susceptible health care workers are at risk of acquiring and
transmitting vaccine-preventable diseases to or from patients. The objective of
this study was to assess antibody levels against diphtheria, tetanus, and
varicella in healthcare workers. METHODS: Antibody levels against diphtheria,
tetanus, and varicella were measured in health care professionals in 2 neonatal
units at the Federal University of São Paulo, Brazil. RESULTS: Between September 
and November 2002, 215 of 222 (96.8%) health care workers were studied. Of those,
122 (56.7%) gave oral information regarding their vaccination status against
diphtheria and tetanus and only 9 (4.2%) had their vaccination cards. Geometric
mean antibody levels against diphtheria, tetanus, and varicella were 0.89 IU/mL
(95%CI, 0.73 to 1.08), 0.86 IU/mL (95%CI, 0.68 to 1.07) and 1.10 IU/mL (95%CI,
0.98 to 1.24), respectively. Using internationally accepted definitions, 200
(93.0%) and 182 (84.7%) individuals had full protection against diphtheria and
tetanus, respectively. Regarding varicella, 213 (99.1%) individuals were immune
and 2 (0.9%) had equivocal immunity against varicella. Of 65 (30.2%) individuals 
without previous history of the illness, 63 (96.9%) were immune against varicella
zoster virus. CONCLUSIONS: Based on serologic screening, most professionals were 
immune to diphtheria, tetanus, and varicella. Absence of previous history of
varicella was an unreliable identifier of susceptibility to varicella zoster
virus in the health care workers studied.

PMID: 18313517 [PubMed - indexed for MEDLINE]

77: J Eur Acad Dermatol Venereol. 2008 Jun;22(6):722-8. Epub 2008 Feb 25.

Identification and characterization of 20 immunocompetent patients with
simultaneous varicella zoster and herpes simplex virus infection.

Giehl KA, Müller-Sander E, Rottenkolber M, Degitz K, Volkenandt M, Berking C.

Department of Dermatology, Ludwig-Maximilian University of Munich, Munich,
Germany.

BACKGROUND: It has been shown that varicella zoster virus (VZV) and herpes
simplex virus (HSV) can co-localize to the same sensory ganglion. However, only a
few case reports on VZV/HSV co-infections exist. Objective To identify and
characterize patients with concurrent VZV and HSV infection at the same body
site. SUBJECTS/METHODS: In 1718 patients, the presence of VZV and HSV in
suspicious skin lesions was investigated by polymerase chain reaction analysis.
Clinical characteristics of co-infected patients were compared with matched
control patients infected with either VZV or HSV. The data are discussed in the
context of an extensive review of the literature. RESULTS: Twenty (1.2%) of 1718 
patients were infected with both VZV and HSV at the same body site. The mean age 
was 54 years (range, 2-83). The clinical diagnosis was zoster in 65%, herpes
simplex in 20%, varicella in 10% and erythema multiforme in 5% of cases. The
trigeminus region was affected in 60% and the trunk in 25%. Involvement of the
head was most commonly associated with a severe course of disease and with older 
age. CONCLUSION: Simultaneous VZV/HSV infection is rare but can occur in
immunocompetent patients, which is often overlooked. The majority of cases is
localized to the trigeminus region and affects elderly people.

PMID: 18312326 [PubMed - indexed for MEDLINE]

78: J Paediatr Child Health. 2008 Mar;44(3):149-51.

Varicella with stridor: think group A streptococcal epiglottitis.

Sivakumar S, Latifi SQ.

Bacterial superinfection complicating varicella is not uncommon, but airway
complications are rare. We report a case of varicella in a 2-year-old boy
complicated by life-threatening stridor secondary to group A streptococcal
epiglottitis.

Publication Types: 
    Case Reports
    Letter

PMID: 18307422 [PubMed - indexed for MEDLINE]

79: Nepal Med Coll J. 2007 Dec;9(4):281-3.

Herpes zoster in a five month old infant subsequent to intrauterine exposure to
varicella infection.

Jha A, Kumar A, Paudel U, Neupane S, Pokhrel DB, Badal KP.

Department of Pathology, Tribhuvan University Teaching Hospital, Maharajgunj
Campus, Maharajgunj, Kathmandu, Nepal. jhaabhimanyu@yahoo.com

Herpes zoster is characterized by painful vesicular eruption in a dermatomal
distribution of sensory nerves as a result of reactivation of latent herpes
zoster virus in posterior root ganglia. The primary varicella infection is
usually acquired in childhood and reactivation usually is seen in elderly. In
rare instances herpes zoster can also occur in infancy as a result of
reactivation of primary varicella infection acquired in utero or in early
infancy. Here, we report a rare case of herpes zoster in a 5 month baby who
acquired primary infection in utero from mother who had varicella infection at 6 
months of gestation.

Publication Types: 
    Case Reports

PMID: 18298022 [PubMed - indexed for MEDLINE]

80: Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):26-33.

Varicella and the pregnant woman: prevention and management.

Daley AJ, Thorpe S, Garland SM.

Infection Control Department, The Royal Women's Hospital and The Royal Children's
Hospital, Melbourne, Australia. andrew.daley@rch.org.au

Infection with varicella zoster virus (VZV) is often considered a childhood
'right of passage'; however, primary infection occurring in women of
child-bearing age can have significant adverse consequences both for the mother
and for her fetus. During the first trimester, primary VZV infection may result
in stillbirth or a baby born with the stigmata of the congenital varicella
syndrome, while infection in the peripartum period can result in neonatal
varicella, which carries a significant mortality rate despite appropriate
antiviral therapy. Varicella in pregnant women can progress to pneumonitis and
other severe sequelae that may also compromise the viability of the fetus.
Exposure to VZV most commonly occurs in the community or from children in the
household, but occasionally, exposure may occur in the hospital environment.
Determining a woman's serostatus prior to pregnancy is advised, as effective
vaccines are now available and should be administered to non-pregnant
seronegative women of child-bearing age. Clinical practice guidelines for
management of a pregnant woman exposed to VZV are presented.

Publication Types: 
    Review

PMID: 18275568 [PubMed - indexed for MEDLINE]

81: Pediatr Blood Cancer. 2008 Oct;51(4):540-2.

Chickenpox in varicella IgG positive patients: experience of a regional
paediatric oncology centre.

Manley S, Mallinson H, Caswell M, Keenan R, Pizer B.

Department of Paediatric Oncology, RLC NHS Trust Alder Hey, Liverpool, UK.
sue.manley@rlc.nhs.uk

Aciclovir prophylaxis was previously given to all immunocompromised patients
treated by our unit, following contact with varicella zoster. In 2003, we changed
practice according to National Guidelines, giving prophylaxis only to patients
without serum varicella zoster immunoglobulin G antibody (VZ IgG) at diagnosis of
their malignancy. Since then we have seen nine patients with acute lymphoblastic 
leukaemia (ALL) and VZ IgG positivity at diagnosis of their malignancy develop
chickenpox. Our observations question current practice for patients with ALL. (c)
2008 Wiley-Liss, Inc.

PMID: 18273870 [PubMed - indexed for MEDLINE]

82: J Infect Dis. 2008 Mar 1;197(5):646-53.

Comment in:
    J Infect Dis. 2008 Mar 1;197(5):635-7.

Comment on:
    J Infect Dis. 2008 Mar 1;197(5):654-7.

Transmission of a newly characterized strain of varicella-zoster virus from a
patient with herpes zoster in a long-term-care facility, West Virginia, 2004.

Lopez AS, Burnett-Hartman A, Nambiar R, Ritz L, Owens P, Loparev VN, Guris D,
Schmid DS.

National Center for Immunizations and Respiratory Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia, USA. alopez@cdc.gov

We investigated a small outbreak of varicella in a long-term-care facility after 
a case of herpes zoster. Clinical specimens and environmental samples were
collected from all case patients and from surfaces in the case patients' rooms
and other common-use areas. Wild-type varicella-zoster virus (VZV) DNA was
identified in all 3 varicella case patients, and high concentrations of VZV DNA
were detected in environmental samples from the room of the herpes zoster case
patient. Genotypic analysis showed that the identical VZV strain was present in
all samples; moreover, the strain was a unique Mosaic genotype isolate that
included a stable Oka vaccine marker that had hitherto never been observed in a
wild-type strain of VZV. This study provides evidence for the value of including 
environmental sampling during the investigation of varicella outbreaks and
illustrates the importance of evaluating multiple vaccine-associated markers for 
the discrimination of vaccine virus from wild-type VZV.

Publication Types: 
    Comment

PMID: 18260757 [PubMed - indexed for MEDLINE]

83: Br J Clin Pharmacol. 2008 Feb;65(2):203-9.

Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft
tissue complications in patients with varicella or zoster disease.

Mikaeloff Y, Kezouh A, Suissa S.

Pediatric Department, Assistance publique-Hôpitaux de Paris, Bicêtre University
Hospital, Le Kremlin Bicêtre, France.

What is already known about this subject: Three previous epidemiological studies 
found an increased risk of severe skin and soft tissue infectious complications
associated with exposure to NSAIDs in children with varicella. In vitro studies
demonstrated that decreases in defences against infections induced by NSAIDs
could be due to impairment of neutrophil blood cell function. What this study
adds: The use of NSAIDs is associated with an increased risk of severe skin and
soft tissue complication of varicella in children. The use of NSAIDs is also
associated with a small increased risk of such complications in zoster disease in
adults and the elderly. This study supports the limited prescription of NSAIDs in
VZV infection. AIMS: To assess the risk of severe skin and soft tissue
complications associated with the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in treating patients with varicella zoster virus infection. METHODS: The
design was a nested case-control study, with matching for age and practice. The
setting was primary care in the United Kingdom (United Kingdom's General Practice
Research Database). Two population-based cohorts of all patients with a primary
varicella (n = 140,111) or zoster (n = 108,257) diagnosis during 1994-2005 were
followed up for 2 months after diagnosis. Main outcome measures of severe skin or
soft tissue complications (mostly cellulitis and abscess) associated with current
NSAID or paracetamol use were estimated, and adjusted for potential confounding
factors, including sex, drug use, and comorbidity. RESULTS: In patients with
varicella, there were 386 cases of severe skin or soft tissue complications (rate
2.8 per 1000) during the 2 month follow-up period (mean age 10.7 years). The rate
of complications associated with exposure to NSAIDs was increased (rate ratio
4.9; 95% CI 2.1, 11.4). In patients with zoster disease, there were 681 cases of 
severe skin or soft tissue complications (rate 6.3 per 1000) during the 2 month
follow-up (mean age 60.9 years). The rate ratio of complications associated with 
exposure to NSAIDs was 1.6 (95% CI 1.1, 2.4). In both conditions, there was no
increased risk of complication associated with a current exposure to paracetamol.
CONCLUSIONS: The use of NSAIDs is associated with an elevated risk of severe skin
and soft tissue complications of varicella zoster virus infection, mostly in
children with varicella.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18251759 [PubMed - indexed for MEDLINE]

84: Nurs Stand. 2008 Jan 9-15;22(18):23.

Another injection?

Moore A.

A national vaccination programme against chickenpox has been recommended by
researchers, but its implementation may be difficult.

PMID: 18240801 [PubMed - indexed for MEDLINE]

85: Pediatr Infect Dis J. 2008 Feb;27(2):119-24.

The burden of varicella complications before the introduction of routine
varicella vaccination in Germany.

Liese JG, Grote V, Rosenfeld E, Fischer R, Belohradsky BH, v Kries R; ESPED
Varicella Study Group.

Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich,
Germany. johannes.liese@med.uni-muenchen.de

BACKGROUND: The true burden of varicella complications in Germany is not known.
We investigated the incidence and pattern of varicella complications in children 
and adolescents using 3 independent surveillance sources. METHODS: Prospective
nationwide surveillance in all pediatric hospitals through the German Pediatric
Surveillance Unit [Erhebungseinheit für Seltene Pädiatrische Erkrankungen in
Deutschland (ESPED)] was used to ascertain hospitalized varicella cases in
children <or=16 years of age between January 2003 and December 2004. In the
federal state, North-Rhine Westphalia (NRW), a practice sentinel network
[European Diabetes Study Group (EURODIAB)] and pediatric hospital based
International Statistical Classification of Diseases and Related Health Problems,
10th Revision (ICD-10) surveillance were additionally used to refine incidence
estimates via capture-recapture methodology. RESULTS: A total of 918 hospitalized
varicella patients (male-to-female: 55%/45%) with a median age of 3.3 years
(interquartile range, 1.4-5.2) and a median hospital stay of 5 days
(interquartile range, 3-8) were reported. Varicella associated complications
occurred in 80% of the hospitalizations, most frequently being neurologic
(25.4%), skin infectious (23.2%), and gastrointestinal tract complications
(15.0%). Most hospitalizations (77%) occurred in previously healthy children. A
predisposing condition existed in 207 children (23%): immunosuppression 7%,
atopic dermatitis 7%, and other underlying chronic conditions 9%. Severity of
varicella complications was related to increasing age and immunosuppression.
Permanent or possible sequelae were reported in 15 (1.7%) and 78 (8.7%) of all
children, respectively; 10 children died. Capture-recapture analyses yielded an
incidence of 14.1 (95% confidence interval, 9.7-18.6) varicella
hospitalizations/100,000 children, corresponding to 1996 (95% confidence
interval, 1363-2629) varicella-related hospitalizations per year in Germany.
CONCLUSIONS: These data show that the severity of varicella complications in
healthy children has been previously underestimated.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18227713 [PubMed - indexed for MEDLINE]

86: Jpn J Infect Dis. 2008 Jan;61(1):65-7.

Molecular characterization of clinical varicella-zoster strains from India and
differentiation from the oka vaccine strain.

Kaushik KS, Lahiri KK, Chumber SK, Gupta RM, Kumar S, Kapila K, Karade S.

Department of Microbiology, Armed Forces Medical College, Pune, India.
mahakaroo@yahoo.com

With the introduction of varicella vaccination in India, surveillance of
circulating varicella-zoster strains has gained significance. The aim of the
present study was to achieve molecular characterization of circulating
varicella-zoster virus (VZV) strains and differentiation from the Oka vaccine
strain. In this study, the genotype of 100 clinical VZV strains was analyzed.
Vesicle fluid was collected from patients with VZV infections (92 cases of
varicella and 8 cases of herpes zoster). The PCR-RFLP analysis of two polymorphic
loci--a PstI restriction site in ORF 38 and a BglI restriction site in ORF 54 was
used to characterize and differentiate them from the vaccine strain. All the
wild-type strains were positive for the PstI restriction site in ORF 38. This
differentiated them from the Oka vaccine strain, which is PstI negative. The
wild-type strains as well as the Oka vaccine strain were positive for the BglI
restriction site in ORF 54. Thus, the genotype of all the VZV strains examined
had the wild-type pattern represented as PstI(+) BglI(+). None of the strains had
the PstI(-) BglI(+) genotype characteristic of the Oka strain or the PstI(+)
BglI(-) wild-type pattern. To conclude, PstI and BglI serve as good reference
markers in the genotyping of circulating varicella strains in India and serve to 
differentiate them from the vaccine strain as well as other wild-type strains.

PMID: 18219137 [PubMed - indexed for MEDLINE]

87: Minn Med. 2007 Dec;90(12):36-9.

Varicella surveillance and policy in the United States and Minnesota.

Murray A.

Minnesota Department of Health, USA.

An estimated 82.7% of Minnesota children 19 months to 35 months of age were
vaccinated against varicella in 2006 as a result of accepted national
recommendations, provider education, and vaccination mandates. Despite the
wide-ranging acceptance of vaccination, outbreaks of varicella continue to occur 
in schools and childcare centers, even those with a high percentage of vaccinated
children. As a result, national recommendations have been modified to include a
universal second dose of vaccine. Starting in September 2008, students entering
kindergarten or 7th grade in Minnesota will be required to provide documentation 
of having had 2 doses of varicella vaccine, a history of the disease, or legal
exemption.

PMID: 18196780 [PubMed - indexed for MEDLINE]

88: Acta Derm Venereol. 2008;88(1):26-30.

Bacterial skin infections in children hospitalized with varicella: a possible
negative impact of non-steroidal anti-inflammatory drugs?

Dubos F, Hue V, Grandbastien B, Catteau B, Martinot A.

Unit of Paediatric Emergency and Infectious Diseases, Jeanne de Flandre
University Hospital, Lille-2 University, Avenue E. Avinée, Lille cedex, France.
f-dubos@chru-lille.fr

This 1-year multicentre prospective study in northern France sought to evaluate
the incidence of secondary bacterial skin complications related to varicella,
describe these superinfections, and analyse risk factors for their onset. The
study included every child admitted to a district paediatric unit with a
varicella infection. Patients with varicella infection, with and without
secondary bacterial skin complication, were compared. The study included 159
children, 43 of whom had a secondary bacterial skin complication on admission, 21
of them had a severe secondary bacterial skin complication (respective incidence:
7.5 and 3.7/100,000 children younger than 16 years old). Persistence or
recurrence of fever > or =38.5 degrees C for > or =3 days after the beginning of 
varicella infection (adjusted odds ratio (aOR)=8.1; 95% confidence interval (CI):
2.3-28.4) and the use of non-steroidal anti-inflammatory drugs (aOR=4.8; 95% CI: 
1.6-14.4) were independent factors associated with severe secondary bacterial
skin complication.

Publication Types: 
    Multicenter Study

PMID: 18176746 [PubMed - indexed for MEDLINE]

89: Rheumatol Int. 2008 Jun;28(8):793-6. Epub 2008 Jan 3.

Exposition to chickenpox of two children with autoinflammatory syndromes under
treatment with anakinra.

Rigante D, Ansuini V, Berrettini A, Bersani G, Stabile A.

Department of Pediatric Sciences, Center of Periodic Fevers, Università Cattolica
Sacro Cuore, Rome, Italy. drigante@gmail.com

We report two children with autoinflammatory syndromes treated with anakinra who 
came in contact with the varicella-zoster virus after being exposed accidentally 
to infected children: both cases were managed prophylactically with specific
antichickenpox intravenous immunoglobulins and anakinra temporary suspension;
neither adverse events nor complications related to the natural course of
chickenpox were experienced by the two patients. The risk of developing
infectious events should be closely monitored, because of the absence of data
concerning long-term safety of biological agents in the pediatric age, and
prevention strategies should be highly encouraged before they are started.

Publication Types: 
    Case Reports

PMID: 18172653 [PubMed - indexed for MEDLINE]

90: Pediatr Infect Dis J. 2008 Jan;27(1):75-7.

Foscarnet salvage therapy for acyclovir-resistant varicella zoster: report of a
novel thymidine kinase mutation and review of the literature.

Hatchette T, Tipples GA, Peters G, Alsuwaidi A, Zhou J, Mailman TL.

Department of Pathology, QEII Health Centre, Halifax, Nova Scotia, Canada.

The authors describe an acyclovir-resistant varicella zoster virus infection in a
pediatric patient after hematopoietic stem cell transplant, the use of foscarnet 
as salvage therapy, and review the literature to clarify the pediatric experience
with foscarnet in this setting. A novel thymidine kinase mutation is described,
along with a new phenotypic assay for characterizing acyclovir resistance in
varicella zoster virus.

Publication Types: 
    Case Reports
    Review

PMID: 18162946 [PubMed - indexed for MEDLINE]

91: Klin Padiatr. 2008 Jul-Aug;220(4):268-70. Epub 2007 Dec 21.

Cellulitis with compartment syndrome as a complication of varicella zoster
infection.

Schwerk N, Rokahr C, Hansen G.

Medizinische Hochschule Hannover, Zentrum für Kinder- und Jugendmedizin,
Pädiatrische Pneumologie und Neonatologie, Hannover.
schwerk.nicolaus@mh-hannover.de

BACKGROUND: Varicella zoster infection (chickenpox) is a common and usually
benign self limiting disease of childhood in non-vaccinated populations. Although
varicella usually goes along with mild to moderate illness in immunocompetent
patients, serious complications can arise. Varicella is highly infectious, with
attack rates in susceptible individuals ranging from 61% to 100%. PATIENT: This
case describes a rare but life threatening complication of varicella zoster
infection in a child. CONCLUSIONS: High morbidity in non-vaccinated populations
that led to rare cases of severe complications became a significant health burden
all over the world. This aspect must be considered in the discussion about the
importance and benefit of a population wide varicella vaccination programme as it
was added to the childhood immunization schedule in Germany in 2004. The case
described here might have been avoided by vaccination.

PMID: 18157764 [PubMed - indexed for MEDLINE]

92: Dermatol Surg. 2007 Dec;33 Suppl 2:S159-67.

A single-center, open-label study on the use of injectable poly-L-lactic acid for
the treatment of moderate to severe scarring from acne or varicella.

Beer K.

Palm Beach Esthetic Center, West Palm Beach, Florida 33401-2717, USA.
kenbeer@aol.com

BACKGROUND AND OBJECTIVE: Acne scars may negatively impact quality of life. The
purpose of this study was to collect preliminary data on the efficacy and safety 
of injectable poly-L-lactic acid (PLLA, Sculptra, Dermik Laboratories) for the
treatment of acne scars. METHODS: Twenty subjects aged 42.4+/-10.7 years (10 men,
10 women) with facial scars resulting from moderate to severe acne or varicella
participated in this single-center, open-label prospective study. The primary end
point was the resolution of the acne or varicella scars. Secondary end points
were the physician and subject assessments of scar improvement. PLLA
reconstituted with 5 mL of sterile water was injected serially at or near the
sites of the acne scars without topical anesthesia. RESULTS:
Investigator-assessed reductions in acne scar size and severity were significant 
(p<.0001) during the course of seven treatments. Subject-rated reduction in scar 
severity was also significant (p=.0078). Subject satisfaction with treatment
trended toward an increase with each treatment session and approached
significance (p=.0899). Adverse events were limited to depression (n=1) not
related to the treatment. CONCLUSION: Injectable PLLA as used in this
investigation appears to correct the types of acne scars treated in this study
without serious adverse effects.

PMID: 18086054 [PubMed - indexed for MEDLINE]

93: Pediatr Emerg Care. 2007 Oct;23(10):719-20.

A 12-month-old infant with Fournier gangrene associated with varicella.

Cortés JR, Arratia JA, Jaime R.

Urology Service, University Hospital Dr José E. González UANL Monterrey, Nuevo
León, Mexico. jrcor77@yahoo.com

Fournier gangrene is a progressive infection of the genital and perianal regions.
It is a truly rare entity in association with varicella. There is only a single
case published in the literature. We present the second case of a Fournier
gangrene associated with varicella in an infant.

Publication Types: 
    Case Reports

PMID: 18090105 [PubMed - indexed for MEDLINE]

94: Pediatrics. 2008 Jan;121(1):e150-6. Epub 2007 Dec 17.

Primary varicella and herpes zoster among HIV-infected children from 1989 to
2006.

Wood SM, Shah SS, Steenhoff AP, Rutstein RM.

Special Immunology Service, Children's Hospital of Philadelphia, 34th Street and 
Civic Center Boulevard, Philadelphia, PA 19104, USA.

OBJECTIVES: The primary objective of this study was to determine the incidence of
herpes zoster in perinatally HIV-infected children. Secondary objectives included
assessing the impact of highly active antiretroviral therapy and varicella zoster
virus immunization on primary varicella and herpes zoster incidence and
identifying risk factors for herpes zoster. We hypothesized that the incidence of
herpes zoster has decreased in this population as a result of highly active
antiretroviral therapy and routine varicella zoster virus immunization. PATIENTS 
AND METHODS: This retrospective cohort study included HIV-infected children at a 
pediatric HIV clinic from 1989 to 2006. Incidence rates for 3 intervals
(1989-1996, 1997-1999, and 2000-2006) were compared on the basis of introduction 
of highly active antiretroviral therapy (1996) and varicella zoster virus
vaccination (1999). A Cox proportional-hazards regression model was developed for
the time to herpes zoster among the subset of patients with primary varicella
infection. RESULTS: In 356 patients followed for 1721 person-years, the incidence
of herpes zoster according to period was 30.0 per 1000 person-years in 1989-1996,
31.9 per 1000 person-years in 1997-1999, and 6.5 per 1000 person-years in
2000-2006. There was no difference in incidence-rate ratio between 1989-1996 and 
1997-1999. However, there was a significant difference in herpes zoster incidence
when comparing 1989-1999 with 2000-2006. The incidence of primary varicella
zoster virus infection and herpes zoster in the 57 patients who received the
varicella zoster virus vaccine was 22.3 per 1000 and 4.5 per 1000 person-years,
respectively. Highly active antiretroviral therapy at the time of primary
varicella zoster virus infection was protective against herpes zoster and
increased herpes zoster-free survival. CONCLUSIONS: The incidence of herpes
zoster has decreased since 1989. The decline occurred after 2000, likely
representing the combined effect of immunization and highly active antiretroviral
therapy. The use of highly active antiretroviral therapy at the time of primary
varicella zoster virus infection decreased the risk of herpes zoster and
increased herpes zoster-free survival. Varicella zoster virus immunization was
effective in preventing both primary varicella zoster virus and herpes zoster in 
this cohort.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18086820 [PubMed - indexed for MEDLINE]

95: Acta Paediatr. 2008 Feb;97(2):187-92. Epub 2007 Dec 10.

Varicella-related deaths in children and adolescents--Germany 2003-2004.

Grote V, von Kries R, Springer W, Hammersen G, Kreth HW, Liese J.

Institute of Social Pediatrics and Adolescent Medicine,
Ludwig-Maximilians-University of Munich, Munich, Germany.
veit.grote@med.uni-muenchen.de

AIM: Although varicella is acknowledged as a rare cause of death in children,
there are few comprehensive data with respect to the clinical course leading to
death. METHODS: A nationwide, active surveillance was carried out in Germany for 
children up to age 17 years who were admitted to a paediatric hospital for
varicella or associated complications, including deaths. RESULTS: A total of 10
children with varicella-associated death were reported over period of 2 years,
yielding a mortality rate of 0.4/1 000 000 children per year. Three deaths
occurred in children diagnosed with acute lymphocytic leukaemia and disseminated 
varicella, two shortly after diagnosis of leukaemia and therefore not
preventable, and one during remission with an untypical presentation. Two
children died with a congenital varicella syndrome. There was no death in
children with neonatal varicella. Four other cases were related to varicella
pneumonia or septicaemia and one to myocarditis. CONCLUSION: In a population with
no general varicella vaccination programme, varicella accounted for a small but
not negligible risk for death in immunocompetent and immunocompromised children. 
Together these data point to the importance of a thoroughly implemented, general 
varicella vaccination programme.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 18076716 [PubMed - indexed for MEDLINE]

96: Eur J Pediatr. 2008 Oct;167(10):1199-201. Epub 2007 Dec 6.

Post varicella hepatic actinomycosis in a 5-year-old girl mimicking acute
abdomen.

Guven A, Kesik V, Deveci MS, Ugurel MS, Ozturk H, Koseoglu V.

Department of Pediatric Surgery, Gulhane Military Medical Academy, Etlik/Ankara, 
06017, Turkey. drahmetguven@yahoo.com

Actinomycosis is an indolent, slowly progressive infection caused by
gram-positive, anaerobic or microaerophilic bacteria. Hepatic involvement is rare
and generally secondary to abdominal or thoracic actinomycosis. Hepatic
actinomycosis in children may mimic a wide variety of diseases and thus make the 
diagnosis much more challenging. Here, we report a 5-year-old girl with
apparently primary hepatic actinomycosis mimicking acute abdomen 2 weeks after
varicella. The diagnosis was made by ultrasonic guided fine needle aspiration
biopsy of a hypoechoic lesion of 3.5 cm diameter in the liver showing sulfur
granules surrounded by neutrophils. Hepatic actinomycosis should be taken into
account when evaluating acute abdomen symptoms in children.

Publication Types: 
    Case Reports

PMID: 18066595 [PubMed - indexed for MEDLINE]

97: Herpes. 2007 Sep;14 Suppl 2:48-51.

Prevention strategies: experience of varicella vaccination programmes.

Patrick D.

University of British Columbia, Centre for Disease Control, Vancouver, BC,
Canada. david.patrick@bccdc.ca

Widespread immunization programmes have had a dramatic effect on the morbidity
associated with varicella in the USA; mortality has declined by 66% (from 0.41 to
0.14 deaths / million population) and the reduction in hospitalizations is at
least 4-fold (from 2.7 to 0.6/100,000 population) compared with the
pre-vaccination era. Although varicella outbreaks have occurred in vaccination
areas, these data may underestimate the true efficacy of the varicella vaccine,
and there is still the potential for two-dose programmes, which have not yet been
fully explored in the USA or Canada. Catch-up vaccination programmes have also
been regarded as an important approach in susceptible individuals, including
women of childbearing potential. Periodic exposure (boosts) to vaccines may
potentially help prevent the reactivation of herpes zoster and accumulation of
susceptibility in these at-risk groups. Pregnant women may also benefit from
prophylaxis with varicella zoster immunoglobulin (VZIG) or possibly with
aciclovir. Ongoing surveillance for the reactivation of herpes zoster and safety 
programmes are also highlighted as key recommendations.

PMID: 17939897 [PubMed - indexed for MEDLINE]

98: Herpes. 2007 Sep;14 Suppl 2:25-9.

Erratum in:
    Herpes. 2007 Dec;14(3):74.

Varicella zoster virus: natural history and current therapies of varicella and
herpes zoster.

Breuer J, Whitley R.

Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts,
UK. j.breuer@qmul.ac.uk

The natural history of varicella zoster virus (VZV) infection and the molecular
mechanisms of viral pathogenesis are incompletely understood. Although no animal 
model yet reproduces all aspects of VZV infection, recently developed models of
VZV infection, and the creation of genetically altered VZV recombinants, are
yielding new information about primary viraemia and latency. During viraemia,
T-cells transport VZV to the skin, where cell-free viral replication facilitates 
person-to-person spread and transmission to the neurons where latency is
established. The alternate viral pathways of lytic infection or latency appear to
be cell-type determined and involve both host and viral components. Antiviral
therapy for varicella is safe and efficacious, and as varicella in children is
usually mild, treatment is generally recommended only for adolescents and adults 
with varicella. Treatment is recommended for all individuals with herpes zoster, 
especially those aged over 50 years. For some varicella and zoster cases,
aciclovir, the original standard, is being replaced by valaciclovir and
famciclovir as preferred therapies. For herpes zoster, bromovinyl deoxyuridine
(brivudin) has been added to the list of treatment options for immunocompetent
individuals, but is contraindicated in patients with cancer. Antiviral therapy
will still have a role in the treatment of disease caused by VZV even after the
widespread implementation of vaccination programmes for both chickenpox and
herpes zoster.

PMID: 17939892 [PubMed - indexed for MEDLINE]

99: Infection. 2007 Dec;35(6):444-50. Epub 2007 Nov 22.

Hospitalization rates for complicated and uncomplicated chickenpox in a poorly
vaccined pediatric population.

Bonsignori F, Chiappini E, Frenos S, Peraldo M, Galli L, de Martino M.

Department of Paediatrics, University of Florence, Anna Meyer Children's
Hospital, via Luca Giordano, 13, I-50132, Florence, Italy.

BACKGROUND: A retrospective study was conducted to provide epidemiological data
on hospitalization for complicated and uncomplicated chickenpox in a pediatric
population. METHODS: The study analyzed hospitalization cases for chickenpox,
among all the 31 Tuscan hospitals, during the period 1997-2003. RESULTS:
Globally, 650 cases were recorded (306 = 47.07% for uncomplicated and 344 =
52.92% for complicated chickenpox). Total hospitalization rate was 22.66 per
100,000 living Tuscan children and 11.52 per 1,000 notified chickenpox cases.
Hospitalization rates for complicated chickenpox were 12.00 per 100,000 living
children and 6.09 per 1,000 notified cases. Notably, significantly increased
hospitalization rates for complicated chickenpox were evidenced over years (p =
0.011 per 100,000 living children and p = 0.001 per 1,000 notified cases), due to
the increased proportion of neurological (p = 0.043 per 100,000 living children
and p = 0.025 per 1,000 notified cases) and respiratory (p = 0.021 per 100,000
living children and p = 0.008 per 1,000 notified cases) complications, whereas
hospitalization rates for other complications as well as for uncomplicated
chickenpox remained constant (p = 0.25 per 100,000 living children and p = 0.09
per 1,000 notified cases). CONCLUSIONS: Chickenpox complications, requiring
hospitalization, occurred at a substantial rate in our pediatric population. In
particular, increasing hospitalization rates for neurological and respiratory
complications were evidenced over the study period. Our epidemiological data may 
provide additional information while planning a vaccination strategy for Italy.

PMID: 18034210 [PubMed - indexed for MEDLINE]

100: J Clin Neurosci. 2007 Dec;14(12):1230-3.

MRI findings in acute disseminated encephalomyelitis following varicella
infection in an adult.

Sawanyawisuth K, Phuttharak W, Tiamkao S, Boonpila A.

Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen,
Thailand. kittisak@kku.ac.th

There are no abnormal magnetic resonance imaging (MRI) findings in children with 
acute disseminated encephalomyelitis (ADEM) after varicella infection. Here, we
report abnormal MRI findings in an adult, namely: hyperintense signal in the
right medullary olive, the right side of the pons, the left middle cerebellar
peduncle, the dorsal aspect of both thalami and the periventricular white matter 
of both cerebral hemispheres. The patient's condition improved after 1 week of
corticosteroid treatment. Four months later, MRI of the brain showed almost
complete resolution and there were no further attacks of motor weakness at
18-months follow-up.

Publication Types: 
    Case Reports

PMID: 18029277 [PubMed - indexed for MEDLINE]

101: Eur J Clin Microbiol Infect Dis. 2008 Mar;27(3):223-6. Epub 2007 Nov 16.

The epidemiology of varicella in school-aged Greek children before the
implementation of universal vaccination.

Katsafadou A, Ferentinos G, Constantopoulos A, Papaevangelou V.

Second Pediatric Clinic, Agia Sophia Children's Hospital, Goudi, Greece.

Data on local epidemiology is necessary when deciding on the introduction of a
vaccine. Parents of children attending 1st and 6th grades completed a
questionnaire on demographical data and varicella history. Analyzing 70,226
questionnaires, varicella was reported in 63.6% and 78.6% of 1st and 6th grade
children, respectively (mean age 4.75 years), indicating that a quarter of
children entering adolescence are susceptible. Children attending day care and
children with older siblings had contracted chickenpox at a younger age. In
conclusion, in Greece, in addition to introducing universal varicella
vaccination, it is necessary to identify older children at risk and offer
catch-up vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18026762 [PubMed - indexed for MEDLINE]

102: Med Microbiol Immunol. 2008 Sep;197(3):329-33. Epub 2007 Nov 15.

Seroprevalence of varicella zoster virus infection in child and adult population 
of Catalonia (Spain).

Salleras L, Domínguez A, Plans P, Costa J, Cardeñosa N, Torner N, Plasència A.

Department of Public Health, University of Barcelona, Barcelona, Spain.

The aim of this study was to determine the prevalence of varicella IgG antibodies
in the population of Catalonia, and the variables associated. The study was
carried out in 2002 in a representative sample of juvenile (5-14 years) and adult
population (> or =15 years) of Catalonia (Spain). The global prevalence
determined by ELISA test was 95.5% (95% CI 94.7-96.3). The prevalence increased
with age, from 82% (95% CI 77.0-87.0) in the 5-9 years age up to 99.4% (95% CI
98.2-100) in >64 years of age. No statistically significant differences in the
seroprevalence according to the sociodemographic variables were observed. The
current strategy of vaccinating preadolescents at 12 years of age who have not
suffered the disease will require more than 30 years to cover the current gap
immunity in adolescents and young adults. Vaccination with two doses of vaccine
for all adolescents and adults < or = 50 years who report not having suffered the
disease during childhood should be considered.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18004592 [PubMed - indexed for MEDLINE]

103: Arch Dis Child. 2007 Dec;92(12):1062-6. Epub 2007 Nov 8.

Comment in:
    Arch Dis Child. 2007 Dec;92(12):1051-2.

Severe complications of chickenpox in hospitalised children in the UK and
Ireland.

Cameron JC, Allan G, Johnston F, Finn A, Heath PT, Booy R.

Health Protection Scotland, Glasgow G3 7LN, Scotland, UK.
claire.cameron@hps.scot.nhs.uk

AIMS: To estimate the annual incidence of hospitalisations due to severe
complications of varicella, describe the complications and estimate annual
mortality. METHODS: Active surveillance throughout the UK and Ireland for 13
months by paediatricians notifying cases to the British Paediatric Surveillance
Unit and completing a questionnaire. The case definition was any child aged <16
years hospitalised with complicated varicella, as defined by a list of
conditions, or admitted to ICU/HDU with varicella. RESULTS: 188 cases were
notified for the surveillance period, of which 112 (0.82/100 000 children/year)
met the case definition and were not duplicates. Confirmed cases had a median age
of 3 years (range 0-14). The complications were: bacteraemia/septic shock (n =
30), pneumonia (n = 30), encephalitis (n = 26), ataxia (n = 25), toxic shock
syndrome/toxin-mediated disease (n = 14), necrotising fasciitis (n = 7), purpura 
fulminans/disseminated coagulopathy (n = 5), fulminant varicella (n = 5) and
neonatal varicella (n = 3). 52 children (46%) had additional bacterial
infections. Six deaths were due, or possibly due, to varicella, including one
intrauterine death. Four of the other five children who died (ages 2-14 years)
had a pre-existing medical condition. Sequelae on discharge were reported for 41 
cases (40%), most frequently ataxia or skin scarring. The median length of
hospital stay was 7 days (range 1-68). CONCLUSIONS: This study provides a minimum
estimate of severe complications and death resulting from varicella in children
in the UK and Ireland. Most complications, excluding deaths, occur in otherwise
healthy children and thus would be preventable only through a universal childhood
immunisation programme.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17991685 [PubMed - indexed for MEDLINE]

104: Compr Ther. 2007 Spring;33(1):25-31.

Acute retinal necrosis complicating chickenpox in a healthy adult--a case report 
and review of literature.

Tajunisah I, Reddy SC.

Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala
Lumpur, 50603, Malaysia. tajun69@yahoo.com

Acute retinal necrosis (ARN) is known to occur in conjunction with primary
varicella or chickenpox infection. The majority of ARN cases reported in the
literature were of milder form with mild to moderate vitritis, limited retinitis,
and rare occurrence of retinal breaks or detachment that responded well to
intravenous acyclovir, with or without oral prednisolone. We report a case of
unilateral ARN with marked vitritis and retinal necrosis leading to retinal
breaks following chickenpox in a 32-year-old healthy lady. This patient was
successfully treated with intravenous acyclovir followed by oral acyclovir and
orbital floor triamcinolone injections to contain the inflammation with barrier
laser therapy to secure the retinal breaks with good visual outcome. This case is
unusual in its severity, and to our knowledge, orbital floor triamcinolone
therapy was not used earlier to contain ARN inflammation.

Publication Types: 
    Case Reports
    Review

PMID: 17984490 [PubMed - indexed for MEDLINE]

105: Front Biosci. 2008 Jan 1;13:2696-704.

Prevention of varicella and zoster by live attenuated VZV vaccine.

Hambleton S.

Children's Bone Marrow Transplant Unit, Newcastle General Hospital, Westgate
Road, Newcastle upon Tyne, NE4 6BE, United Kingdom. shambleton@doctors.org.uk

An effective and safe live attenuated vaccine against varicella zoster virus was 
developed in Japan in the 1970s and has been in widespread use since the
mid-1990s. In the United States, universal vaccination has brought about striking
reductions in varicella incidence together with associated hospitalizations and
mortality. However, it is clear that varicella will continue to occur even in
highly immunized populations, owing to the ability of VZV to reactivate as
zoster. In addressing this challenge, attention is currently focused on efforts
to minimize the proportion of susceptible individuals by administering a second
dose of vaccine to children. The potential of the newly licensed zoster vaccine
to reduce viral circulation still further has yet to be evaluated.

Publication Types: 
    Review

PMID: 17981744 [PubMed - indexed for MEDLINE]

106: Pediatrics. 2007 Nov;120(5):e1345-9.

Severe varicella caused by varicella-vaccine strain in a child with significant
T-cell dysfunction.

Jean-Philippe P, Freedman A, Chang MW, Steinberg SP, Gershon AA, LaRussa PS,
Borkowsky W.

Department of Pediatrics, New York University School of Medicine, New York, New
York, USA. jeanphilippep@niaid.nih.gov

In March 1995, the US Food and Drug Administration approved a live attenuated
varicella vaccine for use in healthy children 12 months to 12 years old. We
report here an 18-month-old girl with cell-mediated immunodeficiency who
developed a severe vaccine-associated rash and clinical evidence of
vaccine-associated pneumonia 1 month after inadvertent receipt of varicella
vaccine.

Publication Types: 
    Case Reports
    Review

PMID: 17974726 [PubMed - indexed for MEDLINE]

107: Pediatr Dermatol. 2007 Sep-Oct;24(5):558-60.

Accentuated varicella exanthems due to cast application.

Kara A, Kurtul T, Ilke N, Yildirim I, Devrim I, Cengiz AB, Tezer H, Seçmeer G.

Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara,
Turkey. ateskara@hacettepe.edu.tr

We report a case of 14-year-old male with local augmentation of varicella zoster 
exanthems on the forearm on which cast application was performed. After 1 week,
the first varicella zoster exanthems began to appear on the left forearm under
the cast and trunk, while lesions on the other forearm and extremities were very 
rare. We postulated that the local pressure and heat increased the number of
exanthems.

Publication Types: 
    Case Reports

PMID: 17958813 [PubMed - indexed for MEDLINE]

108: Curr Med Res Opin. 2007 Dec;23(12):2945-54.

Cost of varicella-related hospitalisations in an Italian paediatric hospital:
comparison with possible vaccination expenses.

Azzari C, Massai C, Poggiolesi C, Indolfi G, Spagnolo G, De Luca M, Gervaso P, de
Martino M, Resti M.

Paediatric Immunology Unit, Anna Meyer Children's Hospital and University of
Florence, Florence, Italy. chiara.azzari@unifi.it

OBJECTIVE: The aims of the study were to evaluate the economic burden of
hospitalisations due to varicella in an Italian paediatric hospital during a
1-year period and to compare the data with potential expenses projected for a
varicella mass vaccination programme. RESEARCH DESIGN AND METHODS: An
observational, retrospective, cohort study was designed to measure hospital
admission costs in a cohort of paediatric patients with varicella in a 12-month
period. A cost comparison with a vaccination programme planned to prevent
varicella in a whole birth cohort was performed. All children 0-16 years referred
to the Anna Meyer Children's Hospital (AMCH) were considered. Since AMCH is a
tertiary-level hospital and accept patients from other Italian regions, in order 
to avoid overestimation of hospitalisation expenses, all analyses pertaining to
both vaccination and hospitalisation costs were uniquely calculated on the basis 
of the cohort of residents in the district of Florence. RESULTS: A total of 279
children were examined in the emergency department for varicella; 47/279 (16.8%) 
were sent to the inpatient clinic. The highest rate of hospitalisation (85.1%)
was found in children < 4 years of age, and the largest number of complications
(87.2%) occurred in previously healthy children. Mean length of hospitalisation
(5.7 +/- 0.6 days) was similar to that reported in other western countries.
CONCLUSION: Excluding any indirect cost, permanent sequelae and serious outcomes 
such as death, hospital expenses (corresponding to euro239 654 in a 1-year
period), would account for around 80% of total expenses for vaccinating an entire
birth cohort (euro310353).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17937842 [PubMed - indexed for MEDLINE]

109: Ann Ophthalmol (Skokie). 2007 Spring;39(1):57-62.

Acute retinal necrosis complicating chicken pox in a healthy adult: a case report
and review of literature.

Tajunisah I, Reddy SC.

Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala
Lumpur, 50603, Malaysia. tajun69@yahoo.com

We report a case of unilateral acute retinal necrosis (ARN) with marked vitritis 
and retinal necrosis leading to retinal breaks following chicken pox successfully
treated with intravenous acyclovir followed by oral acyclovir, orbital floor
triamcinolone injections to contain the inflammation, and barrier laser therapy
to secure the retinal breaks with good visual outcome. This case is unusual in
its severity and the novel use orbital floor triamcinolone therapy to contain ARN
inflammation.

Publication Types: 
    Case Reports
    Review

PMID: 17914207 [PubMed - indexed for MEDLINE]

110: J Dtsch Dermatol Ges. 2007 Oct;5(10):875-80.

Varicella vaccination in children with atopic eczema.

[Article in English, German]

Kienast AK, Kreth HW, Höger PH.

Catholic Children's Hospital Wilhelmstift, Hamburg, Department of Pediatric
Dermatology.

Chickenpox in children may be complicated by local or systemic bacterial
infections. Group A streptococci and S. aureus are the predominant pathogens.
Children with atopic dermatitis are particularly prone to bacterial
superinfection. After the introduction of universal varicella vaccination in the 
USA ten years ago, the number of serious bacterial soft tissue infections in
children dropped significantly. Since 2004, the VZV immunization has also been
included in the routine German series.Many children with atopic dermatitis have
not been immunized because of concerns on the part of parents or physicians.
Recent studies demonstrated the safety and efficacy of VZV vaccination in
children with atopic dermatitis who appear to benefit particularly from this
vaccination.

Publication Types: 
    Review

PMID: 17910669 [PubMed - indexed for MEDLINE]

111: Clin Nucl Med. 2007 Oct;32(10):820-1.

Acute varicella infection mimics recurrent Hodgkin's disease on F-18 FDG PET/CT.

Sheehy N, Israel DA.

Dana Farber Cancer Institute, Boston, MA 02115, USA. nsheehy@partners.org

We report a case where acute varicella infection, chickenpox, mimics the findings
of recurrent Hodgkin disease on F-18 FDG PET/CT. A 28-year-old man with a history
of Hodgkin disease in remission had fatigue, pyrexia, and a raised ESR. His F-18 
FDG PET/CT, performed to exclude lymphoma recurrence, demonstrated FDG-avid
lymphadenopathy and increased FDG uptake in his spleen. A day later he developed 
the generalized rash of acute varicella infection. This was managed with
valacyclovir. Repeat F-18 FDG PET/CT done 1 month later showed no evidence of
FDG-avid disease. In this patient the stimulation of an immune response by the
acute viral infection mimics recurrent lymphoma.

Publication Types: 
    Case Reports

PMID: 17885370 [PubMed - indexed for MEDLINE]

112: Acta Paediatr. 2007 Oct;96(10):1490-3.

Epidemiology of hospital admissions for chickenpox in children: an Italian
multicentre study in the pre-vaccine era.

Marchetto S, de Benedictis FM, de Martino M, Versace A, Chiappini E, Bertaine C, 
Osimani P, Cordiali R, Gabiano C, Galli L.

Department of Paediatrics, University of Florence, Florence, Italy.

AIM: To describe the chickenpox complications in children in Italy. METHODS:
Hospital discharge data from 1 January 2002 to 15 June 2006 were queried for
patients less than 18 years of age in three Italian paediatric university
hospitals. RESULTS: During the study period, 349 children (189 males, 160
females) were admitted. Thirteen out of 349 (3.7%) of them had serious underlying
diseases. Two hundred and sixty-one (74.8%) children (median age: 41 months,
range: 6 days -to 200 months) had complicated chickenpox. Among complications,
neurological disorders were the most common (100/261 = 38.3%), followed by skin
and soft tissue infections (63/261 = 24.1%), lower respiratory tract infections
(57/261 = 21.8%) and haematological disorders (24/261 = 9.2%). Children with
neurological complications were significantly older and had a longer hospital
stay than those with other complications. Three children with encephalitis and
cerebellitis had developed long-term sequelae by the 6-month follow-up. The
mortality rate was 0.4% (1/261 children with complicated chickenpox). CONCLUSION:
Chickenpox is a disease that can provoke serious complications and long hospital 
stays, even in healthy children. Our findings may be useful as background to
evaluate the impact of a tetravalent measles-mumps-rubella-varicella vaccine
(MMRV) which is going to be introduced in Italy.

Publication Types: 
    Multicenter Study

PMID: 17880417 [PubMed - indexed for MEDLINE]

113: Pediatr Dermatol. 2007 Jul-Aug;24(4):429-32.

Chronic varicella-zoster skin infection complicating the congenital varicella
syndrome.

Boussault P, Boralevi F, Labbe L, Sarlangue J, Taïeb A, Leaute-Labreze C.

Pediatric Dermatology Unit National Reference Center for Rare Skin Disorders,
Pellegrin Children's Hospital, Bordeaux Cedex, France.

Congenital varicella is a rare syndrome arising when a pregnant woman develops
varicella before the 24th week of pregnancy. We report an occurrence of
congenital varicella syndrome complicated by a chronic varicella zoster virus
skin infection in an immunocompetent infant. The chronic verrucous skin infection
is puzzling in our patient, as this disease is usually described in
immunosuppressed patients.

Publication Types: 
    Case Reports

PMID: 17845179 [PubMed - indexed for MEDLINE]

114: Indian J Pediatr. 2007 Aug;74(8):774-6.

Recurrent herpes zoster in early childhood.

Ganga Devi NP, Rathinam SN, Ramachandran R, Swaminathan S.

Tuberculosis Research Centre, Chennai, India.

Herpes Zoster is produced by reactivation of latent Varicella Zoster Virus from
the dorsal root ganglion of sensory nerves. It is common in older individuals and
rarely described in the pediatric age group. We report a case of recurrent herpes
zoster in a 3-year-old HIV positive child involving T4 dermatome on the first
occasion and subsequently involving T10 dermatome. The child responded well to
oral acyclovir.

Publication Types: 
    Case Reports

PMID: 17785904 [PubMed - indexed for MEDLINE]

115: Ann Acad Med Singapore. 2007 Aug;36(8):636-41.

Seroepidemiology of varicella and the reliability of a self-reported history of
varicella infection in Singapore military recruits.

Dashraath P, Ong ES, Lee VJ.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

INTRODUCTION: Varicella is an acute disease with significant morbidity. However, 
there is little knowledge on the seroepidemiology of the disease in Singapore.
The objective of this study was to assess the seroprevalence of varicella zoster 
virus (VZV) antibodies in military recruits in Singapore and to ascertain the
predictive value of a self-reported history of varicella. The latter is a
possible proxy for seroprevalence, and may be used to provide efficient
identification of candidates for vaccination. MATERIALS AND METHODS: From
September 2000 to October 2005, 2189 servicemen were selected during their
pre-enlistment medical check-up. Blood samples were obtained to determine the
varicella IgG levels via enzyme-linked immunosorbent assay (ELISA). Information
about the participant's race, history of varicella and vaccination, and other
clinical variables were obtained through a questionnaire. RESULTS: The overall
prevalence of VZV seropositivity in military recruits was 76.0% (75.8% in the 16 
years to 20 years age group). For the reported history, 73.7% of Chinese
participants, 73.0% of Malays, and 63.6% of Indians reported having had varicella
infection and/or vaccination. Overall, the sensitivity, specificity, positive and
negative predictive values of a self-reported history of varicella for
serologically confirmed immunity were 87.2%, 83.2%, 94.3% and 67.1% respectively.
CONCLUSIONS: The prevalence of VZV antibodies in pre-enlistees to the Singapore
Armed Forces (SAF) is high. Incidence of varicella in the SAF is on the wane,
indicating an increase in herd immunity against VZV. A recalled history of
varicella infection was also a good predictor of serological immunity and may be 
used for selection for vaccination.

Publication Types: 
    Validation Studies

PMID: 17767333 [PubMed - indexed for MEDLINE]

116: J Infect Dis. 2007 Oct 1;196(7):1014-20. Epub 2007 Aug 29.

Varicella-zoster-virus genotypes in East London: a prospective study in patients 
with herpes zoster.

Sengupta N, Taha Y, Scott FT, Leedham-Green ME, Quinlivan M, Breuer J.

Department of Virology, Centre for Infectious Diseases, Institute of Cell
Molecular Sciences, Queen Mary School of Medicine and Dentistry, Barts,
Whitechapel, London, E1 2AT, United Kingdom. n.sengupta@qmul.ac.uk

A total of 298 patients with herpes zoster were recruited as part of 2
community-based studies in East London between 1998 and 2003. Single
nucleotide-polymorphism analysis of 4 regions (genes 1, 21, 37, and 60) found
that most genotypes were European strains C and B, representing 58% and 21% of
all samples collected. No change in the proportion of these European clades has
occurred during the past 80 years, strongly supporting the hypothesis that these 
strains are indigenous to the United Kingdom. White patients almost exclusively
had reactivation of genotypes C (66%) and B (21%), whereas patients from Africa, 
Asia, or the Caribbean mainly had reactivation of genotypes A and J. An increase 
in BglI-positive A and J genotypes in UK cases of zoster is only partly explained
by immigration from endemic regions. The data presented provide a baseline
against which to evaluate changes in the molecular epidemiology of
varicella-zoster virus and the effect of immunization with the Japanese Oka
vaccine strain.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17763323 [PubMed - indexed for MEDLINE]

117: J Clin Virol. 2007 Oct;40(2):129-34. Epub 2007 Aug 28.

Detection and differentiation of wild-type and vaccine mutant varicella-zoster
viruses using an Invader Plus method.

Tang YW, Allawi HT, DeLeon-Carnes M, Li H, Day SP, Schmid DS.

Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
37232, USA. yiwei.tang@vanderbilt.edu

We report the use of a prototype Invader Plus method (Third Wave Technologies,
Inc., Madison, WI) for the qualitative detection of varicella-zoster virus (VZV) 
and differentiation of wild-type and Oka vaccine VZV. The analytical sensitivity 
of the VZV Invader Plus reagents is at 10 copies per reaction. A total of 174
skin and mucous swab specimens were used to validate the assay's performance. The
sensitivity and specificity were 98.3% and 98.1%, respectively, in comparison to 
a PCR-EIA assay. A perfect 100% agreement was obtained when VZV wild-type and
vaccine differentiation was performed on 54 VZV-positive swab specimens against
an allele-specific FRET real-time assay. The Invader Plus method provides another
reliable tool for qualitative detection of VZV and differentiation of wild-type
and vaccine virus.

PMID: 17728179 [PubMed - indexed for MEDLINE]

118: Emerg Med J. 2007 Sep;24(9):682-3.

Varicella zoster induced cardiac dysfunction: a case report.

Dennison P, Zaremba E.

Dorset County Hospital, Dorchester, UK. paddydennison@hotmail.com

A case is presented of cardiac arrhythmia associated with varicella zoster
infection, affecting a 34-year-old man. The patient presented with episodes of
seizure-like activity, which were subsequently shown to be caused by ventricular 
fibrillation. The literature regarding this unusual complication of varicella
zoster infection is discussed, as it affects both children and adults. Physicians
who may face this condition, in accident and emergency, acute medicine, critical 
care medicine and infectious diseases, should all be aware of this serious
complication.

Publication Types: 
    Case Reports

PMID: 17711965 [PubMed - indexed for MEDLINE]

119: Med Princ Pract. 2007;16(5):399-401.

Occupationally related outbreak of chickenpox in an intensive care unit.

Aly NY, Al Obaid I, Al-Qulooshi N, Zahed Z.

Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of
Alexandria, Alexandria, Egypt. nasseryehia@gmail.com

OBJECTIVE: To report occupationally related outbreak of chickenpox in intensive
care unit (ICU). CASE PRESENTATION AND INTERVENTION: The index patient was a
4-year-old child who presented with a 3-day history of fever and rash and was
clinically diagnosed as chickenpox encephalitis. She was admitted to an isolation
room in ICU, kept on oxygen mask and given intravenous fluids, anticonvulsant,
antipyretic and acyclovir. Twelve hours later, the patient was transferred to
Infectious Diseases Hospital. Secondary cases were three unvaccinated ICU staff
nurses who developed chickenpox 16-21 days following exposure. They were also
transferred to Infectious Diseases Hospital. The affected nurses were interviewed
and filled out a questionnaire. Individual immune status was verified by
reviewing previous varicella zoster-IgG screening data for all ICU staff. The
chickenpox case was defined according to the CDC case classification. All were
treated with no complications. CONCLUSION: This report shows that adherence to
isolation precautions, exclusion of susceptible staff from attending the affected
patient, education, pre-employment anti-VZV-IgG screening and vaccine coverage of
staff could have prevented the occurrence of this outbreak. 2007 S. Karger AG,
Basel

Publication Types: 
    Case Reports

PMID: 17709931 [PubMed - indexed for MEDLINE]

120: Proc Natl Acad Sci U S A. 2007 Aug 28;104(35):14086-91. Epub 2007 Aug 20.

Aberrant infection and persistence of varicella-zoster virus in human dorsal root
ganglia in vivo in the absence of glycoprotein I.

Zerboni L, Reichelt M, Jones CD, Zehnder JL, Ito H, Arvin AM.

Departments of Pediatrics, Stanford University School of Medicine, Stanford, CA
94305, USA. zerboni@stanford.edu

Varicella-zoster virus (VZV) causes varicella, establishes latency in sensory
ganglia, and reactivates as herpes zoster. Human dorsal root ganglia (DRGs)
xenografts in immunodeficient mice provide a model for evaluating VZV
neuropathogenesis. Our investigation of the role of glycoprotein I (gI), which is
dispensable in vitro, examines the functions of a VZV gene product during
infection of human neural cells in vivo. Whereas intact recombinant Oka (rOka)
initiated a short replicative phase followed by persistence in DRGs, the gI
deletion mutant, rOkaDeltagI, showed prolonged replication with no transition to 
persistence up to 70 days after infection. Only a few varicella-zoster
nucleocapsids and cytoplasmic virions were observed in neurons, and the major VZV
glycoprotein, gE, was retained in the rough endoplasmic reticulum in the absence 
of gI. VZV neurotropism was not disrupted when DRG xenografts were infected with 
rOka mutants lacking gI promoter elements that bind cellular transactivators,
specificity factor 1 (Sp1) and upstream stimulatory factor (USF). Because gI is
essential and Sp1 and USF contribute to VZV pathogenesis in skin and T cells in
vivo, these DRG experiments indicate that the genetic requirements for VZV
infection are less stringent in neural cells in vivo. The observations
demonstrate that gI is important for VZV neurotropism and suggest that a strategy
to reduce neurovirulence by deleting gI could prolong active infection in human
DRGs.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17709745 [PubMed - indexed for MEDLINE]

121: Vaccine. 2007 Sep 17;25(37-38):6655-60. Epub 2007 Jul 27.

Metaanalysis of vaccine effectiveness in varicella outbreaks.

Bayer O, Heininger U, Heiligensetzer C, von Kries R.

Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians
University, Heiglhofstr. 63, 81377 Munich, Germany.
Otmar.Bayer@lrz.uni-muenchen.de

There is a number of reports on varicella outbreaks in populations where a one
dose varicella immunization program has been implemented. We performed a
metaanalysis to provide a summary vaccine effectiveness (VE) estimate and to
assess the possible impact of waning immunity by means of a subgroup analysis by 
time since immunization. We found a VE of 72.5% (95% CI 68.5-76.0) derived from
3157 children in 14 publications. Immunization coverage of the respective
population was unrelated to VE. All studies (n=4) that allowed the computation of
VE over time since immunization showed a substantial decrease. In total, waning
immunity was assessed by nine studies. Two reported no relation between VE and
time since immunization without specifying how this had been assessed. Seven
studies calculated relative risks for contracting varicella after prolonged as
compared to a shorter period since immunization and reported an increased
relative risk for prolonged periods. In conclusion, this metaanalysis confirms a 
limited effectiveness of one dose of varicella vaccine and points to waning
immunity as an important causal factor. Waning might also be an issue with the
newly recommended two dose vaccination schedule. Sustained surveillance for
varicella outbreaks in populations with varicella immunization programs therefore
is mandatory.

Publication Types: 
    Meta-Analysis

PMID: 17706845 [PubMed - indexed for MEDLINE]

122: Pediatr Neurol. 2007 Aug;37(2):138-9.

Optic neuritis caused by varicella infection in an immunocompetent child.

Stergiou PK, Konstantinou IM, Karagianni TN, Kavaki D, Printza NG.

Department of Ophthalmology, Hippokration General Hospital, Aristotle University,
Thessaloniki, Greece.

Chickenpox may lead to several neurologic complications, but optic neuritis has
rarely been described. We report on a 6-year-old immunocompetent patient who
presented with unilateral optic neuritis and severe visual loss because of
varicella infection. A week after varicella eruption, the child experienced
blurred vision. An examination revealed decreased visual acuity of his right eye,
a right pupil poorly reactive to light, and almost no color vision in his right
eye. A history of chickenpox, the fundus examination, and the measurement of
visual-evoked potentials allowed us to make a diagnosis of optic neuritis caused 
by varicella infection. The patient received only symptomatic relief with
antipyretics. Three months later, his visual acuity improved to 20/40 in the
right eye.

Publication Types: 
    Case Reports

PMID: 17675031 [PubMed - indexed for MEDLINE]

123: Eur J Epidemiol. 2007;22(9):641-6. Epub 2007 Aug 1.

Comparison of the dynamics and correlates of transmission of Herpes Simplex
Virus-1 (HSV-1) and Varicella-Zoster Virus (VZV) in a sample of the Israeli
population.

Davidovici BB, Balicer RD, Klement E, Green MS, Mendelson E, Smetana Z, Cohen DI.

Department of Epidemiology and Preventive Medicine, School of Public Health,
Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978,
Israel.

Herpes simplex virus types-1 (HSV-1) and Varicella-zoster virus (VZV) are herpes 
viruses that share many characteristics. However, HSV-1 spreads by close contact 
while VZV spreads mainly by the airborne route. In this study we compared the
dynamics and correlates of transmission of these viruses in the same population. 
In 2000-2001, 1555 sera from an age-stratified general population sample were
tested using commercial ELISA kits to measure type-specific HSV-1 and varicella
IgG antibodies. The VZV seroprevalence increased rapidly with age reaching 50%
seropositivity by the age of 3 years, while HSV-1 reached 50% seropositivity at
the age of 14 years. The highest VZV force of infection was in the 3.5-5.5-year
age group followed by the 5.5-10.5 years age group, while for HSV-1 the age
specific force of infection was substantially lower and stable over the various
age groups. Multivariate analysis revealed that HSV-1 seroprevalence was
significantly, independently associated with age, country of birth, country of
origin, ethnicity, socio-economic status and VZV sero-status. Only age, country
of origin and HSV-1 sero-status were found to be associated with VZV
seropositivity. In developed countries such as Israel the transmission of VZV is 
much quicker and less dependent on socioeconomic status as compared with HSV-1.

Publication Types: 
    Comparative Study

PMID: 17668279 [PubMed - indexed for MEDLINE]

124: BJOG. 2007 Sep;114(9):1122-7. Epub 2007 Jul 30.

Prevalence of varicella-zoster antibodies in pregnant women in Catalonia (Spain).
Rationale for varicella vaccination of women of childbearing age.

Plans P, Costa J, Espuñes J, Plasència A, Salleras L.

General Directorate of Public Health, Department of Health, Generalitat of
Catalonia, Barcelona, Spain. pedro.plans@gencat.net

OBJECTIVE: The objective of this study was to determine the prevalence of
antibodies against varicella-zoster virus (VZV) in pregnant women in Catalonia
(Spain). SETTING: The prevalence of antibodies against VZV was assessed in a
representative sample (n = 1522) of pregnant women of Catalonia obtained in 2003.
METHOD: The sample was obtained including all women attended for childbirth,
during 2 months of 2003, in 27 randomly selected hospitals with maternity
clinics. MAIN OUTCOME MEASURES: Varicella-zoster antibodies were determined using
the enzyme-linked immunosorbent assay test. RESULTS: The total number of women
included in the study was 1522, corresponding to a participation rate of 83%. The
prevalence of varicella-zoster antibodies in pregnant women was 96.1% (95% CI
95.1-97.1). The prevalence of antibodies was 94% in pregnant women aged 15-24
years, 95% in those aged 25-29 years and >95% in those aged 30-49 years. The
prevalence of antibodies was not associated to the place of birth, place of
residence (urban or rural), educational level and social class. The study showed 
that 6% of pregnant women aged 15-24 years and 5% of those aged 25-29 years were 
susceptible to varicella-zoster infections in Catalonia (Spain). CONCLUSION: The 
study showed that a varicella-zoster vaccination programme aimed at women of
childbearing age could be necessary in Catalonia to prevent all varicella-zoster 
infections during pregnancy.

Publication Types: 
    Multicenter Study

PMID: 17666097 [PubMed - indexed for MEDLINE]

125: J Neurol Sci. 2007 Nov 15;262(1-2):113-6. Epub 2007 Jul 30.

On the viral hypothesis of multiple sclerosis: participation of varicella-zoster 
virus.

Sotelo J.

Neuroimmunology Unit, National Institute of Neurology and Neurosurgery, Mexico
City, Mexico. jsotelo@servidor.unam.mx

Recent studies, including our own, have accumulated evidence suggesting the
etiological participation of varicella-zoster virus in multiple sclerosis. If
confirmed, complex issues of individual susceptibility and immunopathogenesis
would have to be unveiled.

Publication Types: 
    Review

PMID: 17663004 [PubMed - indexed for MEDLINE]

126: Epidemiol Infect. 2008 May;136(5):679-87. Epub 2007 Jul 26.

Deterministic SIR (Susceptible-Infected-Removed) models applied to varicella
outbreaks.

Giraldo JO, Palacio DH.

EAFIT (University) Grupo de Lógica y Computación, Medellín, Colombia.

Deterministic SIR models were applied to simulate Susceptible-Infected-Removed
and to estimate the threshold condition for varicella outbreaks in children,
reported in Medellín, Colombia. The expected numbers of susceptible, infected and
removed individuals were compared with observed cases from notification of
varicella outbreaks to the local Board of Health and from survey data. The
threshold condition was estimated by the basic reproductive ratio and by the
relative removal rate, through which measures for preventing and curtailing the
outbreaks were identified. The model demonstrated a reasonable fit to the
observations, except in two of the six outbreaks which probably reflected
under-registration of cases. In order to have prevented these outbreaks, between 
4.4% and 52.9% of the susceptible population should have been vaccinated assuming
an 85% vaccine effectiveness. Similarly, isolation of affected children should
have been increased to between 4.3% and 44.8% per week.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17655783 [PubMed - indexed for MEDLINE]

127: Virology. 2007 Nov 10;368(1):50-9. Epub 2007 Jul 24.

Simian varicella virus reactivation in cynomolgus monkeys.

Mahalingam R, Traina-Dorge V, Wellish M, Lorino R, Sanford R, Ribka EP, Alleman
SJ, Brazeau E, Gilden DH.

Department of Neurology , University of Colorado Health Sciences Center, Denver, 
CO 80262, USA. ravi.mahalingam@uchsc.edu

SVV infection of primates closely resembles VZV infection of humans. Like VZV,
SVV becomes latent in ganglionic neurons. We used this model to study the effect 
of immunosuppression on varicella reactivation. Cynomolgus monkeys latently
infected with SVV were irradiated and treated with tacrolimus and prednisone. Of 
four latently infected monkeys that were immunosuppressed and subjected to the
stress of transportation and isolation, one developed zoster, and three others
developed features of subclinical reactivation. Another non-immunosuppressed
latently infected monkey that was subjected to the same stress of travel and
isolation showed features of subclinical reactivation. Virus reactivation was
confirmed not only by the occurrence of zoster in one monkey, but also by the
presence of late SVV RNA in ganglia, and the detection of SVV DNA in
non-ganglionic tissue, and SVV antigens in skin, ganglia and lung.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17651776 [PubMed - indexed for MEDLINE]

128: Public Health Rep. 2007 Jul-Aug;122(4):499-506.

Validity of self-reported varicella disease history in pregnant women attending
prenatal clinics.

Watson B, Civen R, Reynolds M, Heath K, Perella D, Carbajal T, Mascola L, Jumaan 
A, Zimmerman L, James A, Quashi C, Schmid S.

Philadelphia Department of Public Health, 500 South Broad St., Philadelphia, PA
19146, USA. barbara.watson@phila.gov

OBJECTIVE: The purpose of this study was to assess the validity of self-reported 
history for varicella disease relative to serological evidence of varicella
immunity in pregnant women attending antenatal care at clinics located in two
diverse geographical locations in the U.S. (Antelope Valley, California, and
Philadelphia) with high varicella vaccination coverage. METHODS: Pregnant women
attending prenatal care appointments who needed blood drawn as part of their
routine care were eligible to participate. Self-reported varicella disease
history was obtained via questionnaire. Varicella serostatus was determined using
a whole-cell enzyme-linked immunosorbent assay to test for varicella zoster
virus-specific immunoglobulin G (VZV IgG) antibodies. RESULTS: Of the 309 study
participants from Antelope Valley and the 528 participants from Philadelphia who 
self-reported having had chickenpox disease, 308 (99.7%; 95% confidence interval 
[CI]: 98.2, 100) and 517 (97.9%; 95% CI: 96.3, 99.0), respectively, had
serological evidence of immunity to varicella. Only 6.8% (95% CI: 3.9, 11.0) and 
17.4% (95% CI: 13.1, 22.5) of women who self-reported having a negative or
uncertain varicella disease history in Antelope Valley and Philadelphia,
respectively, were seronegative for varicella antibodies. CONCLUSION: Despite the
dramatic changes in the epidemiology of varicella that have occurred since 1995
due to the introduction and subsequent widespread use of the varicella vaccine,
self-reported history of varicella continues to be a strong predictor of VZV IgG 
antibodies in pregnant women. Negative or uncertain history remains poorly
predictive of negative serostatus.

Publication Types: 
    Validation Studies

PMID: 17639653 [PubMed - indexed for MEDLINE]

129: Vaccine. 2007 Aug 10;25(32):6086-8. Epub 2007 Jun 4.

Susceptibility to varicella in childbearing age women, Central Italy: is there a 
need for vaccinating this population group?

Alfonsi V, Montomoli E, Manini I, Alberini I, Gentile C, Rota MC, Ciofi degli
Atti ML.

Istituto Superiore di Sanità, National Center for Epidemiology Surveillance and
Health Promotion, Italy.

We conducted a cross-sectional seroprevalence study of varicella-zoster virus
(VZV) antibodies in childbearing age women aged 17-42 years. Sera were collected 
in Central Italy in years 2001-2002 and were tested by a commercial VZV IgG
enzyme immunoassay. Overall VZV seroprevalence was 80.9% and it showed a
significant increase by age, confirming a considerable circulation of VZV also in
the older age groups not commonly considered at high risk. This study further
supports the importance of vaccinating susceptible adolescents and women of
childbearing age in order to reduce both maternal and foetal complications
associated with varicella in pregnancy.

PMID: 17629374 [PubMed - indexed for MEDLINE]

130: Clin Vaccine Immunol. 2007 Sep;14(9):1057-61. Epub 2007 Jul 11.

Genotypic analysis of varicella-zoster virus and its seroprevalence in Finland.

Koskiniemi M, Lappalainen M, Schmid DS, Rubtcova E, Loparev VN.

Haartman Institute, Department of Virology, University of Helsinki, P.O. Box 21
(Haartmaninkatu 3), Helsinki, Finland. Marjaleena.Koskiniemi@Helsinki.Fi

We evaluated the seroprevalence of varicella-zoster virus (VZV) in the Finnish
population among various age groups and genetically characterized VZV strains
from documented cases of varicella and zoster. VZV-specific immunoglobulin G was 
measured in 2,842 serum samples that had been submitted for virological studies
to the Department of Virology, University of Helsinki, from 1995 to 1996.
Specimens for VZV genotyping were obtained from vesicular lesions from two
pediatric patients and 26 adult patients. Seroprevalence to VZV varied markedly
by age: 45% in children aged < or = 2 months, 12.5% in children aged 6 to 8
months, and > 90% in children near 10 years of age, plateauing thereafter into
advanced age. The seroprevalence rates indicate that in Finland, as in other
countries with temperate climates, primary VZV infection usually occurs during
the first decade of life. Twenty-eight VZV DNA-positive specimens were analyzed
to identify VZV vaccine and wild-type genotypes. All analyzed specimens were wild
type and the European (E) genotype.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 17626161 [PubMed - indexed for MEDLINE]

131: Braz J Infect Dis. 2007 Feb;11(1):179-81.

Transverse myelitis caused by varicella zoster: case reports.

Yýlmaz S, Köseolu HK, Yücel E.

Division of Rheumatology, Konya Medical and Research Center, Baskent University, 
Konya, Turkey. drsemayilmaz@hotmail.com

Transverse myelitis is a group of disorders characterized by focal inflammation
of the spinal cord and results in loss of motor and sensory function below the
level of injury. Occurrence of this condition during or following varicella
infection is uncommon. This report describes two cases of transverse myelitis
caused by varicella zoster.

Publication Types: 
    Case Reports

PMID: 17625754 [PubMed - indexed for MEDLINE]

132: Exp Clin Transplant. 2007 Jun;5(1):604-6.

An outbreak of chickenpox in adult renal transplant recipients.

Shahbazian H, Ehsanpour A.

Department of Nephrology and Kidney Transplantation, Ahwaz Jondi Shapour Medical 
University, Ahwaz, Iran. shahbazian_he@yahoo.com

Infection with the varicella-zoster virus, the etiologic agent of chickenpox and 
herpes zoster, is more serious in immunosuppressed renal transplant recipients
than it is in the general population. Chickenpox is a rare infection in adult
renal transplant recipients; however, it is significant owing to the severity of 
its clinical features and its associated high mortality rate. To date, there are 
no reported outbreaks of primary varicella-zoster virus infection in adult renal 
transplant recipients. Here, we report 3 patients with chickenpox who presented
to our center between May 2006 and June 2006.

Publication Types: 
    Case Reports

PMID: 17617051 [PubMed - indexed for MEDLINE]

133: Pediatrics. 2007 Jul;120(1):221-31.

Prevention of varicella: recommendations for use of varicella vaccines in
children, including a recommendation for a routine 2-dose varicella immunization 
schedule.

American Academy of Pediatrics Committee on Infectious Diseases.

National varicella immunization coverage using the current 1-dose immunization
strategy has increased among vaccine-eligible children 19 through 35 months of
age from 27% in 1997 to 88% by 2005. These high immunization rates have resulted 
in a 71% to 84% decrease in the reported number of varicella cases, an 88%
decrease in varicella-related hospitalizations, a 59% decrease in
varicella-related ambulatory care visits, and a 92% decrease in varicella-related
deaths in 1- to 4-year-old children when compared with data from the prevaccine
era. Despite this significant decrease, the number of reported cases of varicella
has remained relatively constant during the past 5 to 6 years. Since vaccine
effectiveness for prevention of disease of any severity has been 80% to 85%, a
large number of cases of varicella continue to occur among people who already
have received the vaccine (breakthrough varicella), and outbreaks of varicella
have been reported among highly immunized populations of schoolchildren. The peak
age-specific incidence has shifted from 3- to 6-year-old children in the
prevaccine era to 9- to 11-year-old children in the postvaccine era for cases in 
both immunized and unimmunized children during these outbreaks. Outbreaks of
varicella are likely to continue with the current 1-dose immunization strategy.
After administration of 2 doses of varicella vaccine in children, the immune
response is markedly enhanced, with > 99% of children achieving an antibody
concentration (determined by glycoprotein enzyme-linked immunosorbent assay) of >
or = 5 U/mL (an approximate correlate of protection) and a marked increase in
geometric mean antibody titers after the second vaccine dose. The estimated
vaccine efficacy over a 10-year observation period of 2 doses for prevention of
any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy
for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 
3.3-fold less likely to have breakthrough varicella, compared with those who are 
given 1 dose, during the first 10 years after immunization. To achieve greater
levels of immunity with fewer serosusceptible people, greater protection against 
breakthrough varicella disease, and reduction in the number of outbreaks that
occur nationwide among school-aged populations, a 2-dose varicella immunization
strategy is now recommended for children > or = 12 months of age.

Publication Types: 
    Practice Guideline

PMID: 17606582 [PubMed - indexed for MEDLINE]

134: Pediatr Infect Dis J. 2007 Jul;26(7):572-6.

Immunogenicity of Oka/Merck varicella vaccine in children vaccinated at 12-14
months of age versus 15-23 months of age.

Silber JL, Chan IS, Wang WW, Matthews H, Kuter BJ.

Merck & Co., Inc., West Point, PA 19486, USA.

OBJECTIVE: Recent reports suggest that breakthrough varicella may be more common 
in children when the Oka/Merck varicella vaccine is given at 12-14 months of age 
than when it is given at older ages. An analysis of 5 postlicensure clinical
trials with this vaccine was conducted to evaluate immune response relative to
the age of the vaccine recipient. METHODS: In 5 clinical trials, 3771 children,
12 through 23 months of age with no history of varicella, received an injection
of varicella vaccine. Varicella-zoster virus (VZV) antibody was measured 6 weeks 
postvaccination by glycoprotein enzyme-linked immunosorbent assay (gpELISA), an
assay that correlates with neutralizing antibody. Endpoints evaluated were the
response rate (percent of subjects with VZV antibody > or =5 gpELISA units/mL, a 
titer shown to correlate with protection) and geometric mean titer (GMT) of VZV
antibody. Each endpoint was compared across 3 age groups (12-14, 15-17, and 18-23
months of age). Response rates by initial VZV serostatus were evaluated for
children vaccinated at 12-14 months of age to assess whether maternal antibody
had an impact on the immune response. RESULTS: The response rates were similar
among 12-14, 15-17, and 18-23 month olds (93.8, 90.8, and 93.1%, respectively);
GMTs were significantly higher among the 12-14 month olds (15.1, 13.5, and 13.7
gpELISA units/mL, respectively). Among children 12-14 months of age, response
rates and GMTs were similar regardless of their prevaccination VZV serostatus.
CONCLUSIONS: Oka/Merck varicella vaccine is highly immunogenic when given to
children 12-14 months of age. The immunogenicity profile is similar to that of
children 15-17 and 18-23 months of age. The presence of low titers of VZV
antibody before vaccination did not influence vaccine response in 12-14 month
olds. These results support current recommendations for universal varicella
vaccination beginning at 12 months of age.

Publication Types: 
    Meta-Analysis

PMID: 17596796 [PubMed - indexed for MEDLINE]

135: Clinics. 2007 Jun;62(3):309-14.

Reliability of information on varicella history in preschool children.

Bricks LF, Pannuti CS, Sato HK, Vico ES, de Faria AM, Souza VV, Sumita LM, Costa 
Ide C, Baldacci ER.

Children's Institute, Hospital das Clínicas, University of Sao Paulo, Sao Paulo, 
SP, Brazil. lfbricks@gmail.com

OBJECTIVE: To verify how reliable is the information provided by parents about
the history of varicella in their children. METHODS: 204 parents of previously
healthy children attending two municipal day-care centers of São Paulo city were 
interviewed between August 2003 and September 2005. A standardized form was
filled out with information regarding age, sex, history of varicella and other
diseases, drug use and antecedent of immunization, After medical history,
physical examination and checking of immunization records, 5 ml of blood were
collected for ELISA (in house) varicella test. Exclusion criteria were: age less 
than 1 year or more than 60 months, previous immunization against chickenpox,
presence of co-morbidities or recent use of immunosuppressive drugs. Data were
filed in a data bank using the Excel 2003 Microsoft Office Program and stored in 
a PC computer. The exact Fisher test was employed to calculate sensibility,
specificity, positive and negative predictive values of history of varicella
informed by children's parents. RESULTS: The age of the children varied from 12
to 54 months (median, 26 months; 49 (24%) children had positive history of
varicella, 155 (76%) a negative or doubtful history. The predictive positive and 
negative values of the information were 90% and 93%, respectively (p = 0.0001).
CONCLUSIONS: The degree of reliability of information about history of varicella 
informed by parents of children attending day care centers was high and useful to
establish recommendations on varicella blocking immunization in day-care centers.

Publication Types: 
    Multicenter Study

PMID: 17589672 [PubMed - indexed for MEDLINE]

136: MMWR Recomm Rep. 2007 Jun 22;56(RR-4):1-40.

Prevention of varicella: recommendations of the Advisory Committee on
Immunization Practices (ACIP).

Marin M, Güris D, Chaves SS, Schmid S, Seward JF; Advisory Committee on
Immunization Practices, Centers for Disease Control and Prevention (CDC).

Division of Viral Diseases, National Center for Immunization and Respiratory
Diseases, CDC, Atlanta, GA 30333, USA. mmarin@cdc.gov

Two live, attenuated varicella zoster virus-containing vaccines are available in 
the United States for prevention of varicella: 1) a single-antigen varicella
vaccine (VARIVAX, Merck & Co., Inc., Whitehouse Station, New Jersey), which was
licensed in the United States in 1995 for use among healthy children aged > or = 
12 months, adolescents, and adults; and 2) a combination measles, mumps, rubella,
and varicella vaccine (ProQuad, Merck & Co., Inc., Whitehouse Station, New
Jersey), which was licensed in the United States in 2005 for use among healthy
children aged 12 months-12 years. Initial Advisory Committee on Immunization
Practices (ACIP) recommendations for prevention of varicella issued in 1995 (CDC.
Prevention of varicella: recommendations of the Advisory Committee on
Immunization Practices [ACIP]. MMWR 1996;45 [No. RR-11]) included routine
vaccination of children aged 12-18 months, catch-up vaccination of susceptible
children aged 19 months-12 years, and vaccination of susceptible persons who have
close contact with persons at high risk for serious complications (e.g.,
health-care personnel and family contacts of immunocompromised persons). One dose
of vaccine was recommended for children aged 12 months-12 years and 2 doses, 4-8 
weeks apart, for persons aged > or = 13 years. In 1999, ACIP updated the
recommendations (CDC. Prevention of varicella: updated recommendations of the
Advisory Committee on Immunization Practices [ACIP]. MMWR 1999;48 [No. RR-6]) to 
include establishing child care and school entry requirements, use of the vaccine
following exposure and for outbreak control, use of the vaccine for certain
children infected with human immunodeficiency virus, and vaccination of
adolescents and adults at high risk for exposure or transmission. In June 2005
and June 2006, ACIP adopted new recommendations regarding the use of live,
attenuated varicella vaccines for prevention of varicella. This report revises,
updates, and replaces the 1996 and 1999 ACIP statements for prevention of
varicella. The new recommendations include 1) implementation of a routine 2-dose 
varicella vaccination program for children, with the first dose administered at
age 12-15 months and the second dose at age 4-6 years; 2) a second dose catch-up 
varicella vaccination for children, adolescents, and adults who previously had
received 1 dose; 3) routine vaccination of all healthy persons aged > or = 13
years without evidence of immunity; 4) prenatal assessment and postpartum
vaccination; 5) expanding the use of the varicella vaccine for HIV-infected
children with age-specific CD4+ T lymphocyte percentages of 15%-24% and
adolescents and adults with CD4+ T lymphocyte counts > or = 200 cells/microL; and
6) establishing middle school, high school, and college entry vaccination
requirements. ACIP also approved criteria for evidence of immunity to varicella.

Publication Types: 
    Practice Guideline

PMID: 17585291 [PubMed - indexed for MEDLINE]

137: Acta Paediatr. 2007 Jul;96(7):1099-100.

Consequences of varicella in pregnancy: a report of four cases.

Narkeviciute I.

Clinic of Children's Diseases of Vilnius University, Vilnius, Lithuania.
irena.narkeviciute@vuvl.lt

Four infants are reported with varicella-Zoster virus (VZV) infection, whose
mothers had varicella during the second-third trimester of pregnancy. Two
newborns had neonatal varicella. One of them, whose mother contracted varicella 5
days before delivery, had a severe and complicated form of the disease. The
infants who had herpes zoster did not have specific VZV-IgG antibodies at the
onset of the disease. CONCLUSION: These cases showed that varicella during the
second-third trimester of pregnancy may have serious consequence for infants.

Publication Types: 
    Case Reports

PMID: 17577346 [PubMed - indexed for MEDLINE]

138: BMC Infect Dis. 2007 Jun 15;7:59.

Varicella and herpes zoster in Madrid, based on the Sentinel General Practitioner
Network: 1997-2004.

Pérez-Farinós N, Ordobás M, García-Fernández C, García-Comas L, Cañellas S,
Rodero I, Gutiérrez-Rodríguez A, García-Gutiérrez J, Ramírez R.

Department of Epidemiology, Madrid Public Health Institute, Julián Camarillo 4B, 
Madrid, Spain. napoleon.perez@salud.madrid.org

BACKGROUND: Varicella (chickenpox) is the primary disease caused by
varicella-zoster virus. It is extremely contagious and is frequent in children.
Indeed, in the absence of vaccination, a high proportion of the population is
liable to contract it. Herpes zoster -more frequent among adults- is caused by
reactivation of the latent virus. The objective of this study is to describe the 
status of and time trend for varicella and herpes zoster in the Madrid Autonomous
Region prior to the introduction of the vaccine to the general population.
METHODS: Data source: individualised varicella and herpes zoster case records
kept by the Madrid Autonomous Region Sentinel General Practitioner Network for
the period 1997-2004. Cumulative incidences, crude and standardised incidence
rates, and age-specific rates of varicella and herpes zoster were calculated for 
each year. Kendall's Tau-b correlation coefficient was calculated to evaluate
whether incidence displayed a time trend. Spectral density in the time series of 
weekly incidences was estimated using a periodogram. RESULTS: Standardised annual
varicella incidence rates ranged from 742.5 (95% CI: 687.2-797.7) to 1239.6 (95% 
CI: 1164.5-1313.4) cases per 100 000 person-years. Most cases affected children, 
though complications were more frequent in adults. Varicella incidence displayed 
an annual periodicity but no trend over time. Most herpes zoster cases occurred
at advanced ages, with incidence registering a rising annual trend but no
seasonality factor. CONCLUSION: In the absence of vaccination, no significant
changes in varicella incidence were in evidence recent years, though these were
observed in the incidence of herpes zoster. Sentinel general practitioner
networks are a valid instrument for surveillance of diseases such as varicella.
Further varicella vaccination-coverage and vaccine-efficacy studies are called
for.

PMID: 17570859 [PubMed - indexed for MEDLINE]

139: Singapore Med J. 2007 Jun;48(6):e177-80.

Post-varicella myasthenia gravis.

Saha A, Batra P, Vilhekar KY, Chaturvedi P.

Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences,
Sevagram, Wardha, Maharashtra, India.

Myasthenia gravis is an autoimmune disease of neuromuscular junctions. We report 
a three-year-old boy with post-varicella myasthenia gravis. This patient, to the 
best of our knowledge, is the youngest in age and second reported case of the
condition. The patient presented with drooping of both eyelids which increased as
the day progressed, two weeks after varicella infection. Repetitive nerve
stimulation tests showed decremental response in action potential, and the child 
responded dramatically to test doses of neostigmine. A diagnosis of
post-varicella myasthenia gravis was made and the patient was started on oral
pyridostigmine. He is doing well at follow-up and there is no recurrence of
symptoms to date.

Publication Types: 
    Case Reports

PMID: 17538742 [PubMed - indexed for MEDLINE]

140: J Dermatol. 2007 Jun;34(6):387-9.

Systemic varicella zoster virus reinfection in a case of angioimmunoblastic
T-cell lymphoma.

Imafuku S, Yoshimura D, Moroi Y, Urabe K, Furue M.

Department of Dermatology, Graduate School of Medical Sciences, Kyushu
University, Fukuoka city, Japan. dermatologist@mac.com

Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of peripheral T-cell 
lymphoma that causes immunological disorders such as immunosuppression,
autoimmune disease-like symptoms and allergy. We report a case of a 67-year-old
man with AITL who had a serious varicella zoster virus (VZV) reinfection that
appeared clinically to be varicella. Forty percent of cases of AITL are
associated with skin rash. A variety of cutaneous manifestations have been
reported; however, the majority are macropapular eruptions that are often
diagnosed as drug associated. Our study emphasizes the need to correctly diagnose
opportunistic infections, such as the varicella that is documented in our
patient, at early stages in AITL.

Publication Types: 
    Case Reports

PMID: 17535405 [PubMed - indexed for MEDLINE]

141: J Med Virol. 2007 Jul;79(7):1025-31.

Different genotype pattern of varicella-zoster virus obtained from patients with 
varicella and zoster in Germany.

Sauerbrei A, Wutzler P.

Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of
Jena, Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de

The general use of the varicella vaccine requires the surveillance of
varicella-zoster virus (VZV) strains in patients infected with VZV. This paper
reports the data achieved from a prospective study of genotyping VZV in Germany, 
analyzing the restriction fragment length polymorphism (RFLP) of the open reading
frames (ORF) 38, 54, and 62 as well as the polymorphism of the R5 repeat region. 
The study included 177 patients with varicella. Seventy-eight patients with
zoster served as controls. Results revealed that 78% of VZV strains in patients
with varicella had the genetic profile of the dominant wild-genotype occurring in
Europe and 22% had the markers of African or Asian strains. Varicella patients
with the profile of African or Asian strains were significantly younger than
patients with varicella caused by the dominant genotype. By contrast, all zoster 
patients exhibited strains representing the majority of wild-type strains in
Europe. In conclusion, VZV strains from patients with varicella have a
significantly higher genetic variability than viral strains from zoster patients.
Since variants with the markers of African or Asian strains could only be found
in young children with chickenpox, the results suggest a changing scene of VZV
genotypes in Germany. As reasons, the spread of viruses, which may be imported
originally by persons immigrating from warmer climates, or the recombination
between wild-and vaccine-type viruses have to be considered.

Publication Types: 
    Comparative Study

PMID: 17516537 [PubMed - indexed for MEDLINE]

142: J Virol. 2007 Aug;81(15):8149-56. Epub 2007 May 16.

Simian varicella virus expresses a latency-associated transcript that is
antisense to open reading frame 61 (ICP0) mRNA in neural ganglia of latently
infected monkeys.

Ou Y, Davis KA, Traina-Dorge V, Gray WL.

Dept. of Microbiology and Immunology, Slot 511, University of Arkansas for
Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA.

Simian varicella virus (SVV) and varicella-zoster virus (VZV) are closely related
alphaherpesviruses that cause varicella (chickenpox) in nonhuman primates and
humans, respectively. After resolution of the primary disease, SVV and VZV
establish latent infection of neural ganglia and may later reactivate to cause a 
secondary disease (herpes zoster). This study investigated SVV gene expression in
neural ganglia derived from latently infected vervet monkeys. SVV transcripts
were detected in neural ganglia, but not in liver or lung tissues, of latently
infected animals. A transcript mapping to open reading frame (ORF) 61 (herpes
simplex virus type 1 [HSV-1] ICP0 homolog) was consistently detected in latently 
infected trigeminal, cervical, and lumbar ganglia by reverse transcriptase PCR.
Further analysis confirmed that this SVV latency-associated transcript (LAT) was 
oriented antisense to the gene 61 mRNA. SVV ORF 21 transcripts were also detected
in 42% of neural ganglia during latency. In contrast, SVV ORF 28, 29, 31, 62, and
63 transcripts were not detected in ganglia, liver, or lung tissues of latently
infected animals. The results demonstrate that viral gene expression is limited
during SVV latency and that a LAT antisense to an ICP0 homolog is expressed. In
this regard, SVV gene expression during latency is similar to that of HSV-1 and
other neurotropic animal alphaherpesviruses but differs from that reported for
VZV.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17507490 [PubMed - indexed for MEDLINE]

143: Ren Fail. 2007;29(3):359-62.

Varicella-zoster infection with encephalopathy, pneumonia, and renal failure: a
case report.

Chuang FR, Lee CH, Chuang CH, Lee WC, Yang CC, Chen TC, Lu CH, Chang HY, Sheu MJ,
Wang IK.

The Division of Nephrology, Department of Neurology, Chang Gung Memorial
Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine,
Taiwan.

Primary varicella-zoster (VZ) infection is rare in adults, but the rate of
morbidity and mortality is higher than in children. Pneumonia is the most common 
complication of primary VZ infection in adults. Moreover, varicella pneumonia
associated with acute renal failure and acute encephalopathy is very rare. This
study reports on a case of disseminated VZ infection successfully treated with
acyclovir. The patient was otherwise healthy and denied previous systemic or
infectious disease. The initial diagnosis was varicella pneumonia. However,
multiple organ involvement subsequently was found in several organs, including
the kidney, brain, lung, liver, blood, and skin. The reactivation of VZ infection
was strongly suspected. Abnormal renal and liver function and thrombocytopenia
also were noted. The patient with chickenpox was treated successfully with
acyclovir without complication. In conclusion, multiple organ involvement is a
rare complication of VZ infection in adults. In the severe case presented here,
adequate intravenous acyclovir administration and close observation of the
general condition were essential for successfully treating disseminated VZ
infection without complications.

Publication Types: 
    Case Reports

PMID: 17497452 [PubMed - indexed for MEDLINE]

144: Acta Paediatr. 2007 Jun;96(6):861-3. Epub 2007 Apr 27.

Comment in:
    Acta Paediatr. 2007 Jun;96(6):794-5.

Varicella seroprevalence in Turkish population in Cyprus.

Kurugol Z, Koturoglu G, Aksit S, Ozacar T.

Department of Paediatrics, Ege University Medical Faculty, Izmir, Turkey.
zafer.kurugol@ege.edu.tr

AIM: This study was conducted to determine the age-specific seroprevalence of
varicella zoster virus (VZV) infection in Turkish population in Cyprus. METHODS: 
A total of 600 unvaccinated individuals aged 1-30 years were selected for the
study with cluster sampling. Information on socio-demographic characteristics was
gathered for each participant and, anti-VZV antibodies were assayed by using
enzyme immune assay. RESULTS: Of the 578 assayed samples, 486 (84.1%) were
seropositive. Varicella seroprevalence increased sharply with age from 25% for
the 2-3 year olds to 55, 78 and 85% for 4-5, 6-7 and 8-9 year olds, respectively.
More than 90% of individuals >16 years of age were seropositive. Varicella
seroprevalence was higher in large families with five and more members (91.2%)
than in small families with four or fewer members (80.2%). CONCLUSION: The
majority of varicella-zoster virus infections occur during preschool period and
at the first years of schooling. Therefore, routine varicella vaccination of
children would be logical in Northern Cyprus, as is currently recommended by the 
European Working Group on Varicella.

PMID: 17465984 [PubMed - indexed for MEDLINE]

145: Infect Control Hosp Epidemiol. 2007 May;28(5):564-9. Epub 2007 Apr 12.

Immunity against infectious diseases: predictive value of self-reported history
of vaccination and disease.

Trevisan A, Frasson C, Morandin M, Beggio M, Bruno A, Davanzo E, Di Marco L,
Simioni L, Amato G.

Department of Environmental Medicine and Public Health, University of Padova,
Padova, 35128, Italy. andrea.trevisan@unipd.it

OBJECTIVE: To determine whether self-reported history of disease and/or
vaccination is predictive of immunity against hepatitis B, varicella, rubella,
mumps, and measles. DESIGN: The seroprevalence of viral antibodies and the
predictive value of a self-report questionnaire were determined for 616
paramedical students who matriculated into Padua Medical School (Padua, Italy)
during 2003-2005. RESULTS: The majority of subjects (86.9%) remembered being
vaccinated against hepatitis B but had no recollection of disease. Among
vaccinees, 1.5% showed markers of previous infection, 6.7% tested negative for
anti-hepatitis B virus surface antigen (anti-HBsAg) antibodies, and 91.8% tested 
positive for anti-HBsAg. Self-reported vaccination history had a positive
predictive value of 93.2% for test results positive for immunity against
hepatitis B. Immunity against varicella (93.7% of subjects) and rubella (95.5%)
was high, compared with immunity against mumps (79.9%) and measles (83.1%). In
addition, results of tests for detection of immunity against mumps and measles
were equivocal for more than 7% of subjects, probably because their vaccination
regimen was not completed. Self-reported histories of varicella disease and
rubella disease and vaccination had high positive predictive values (greater than
98% each) for testing positive for antiviral antibodies, compared with
self-reported histories of mumps disease and vaccination and measles disease and 
vaccination; however, high positive predictive values were observed for
self-reported histories of mumps only (92.0%) and measles only (94.7%).
CONCLUSIONS: The self-report questionnaire used in this study did not accurately 
predict immunity against 5 transmittable but vaccine-preventable diseases. A
complete serological evaluation of healthcare workers, followed by vaccination of
those with negative or equivocal results of serological tests, is an appropriate 
measure to decrease the risk of infection in this population.

PMID: 17464916 [PubMed - indexed for MEDLINE]

146: Aust N Z J Public Health. 2007 Apr;31(2):113-9.

An outbreak of chickenpox at a child care centre in Western Australia. Costs to
the community and implications for vaccination policy.

Vally H, Dowse GK, Eastwood K, Cameron S.

Communicable Disease Control Directorate, Department of Health, Western
Australia. Hassan.Vally@anu.edu.au

OBJECTIVE: Between May and June 2002 an outbreak of chickenpox (CP) occurred at a
child care centre in Perth, Western Australia. An epidemiological study was
undertaken in order to determine the characteristics of the outbreak, assess
vaccine effectiveness, and to define the direct and indirect costs associated
with CP infections in young children. METHODS: A cohort study of the outbreak
utilising attendance records and a telephone survey of parents was conducted.
RESULTS: Of the 211 children attending the child care centre at the time of the
outbreak, 44 contracted CP (attack rate 25.7%). In addition, two staff members,
five secondary household contacts (secondary attack rate 38.5%) and four
secondary non-household associated contacts were infected. There were no severe
complications or any hospitalisations recorded in infected persons. Two cases had
been vaccinated previously. Vaccine effectiveness for CP of any severity was
78.0% (95% CI 15.4-94.3%) while vaccine effectiveness against severe CP was 100%.
Direct costs during this outbreak were estimated to be $54 per case and the total
costs, including cost of parental time off work or study, were estimated to be
$525.73 per case. CONCLUSIONS AND IMPLICATIONS: Although morbidity associated
with CP in young children is not great, infection in childhood is almost
universal. This study found that the average costs associated with each CP case
were considerable. Since varicella vaccine affords good protection against CP,
the recent inclusion of this vaccine in the Australian childhood vaccination
schedule should save the community a considerable amount in direct and indirect
costs if high coverage rates can be achieved.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17461000 [PubMed - indexed for MEDLINE]

147: J Adolesc Health. 2007 May;40(5):405-11. Epub 2007 Mar 9.

The impact of state policies on vaccine coverage by age 13 in an insured
population.

Olshen E, Mahon BE, Wang S, Woods ER.

Departments of Pediatrics and Population and Family Health, Columbia University, 
New York, New York 10032, USA. eo85@columbia.edu

PURPOSE: To determine the impact of state policies on vaccine coverage among
adolescents with managed care insurance. METHODS: We used the 2003 Health Plan
Employer Data and Information Set to determine state-specific hepatitis B and
varicella vaccine coverage among children with managed care insurance who turned 
13 years in 2002. Our outcomes of interest were receipt of hepatitis B and
varicella vaccines by age 13. Utilizing weighted least-squares methods, multiple 
linear regression models were developed to evaluate the relationship between
hepatitis B and varicella vaccine coverage and state policies, while controlling 
for state sociodemographic variables. RESULTS: Across 28 states, adolescent
hepatitis B vaccine coverage ranged from 35.3% to 80.5% (mean = 55.3%) and
varicella vaccine coverage ranged from 22.9% to 7.6% (mean = 42.3%). In separate 
multiple regression models, after adjusting for potentially confounding
sociodemographic variables, middle school mandates were significantly associated 
with hepatitis B vaccine coverage (p = .002) and varicella vaccine coverage (p = 
.024). Other policies, including universal purchase of vaccines and availability 
of philosophic exemptions, were not associated with vaccine coverage in this
insured population. CONCLUSIONS: In this population of insured adolescents,
middle school vaccine mandates were the only state policy associated with
improved hepatitis B and varicella vaccine coverage. Mandates are an effective
method for promoting adolescent immunization.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 17448397 [PubMed - indexed for MEDLINE]

148: J Microbiol Immunol Infect. 2007 Apr;40(2):112-5.

Survey of the status of self-paid varicella vaccination among children one to six
years of age in Taiwan.

Liao SL, Huang T, Huang YC, Jiang DD.

Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial 
Hospital, Taoyuan, Taiwan.

BACKGROUND AND PURPOSE: Prior to 2004, the mass immunization program in Taiwan
did not include varicella vaccine; however, parents could have their children
vaccinated by the self-payment option. METHODS: In April 2002, we distributed
1271 questionnaires to the caregivers of children aged 1 to 6 years in Taoyuan
county, Taiwan, to survey the status of vaccination rate against varicella,
parental attitudes toward self-paid varicella vaccine, and the demographic
characteristics of the family. RESULTS: Based on the answers provided in the
questionnaires (99% response rate), we learned that until April 2002, the
vaccination rate against varicella was 26%. Most children received this vaccine
by the age of 1 to 2 years (64%) mainly at local clinics (66%). Majority of the
caregivers (94%) would have immunized their children against varicella if the
vaccines were freely provided or partially paid for. Caregivers living in the
city, those children whose parents had a relatively high education level, those
from families with fewer children, those whose children were inoculated with
other self-paid vaccines, and those parents with a higher family income were
significantly (p<0.0001) willing to have their children inoculated. CONCLUSIONS: 
In Taiwan, most caregivers were willing to have their children immunized against 
varicella if the vaccines were freely provided, or even if they were partially
paid for. In case of other effective vaccines of high cost and not included in
mass immunization, partially paying for the vaccine may be an option, since the
parents' willingness was substantially greater when the cost is lowered.

PMID: 17446958 [PubMed - indexed for MEDLINE]

149: Epidemiol Infect. 2007 Nov;135(8):1344-53. Epub 2007 Apr 20.

The seroepidemiology of varicella zoster virus among pregnant Bangladeshi and
white British women in the London Borough of Tower Hamlets, UK.

Talukder YS, Kafatos G, Pinot de Moira A, Aquilina J, Parker SP, Crowcroft NS,
Brown DW, Breuer J.

Centre for Infectious Disease, Institute of Cell and Molecular Science, Queen
Mary School of Medicine and Dentistry, London, UK. ingrej@gmail.com

We investigated the comparative seroepidemiology of varicella zoster virus (VZV) 
in pregnant women of two ethnic groups, white British and Bangladeshi, living in 
an inner city area of London, United Kingdom. Women aged 16-45 years were
recruited from antenatal clinics of the Royal London Hospital in the Borough of
Tower Hamlets. Complete data were obtained from 275 white British and 765
Bangladeshi women. VZV antibody prevalence was 93.1% (95% CI 89.4-95.8) and 86.0%
(95% CI 83.3-88.4) respectively. Women who were born in Bangladesh and lived
there at least until the age of 15 years had the lowest odds of being immune (OR 
0.37, 95% CI 0.22-0.63). This implies they will have an increased risk of
varicella during pregnancy. Women arriving in the United Kingdom in adulthood
should be screened routinely during pregnancy and vaccination offered postpartum 
if they are susceptible.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17445317 [PubMed - indexed for MEDLINE]

150: Int J Dermatol. 2007 Apr;46(4):362-6.

Risk factors for chickenpox incidence in Taiwan from a large-scale computerized
database.

Wu PY, Li YC, Wu HD.

Graduate Institute of Medical Informatics, Taipei Medical University, Guangyan
Dermatology Clinic, School of Public Health, China Medical University, Taipei,
Taiwan.

OBJECTIVE: We analyzed data from the National Health Insurance Research (NHIR)
database in the year 2000 to estimate the seasonal variation in the chickenpox
rate in Taiwan. PATIENTS AND METHODS: All chickenpox cases listed in the NHIR
database were included (n = 165,719). A Lorenz curve was plotted and a chi-square
test for equal proportions calculated for seasonal variation. To determine the
effects of temperature and season on outcome values, generalized estimating
equation methods were utilized to adjust the effects of other possible
influencing factors and take into account the within-subject dependence over
repeated assessments. RESULTS: All four regions of the country had highest
incidence rates in January, and three of them had lowest rates in September.
Incidence was significantly higher in females aged 15-24 years than in males. An 
increment of 1 degrees C resulted in an incidence ratio of approximately 0.98 or,
equivalently, a 10 degrees C increment gives an incidence ratio of approximately 
0.78. CONCLUSION: The results suggest that season and temperature are
significantly related to the incidence of chickenpox. Infectious diseases can be 
monitored. Prevention procedures can be taken by understanding its pattern and
activity in order to decide the best policy for vaccination. Further studies are 
warranted, particularly for long-term trends, and in other nations with different
seasonal temperatures from Taiwan.

PMID: 17442073 [PubMed - indexed for MEDLINE]

151: Cleve Clin J Med. 2007 Apr;74(4):290-6.

Managing varicella zoster infection in pregnancy.

Gardella C, Brown ZA.

Department of Obstetrics and Gynecology, Division of Women's Health, University
of Washington Medical Center, Seattle, WA 98195-6460, USA.
cgardel@u.washington.edu

Varicella zoster virus (VZV) infection can be serious for pregnant women and
their babies, although it is rare. The implications of primary VZV infection vary
with the gestational age at infection. For the mother, the risk of severe illness
is greatest after mid-pregnancy, when she is relatively immunocompromised. For
the fetus, the risk of congenital infection is greatest when maternal infection
occurs in the first or second trimester. Maternal infection is preventable by
preconception vaccination.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17438678 [PubMed - indexed for MEDLINE]

152: J Infect. 2007 Jul;55(1):64-7. Epub 2007 Apr 5.

VZV infection in pregnancy: a retrospective review over 5 years in Sheffield and 
discussion on the potential utilisation of varicella vaccine in prevention.

McKendrick MW, Lau J, Alston S, Bremner J.

Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS
Foundation Trust, UK. mike.mckendrick@sth.nhs.uk

OBJECTIVES: To study retrospectively the epidemiology, demography and clinical
issues related to varicella in pregnancy in a UK city over a 5-year period and
help inform the debate on the potential of varicella immunisation in prevention. 
METHODS: The hospital records of pregnant women with varicella receiving care at 
the Regional Department of Infection and Tropical Medicine in Sheffield between
1997 and 2002 were reviewed. Data on pregnant women with varicella not presenting
acutely to medical care were obtained. The use of Varicella Zoster Immune
Globulin (VZIG) in prevention of varicella during the same 5-year period was
determined. The records from the maternity department of Sheffield Hospitals for 
women undergoing VZV antibody testing between January and December 2004 were
reviewed. Data on annual number of deliveries were recorded and the neonatology
database used as a source of information regarding effects of chickenpox on the
baby. RESULTS: The incidence of varicella infection in pregnancy was at least 6
per 10,000 deliveries. Nineteen pregnant women with varicella were admitted to
hospital. Three had pneumonia. Infection occurred in the first pregnancy in a
quarter of cases. The minimum cost for all cases admitted to hospital during this
period (basic costs per day) was 20,520 pounds sterling. The cost of VZIG use for
chickenpox during the same period adjusted for the population size was 10,881
pounds sterling. This was not a comprehensive health economic study and did not
attempt to assess additional GP, midwifery, obstetric or social costs nor costs
associated with those who did not attend hospital. Two hundred and thirty-three
women underwent VZV antibody test during 2004 usually after contact with
chickenpox. Sixty percent of women in contact with chickenpox did not present to 
their GP or hospital immediately. CONCLUSION: Varicella in pregnancy may be
associated with significant morbidity and health care cost and prevention by
immunisation is desirable. Though targeted vaccination is attractive, screening
in pregnancy followed by a post-partum varicella immunisation programme would
fail to protect 25% and would be associated with logistical challenges not
occurring with rubella immunisation. Varicella is now a preventable disease by
immunisation. Exposure in pregnancy with or without infection has financial costs
related to antibody testing and prophylaxis. Infection in pregnancy may be
associated with additional costs and potential morbidity to mother and baby.
Potential immunisation strategies are considered.

PMID: 17418420 [PubMed - indexed for MEDLINE]

153: Pediatr Infect Dis J. 2007 Apr;26(4):300-5.

A role for genetics in the immune response to the varicella vaccine.

Klein NP, Fireman B, Enright A, Ray P, Black S, Dekker CL; Clinical Immunization 
Safety Assessment Network.

Kaiser Permanente Vaccine Study Center and Division of Research, Oakland, CA
94612, USA. nicola.klein@kp.org

BACKGROUND: A wide range in antibody titers has been found after immunization
with the varicella vaccine, although the basis for these differences has not been
described. METHODS: To evaluate the contribution of a genetic component in the
immune response to the varicella vaccine, concordance for six-week
postimmunization antibody titers was evaluated among 248 biologic siblings who
participated in varicella vaccine clinical trials by comparing all pairs of
siblings (151 pairs) to all possible unrelated, nonsibling pairs created from
within this same cohort (30,477 pairs). RESULTS: Postimmunization antibody titers
after 1 varicella vaccine dose were within the range observed historically among 
healthy vaccinees, with 85.4% of subjects having antibody responses greater than 
the approximate correlate of protection of 5 gpELISA units. Postimmunization
antibody titers within sibling pairs clustered together more than or less than 10
gpELISA units when compared with within nonsibling pairs (P < 0.0001).
Postimmunization titers within sibling pairs were also quantitatively closer
together than were those within unrelated, nonsibling pairs (P = 0.022). The
age-adjusted intraclass correlation coefficient indicated that the heritability
of the varicella vaccine immune response is 45% (95% confidence interval of
15-75%). CONCLUSIONS: Similarities in siblings' response to varicella vaccine are
supportive of the hypothesis that genetic factors play a role in the antibody
response to the varicella vaccine.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 17414391 [PubMed - indexed for MEDLINE]

154: J Virol. 2007 Jun;81(12):6752-6. Epub 2007 Apr 4.

Productive varicella-zoster virus infection of cultured intact human ganglia.

Gowrishankar K, Slobedman B, Cunningham AL, Miranda-Saksena M, Boadle RA,
Abendroth A.

Center for Virus Research, Westmead Millenium Institute, and Department of
Infectious Diseases and Immunology, University of Sydney, Blackburn Building,
2006 NSW, Australia.

Varicella-zoster virus (VZV) is a species-specific herpesvirus which infects
sensory ganglia. We have developed a model of infection of human intact explant
dorsal root ganglia (DRG). Following exposure of DRG to VZV, viral antigens were 
detected in neurons and nonneuronal cells. Enveloped virions were visualized by
transmission electron microscopy in neurons and nonneuronal cells and within the 
extracellular space. Moreover, rather than remaining highly cell associated
during infection of cultured cells, such as fibroblasts, cell-free VZV was
released from infected DRG. This model enables VZV infection of ganglionic cells 
to be studied in the context of intact DRG.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17409155 [PubMed - indexed for MEDLINE]

155: Acta Paediatr. 2007 Mar;96(3):428-31.

Parent-dependent barriers to varicella immunization in Israel: the importance of 
adequate information.

Adler A, Herring E, Babilsky H, Gazala E, Cohen A, Levy I.

Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel,
Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel. amosa@hadassah.org.il

AIM: To examine the parent-dependent barriers to varicella immunization in
Israel. METHODS: Data were collected by questionnaire from parents of children
aged 1 to 18 years who attended an outpatient paediatric centre in five cities in
Israel from March to May 2003. RESULTS: A total of 1474 parents completed the
questionnaire. A history of chicken pox was reported in 850 children (57.8%),
mostly (83%) between ages 1-6 years. Of the 624 children without a history of
chicken pox, 213 (34.1%) were immunized against varicella. Immunization rates
were significantly lower in families with lower parental education and in
patients from cities with a lower socioeconomic ranking (p < 0.05). The main
reasons for not being vaccinated (49%) were related to insufficient information
about the vaccine itself and the vaccination process. These reasons were more
common in families with lower parental education and from cities with lower
socioeconomic ranking (p < 0.01). Other reasons included fear of adverse effects 
(12%) and waning immunity (6%), preference of natural illness over immunization
(12%), and financial limitations (5%). CONCLUSIONS: Promoting parental knowledge 
about the varicella vaccine appears to be a key factor in improving the
immunization rate, especially in families of lower education, and from cities
with low socioeconomic ranking.

Publication Types: 
    Multicenter Study

PMID: 17407471 [PubMed - indexed for MEDLINE]

156: Infect Control Hosp Epidemiol. 2007 Apr;28(4):430-4. Epub 2007 Feb 26.

Outbreak of varicella-zoster virus infection among Thai healthcare workers.

Apisarnthanarak A, Kitphati R, Tawatsupha P, Thongphubeth K, Apisarnthanarak P,
Mundy LM.

Division of Infectious Diseases, Faculty of Medicine, Thammasart University
Hospital, Pratumthani, Thailand. anapisarn@yahoo.com

OBJECTIVE: To evaluate the correlation between self-report of a prior history of 
chickenpox and results of varicella-zoster virus (VZV) immunoglobulin (Ig) G
serologic test results in an outbreak of VZV infection among Thai healthcare
workers (HCWs) and to conduct a cost-benefit analysis of establishing routine VZV
immunization as part of an occupational health program on the basis of the
outbreak data. METHODS: All exposed patients received prophylaxis and the HCWs in
our 3 intensive care units (ICUs) were prospectively evaluated. HCWs were
assessed for disease history and serologic evidence of VZV IgG. A cost-benefit
analysis was performed. RESULTS: After 140 HCWs and 18 ICU patients were exposed 
to VZV, 10 HCWs (7%) with active VZV infection were relieved from work until skin
lesions were crusted. Acyclovir (ACV) was prescribed to all 10 HCWs with active
disease, and all 18 exposed patients received prophylaxis with ACV. Of 140 HCWs, 
100 consented to longitudinal follow-up. Twenty-three (100%) of the HCWs who
reported a history of chickenpox also had serologic test results that were
positive for VZV IgG, compared with 30 (39%) of 77 HCWs who reported no prior
history of chickenpox, yet had test results that were positive for VZV IgG.
Reported history of chickenpox had a sensitivity of 43%, a specificity of 100%, a
positive predictive value of 100%, and a negative predictive value of 61% with
respect to VZV infection immunity. The total cost estimate for this outbreak
investigation was $23,087. CONCLUSIONS: An HCW's reported history of chickenpox
was a reliable predictor of immunity; a report of no prior history of chickenpox 
was unreliable. Our cost-benefit analysis suggests that the costs of an
occupational health program that included VZV surveillance and immunization for
the next 323 HCWs would be approximately equal to the excess costs of $17,227 for
the ACV therapy, HCW furloughs, and staff overtime associated with this outbreak.

PMID: 17385149 [PubMed - indexed for MEDLINE]

157: Ir Med J. 2007 Jan;100(1):332-3.

Ischaemic stroke in children secondary to post varicella angiopathy.

Hayes B, Baker L, Alhajeri A, Ryan S, Lynch B.

The Childrens University Hospital, Temple Street, Dublin.

Varicella in childhood is a self-limiting disease, which usually follows a benign
course. However, complications, although rare, may have serious consequences.
Ischaemic stroke secondary to post varicella angiopathy is a well-described
complication and is estimated to account for up to a third of all strokes in
infants. We present three previously healthy children who presented to our centre
with ischaemic cerebrovascular infarction due to varicella angiopathy. All three 
children first presented within six weeks after onset of varicella infection and 
had MRI changes characteristic of ischaemic stroke secondary to post varicella
angiopathy. While one child made an excellent recovery being left with only a
minor deficit, the remaining two children were left with considerable morbidity
severely affecting quality of life. The varicella vaccine has been proven to be
well tolerated, safe and effective. We conclude that varicella vaccination should
be considered for inclusion in the vaccination schedule to prevent serious
complications which while rare may have devastating consequences.

Publication Types: 
    Case Reports

PMID: 17380923 [PubMed - indexed for MEDLINE]

158: Clin Microbiol Infect. 2007 May;13(5):546-9. Epub 2007 Mar 22.

Paediatric varicella hospitalisations in France: a nationwide survey.

Grimprel E, Levy C, de La Rocque F, Cohen R, Soubeyrand B, Caulin E, Derrough T, 
Lecuyer A, d'Athis P, Gaudelus J; Pediatricians Working Group.

Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de
Pédiatrie, Paris, France. emmanuel.grimprel@trs.ap-hop-paris.fr

Paediatric patients hospitalised with varicella (n = 1575) were reported to a
French national network between March 2003 and July 2005. Superinfection was
identified in 50.3% of cases, principally of skin and soft-tissue (36.5%). The
risk of superinfection increased with fever relapse, use of non-steroidal
anti-inflammatory drugs, prolonged fever, an age of 1-5 years, and contamination 
at the childminder's home. Neurological complications were observed in 7.8% of
cases, while pulmonary complications were less frequent (3.1%). Forty-nine
patients had sequelae and eight patients died. Surveillance should continue in
France with a view to the future implementation of a universal vaccination
programme.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17378927 [PubMed - indexed for MEDLINE]

159: Med Mal Infect. 2007 Apr;37(4):222-8. Epub 2007 Mar 26.

Analysis of factors associated with varicella-zoster virus susceptibility among
children 0-12 years old in Taiwan.

Chang CK, Tan HF, Tseng HF, Lin CC.

Department of Sport Management and Sport Science Research Center, National Taiwan
College of Physical Education, 16, Sec. 1, Shuan-Shih Road, Taichung 404, Taiwan,
ROC.

OBJECTIVES: Varicella is a highly infectious disease caused by varicella-zoster
virus (VZV). The aim of this study was to explore the geographical difference of 
VZV antibody seroprevalence among children in private vaccination areas in
Taiwan, controlling for potential factors relating to varicella susceptibility.
PATIENTS AND METHOD: A cross-sectional survey of the seroprevalence of VZV
antibodies among children 0-12 years of age was conducted in Taiwan between
August and December 2003. Sera of children visiting the outpatient unit of the
participating hospitals around the island were collected. Six hundred and
fifty-six parents among those of the 931 children studied agreed to answer the
self-administered questionnaire regarding the possible factors associated with
varicella susceptibility. IgG antibodies to VZV were measured using an
enzyme-linked immunosorbent assay kit, Enzygnost anti VZV/IgG. RESULTS: The
susceptibility was the highest at age 1 year, and then decreased as the age
increased. Children living in southern and eastern Taiwan showed higher
susceptibility to varicella than those living in northern area (odds ratio (OR) =
2.71 and 2.10, respectively). Prior history of varicella infection, varicella
vaccination, and contact with cases remained to be associated with the
susceptibility after multivariate analysis. CONCLUSIONS: Children who lived in
tropical and rural regions and those who had no history of varicella infection,
varicella vaccination, and contact with cases, might be more susceptible to
varicella. Island-wide VZV seroprevalence surveillance is required to examine
whether the geographical difference of susceptibility in Taiwan will become less 
significant or disappear after the mass varicella vaccination program initiated
in 2004.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17368781 [PubMed - indexed for MEDLINE]

160: N Engl J Med. 2007 Mar 15;356(11):1121-9.

Comment in:
    J Fam Pract. 2007 Jun;56(6):437.    N Engl J Med. 2007 Jun 21;356(25):2648-9; author reply 2648-9.    N Engl J Med. 2007 Jun 21;356(25):2648-9; author reply 2648-9.

Loss of vaccine-induced immunity to varicella over time.

Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L, Seward JF.

Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. bev8@cdc.gov

BACKGROUND: The introduction of universal varicella vaccination in 1995 has
substantially reduced varicella-related morbidity and mortality in the United
States. However, it remains unclear whether vaccine-induced immunity wanes over
time, a condition that may result in increased susceptibility later in life, when
the risk of serious complications may be greater than in childhood. METHODS: We
examined 10 years (1995 to 2004) of active surveillance data from a sentinel
population of 350,000 subjects to determine whether the severity and incidence of
breakthrough varicella (with an onset of rash >42 days after vaccination)
increased with the time since vaccination. We used multivariate logistic
regression to adjust for the year of disease onset (calendar year) and the
subject's age at both disease onset and vaccination. RESULTS: A total of 11,356
subjects were reported to have varicella during the surveillance period, of whom 
1080 (9.5%) had breakthrough disease. Children between the ages of 8 and 12 years
who had been vaccinated at least 5 years previously were significantly more
likely to have moderate or severe disease than were those who had been vaccinated
less than 5 years previously (risk ratio, 2.6; 95% confidence interval [CI], 1.2 
to 5.8). The annual rate of breakthrough varicella significantly increased with
the time since vaccination, from 1.6 cases per 1000 person-years (95% CI, 1.2 to 
2.0) within 1 year after vaccination to 9.0 per 1000 person-years (95% CI, 6.9 to
11.7) at 5 years and 58.2 per 1000 person-years (95% CI, 36.0 to 94.0) at 9
years. CONCLUSIONS: A second dose of varicella vaccine, now recommended for all
children, could improve protection from both primary vaccine failure and waning
vaccine-induced immunity. Copyright 2007 Massachusetts Medical Society.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 17360990 [PubMed - indexed for MEDLINE]

161: Indian J Med Sci. 2007 Mar;61(3):128-34.

Comment in:
    Indian J Med Sci. 2007 Mar;61(3):123-4.

Seroprevalence of varicella zoster virus infections in Colombo district, Sri
Lanka.

Liyanage NP, Fernando S, Malavige GN, Mallikahewa R, Sivayogan S, Jiffry MT,
Vitarana T.

Department of Microbiology, Faculty of Medical Sciences, University of Sri
Jayawardanapura, Sri Lanka.

BACKGROUND: Although Varicella Zoster virus (VZV) infections occur worldwide, the
epidemiology is remarkably different in tropical and temperate climates. VZV
infections result in significant morbidity and mortality among adults in Sri
Lanka. AIMS: For future VZV vaccination strategies, we set to determine the
age-specific seroprevalence rate of VZV infections in Colombo, Sri Lanka.
MATERIALS AND METHODS: The study was carried out from 1999 to 2000. Multi-stage
cluster sampling technique was used to collect 913 blood samples, which were
tested for the presence of VZV-specific IgG antibodies. RESULTS: VZV
seroprevalence rates were markedly lower in all age groups when compared to
temperate climates. The seroprevalence rates increased with age in both the rural
and urban populations. Of those aged 60 years, only 50% in the rural population
and 78.9% in the urban population were immune to VZV. Seroprevalence rates of VZV
infections were significantly different between the urban and rural populations
(P< 0.001), with VZV-specific IgG antibodies detected in 47.5% in the urban
population and 27.9% in the rural population. It was found that 56.2% (131) of
females of childbearing age were nonimmune to VZV. CONCLUSIONS: These findings
highlight the need for a VZV vaccination program, which is likely to have a huge 
impact on the incidence of chickenpox and its associated morbidity and mortality.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17337813 [PubMed - indexed for MEDLINE]

162: Eur J Pediatr. 2008 Jan;167(1):47-55. Epub 2007 Mar 3.

Varicella vaccination in Europe: are we ready for a universal childhood
programme?

Sengupta N, Booy R, Schmitt HJ, Peltola H, Van-Damme P, Schumacher RF, Campins M,
Rodrigo C, Heikkinen T, Seward J, Jumaan A, Finn A, Olcén P, Thiry N,
Weil-Olivier C, Breuer J.

Centre for Child Health, Royal London Hospital, 38 New Road, Whitechapel, London,
E1 2AX, UK. n.sengupta@qmul.ac.uk

Safe and effective vaccines against varicella zoster virus (VZV), the
aetiological agent of varicella and shingles, have been available in Europe for
the last 5-10 years. The USA has had a universal childhood vaccination policy
since 1995 and this has resulted in a dramatic decrease in the incidence,
morbidity and mortality related to varicella. The economic and medical burden of 
VZV has led to discussions regarding both the desirability and feasibility of a
similar routine immunisation policy for all European children. This article
examines the epidemiology of varicella in Europe and how the data emerging from
the USA can be used to achieve adequate prevention of the disease. It looks into 
the current evidence of the health economic evaluation of universal varicella
vaccination and explores the concerns surrounding such a policy, including the
postulated impact on the incidence of zoster. In conclusion, the Society of
Independent European Vaccination Experts (SIEVE) recommends that the immunisation
of susceptible adolescents needs to be urgently implemented, in addition to the
current recommendations targeting high-risk patients, their close contacts with a
negative history of varicella and seronegative health-care workers. A universal
policy, optimally incorporating a two-dose schedule, will be needed to finally
reduce the burden of disease of varicella from a societal point of view. The
SIEVE recommends the implementation of such a policy as soon as financially and
practically possible.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17334784 [PubMed - indexed for MEDLINE]

163: J Clin Virol. 2007 Apr;38(4):358-61. Epub 2007 Feb 23.

An increasing incidence of chickenpox central nervous system complications in
children: what's happening in Tuscany?

Frenos S, Galli L, Chiappini E, de Martino M.

Department of Pediatrics, University of Florence, Anna Meyer Children's Hospital,
Via Luca Giordano, 13, I-50132 Florence, Italy.

BACKGROUND: The most frequent noncutaneous site of involvement of chickenpox is
the central nervous system (CNS) and complications include cerebellar ataxia,
encephalitis, and meningitis. OBJECTIVES: We have recently observed an unusually 
high number of children with chickenpox CNS complications in our university
children's hospital. A study to evaluate the incidence of these complications
over time in children living in Tuscany was carried out. STUDY DESIGN: We
evaluated all cases of chickenpox and chickenpox complications leading to
hospitalization in children aged 1 month-14 years reported to the Tuscany public 
health centre between 1997 and 2004. The International Classification of Disease 
Ninth Revision-CM hospital discharge diagnostic codes and medical records were
used. RESULTS: The incidence (95% confidence interval) of CNS complications/1000 
chickenpox cases was stable between 1997 and 2001 [1997: 0.80 (0.29-1.74); 1998: 
0.73 (0.29-1.50); 1999: 0.67 (0.25-1.46); 2000: 0.56 (0.15-1.44); 2001: 0.59
(0.16-1.50)] but increased significantly (chi(2) for trend: 9.401; p=.0021) in
2002 [1.56 (0.83-2.66)], in 2003 [1.73 (0.95-2.90)] and in 2004 [1.51
(0.74-2.27)]. Non-CNS complications remained stable over time. CONCLUSIONS:
Possible factors biasing the result were taken into account. Reasons of increased
CNS complications remain unknown, but the possible emergence of a particularly
neurotropic strain of varicella-zoster virus should be further investigated.

Publication Types: 
    Case Reports

PMID: 17321202 [PubMed - indexed for MEDLINE]

164: J Paediatr Child Health. 2007 Mar;43(3):193-5.

Varicella encephalopathy in immunocompetent children.

Carreño A, López-Herce J, Verdú A, Riaza M, García E.

Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, 
Madrid, Spain.

Two previously healthy girls presented acute encephalopathy due to varicella,
with severe alteration of the conscious level and seizures. Both patients
improved progressively after 15 days, with complete clinical recovery.

Publication Types: 
    Case Reports

PMID: 17316198 [PubMed - indexed for MEDLINE]

165: Mayo Clin Proc. 2007 Feb;82(2):175-80.

Seroprevalence of antibody to varicella among Somali refugees.

Nysse LJ, Pinsky NA, Bratberg JP, Babar-Weber AY, Samuel TT, Krych EH, Ziegler
AW, Jimale MA, Vierkant RA, Jacobson RM, Poland GA.

Mayo Vaccine Research Group , Mayo Clinic College of Medicine, Rochester, Minn
55905, USA.

OBJECTIVES: To determine the seroprevalence of varicella antibody among recent
Somali refugees living in Olmsted County, Minnesota, and to estimate the risk of 
varicella-zoster virus (VZV) infection in this group. SUBJECTS AND METHODS: We
obtained blood samples from the study subjects, along with demographic
information, immunization records, and vaccine-preventable disease history. Serum
samples were tested using a whole-virus IgG VZV-specific commercial enzyme-linked
immunosorbent assay kit. This study was completed in 1998. RESULTS: Overall, 200 
Somali refugees, comprising 33 extended families, were interviewed, with 193
providing adequate blood samples. Thirty-five subjects (18%) were seronegative
for varicelia. Males had a significantly higher seronegativity rate (25% [n =
23]) compared with females (12% [n = 12]; P = .02); however, this association
disappeared after adjustment for age and varicella infection history. Five
percent (5/92) of adults were seronegative compared with 30% (30/101) of all
children (P < .001). Eight percent (5/61) of the adult females were seronegative,
whereas none (0/31) of the adult males were seronegative. Conversely, 38% (23/60)
of male children were seronegative compared with 17% (7/41) of female children (P
< .001). CONCLUSION: These results demonstrate a high prevalence of varicella
seronegativity among Somali refugees who have immigrated to an endemic area. We
recommend instituting improved education regarding varicella among Somali
communities and increasing vaccine uptake or routine testing for serum varicella 
antibody to prevent VZV-related morbidity and mortality, particularly in
adolescents, adult refugees, and women of childbearing age.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17290724 [PubMed - indexed for MEDLINE]

166: Neurology. 2007 Mar 27;68(13):1069-73. Epub 2007 Feb 7.

The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy.

Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, Katzan I,
Lin R, Gardner CJ, Gilden DH.

Department of Neurology, University of Colorado Health Sciences Center, Denver,
CO 80262, USA.

BACKGROUND: Factors that may obscure the diagnosis of varicella zoster virus
(VZV) vasculopathy include the absence of rash before TIAs or stroke as well as
similar clinical features and imaging, angiographic, and CSF abnormalities to
those of other vasculopathies. Diagnosis relies on virologic confirmation that
detects VZV DNA, anti-VZV IgG antibody, or both in the CSF. METHODS: We reviewed 
our current 14 cases of patients diagnosed with VZV vasculopathy based on
combined clinical, imaging, angiographic, or CSF abnormalities. All CSFs must
have been tested for VZV DNA by PCR and for anti-VZV IgG antibody by enzyme
immunoassay and found to be positive for either or both. Of the 14 subjects, 8
had a history of recent zoster, whereas 6 had no history of zoster rash before
developing vasculopathy. RESULTS: All 14 subjects (100%) had anti-VZV IgG
antibody in their CSF, whereas only 4 (28%) had VZV DNA. The detection of
anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy
than detection of VZV DNA (p < 0.001). CONCLUSIONS: In varicella zoster virus
(VZV) vasculopathy, the diagnostic value of detecting anti-VZV IgG antibody in
CSF is greater than that of detecting VZV DNA. Although a positive PCR for VZV
DNA in CSF is helpful, a negative PCR does not exclude the diagnosis of VZV
vasculopathy. Only when the CSF is negative for both VZV DNA and anti-VZV IgG
antibody can the diagnosis of VZV vasculopathy be excluded.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17287447 [PubMed - indexed for MEDLINE]

167: Pediatrics. 2007 Feb;119(2):258-64.

Physician attitudes regarding breakthrough varicella disease and a potential
second dose of varicella vaccine.

Davis MM, Marin M, Cowan AE, Guris D, Clark SJ.

Child Health Evaluation and Research Unit, Division of General Pediatrics,
University of Michigan, Ann Arbor, MI, USA. mattdav@med.umich.edu

OBJECTIVE: We assessed physicians' attitudes about the 1-dose varicella
vaccination program and whether physicians think a 2-dose recommendation is
needed to reduce the risk of breakthrough disease. METHODS: We conducted a
national mail survey of a random sample of 550 pediatricians and 550 family
physicians from April to June 2005. Physicians who provide outpatient primary
care to children < or = 6 years of age were eligible for analysis. RESULTS:
Surveys were returned by 727 respondents, for a response rate of 69%; 610
physicians were eligible. Most respondents (94%) recommend routine 1-dose
varicella vaccination, and 79% have seen breakthrough disease in the past 5 years
(95% of pediatricians and 58% of family physicians). The majority (68%) agreed or
strongly agreed that the current burden of breakthrough disease is acceptable.
Only 38% (46% of pediatricians and 28% of family physicians) agreed or strongly
agreed that a second dose of varicella vaccine is needed to address the burden of
breakthrough disease, whereas 40% were neutral. However, if the Advisory
Committee on Immunization Practices were to recommend a second dose of varicella 
vaccine, then 65% of pediatricians and 39% of family physicians would likely
follow the recommendation. Most respondents (78%) would be more willing to
recommend a second dose if a combination measles-mumps-rubella-varicella vaccine 
was available. CONCLUSIONS: Pediatricians and family physicians support the
1-dose varicella vaccination program. A new Advisory Committee on Immunization
Practices recommendation for a second dose of varicella vaccine for children was 
issued after the survey (in June 2006). Two of 3 pediatricians and 2 of 5 family 
physicians stated that they would adopt a 2-dose recommendation in practice;
rates of adoption may be bolstered with current availability of
measles-mumps-rubella-varicella vaccine and harmonization of the varicella
vaccination schedule with that of measles-mumps-rubella vaccine.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 17272614 [PubMed - indexed for MEDLINE]

168: Vaccine. 2007 Mar 30;25(14):2630-3. Epub 2006 Dec 26.

Evaluation of the National Notifiable Disease Surveillance System in Taiwan: an
example of varicella reporting.

Tan HF, Chang CK, Tseng HF, Lin W.

Department of Healthcare Administration, Chang-Jung Christian University, Taiwan.

Despite the mandatory reporting by laws, the incompleteness of notifiable
infectious disease reporting is well-documented in many countries for various
diseases. The purpose of this study is to investigate the completeness of
varicella reporting in Taiwan. Annual reports of National Notifiable Disease
Surveillance System in Taiwan were compared to the annual outpatient claims of
National Health Insurance (NHI) in the years of 2000, 2001, and 2002. Age and
area-specific reporting rates of varicella were calculated by dividing the
respective reported cases by the number of incidence cases. The reporting rate
was the highest in aged 0 year in all years, followed by the 20-29- and
30-39-year groups. The reporting rate in each age group increased gradually
during the study period. Other than Taipei City, the reporting rates in all
regions were below 9% during this period. This study suggested that varicella
reporting rate is very low in Taiwan. In addition, the reporting rates were
inconsistent in 2000-2002, making the estimation of prevalence and vaccine
efficacy using data from the National Notifiable Disease Surveillance System
almost impossible. This study indicated that the physicians in Taiwan should
improve their knowledge and attitude toward notifiable infectious diseases.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17270318 [PubMed - indexed for MEDLINE]

169: J Infect Dis. 2007 Mar 1;195(5):660-4. Epub 2007 Jan 22.

Rapid effector function of varicella-zoster virus glycoprotein I-specific CD4+ T 
cells many decades after primary infection.

Malavige GN, Jones L, Black AP, Ogg GS.

Medical Research Council Human Immunology Unit, Weatherall Institute of Molecular
Medicine, University of Oxford, Oxford, United Kingdom.

Glycoprotein I (gI) of varicella-zoster virus (VZV) contributes to viral
virulence and is therefore a potentially important target for T cell control of
viral replication. Persisting effector function of gI-specific T cells after
primary infection has not been previously examined. We have shown that, many
decades after infection, relatively high frequencies gI-specific interferon-
gamma responses are detectable ex vivo and are dominated by CD4(+) T cells. We
characterized the optimal peptide of the strongest response in our cohort showing
restriction through DRB4*01. These findings are consistent with gI-specific
CD4(+) T cell involvement in the control of VZV replication.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17262706 [PubMed - indexed for MEDLINE]

170: Vaccine. 2007 Feb 26;25(10):1764-70. Epub 2006 Nov 27.

Assessment of the potency and potential immunomodulatory effects of the measles
mumps rubella and varicella vaccine in infants.

Yerkovich ST, Rowe J, Richmond P, Suriyaarachchi D, Heaton T, Hollams E, Ladyman 
C, Serralha M, Sadowska A, Loh R, Wesselingh SL, Sly PD, Holt PG.

Telethon Institute for Child Health Research, and Centre for Child Health
Research, Faculty of Medicine and Dentistry, The University of Western Australia,
Perth, WA, Australia.

This study compared the potency and immunomodulatory effects of measles mumps
rubella (MMR) vaccine given to infants alone or in combination with varicella
(MMR and V). In an additional group, MMR vaccination was delayed 42 days to
permit analysis of potential effects on underlying maturation of systemic immune 
functions. Assessment of immunity to the vaccines indicated consistent antibody
production coupled with mixed Th1/Th2 memory, and no significant differences
between vaccine groups or to the group who had their MMR vaccination delayed.
Parallel analyses of cytokine responses to phytohaemagglutinin and tetanus toxoid
did not detect any "bystander" effects of the vaccines on systemic immunity.

Publication Types: 
    Comparative Study

PMID: 17224218 [PubMed - indexed for MEDLINE]

171: Med Microbiol Immunol. 2007 Jun;196(2):95-102. Epub 2006 Dec 16.

Herpes simplex and varicella-zoster virus infections during pregnancy: current
concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus
infections.

Sauerbrei A, Wutzler P.

Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of
Jena, Hans-Knoell-Strasse 2, 07745 Jena, Germany.
Andreas.Sauerbrei@med.uni-jena.de

Varicella during pregnancy can be associated with severe illnesses for both the
mother and her neonate. Varicella pneumonia must be regarded as a medical
emergency, since pregnant women are at risk of life-threatening ventilatory
compromise and death. After maternal chickenpox in the first and second
trimesters, congenital varicella syndrome may occur in nearly 2% of the cases.
The characteristic symptoms consist of skin lesions in dermatomal distribution,
neurological defects, eye diseases and skeletal anomalies. If the mother develops
varicella rashes between day 4 (5) antepartum and day 2 postpartum, generalized
neonatal varicella leading to death in about 20% of the cases has to be expected.
Normal zoster has not been shown to be associated with maternal pneumonia, birth 
defects or problems in the perinatal period. On the basis of the clinical
consequences of varicella-zoster virus infections during pregnancy, the present
paper summarizes the currently available concepts of prevention, diagnosis and
therapy.

Publication Types: 
    Review

PMID: 17180380 [PubMed - indexed for MEDLINE]

172: J Med Virol. 2007 Feb;79(2):192-9.

Increased prevalence of varicella zoster virus DNA in cerebrospinal fluid from
patients with multiple sclerosis.

Mancuso R, Delbue S, Borghi E, Pagani E, Calvo MG, Caputo D, Granieri E, Ferrante
P.

Laboratory of Molecular Medicine and Biotechnology, Don C. Gnocchi Foundation,
IRCCS, Milan, Italy.

In order to investigate the possible involvement of viruses in Multiple Sclerosis
(MS), the study evaluated the presence of viral genomic sequences in
cerebrospinal fluid (CSF), as markers of viral replication within the central
nervous system (CNS). A total of 85 CSF samples were collected from 38 MS
patients, 28 patients with other neurological diseases and 19 subjects without
neurological diseases. Using nested-PCR, the investigation focused on the
presence of human herpes virus DNA, including herpes simplex virus 1 (HSV-1) and 
2 (HSV-2), the Epstein-Barr virus (EBV), varicella zoster virus (VZV), human
cytomegalovirus (HCMV), human herpes virus 6 (HHV-6) and JC virus (JCV). All the 
CSF samples from the individuals without neurological diseases were negative for 
viral DNA. Genomic sequences of HSV-1, HCMV, EBV, HHV6, and JCV were found in
patients with MS and other neurological diseases without significant differences 
between the two groups. VZV DNA was detected more frequently (P < 0.05) in the MS
group (31.6%), particularly among the relapsing-remitting MS patients (43.5%),
compared with patients with other neurological diseases (10.7%). In addition, the
results indicated that JCV and HHV-6 were replicating actively in the CNS of a
small, but significant number of patients with MS and other neurological
diseases. Most importantly, the study revealed a high frequency of VZV DNA in the
CSF of patients with MS, suggesting a possible role of this virus in the
pathogenesis of MS.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17177306 [PubMed - indexed for MEDLINE]

173: Transplant Proc. 2006 Dec;38(10):3418-9.

Varicella zoster virus serostatus before and after kidney transplantation, and
vaccination of adult kidney transplant candidates.

Geel AL, Landman TS, Kal JA, van Doomum GJ, Weimar W.

Erasmus Medical Center, Department of Internal Medicine, Rotterdam, The
Netherlands. ageel@erasmusmc.nl

In recent years we observed 3 lethal primary varicella infections in adult kidney
transplant recipients. Therefore, we wondered how many of our adult renal
transplant patients were not protected against varicella zoster virus (VZV), and 
therefore were at risk for such a primary infection. We also studied the
prevalence of VZV seronegativity in the adult patients on our waitlist for kidney
transplantation. Finally, we vaccinated these seronegative patients with an
attenuated live vaccine. Sera were obtained from 854 transplanted patients, and
from 286 candidates on the waitlist for kidney transplantation. We observed that 
2.1% of our renal transplant recipients and 3.2% of the patients on the waitlist 
were seronegative for VZV. We vaccinated 11 seronegative patients on the waitlist
twice without side effects. In 7 of 11 patients this resulted in a positive
serologic response. In conclusion, the prevalence of VZV seronegativity was low
both in renal transplant recipients (2%) and in patients on the waitlist (3%).
Vaccination of transplant candidates resulted in a moderate efficiency of 64%.

PMID: 17175291 [PubMed - indexed for MEDLINE]

174: Turk J Pediatr. 2006 Jul-Sep;48(3):185-8.

Seroprevalence of mumps, varicella and rubella antibodies in children 1-16 years 
of age in eastern Turkey.

Gürgöze MK, Yilmaz E, Gödekmerdan A, Akça Z, Doğan Y, Akarsu S, Aygün AD.

Department of Pediatrics, Firat University Faculty of Medicine, Elaziğ, Turkey.

In this study, seroprevalence of mumps, varicella and rubella was investigated in
803 unvaccinated children in eastern Turkey whose ages ranged between 1 and 16
years. Mumps IgG, varicella IgG and rubella IgG antibody levels in all children
were studied by enzyme-linked immunosorbent assay (ELISA) method. Information
regarding socioeconomic characteristics, number of siblings and disease history
was gathered for each participant. No significant difference in seropositivity
was detected between girls and boys. Seroprevalence of mumps increased with age, 
with a seropositivity rate of 29.9% in children aged 1-4 years and of 88.8% in
those aged 13-16 years. Seroprevalence of varicella increased with age, with a
seropositivity rate of 26.8% in children aged 1-4 years and of 90.3% in those
aged 13-16 years. Seroprevalence of rubella also increased with age, with a
seropositivity rate of 47.3% in the children aged 1-4 years and of 89.2% in those
aged 13-16 years. There was a statistically significant increase in the rate of
seropositivity with advancing age through the group of 13-16 years old (p <
0.05). In conclusion, in order to avoid mumps, varicella and rubella diseases and
their possible complications, children should be vaccinated against these three
diseases before the age of two, since seroprevalence increases with age.

PMID: 17172059 [PubMed - indexed for MEDLINE]

175: Inflammation. 2007 Apr;30(1-2):38-43. Epub 2006 Dec 14.

Nerve growth factor immunoreactivity of mast cells in acute involuted human
thymus.

Marinova T, Philipov S, Aloe L.

Department of Biology, Medical Faculty, Medical University, 2 Zdrave Street,
BG-1431 Sofia, Bulgaria. tsvetamarin@yahoo.com

The acute involution of the thymus is induced by either exogenous or endogenous
factors, including some infections (infection type involution). The present study
was focused on both detection and immunocytochemical analysis of NGF
immunopositive mast cells in child thymus with acute infection-induced
involution. Autopsy thymus specimens from children with infection diseases
(Sepsis, Encephalomyelitis, Varicella) were examined at light and electron
microscopic level and compared to normal infantile thymuses. We observed a
redistribution of NGF immunopositive mast cells in infection-affected child
thymus, which lobular architecture was collapsed. A positive correlation between 
the degree of the involutive changes, increased distribution and enhanced NGF
immunoreactivity of mast cells was defined. The possible involvement of NGF
immunopositive mast cells in the process of acute thymus involution is discussed.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17171437 [PubMed - indexed for MEDLINE]

176: Herpes. 2006 Nov;13(3):75-80.

Investigations of the pathogenesis of Varicella zoster virus infection in the
SCIDhu mouse model.

Arvin AM.

Departments of Pediatrics, and Microbiology and Immunology, Stanford University
School of Medicine, Stanford, CA 94305, USA. aarvin@stanford.edu

Varicella zoster virus (VZV) is a medically important human herpesvirus that
causes varicella, establishes latency in sensory ganglia and may reactivate to
cause herpes zoster in healthy and immunocompromised patients. Experiments in the
severe combined immunodeficiency (SCID) mouse model have provided new insights
about VZV pathogenesis. In addition, the evaluation of VZV recombinant viruses,
with targeted mutations of viral genes or their promoters in SCIDhu skin, T-cell 
and dorsal root ganglia xenografts, has the potential to identify options for the
design of a recombinant 'second-generation' VZV vaccine. This would be
characterized by the retention of infectivity in skin combined with a restricted 
tropism for T-cells and neurons within sensory ganglia.

Publication Types: 
    Review

PMID: 17147912 [PubMed - indexed for MEDLINE]

177: Herpes. 2006 Nov;13(3):60-5.

Prevention of VZV infection in immunosuppressed patients using antiviral agents.

Boeckh M.

Fred Hutchinson Cancer Research Center, Program in Infectious Diseases,
University of Washington, Seattle, WA 98109, USA. mboeckh@fhcrc.org

Antiviral agents play a key role in the prevention and treatment of varicella
zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show
that aciclovir is effective in preventing VZV reactivation disease; however, no
consensus exists on dose, duration and patient population for its use. The recent
shortage of VZV-specific immunoglobulin has generated renewed interest in the use
of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for
post-exposure prophylaxis is not supported by randomized trials, but uncontrolled
experience suggests that it might be a reasonable alternative if
varicella-specific immunoglobulin is not available. Current evidence on the use
of antiviral agents in the prevention of reactivation disease and management of
exposure to VZV is discussed.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17147908 [PubMed - indexed for MEDLINE]

178: J Clin Microbiol. 2007 Feb;45(2):559-63. Epub 2006 Nov 29.

Toward universal varicella-zoster virus (VZV) genotyping: diversity of VZV
strains from France and Spain.

Loparev V, Martro E, Rubtcova E, Rodrigo C, Piette JC, Caumes E, Vernant JP,
Schmid DS, Fillet AM.

Biotechnology Core Facility, Coordinating Center for Infectious Diseases, Centers
for Disease Control and Prevention, Atlanta, GA 30333, USA.

Thirty-one isolates from France and Spain were genotyped using a published method
analyzing DNA sequence variation in open reading frame (ORF) 22, together with an
evaluation of three well-characterized single nucleotide polymorphisms (SNP) in
ORF 38, 54, and 62. Nineteen were allocated to the European (E) genotype, six
were mosaic-1 (M1), and two were mosaic-2 (M2). Four strains were assigned to a
new genotype, mosaic-4 (M4). All isolates were wild type, with no Oka
vaccine-associated markers. No isolates of the mosaic-3 (M3) or Japanese (J)
genotype were observed. We also evaluated 13 selected isolates of E, J, M1, and
M2 strains (9 of the 31 described above) using an alternative genotyping method
based on the assessment of multiple SNP located in ORF 1, 9, 10, 21, 31, 50, 54, 
62, and 68. This method assigns wild-type varicella-zoster virus (VZV) strains to
seven genotypes: A1, A2, J1, B1, B2, C, and C1. VZV isolates identified as E
(ORF22 method) had the genetic signature of genotype C VZV strains, M1 strains
were A1, and M2 were A2. No J strains were detected, but parental Oka and vaccine
Oka (genotype J) corresponded to genotype J1. M4 isolates (B) share the SNP array
observed for M1 and E viruses, and probably represent recombinants between
African-Asian (M1) and European (E) viruses. The two genotyping methods, using
entirely different genomic targets, produced identical clusters for the strains
examined, suggesting robust phylogenetic linkages among VZV strains circulating
in Europe.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 17135433 [PubMed - indexed for MEDLINE]

179: J Virol Methods. 2007 Feb;139(2):227-9. Epub 2006 Nov 28.

Different real-time PCR assays could lead to a different result of detection of
varicella-zoster virus in facial palsy.

Yamakawa K, Hamada M, Takeda T.

Department of Otolaryngology, Kochi Medical School, Kohasu, Oko-chou, Kochi
783-8505, Japan. yamakawk@med.kochi-u.ac.jp

Real-time PCR is a useful tool for rapid detection of viral genomic DNA. However,
there are many types of real-time PCR, and this variation may induce different
results. The sensitivity of two different real-time PCR assays was evaluated for 
the detection of the varicella-zoster virus (VZV) genome: LightCycler PCR and
TaqMan PCR. Auricular skin cells and saliva were sampled from 201 patients with
facial nerve paralysis. A hundred and seventy-one of these patients were
diagnosed clinically with Bell's palsy, and the remaining 30 with Ramsay Hunt
syndrome. In 30 specimens obtained from Ramsay Hunt syndrome patients, VZV DNA
was detected in 26 skin and 3 saliva specimens using the LightCycler PCR, while
28 skin and 9 saliva specimens were positive using the TaqMan PCR. None of the
patients with Bell's palsy were positive for VZV by the LightCycler PCR, whereas 
five of these patients were positive by the TaqMan PCR. The TaqMan PCR assay has 
a better sensitivity compared to the LightCycler PCR for the detection of VZV
genome from patients with facial palsy. Further study is required to develop a
more sensitive real-time PCR.

PMID: 17134766 [PubMed - indexed for MEDLINE]

180: Am J Hematol. 2007 May;82(5):403-4.

The high incidence of varicella herpes zoster with the use of bortezomib in 10
patients.

Tong Y, Qian J, Li Y, Meng H, Jin J.

Department of Hematology, The First Affiliated Hospital of Zhejiang University,
Hangzhou, Zhejiang, China.

Bortezomib, a proteasome inhibitor, has been used for patients with refractory
and relapsed multiple myeloma, lymphoma and leukemia. We used bortezomib in ten
refractory or relapsed patients (seven of multiple myeloma, two of lymphoma and
one of acute myeloblastic leukemia). Six out of ten (60%) patients developed
varicella herpes zoster after the complete of one cycle of bortezomib. The
incidence of varicella herpes zoster was higher than reported in the literature. 
It may be due to immunosuppression caused by the combination of high-dose
dexamethasone or other drugs. We considered that prophylactic antiviral
medication could be used in predisposed patients to reduce the incidence of
varicella herpes zoster. (c) 2006 Wiley-Liss, Inc.

PMID: 17133426 [PubMed - indexed for MEDLINE]

181: AIDS. 2006 Nov 28;20(18):2321-9.

Varicella vaccination in HIV-1-infected children after immune reconstitution.

Bekker V, Westerlaken GH, Scherpbier H, Alders S, Zaaijer H, van Baarle D,
Kuijpers T.

Emma Children's Hospital, The Netherlands.

BACKGROUND: HIV-1-infected children have an increased risk of severe chickenpox. 
However, vaccination is not recommended in severely immunocompromised children.
OBJECTIVE: Can the live-attenuated varicella zoster virus (VZV) Oka strain be
safely and effectively given to HIV-1-infected children despite previously low
CD4 T-cell counts? METHODS: VZV vaccine was administered twice to 15
VZV-seronegative HIV-1-infected children when total lymphocyte counts were
greater than 700 lymphocytes/microl, and six HIV-negative VZV-seronegative
siblings. Weekly clinical follow-up and sampling were performed. RESULTS: None of
the children developed any clinical symptom or serious adverse reaction after
immunization. Only nine (60%) of the HIV-1-infected children had VZV-specific
antibodies after two immunizations, whereas 100% of the siblings seroconverted.
Age at baseline was negatively correlated with the VZV IgG titre at 6 weeks after
the second vaccination in HIV-1-infected children. VZV-specific antibody titres
after two immunizations were at a similar level to those found after wild-type
infection in non-vaccinated HIV-1-infected patients, but significantly lower than
in HIV-negative siblings. Importantly, VZV-specific T-cell responses increased
after vaccination and were comparable in both groups over time. Documented
wild-type VZV contact in three vaccinated patients did not result in breakthrough
infections. CONCLUSION: VZV vaccination of previously immunocompromised
HIV-1-infected children was safe. Vaccination induced specific immune responses
in some of the vaccinated HIV-1-infected children, suggesting that previously
immunocompromised individuals are protected against severe forms of varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17117018 [PubMed - indexed for MEDLINE]

182: Postgrad Med J. 2006 Nov;82(973):760-2.

Varicella vaccination in children with lymphoma and solid tumours.

Emir S, Büyükpamukçu M, Köseoğlu V, Hasçelik G, Akyüz C, Kutluk T, Varan A.

Department of Pediatric Oncology, SB Ankara Dişkapi Children's Training and
Research Hospital, Ankara, Turkey. emirs@ttnet.net.tr

BACKGROUND: Varicella infection can be a severe disease, especially in
immunosuppressed patients. Here, experience with live varicella vaccine to
prevent varicella infection is reported in children who were undergoing treatment
for lymphoma and solid tumours. METHODS: 40 children, aged between 12 months and 
15 years with no clinical history of varicella, were vaccinated with live
varicella vaccine. All received two doses of the vaccine subcutaneously 4 weeks
apart. Serum samples were taken before the first dose and 6 weeks after the
second dose of vaccine. RESULTS: Before vaccination, 32 patients were
seronegative for varicella and eight were seropositive. Seroconversion was
observed 6 weeks after the second dose in 24 of the 32 (75%) seronegative
children. In 4 of 8 previously seropositive patients, antibody titres increased
after immunisation. Zoster infection occurred 5 weeks after the second dose of
vaccine in only one previously seronegative child. 7 children, who had responded 
to the vaccine, have been exposed to varicella in their families or in school
without contracting clinical disease. CONCLUSION: Although the small number of
patients in our group prevents us from drawing definitive conclusions, the
varicella vaccine seems to be well tolerated and can be administered to children 
with lymphoma and solid tumours undergoing treatment.

PMID: 17099098 [PubMed - indexed for MEDLINE]

183: Am J Infect Control. 2006 Nov;34(9):583-7.

Measles, rubella, mumps, and varicella seroprevalence among health care workers
in Turkey: is prevaccination screening cost-effective?

Celikbas A, Ergonul O, Aksaray S, Tuygun N, Esener H, Tanir G, Eren S, Baykam N, 
Guvener E, Dokuzoguz B.

Ankara Numune Education and Research Hospital, The First Infectious Diseases and 
Clinical Microbiology Clinic, Turkey.

BACKGROUND: To investigate the immune status of health care workers (HCWs)
against measles, rubella, mumps, and varicella zoster (MMRV) in Turkey and to
define an appropriate vaccination program among HCWs. METHODS: Voluntary HCWs
from a children's hospital and a general hospital were included in the study
between March and May 2005. The specific IgG antibodies against MMRV viruses were
screened by ELISA. RESULTS: Three hundred sixty-three HCWs participated in the
study; 186 (51%) were physicians, 118 (33%) were nurses, 36 (10%) were
housekeeping staff, and 23 (6%) were medical technicians. The proportion of HCWs 
who had antibodies against measles was 98.6%; rubella, 98.3%; mumps, 92.2%; and
varicella, 98%. No association was found between the susceptibility to at least 1
of MMRV virus infections and gender, age, duration of work, profession, and
department of work in analysis either among the whole study group, or each
hospital. The positive predictive value for the history of varicella was 100%,
whereas it was 92% for MMR. The cost of vaccination for varicella was
significantly expensive without screening before vaccination. However, there was 
not much difference for MMR infections. CONCLUSION: A policy based on obtaining
the history of varicella infection from the staff and then screening the ones
with negative history and vaccination of only seronegative HCWs was found to be
appropriate.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17097453 [PubMed - indexed for MEDLINE]

184: Infect Control Hosp Epidemiol. 2006 Nov;27(11):1178-83. Epub 2006 Oct 17.

Seroprevalence survey of varicella, measles, rubella, and hepatitis A and B
viruses in a multinational healthcare workforce in Saudi Arabia.

Almuneef MA, Memish ZA, Balkhy HH, Otaibi B, Helmi M.

Department of Infection Prevention and Control, National Guard Health Affairs,
King Abdulaziz Medical City-King Fahad National Guard Hospital, Riyadh, Saudi
Arabia.

OBJECTIVE: To determine the prevalence of the vaccine-preventable diseases caused
by varicella, measles, rubella, and hepatitis A and B viruses in a multinational 
healthcare workforce. DESIGN: Prospective cohort study. SETTING: A 750-bed
tertiary care center located in Riyadh, Saudi Arabia. METHODS: In compliance with
hospital policy, newly recruited healthcare workers (HCWs) were enrolled in the
study from September 2001 to March 2005. Serum samples were collected from all
HCWs during the initial hiring process and tested for IgG antibodies against each
of the 5 viral agents. Nonimmune HCWs were subsequently vaccinated at the
earliest opportunity. RESULTS: A total of 4,006 newly hired (international and
local) employees were included in the study. All underwent serologic testing for 
IgG antibodies against varicella, measles, rubella, hepatitis A, and hepatitis B 
viruses. Of the total, 63% were female and 37% were male. Middle Eastern
employees comprised 47% of the total, followed by employees from the Far East
(35%), the West (10%), and Africa (8%). Forty-two percent were nurses, 27% were
in administration, 18% were medical technicians, and 13% were physicians. Among
the 4,006 newly hired HCWs, 14% had negative IgG antibody test results for
varicella virus, 13% for measles virus, 10% for rubella virus, 33% for hepatitis 
A virus, and 43% for hepatitis B virus. More women than men were susceptible to
hepatitis A (40% vs. 24%; P<.001), whereas more men were susceptible to hepatitis
B (55% vs. 35%; P<.001). Varicella susceptibility was more common among HCWs from
the Far East (19%), whereas susceptibility to measles, rubella, hepatitis A, and 
hepatitis B was highest among HCWs from the Middle East. Both relative youth and 
male sex were associated with lack of antibodies against hepatitis B virus and
rubella virus. In contrast, female sex and younger age were associated with lack 
of antibodies against hepatitis A virus (P<.001). CONCLUSION: Seroprevalence
surveys of vaccine-preventable diseases among HCWs, although labor intensive, are
invaluable in caring for a multinational workforce.

PMID: 17080374 [PubMed - indexed for MEDLINE]

185: Cornea. 2006 Aug;25(7):866-7.

Ocular manifestations after primary varicella infection.

Fernández de Castro LE, Sarraf OA, Hawthorne KM, Solomon KD, Vroman DT.

Magill Research Center for Vision Correction, Storm Eye Institute, Medical
University of South Carolina, Charleston, SC 29425, USA.

PURPOSE: To report a case of ocular manifestations after a primary varicella
infection. METHODS: Review of the literature and a case report of a 10-year-old
male patient with history of blurry vision and an enlarged pupil 2 months after a
varicella infection. Examination revealed uveitis, interstitial keratitis, and
internal ophthalmoplegia. RESULTS: The uveitis resolved with topical steroids;
the interstitial keratitis resolved with a faint scar, and the internal
ophthalmoplegia persisted. CONCLUSION: This case report describes a patient with 
uncommon ocular manifestations after primary varicella.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17068470 [PubMed - indexed for MEDLINE]

186: J Microbiol Immunol Infect. 2006 Oct;39(5):402-7.

Complications of varicella infection in children in southern Taiwan.

Chi CY, Wang SM, Lin HC, Liu CC.

Division of Clinical Research, National Health Research Institutes, Zhunan,
Taiwan.

BACKGROUND AND PURPOSE: This study was designed to compare the change in
complications of varicella infection in children requiring hospitalization before
and after varicella vaccine introduction at a tertiary care hospital in southern 
Taiwan. METHODS: Based on the results of a retrospective study conducted in the
pre-vaccine era (1988-1998), a second study was carried out from 1998-2004
(post-vaccine era). In children admitted for varicella-related complications,
demographic data, clinical features, microbiological findings, and outcomes were 
recorded and compared between the two eras. RESULTS: A decreased annual rate of
hospitalization was observed between the two eras. Age-specific hospitalization
rates significantly declined in the age group of 1-10 years after vaccine
introduction. Secondary skin or soft tissue infections were the most common
complications in both periods (pre-vaccine era, 44.1%; post-vaccine introduced
era, 56.6%). In the post-vaccine era, 23 (52%) patients had positive bacterial
isolates, including 19 Staphylococcus aureus (12 oxacillin-sensitive, 7
oxacillin-resistant) and 4 coagulase-negative staphylococci; a higher rate of
pneumonitis and lower rate of central nervous system involvement were also
observed. No differences were observed in other complications between the two
eras. In the post-vaccine era, hematological diseases were the most common
underlying conditions (17/18, 94%). The case-fatality rate in the post-vaccine
era (1.3%) was similar to that in the pre-vaccine era (2.2%). CONCLUSIONS: A
universal childhood varicella vaccination program would ultimately prevent the
spread and potential complications of varicella. The result of this study may
serve as baseline information as the national vaccination program begins.

Publication Types: 
    Comparative Study

PMID: 17066203 [PubMed - indexed for MEDLINE]

187: MMWR Morb Mortal Wkly Rep. 2006 Oct 20;55(41):1126-9.

Varicella surveillance practices--United States, 2004.

Centers for Disease Control and Prevention (CDC).

Varicella became a reportable disease in the United States in 1972, with states
reporting weekly aggregate data to the National Notifiable Disease Surveillance
System (NNDSS). In 1981, varicella reporting was removed from the national
notifiable diseases list because reporting of this common disease was becoming a 
burden in the absence of a vaccine. This action was followed by additional
changes in varicella surveillance practices. In 1995, varicella vaccine was
licensed and added to the routine childhood vaccination schedule. In 2002, the
Council of State and Territorial Epidemiologists (CSTE) recommended that
varicella casebased surveillance be implemented in all states by 2005; in 2003,
varicella again was added to the national notifiable diseases list to allow for
monitoring of the effect of varicella vaccine on varicella incidence. In 2004, to
assess the progress in varicella surveillance in the United States, CDC surveyed 
immunization program managers in selected public health jurisdictions. This
report describes the results of that survey, which indicated that substantial
progress has been made toward the implementation of case-based surveillance as
recommended by CSTE in 2002. As of 2004, however, 28 jurisdictions still had not 
implemented case-based surveillance. To monitor the effect of the vaccination
program on the changing epidemiology of varicella disease, every state should now
be conducting case-based surveillance for varicella. This is particularly
important in light of the 2006 recommendation by the Advisory Committee on
Immunization Practices for a routine second dose of varicella vaccine for
children aged 4-6 years because enhanced surveillance is needed to further
monitor varicella epidemiology.

PMID: 17060900 [PubMed - indexed for MEDLINE]

188: Int J Hematol. 2006 Oct;84(3):220-3.

Development of mixed-type autoimmune hemolytic anemia and Evans' syndrome
following chicken pox infection in a case of low-titer cold agglutinin disease.

Tanaka Y, Masuya M, Katayama N, Miyata E, Sugimoto Y, Shibasaki T, Yamamura K,
Ohishi K, Minami N, Shiku H, Nobori T.

Blood Transfusion Service, Mie University Hospital, Tsu, Mie, Japan.

We describe a patient with low-titer cold agglutinin disease (CAD) who developed 
mixed-type autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenia
following chicken pox infection. At least 1 year before admission to hospital,
the patient had mild hemolytic anemia associated with low-titer cold agglutinins.
A severe hemolytic crisis and thrombocytopenia (Evans' syndrome) occurred several
days after infection with chicken pox, and the patient was referred to our
hospital. Serological findings revealed the presence of both cold agglutinins and
warm-reactive autoantibodies against erythrocytes, and the diagnosis was
mixed-type AIHA. Following steroid therapy, the hemoglobin (Hb) level and
platelet count improved. The patient was closely followed over a 10-year period
with recurrent documented hemolysis after viral or bacterial infections.
Warm-reactive autoantibodies have not been detected in the last 2 years, and only
the immunoglobulin M anti-I cold agglutinins with a low titer and wide thermal
amplitude have remained unchanged. Therefore, the patient has received at least
10 mg prednisolone daily to maintain a Hb level of 10 g/dL. To the best of our
knowledge, no adult case of low-titer CAD that has evolved into mixed-type AIHA
and Evans' syndrome after chicken pox infection has been previously reported in
the literature.

Publication Types: 
    Case Reports

PMID: 17050195 [PubMed - indexed for MEDLINE]

189: Vaccine. 2006 Nov 17;24(47-48):6875-85. Epub 2006 Jul 7.

Safety, tolerability, and immunogenicity of a two-dose regimen of high-titer
varicella vaccine in subjects > or =13 years of age.

Diaz C, Dentico P, Gonzalez R, Mendez RG, Cinquetti S, Barben JL, Harmon A,
Chalikonda I, Smith JG, Stek JE, Robertson A, Caulfield MJ, Biasio LR, Silber JL,
Chan CY, Vessey R, Sadoff J, Chan IS, Matthews H, Wang W, Schlienger K, Schödel
FP; Protocol 049 Study Group.

University of Puerto Rico School of Medicine, San Juan, Puerto Rico.

A new manufacturing process, known as process upgrade varicella vaccine (PUVV)
was developed for a refrigerated formulation of varicella vaccine and for an
investigational zoster vaccine. Safety and tolerability of a two-dose regimen of 
high-titered (approximately 50,000 PFU) PUVV were compared to a lower-titer
formulation (approximately 5400 PFU) of VARIVAX; in 1366 healthy subjects > or
=13 years old. Only one vaccine-related clinical serious adverse experience
(pruritus; no hospitalization) was reported, in the VARIVAX group. Injection-site
adverse experiences following any dose were higher in the PUVV group, 70.0%, than
in the VARIVAX group, 56.2%, but generally were mild. Immunogenicity were similar
in both groups in seronegative subjects. PUVV was generally well tolerated, and
elicited an immune response similar to that induced by the marketed formulation
of VARIVAX.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial

PMID: 17050042 [PubMed - indexed for MEDLINE]

190: Lancet. 2006 Oct 14;368(9544):1365-76.

Erratum in:
    Lancet. 2007 Feb 17;369(9561):558.

Comment in:
    Lancet. 2006 Dec 23;368(9554):2208.    Lancet. 2006 Dec 23;368(9554):2208-9.

Varicella.

Heininger U, Seward JF.

Division of Paediatric Infectious Diseases and Vaccinology, University Children's
Hospital, Basel, Switzerland. Ulrich.Heininger@unibas.ch

Varicella-zoster virus, a herpesvirus, causes varicella (chickenpox) and, after
endogenous reactivation, herpes zoster (shingles). Varicella, which is recognised
by a characteristic vesicular rash, arises mainly in young children, although
older individuals can be affected. In immunocompetent patients, symptoms are
usually mild to moderate, but an uncomplicated severe case can have more than
1000 lesions and severe constitutional symptoms. Serious complications--including
central nervous system involvement, pneumonia, secondary bacterial infections,
and death--are sometimes seen. Varicella can be prevented by vaccination. Vaccine
is about 80-85% effective against all disease and highly (more than 95%)
effective in prevention of severe disease. In the USA, a routine childhood
immunisation programme has reduced disease incidence, complications, hospital
admissions, and deaths in children and in the general population, indicating
strong herd immunity. Similar immunisation programmes have been adopted by some
other countries, including Uruguay, Germany, Taiwan, Canada, and Australia, and
are expected to be implemented more widely in future.

Publication Types: 
    Review

PMID: 17046469 [PubMed - indexed for MEDLINE]

191: Virus Genes. 2007 Aug;35(1):29-32. Epub 2006 Oct 13.

Varicella-Zoster virus gene expression at variable periods following death in a
rat model of ganglionic infection.

Grinfeld E, Goodwin R, Kennedy PG.

Division of Clinical Neurosciences, Institute of Neurological Sciences,
University of Glasgow, Southern General Hospital, Glasgow, G51 4TF, Scotland, UK.

We used a rat model of Varicella-Zoster virus (VZV) ganglionic infection, which
mirrors some of the features of VZV latency in humans, to determine the temporal 
pattern of expression of a VZV immediate-early gene (63) and a VZV late gene (40)
at 0, 24 and 48 h after death of the animal. The immediate-early VZV gene 63 is
known to be abundantly expressed during human ganglionic latency, while the late 
VZV gene 40 is not expressed during human latency. Using both RNA in situ
hybridisation (ISH) and nested RT-PCR, it was found that at all time points in
both thoracic and lumbar ganglia, the number of ganglia positive for VZV gene 63 
was higher than for gene 40. The expression of gene 40 did not increase with time
postmortem (pm) These results provide indirect support for the hypothesis that
patterns of expression of VZV genes detected in human tissue at even 48 h pm
reflect the pattern of expression during human ganglionic latency.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17039406 [PubMed - indexed for MEDLINE]

192: Hum Vaccin. 2005 Sep-Oct;1(5):204-6. Epub 2005 Sep 27.

Seroprevalence of varicella among children and adolescents in Valencia, Spain.
Reliability of the parent's reported history and the medical file for
identification of potential candidates for vaccination.

Diez-Domingo J, Gil A, San-Martín M, González A, Esteban J, Baldó JM, Planelles
MV, Ubeda MI, Graullera M, Peris A, Martínez M, Antón V, Gallego D, Alvarez T,
Villarroya JV, Jubert A, Casaní C, Peidró C, García M, Ballester A.

Pediatrics, Centros de Salud, VIVA, Valencia, Spain. diez_jav@gva.es

This study assessed the seroprevalence of varicella antibodies in children and
adolescents in Spain and evaluated the reliability of two methods for detecting
susceptible individuals: (1) parental-reported history of varicella and (2)
medically-documented histories maintained by the pediatrician. A total of 186
children (6 to 15 years of age) were recruited in 13 pediatric offices of
Valencia, Spain. A brief case report form was completed including previous
history of varicella referred by the parents, and a 5 mL blood sample was
obtained. The pediatrician medical file was reviewed for antecedent of varicella.
The overall prevalence of varicella antibodies was 84% and 88% in the 6-9 years
and 10-15 years age brackets, respectively. The predictive value of a negative
history of varicella disease was 48% by parental recall (52% "false negative"),
and only 26% by medical record (74% "false negative"). However, the positive
predictive value of a positive parental reported history or a positive
medically-documented history was 95%. The most effective strategy for varicella
vaccination of older children and adolescents in Spain will be to immunize those 
individuals with a lack of positive (unknown or negative) history of disease.

PMID: 17012857 [PubMed - indexed for MEDLINE]

193: Scand J Infect Dis. 2006;38(10):920-1.

Enhanced chickenpox exanthema in vaccine injection site.

Hentgen V, Cohen R, Siegrist CA.

Service de Pédiatrie, Centre Hospitalier de Versailles, France.
vhentgen@ch-versailles.fr

Exacerbation of viral exanthema has been described after different types of
aggression. We report a case of enhanced chickenpox exanthema occurring in the
vaccination site of an otherwise healthy boy. Specific local inflammatory
modifications may explain the increased number of varicella skin lesions on the
site of a previous vaccine-induced inflammation.

Publication Types: 
    Case Reports

PMID: 17008239 [PubMed - indexed for MEDLINE]

194: J Child Neurol. 2006 Oct;21(10):890-3.

Acute childhood hemiplegia associated with chickenpox and elevated
anticardiolipin antibody.

Aydin K, Sert A, Ati Güzeş E, Kireşi DA.

Universitesi Meram Tip Fakültesi, Konya, Turkey. kursadaydin@hotmail.com

Chickenpox is a common infection of childhood. Central nervous system
complications, such as cerebellar ataxia and meningoencephalitis, are estimated
to occur in less than 1% of cases of chickenpox. Although transverse myelitis and
hemiplegia have also, although rarely, been reported, hemiplegia associated with 
chickenpox and elevated anticardiolipin antibody has not been reported in the
literature. We report the case of a 2.5-year-old boy who developed a right
hemiplegia 3 weeks after the onset of a primary varicella infection. The serum
level of anticardiolipin antibody IgG was markedly elevated. Brain magnetic
resonance imaging (MRI) revealed an infarction involving the left globus
pallidus, caudate nucleus, and posterior leg of the internal capsule. Laboratory 
studies ruled out all known causes of stroke. Neurologic signs and symptoms
slowly improved with supportive treatment. Varicella infection should be
considered one of the possible causes of acute ischemic strokes in children.
Usually, two or more risk factors are detected in children with ischemic strokes,
and we suggest that all possible causes of strokes be investigated in children
with ischemic strokes.

Publication Types: 
    Case Reports

PMID: 17005107 [PubMed - indexed for MEDLINE]

195: Neurol Sci. 2006 Sep;27(4):278-80.

Isolated bilateral anterior optic neuritis following chickenpox in an
immunocompetent adult.

Galbussera A, Tagliabue E, Frigo M, Apale P, Ferrarese C, Appollonio I.

Neurology Section, Department of Neurosciences, University of Milan Bicocca S.
Gerardo Hospital, Via Donizetti 106, I-20052, Monza (MI), Italy. galbuz@libero.it

Chickenpox may lead to several different neurological complications, but optic
neuritis has rarely been described; in particular, only one case of isolated
bilateral anterior optic neuritis (AON) in an immune-competent adult has so far
been reported. We describe a second case of this type and consider similarities
and differences between our patient and all other cases of AON following
chickenpox. Then, we discuss the therapeutic role of steroids and advance the
hypothesis of different pathogenetic pathways in immune-competent and
immune-compromised subjects.

Publication Types: 
    Case Reports

PMID: 16998733 [PubMed - indexed for MEDLINE]

196: J Adolesc Health. 2006 Oct;39(4):598-600. Epub 2006 Jul 10.

Screening emergency department patients for under-immunized adolescents.

Mahon BE, Anah K, Kharasch SJ.

Department of Epidemiology, Boston University School of Public Health, Boston,
Massachusetts 02118, USA. mahonbe@bu.edu

Among 200 adolescents presenting to an emergency department in a city with high
vaccination coverage, 11 (6%) were seronegative to rubella or varicella.
Seronegative adolescents were older and more likely to be immigrants. ED
screening for under-immunized adolescents may have a low yield in settings with
high vaccine coverage.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16982399 [PubMed - indexed for MEDLINE]

197: MMWR Morb Mortal Wkly Rep. 2006 Sep 15;55(36):993-5.

Public health response to varicella outbreaks--United States, 2003-2004.

Centers for Disease Control and Prevention (CDC).

Since introduction of varicella vaccine in 1995, incidence of varicella has
decreased as vaccination coverage has increased. Nevertheless, varicella
outbreaks continue to occur, even among populations with high vaccination
coverage. Although varicella typically is mild, the outbreaks can last for
several months and be challenging and costly for health departments to control.
In 2005, CDC conducted a national survey to determine the distribution and extent
of reported varicella outbreaks during 2003-2004 and the public health response. 
This report summarizes the results of that survey, which indicated that varicella
outbreaks are still common and that health jurisdictions are responding to these 
outbreaks, although they have varying definitions and guidelines for
varicella-outbreak management.

PMID: 16971888 [PubMed - indexed for MEDLINE]

198: J Clin Virol. 2006 Oct;37(2):118-23. Epub 2006 Sep 12.

Changes in seroprevalence to four herpesviruses over 30 years in Swedish children
aged 9-12 years.

Svahn A, Berggren J, Parke A, Storsaeter J, Thorstensson R, Linde A.

Department of Virology, Swedish Institute for Infectious Disease Control, Solna, 
Sweden. anita.svahn@swipnet.se

BACKGROUND: Changing social conditions and life-styles in Sweden may have
affected the spread of varicella-zoster virus (VZV), herpes simplex virus (HSV), 
cytomegalovirus (CMV), and Epstein-Barr virus (EBV). OBJECTIVES: To study
possible changes over 30 years in prevalence of antibodies against VZV, HSV, CMV,
and EBV in Swedish children, using modern serological methods. STUDY DESIGN:
Serum samples from 819 Swedish children who were 9-12 years old in 1967-1968, in 
1977-1978 (two cohorts), and in 1997, respectively, were examined. IgG antibodies
against VZV, HSV, and CMV were measured by well validated enzyme-linked
immunosorbent assays and against EBV by indirect immunoflourescense. RESULTS: The
seropositivity for VZV for 9-12 years old children was 50% in 1967-1968, 74-82%
in 1977-1978, and 98% in 1997. The corresponding figures were 31%, 53%, 50%, and 
58% for CMV, 35%, 35%, 32%, and 38% for HSV, and 64% in 1967-1968 and in
1977-1978 (both cohorts), and 62% in 1997 for EBV. CONCLUSIONS: The
seroprevalence for VZV increased significantly from 1967-1968 to 1997, and there 
was also a significant but smaller increase in the CMV seroprevalence, while
seroprevalence to HSV and EBV remained relatively stable.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16971177 [PubMed - indexed for MEDLINE]

199: Pediatr Infect Dis J. 2006 Sep;25(9):774-8.

Varicella vaccine effectiveness during an outbreak in a partially vaccinated
population in Spain.

Arnedo-Pena A, Puig-Barberà J, Aznar-Orenga MA, Ballester-Albiol M, Pardo-Serrano
F, Bellido-Blasco JB, Romeu-García MA.

Epidemiology Division, Castellón Public Health Centre, Castellón, Spain.
arnedo_alb@gva.es

BACKGROUND: An outbreak of varicella occurred between December 2004 and April
2005 in the primary school and day-care center of a town of 5430 inhabitants in
Spain. Although the varicella vaccine is not included in the infant vaccination
program, some children had been vaccinated before the outbreak. STUDY AIM: The
aim of this study was to estimate varicella vaccine effectiveness during an
outbreak that took place in a partially vaccinated population of children.
METHODS: A cohort study was carried out. Cases were identified through
notification by doctors and active search. Information was gathered on the
current disease, history of varicella and previous vaccinations together with
age, course, school year and other sociodemographic factors. The relative risk
(RR) of varicella and the contribution of the previously mentioned factors to the
probability of contracting the disease was estimated for vaccinated and
unvaccinated children. RESULTS: Participation reached 96.5% (387 of 401 children)
in the school and 91.2% (31 of 34 children) in the day-care center. Of 269
children with no history of varicella and with a documented vaccination record,
96 (35.7%) had been previously vaccinated. During the outbreak, 148 cases of
varicella were observed. The overall attack rate was 54.4%, 22.9% in vaccinated
and 72.8% in unvaccinated children. RR of varicella in vaccinated children was
0.31 (95% confidence interval [CI] = 0.21-0.46). The overall adjusted vaccine
effectiveness against varicella was 69.5% (95% CI = 50.5-81.5%) and 96.9% (95% CI
= 77.5-99.6%) against mild and severe forms. Only time since vaccination was
associated with vaccine failure. CONCLUSIONS: In the varicella outbreak studied, 
we conclude that vaccine was effective in the prevention of the disease,
particularly in its moderate and severe forms, but because the proportion of
vaccinated children was low, an outbreak still occurred.

PMID: 16940832 [PubMed - indexed for MEDLINE]

200: Int J Toxicol. 2006 Sep-Oct;25(5):313-7.

The case against universal varicella vaccination.

Goldman GS.

Medical Veritas International Inc., Pearblossom, California 93553, USA.
pearblossominc@aol.com

In 1995, the United States became the first country to implement a Universal
Varicella Vaccination Program. Several questions remain: Is the varicella
(chickenpox) vaccine needed? Is it cost effective as a routine immunization for
all susceptible children? Or is it more beneficial for the disease to remain
endemic so that adults may receive periodic exogenous exposures (boosts) that
help suppress the reactivation of herpes zoster (shingles). In addition, as
vaccination coverage becomes widespread, does loss of immunologic boosting cause 
a decline in vaccine efficacy and result in a reduced period of immunity?
Scientific literature regarding safety of the varicella vaccine and its
associated cost-benefit analysis have often reported optimistic evaluations based
on ideal assumptions. Deleterious outcomes and their associated costs must be
included when making a circumspect assessment of the Universal Varicella
Vaccination Program.

PMID: 16940003 [PubMed - indexed for MEDLINE]

201: J Natl Med Assoc. 2006 Aug;98(8):1350-2.

Kawasaki disease onset during concomitant infections with varicella zoster and
Epstein-Barr virus.

Turkay S, Odemis E, Karadag A.

Department of Pediatrics, Fatih University Faculty of Medicine, Ankara, Turkey.

Kawasaki disease is an acute systemic vasculitis that predominantly affects
preschool-aged children. It has a predilection to coronary arteries, and its
precise etiology is still unknown. Many infectious agents, including viruses and 
bacteria, have been suggested as potential causes of the disease. Here, we report
a patient who met the diagnostic criteria of Kawasaki disease during concomitant 
Epstein-Barr virus and varicella-zoster virus infections, and we discuss the
possible roles of these viruses in etiology.

Publication Types: 
    Case Reports

PMID: 16916136 [PubMed - indexed for MEDLINE]

202: BMC Fam Pract. 2006 Aug 15;7:51.

Immediate and longer term impact of the varicella shortage on children 18 and 24 
months of age in a community population.

Yawn BP, Schroeder C, Wollan P, Rocca L, Zimmerman R, Bardenheier B.

Department of Research, Olmsted Medical Center, Rochester, MN, USA.
yawnx002@umn.edu

BACKGROUND: Little is known about the impact of the recent varicella vaccine
shortage. To assess the temporal trend in varicella vaccine administration before
18 and 24 months of age in a community cohort of children prior to, during and
after the recent varicella vaccine shortage. And to compare the temporal trends
in varicella vaccinations to trends of an older, more widely accepted vaccine,
the MMR. METHODS: Community population-based birth cohorts were identified who
were eligible for the varicella vaccination before, during and after the 2001 to 
2002 varicella vaccine shortage. Only children (84% of all) who remained in the
community through their second birthday were included. For each child in the
cohort, the medical records and immunization registry records from both medical
facilities in the county were reviewed to identify the dates and sites for all
varicella immunizations given. In addition to varicella immunizations, the dates 
of all MMR vaccinations were recorded. Additional data abstracted included the
child's birth date, gender and dates of any recognized cases of chickenpox up
through age 24 months. RESULTS: Of the 2,512 children in the birth cohorts, 50.8%
were boys. In the three cohorts combined, 81.1% of the boys and 79.3% of the
girls (p = 0.30) received the varicella vaccine by age 24 months. The
pre-shortage community rate of varicella immunization was 79.7% by 24 months of
age. During the varicella vaccine shortage, the rate of varicella immunization by
24 months fell to 77.2%. Only 6 additional children received a "catch-up"
immunization by 36 months of age. In the post shortage period the community
24-month immunization rate rebounded to a level higher than the pre-shortage rate
84.0%. During the almost three years of observation, the MMR immunization rate by
age 24 months was constant (87%). CONCLUSION: The varicella shortage was
associated with an immediate drop in the 24-month varicella immunizations rate
but rebounded quickly to above pre-shortage rates. In this community the only
long term impact of the varicella vaccine shortage may be on the small number of 
children who still had not received catch-up varicella immunizations by 36 months
of age.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16911801 [PubMed - indexed for MEDLINE]

203: Infection. 2006 Aug;34(4):222-6.

Loss of varicella zoster virus antibodies despite detectable cell mediated
immunity after vaccination.

Ludwig B, Kraus FB, Allwinn R, Keim S, Doerr HW, Buxbaum S.

Institute for Medical Virology, Johann Wolfgang Goethe University Frankfurt,
Paul-Ehrlich-Str. 40, 60596, Frankfurt a.M., Germany.

BACKGROUND: Vaccination of children against VZV has been included in the
recommendations of the "permanent committee of vaccination" (STIKO; Ständige
Impfkommission of the Robert Koch Institute, Berlin, Germany) in July 2004. Due
to this recommendation the medical practitioner and the laboratories will be
confronted with the problem of serologic non-responders or loss of humoral
immunity more frequently. PATIENTS AND METHODS: Here we report the case of a
Varicella Zoster Virus (VZV) vaccinee, who lost detectable VZV antibodies
although she had a persisting VZV specific CD4 cellular immune response. We
compare these parameters to the VZV specific CD4 T cell responses of VZV
seronegative and seropositive healthy persons, as well as patients with VZV
disease. RESULTS: VZV specific CD4 frequencies of VZV antibody seronegative
persons remained on the average below 0.1% (median 0.04%, +/- SD 0.03, range
0.01-0.08%) and were significantly lower than VZV specific frequencies of
seropositive healthy persons (median 0.3%, +/- SD 0.24, range 0.06-0.81%;
Mann-Whitney U-test p = 0.001). The samples of patients with VZV associated
disease showed an even higher median level of VZV specific CD4 cell response than
the VZV seropositive healthy persons (median 1.04%, +/- SD 1.06, range
0.51-2.92%, Mann-Whitney U-test p = 0.008). The VZV specific immune response of
the health care worker directly after vaccination was comparable to the VZV
specific immunity in VZV seropositive healthy adults. Despite serological
reconversion 1.5 years later the VZV specific CD4 response still remained
measurable and positive. CONCLUSION: The new general VZV vaccination
recommendation for children in Germany will probably increase the number of
persons that will be seronegative after vaccination. To gain more information
concerning the absence of seroconversion or the loss of immunity, it will be
necessary to focus future post-VZV vaccination immunity studies not only on
serologic testing but also on the measuring of the cell mediated immunity.

PMID: 16896582 [PubMed - indexed for MEDLINE]

204: Infection. 2006 Aug;34(4):208-13.

Seroepidemiology of Varicella zoster in Israel prior to large-scale use of
varicella vaccines.

Cohen DI, Davidovici BB, Smetana Z, Balicer RD, Klement E, Mendelson E, Green MS.

Department of Epidemiology and Preventive Medicine, Tel Aviv University, Sackler 
Faculty of Medicine, Tel Aviv, Israel. dancohen@post.tau.ac.il

OBJECTIVES: This large-scale study provides up-to-date estimates of Varicella
zoster virus (VZV) age-specific seroprevalence and characteristics of VZV
transmission in a representative sample of the Israeli population. METHODS: In
2000-2001, 1,642 sera collected from an agestratified general population sample
were tested for VZV antibodies using an indirect IgG ELISA system. RESULTS: The
age-weighted VZV overall estimate was 90.2%. Seropositivity increased rapidly
with age, from 68.9% at age 4 to 94.4% at age 7 and 96.6% at age 12 years. The
highest force of infection was in the 4-5 years age group (0.548 per susceptible 
year) followed by the 6-9 years age group. Multivariate analysis revealed that
VZV seroprevalence estimates were significantly associated with age and place of 
origin. The highest seroprevalence estimate was found among subjects of Eastern
origin. CONCLUSIONS: The seroepidemiology of VZV in Israel shows a pattern
corresponding to that described for developed European countries. This study
indicates that the highest force of infection is in pre-school children.
Knowledge of pre-vaccination seroepidemiology is important to evaluate the effect
of vaccination programs on the epidemiology of the disease.

PMID: 16896579 [PubMed - indexed for MEDLINE]

205: Ir Med J. 2006 May;99(5):133-5.

Varicella outbreak in a residential home.

Enright F, Mc Mahon B, Washington A.

Children's Sunshine Home, Foxrock, Dublin.

We report an outbreak of varicella in a residential home for 29 children(aged 4
to 16 years) with severe physical and learning disability. We report our group's 
incidence, complication and hospitalisation rate of varicella despite anti-viral 
therapy. As we did not have a control group we use statistics pertaining to the
general population for comparison. All 15 non-immune children contracted
varicella within 30 days of the index case. The complication rate was 9 in 15,
three time higher than in the general population. The hospitalisation rate was 5 
in 15. This is remarkably high. The incidence of hospitalisation in the general
population is 1 to 5 per 1,000. In conclusion we suggest that the guidelines for 
varicella vaccination should include all non-immune children and adults with
severe to profound physical and learning disability. We recommend that this
disease should be notifiable in the severely physically disabled population. We
recommend that within 3 days of exposure to varicella children with severe to
profound physical and learning disability are vaccinated to prevent infection
(post exposure prophylaxis). These findings are important in countries where
varicella vaccination is not part of the routine vaccination program and is not
part of the routine vaccination program and is only offered to select groups of
children.

PMID: 16892915 [PubMed - indexed for MEDLINE]

206: Clin Infect Dis. 2006 Sep 1;43(5):599-601. Epub 2006 Jul 27.

Comment in:
    Clin Infect Dis. 2006 Sep 1;43(5):602-3.

An outbreak of cadaver-acquired chickenpox in a health care setting.

Paul N, Jacob ME.

Department of Medicine, Christian Medical College, Vellore, India.
navinpaul@yahoo.com

The varicella-zoster virus (the chickenpox virus) is highly infectious and may
affect nonimmune health care professionals. We report an outbreak of chickenpox
in our hospital in which the source of infection was a cadaver. The spread of
infection occurred in the course of an autopsy.

Publication Types: 
    Case Reports

PMID: 16886152 [PubMed - indexed for MEDLINE]

207: Braz J Infect Dis. 2006 Apr;10(2):156-8.

Occupational and nosocomial transmission of varicella.

Façanha MC, Monroe AC.

Federal University of Ceará, Fortaleza, CE, Brazil. mfacanha@yahoo.com

We examined varicella transmission in a hospital specialized in cancer treatment.
A cases series study was made of a case of intra-hospital transmission of
varicella, based on a revision of the records of patients who had been admitted
during the time the index case was in the same service. Records of interviews of 
employees were also reviewed. During the period that the index case was in the
intensive care unit, 34 patients were admitted and 35 employees worked there. Two
employees and a patient developed the illness, due to transmission directly or
indirectly from the index case. Although this is a service in which most of the
patients are adults who have cancer, attention needs to be directed towards
diagnosis and to procedures to reduce the transmission of this illness, both to
healthcare professionals, and to other patients. A standard schedule for
varicella prevention already exists; however, this case reinforces the need for
specific vaccination of at-risk professionals.

Publication Types: 
    Case Reports

PMID: 16878270 [PubMed - indexed for MEDLINE]

208: J Clin Virol. 2006 Sep;37(1):72-4. Epub 2006 Jul 28.

A novel mutation of varicella-zoster virus associated to fatal hepatitis.

Natoli S, Ciotti M, Paba P, Testore GP, Palmieri G, Orlandi A, Sabato AF,
Leonardis F.

Istituto di Anestesia e Rianimazione, Università di Roma Tor Vergata, Policlinico
di Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. silvia.natoli@ptvonline.it

BACKGROUND: Lethal varicella in immunocompetent hosts is rare and its
pathogenesis is largely unknown. The discovery of glycoprotein E (gE) mutants
showing attributes consistent with increased virulence in vitro and in animal
models, provided a possible molecular mechanism underlying a more aggressive
virus infection. However, these mutants have never been associated with unusually
severe clinical cases. OBJECTIVES: To varicella-zoster virus (VZV) mutations that
correlate with increased virulence. RESULTS: We report a case of fatal hepatitis 
caused by a VZV bearing a novel mutation on the 3B3 monoclonal antibody epitope
of gE in an immunocompetent host. CONCLUSIONS: This report describes a mutant VZV
responsible for an aggressive clinical course in an immunocompetent host. Linking
these severe clinical presentations of VZV infection to virus mutations might
provide insights into the underlying pathogenic mechanisms.

Publication Types: 
    Case Reports

PMID: 16876475 [PubMed - indexed for MEDLINE]

209: Vaccine. 2006 Nov 17;24(47-48):6980-9. Epub 2006 May 4.

Economic evaluation of varicella vaccination in Spain: results from a dynamic
model.

Lenne X, Diez Domingo J, Gil A, Ridao M, Lluch JA, Dervaux B.

CRESGE-LEM, Catholic University of Lille, Lille, France.

Varicella is a universal childhood disease in Spain, causing approximately
400,000 cases, 1,500 hospitalizations and 15 deaths every year. The aim of this
study is to determine the economic impact of childhood varicella vaccination on
the burden of disease and associated costs by using a dynamic model. The analysis
is based on the varicella transmission model developed by Halloran and adapted to
the Spanish context. Cost data (Euro, 2004) were derived from previous studies
and official tariffs. Two vaccination scenarios were analysed: (1) routine
vaccination program for children aged 1-2 years, and (2) routine vaccination
program for children aged 1-2 years completed by a catch-up program during the
first year of vaccine marketing for children aged 2-11 years. The analysis
considers that a similar coverage rate to the MMR one would be achieved (97.15%).
A societal perspective, including direct and indirect costs, and a health care
payor perspective were adopted. A probabilistic sensitivity analysis was
performed. A routine vaccination program has a positive impact on
varicella-related morbidity: the number of varicella cases is estimated to be
reduced by 89%, and 1230 hospitalizations are prevented. From the societal
perspective, scenario (1) is cost-saving whether or not indirect costs are
considered (-51 and -4%, respectively). From the Health Care System the strategy 
is cost-effective, with a cost-effectiveness ratio estimated at 3,982 Euro per
life-year gained, although it leads to a small increase in the costs. Considering
the impact of vaccination on morbidity and costs, a routine childhood vaccination
program against varicella is worth while in Spain without taking into account the
potential impact on HZ.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16860909 [PubMed - indexed for MEDLINE]

210: MMWR Morb Mortal Wkly Rep. 2006 Jul 14;55(27):749-52.

Comment in:
    Ann Emerg Med. 2007 Jan;49(1):99-102.

Varicella outbreak among vaccinated children--Nebraska, 2004.

Centers for Disease Control and Prevention (CDC).

On November 19, 2004, a school nurse notified the Nebraska Health and Human
Services System (NHHSS) of a varicella outbreak in an elementary school (grades
kindergarten through 7). In collaboration with local health department officials 
and CDC, NHHSS initiated a retrospective cohort study to determine the magnitude 
of the outbreak, assess vaccine coverage and effectiveness, and compare disease
severity among vaccinated and unvaccinated students. This report summarizes the
investigation and considers the suitability of school settings for case-based
surveillance. The findings highlighted the importance of improving varicella
vaccination coverage and implementing varicella vaccination school-entry
requirements.

PMID: 16837895 [PubMed - indexed for MEDLINE]

211: Eur J Pediatr. 2006 Oct;165(10):677-83. Epub 2006 Jul 12.

Safety, reactogenicity, and immunogenicity of live attenuated varicella vaccine
in children between 1 and 9 years of age with atopic dermatitis.

Kreth HW, Hoeger PH; The Members of the VZV-AD study group.

Department of Pediatrics, University of Würzburg, Josef Schneider Strasse 2,
97080, Würzburg, Germany.

INTRODUCTION: Infection with varicella-zoster virus (VZV) is known to facilitate 
secondary bacterial infection, which is cause for particular concern in children 
with atopic dermatitis. This 2-year study assessed the safety, reactogenicity,
and immunogenicity of a live attenuated Oka strain varicella vaccine (Varilrix,
GlaxoSmithKline Biologicals) in 160 children aged 1-9 years with atopic
dermatitis randomized to vaccination at the start of either the 1st or 2nd study 
year (VAR-1Y and VAR-2Y, respectively). Mean SCORing Atopic Dermatitis (SCORAD)
scores at baseline were 19.3+/-11.1 and 26.0+/-10.4 in the two groups,
respectively. RESULTS: Varicella vaccination did not adversely affect the
severity of atopic dermatitis, with analysis of variance (ANOVA) confirming
equivalence for the change in SCORAD index from baseline to week 8 between
vaccinated and unvaccinated subjects. Within-group comparison of post-vaccination
changes in SCORAD index from baseline to week 8 and month 12 in the VAR-2Y group 
showed a greater reduction in mean SCORAD scores following vaccination in year 2 
than in year 1 when subjects were unvaccinated. Overall, SCORAD indices fell by
approximately 10 points in both study groups over the 2 years of follow-up.
Varicella vaccination was well tolerated, with no children withdrawn due to
adverse events. Injection site redness was the most frequent solicited adverse
event, occurring in 17.1% of subjects. Seroconversion rates were 94.3% at week 8 
and 88.9% at month 12. In all, 43.6% of vaccinees reported at least one varicella
contact during the course of the study. However, none developed varicella
infection after vaccination over the 2 years of follow-up. CONCLUSION: In
summary, vaccination with a live attenuated varicella vaccine appears safe and
effective in children with atopic dermatitis.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16835758 [PubMed - indexed for MEDLINE]

212: Nepal Med Coll J. 2006 Mar;8(1):69-71.

Atypical varicella zoster as SJS-TEN overlap syndrome with involvement of palm
and sole.

Bhattarai S, Agrawal S, Rijal A, Dhali TK.

Department of Dermatology and Venereology, B.P. Koirala Institute of Health
sciences, Dharan, Nepal.

A 14-month-old boy presented with generalised vesicular eruption involving the
face, trunk and extremities accompanied by high grade fever. He had associated
redness and purulent discharge from both eyes. Examination revealed erosions on
the tongue, soft palate and genitalia with haemorrhagic crusts on the lips and
nasal orifices. All laboratory investigations were within normal limits except
leucocytosis. Chest x-ray showed left middle zone pneumonitis. Treatment was by
paracetamol, antibiotics and oral acyclovir. Desquamation started from the eighth
day. Our purpose in reporting this case is to highlight the fact that varicella
can be atypical with distal involvement and can present as SJS-TEN overlap
syndrome.

Publication Types: 
    Case Reports

PMID: 16827098 [PubMed - indexed for MEDLINE]

213: Drugs Today (Barc). 2006 May;42(5):321-9.

A new combination vaccine for measles, mumps, rubella and varicella.

Zareba G.

Department of Environmental Medicine, University of Rochester, School of Medicine
and Dentistry, Rochester, New York 14642, USA. grazyna_zareba@urmc.rochester.edu

ProQuad is a recently approved combination vaccine for simultaneous vaccination
against measles, mumps, rubella and varicella in children aged 12 months to 12
years. It combines two well-established vaccines: Measles, Mumps, Rubella Virus
Vaccine Live (M-M-R II) and Varicella Virus Vaccine Live (Varivax with higher
varicella-zoster titer). Whereas vaccination against measles, mumps and rubella
has almost 100% coverage, vaccination against varicella shows a significantly
lower uptake of approximately 84%. Clinical studies on the immunogenicity and
efficacy of ProQuad demonstrated seroconversion rates and a magnitude of antibody
response similar to those observed after administration of its individual
components, M-M-R II and Varivax vaccines. The incidence of local side effects
(pain/tenderness/soreness, erythema, swelling, ecchymosis and rash) and systemic 
adverse effects (fever, irritability, rash, upper respiratory infection, viral
exanthema and diarrhea) is similar to or lower than that observed in component
vaccines. ProQuad is a highly immunogenic combination vaccine with a good safety 
profile. The use of ProQuad combination vaccine will simplify immunization
delivery by providing protection against more diseases with fewer injections and 
less pain, improve timely vaccination coverage and reduce the health-care costs
for additional health visits. The ProQuad combination vaccine facilitates
implementation of varicella vaccination into routine childhood immunization
schedules and will help to protect children against these four potentially
serious diseases.

Publication Types: 
    Review

PMID: 16801995 [PubMed - indexed for MEDLINE]

214: Rev Med Virol. 2006 Jul-Aug;16(4):225-50.

Molecular studies of Varicella zoster virus.

Quinlivan M, Breuer J.

Centre for Infectious Diseases, Institute for Cell and Molecular Science, 4
Newark Street, Whitechapel, London, E1 2AT, UK. m_quinlivan@hotmail.com

VZV is a highly cell-associated member of the Herpesviridae family and one of the
eight herpesviruses to infect humans. The virus is ubiquitous in most populations
worldwide, primary infection with which causes varicella, more commonly known as 
chickenpox. Characteristic of members of the alphaherpesvirus sub-family, VZV is 
neurotropic and establishes latency in sensory neurones. Reactivation from
latency, usually during periods of impaired cellular immunity, causes herpes
zoster (shingles). Despite being one of the most genetically stable human
herpesviruses, nucleotide alterations in the virus genome have been used to
classify VZV strains from different geographical regions into distinct clades.
Such studies have also provided evidence that, despite pre-existing immunity to
VZV, subclinical reinfection and reactivation of reinfecting strains to cause
zoster is also occurring. During both primary infection and reactivation, VZV
infects several PBMC and skin cell lineages. Difficulties in studying the
pathogenesis of VZV because of its high cell association and narrow host range
have been overcome through the development of the VZV severe combined
immunodeficient mouse model carrying human tissue implants. This model has
provided a valuable tool for studying the importance of individual viral proteins
during both the complex intracellular replication and assembly of new virions and
for understanding the underlying mechanism of attenuation of the live varicella
vaccine. In addition, a rat model has been developed and successfully used to
uncover which viral proteins are important for both the establishment and
maintenance of latent VZV infection.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16791838 [PubMed - indexed for MEDLINE]

215: Vaccine. 2006 Sep 11;24(37-39):6288-99. Epub 2006 Jun 8.

Assessing the introduction of universal varicella vaccination in the Netherlands.

Boot HJ, de Melker HE, Stolk EA, de Wit GA, Kimman TG.

Laboratory of Vaccine-preventable Diseases, National Institute for Public Health 
and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
Hein.Boot@RIVM.NL <Hein.Boot@RIVM.NL>

Although varicella is seen as a benign disease in the Netherlands, about 40,000
visits to a general practitioner (GP) are made, over 200 hospital admission
occur, and 2.3 persons die on average each year. Most of this burden of disease
can be prevented by universal varicella childhood vaccination. Ten years after
the introduction of the single-shot, single-component varicella childhood
vaccination in the USA, a major reduction in hospitalization, mortality, and
burden of disease has been reported. Using our recently vaccine evaluation model 
for the introduction of a new vaccine in our national immunization program, we
have analyzed the feasibility of universal varicella vaccination by replacing the
measles-mumps-rubella (MMR) vaccine with a measles-mumps-rubella-varicella (MMRV)
vaccine. After structuring and reviewing the available data, two major points of 
uncertainty remain: (1) the influence of universal childhood vaccination on the
incidence of zoster later in life; (2) the cost-effectiveness ratio for the Dutch
situation. Despite these uncertainties it is clear that universal childhood
vaccination will prevent most of the varicella related GP-visits,
hospitalizations, and deaths.

PMID: 16790302 [PubMed - indexed for MEDLINE]

216: J Infect Dis. 2006 Jul 15;194(2):247-55. Epub 2006 Jun 14.

Administration of live varicella vaccine to HIV-infected children with current or
past significant depression of CD4(+) T cells.

Levin MJ, Gershon AA, Weinberg A, Song LY, Fentin T, Nowak B; Pediatric AIDS
Clinical Trials Group 265 Team.

University of Colorado School of Medicine, Denver, Denver, CO 80262, USA.
myron.levin@uchsc.edu

BACKGROUND: Varicella can be a severe illness in human immunodeficiency virus
(HIV)-infected children. The licensed, live attenuated varicella vaccine is safe 
and immunogenic in HIV-infected children with minimal symptoms and good
preservation of CD4(+) T cells (Centers for Disease Control and Prevention
immunologic category 1). METHODS: To study the safety and immunogenicity of this 
vaccine in varicella-zoster virus (VZV)-naive, HIV-infected children with
moderate symptoms and/or more pronounced past or current decreases in CD4(+) T
cell counts, such children (age, 1-8 years) received 2 doses of vaccine 3 months 
apart. The children were observed in a structured fashion for adverse events.
Blood was tested for VZV antibody and VZV-specific cell-mediated immunity (CMI)
at baseline, 8 weeks after each dose, and annually for 3 years. Subjects who had 
no evidence of immunity 1 year after vaccination received a third dose and were
retested. RESULTS: The vaccine was well tolerated; there were no vaccine-related,
serious adverse events. Regardless of immunologic category, at least 79% of
HIV-infected vaccine recipients developed VZV-specific antibody and/or CMI 2
months after 2 doses of vaccine, and 83% were responders 1 year after
vaccination. CONCLUSIONS: HIV-infected children with a CD4(+) T cell percentage
of > or =15% and a CD4(+) T cell count of > or =200 cells/ microL are likely to
benefit from receiving varicella vaccine.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16779732 [PubMed - indexed for MEDLINE]

217: Respirology. 2006 Jul;11(4):437-41.

Effect of corticosteroids on adult varicella pneumonia: cohort study and
literature review.

Adhami N, Arabi Y, Raees A, Al-Shimemeri A, Ur-Rahman M, Memish ZA.

Department of Intensive Care Medicine & Infection prevention & control, King
Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.

BACKGROUND: Varicella pneumonia (VP) is a serious entity associated with
morbidity and mortality. There have been sporadic reports using corticosteroids
in life-threatening VP. We report a case series of VP to examine the outcome and 
the effect of corticosteroid use. METHODS: A retrospective chart review was
conducted on all adult patients admitted to a tertiary care hospital with VP
during a 14-year period. We documented oxygenation (SpO2, PaO2/FIO2) on admission
and after 48 h, whether the patients were admitted to an intensive care unit
(ICU), the use of mechanical ventilation, ICU and hospital length of stay (LOS)
and patient outcome. We compared those patients who received corticosteroids with
those who did not. RESULTS: We identified 19 patients with VP. Ten received
corticosteroids, in addition to antiviral and supportive treatment. Patients who 
received corticosteroids were significantly more hypoxaemic on admission and all 
were admitted to ICU with seven of them intubated. Only two of the nine in
non-steroid group were intubated. Despite their greater severity, the
corticosteroid group showed a much more rapid improvement in oxygenation and a
trend towards shorter duration of mechanical ventilation. The duration of ICU and
hospital LOS were not significantly different. All patients survived.
CONCLUSIONS: Corticosteroids in severe VP accelerate the physiological recovery
and may shorten the duration of mechanical ventilation.

Publication Types: 
    Comparative Study
    Review

PMID: 16771913 [PubMed - indexed for MEDLINE]

218: J Pediatr. 2006 Jun;148(6):842-4.

Secondary transmission of varicella vaccine virus in a chronic care facility for 
children.

Grossberg R, Harpaz R, Rubtcova E, Loparev V, Seward JF, Schmid DS.

Hattie Larlham Center for Children With Disabilities, Mantua, Ohio, USA.

A 16-year-old varicella-seronegative resident at a chronic care facility received
varicella vaccine; 15 days later he developed severe varicella. Subsequently, a
13-year-old resident and a 39-year-old health care worker developed mild
varicella. We demonstrate that vaccine-strain virus was transmitted to both
persons, and that transmission included at least 2 variant vaccine strains.

Publication Types: 
    Case Reports

PMID: 16769402 [PubMed - indexed for MEDLINE]

219: Eur J Paediatr Neurol. 2006 May;10(3):152-3. Epub 2006 Jun 9.

Post-varicella arteriopathy: benefits of using serial transcranial Doppler
examinations.

Rougeot C, Boissier C, Chabrier S.

Services de Pédiatrie, Hôpital Nord, 42055 Saint-Etienne Cedex 02, France.
stephane.chabrier@chu-st-etienne.fr

A 2(8/12)-year old boy suffered from hemiplegia secondary to a post-varicella
arteriopathy. His clinical status improved and after 4 years of follow-up he had 
no recurrent stroke or transient ischemic attack. Regular improvement of arterial
lesions, demonstated by serial transcranial Doppler investigations, excluded a
progressive arteriopathy. Aspirin therapy was initiated and continued during 2,5 
years. Transcranial Doppler is a portable, non-invasive tool that can be easily
used on a regular basis to follow-up children with post-varicella arteriopathy.

Publication Types: 
    Case Reports

PMID: 16765621 [PubMed - indexed for MEDLINE]

220: J Clin Virol. 2006 Aug;36(4):303-5. Epub 2006 Jun 9.

CT appearance of Varicella Zoster lesions in liver and spleen in an
immunocompetent patient.

Venkatesh SK, Lo LL.

Department of Diagnostic Radiology, National University Hospital, Yong Loo Lin
School of Medicine, National University of Singapore, Lower Kent Ridge Road,
Singapore 119074, Singapore. dnrskv@nus.edu.sg

An adult patient presented with vesicular rash and abdominal pain of 5 days
duration. His initial laboratory results showed elevated liver enzymes. A
contrast enhanced CT scan demonstrated multiple small hypodense nodules in liver 
and spleen. His serum was reactive for Varicella Zoster IgM. Patient was treated 
with intravenous Acyclovir for 5 days and followed up with oral tablets for 2
weeks. At 3 weeks, CT scan showed resolution of hypodense nodules and his serum
liver enzymes returned to normal at 6 weeks. Patient is on follow up and
asymptomatic for 2 years. The CT appearances of nodules and their resolution
following specific antiviral therapy are useful in diagnosis and in follow up of 
disseminated Varicella Zoster.

Publication Types: 
    Case Reports

PMID: 16765081 [PubMed - indexed for MEDLINE]

221: Fetal Pediatr Pathol. 2005 Nov-Dec;24(6):317-30.

Clinico-pathologic conference: an 11-year-old girl with lupus erythematosus,
venous thromboses, and purpura fulminans.

Mayer JL, Myers P, Barness EG, Nora F, Patterson R, Pomerance HH.

Department of Pediatrics, USF College of Medicine, 17 Davis Boulevard, Suite 200,
Tampa, FL 33606, USA.

An 11 year old girl with known diagnosis of lupus erythematosus with nephritis
was admitted with respiratory distress during an episode in which she had
infection with varicella-zoster virus complicated by purpura fulminans. She had a
downhill course, terminating with a pulmonary embolus.

Publication Types: 
    Case Reports
    Clinical Conference

PMID: 16761561 [PubMed - indexed for MEDLINE]

222: Pediatrics. 2006 Jun;117(6):e1070-7.

One dose of varicella vaccine does not prevent school outbreaks: is it time for a
second dose?

Lopez AS, Guris D, Zimmerman L, Gladden L, Moore T, Haselow DT, Loparev VN,
Schmid DS, Jumaan AO, Snow SL.

Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
alopez@cdc.gov

OBJECTIVES: The implementation of a routine childhood varicella vaccination
program in the United States in 1995 has resulted in a dramatic decline in
varicella morbidity and mortality. Although disease incidence has decreased,
outbreaks of varicella continue to be reported, increasingly in highly vaccinated
populations. In 2000, a varicella vaccination requirement was introduced for
kindergarten entry in Arkansas. In October 2003, large numbers of varicella cases
were reported in a school with high vaccination coverage. We investigated this
outbreak to examine transmission patterns of varicella in this highly vaccinated 
population, to estimate the effectiveness of 1 dose of varicella vaccine, to
identify risk factors for vaccine failure, and to implement outbreak control
measures. METHODS: A retrospective cohort study involving students attending an
elementary school was conducted. A questionnaire was distributed to parents of
all of the students in the school to collect varicella disease and vaccination
history; parents of varicella case patients were interviewed by telephone. A case
of varicella was defined as an acute, generalized, maculopapulovesicular rash
without other apparent cause in a student or staff member in the school from
September 1 to November 20, 2003. Varicella among vaccinated persons was defined 
as varicella-like rash that developed >42 days after vaccination. In vaccinated
persons, the rash may be atypical, maculopapular with few or no vesicles. Cases
were laboratory confirmed by polymerase chain reaction, and genotyping was
performed to identify the strain associated with the outbreak. RESULTS: Of the
545 students who attended the school, 88% returned the questionnaire. Overall
varicella vaccination coverage was 96%. Forty-nine varicella cases were
identified; 43 were vaccinated. Three of 6 specimens tested were positive by
polymerase chain reaction. The median age at vaccination of vaccinated students
in the school was 18 months, and the median time since vaccination was 59 months.
Forty-four cases occurred in the East Wing, where 275 students in grades
kindergarten through 2 were located, and vaccination coverage was 99%. In this
wing, varicella attack rates among unvaccinated and vaccinated students were 100%
and 18%, respectively. Vaccine effectiveness against varicella of any severity
was 82% and 97% for moderate/severe varicella. Vaccinated cases were
significantly milder compared with unvaccinated cases. Among the case patients in
the East Wing, the median age at vaccination was 18.5 and 14 months among
non-case patients. Four cases in the West Wing did not result in further
transmission in that wing. The Arkansas strains were the same as the common
varicella-zoster virus strain circulating in the United States (European
varicella-zoster virus strain). CONCLUSIONS: Although disease was mostly mild,
the outbreak lasted for approximately 2 months, suggesting that varicella in
vaccinated persons was contagious and that 99% varicella vaccination coverage was
not sufficient to prevent the outbreak. This investigation highlights several
challenges related to the prevention and control of varicella outbreaks with the 
1-dose varicella vaccination program and the need for further prevention of
varicella through improved vaccine-induced immunity with a routine 2-dose
vaccination program. The challenges include: 1-dose varicella vaccination not
providing sufficient herd immunity levels to prevent outbreaks in school settings
where exposure can be intense, the effective transmission of varicella among
vaccinated children, and the difficulty in the diagnosis of mild cases in
vaccinated persons and early recognition of outbreaks for implementing control
measures. The efficacy of 2 doses of varicella vaccine compared with 1 dose was
assessed in a trial conducted among healthy children who were followed for 10
years. The efficacy for 2 doses was significantly higher than for 1 dose of
varicella vaccine. This higher efficacy translated into a 3.3-fold lower risk of 
developing varicella >42 days after vaccination in 2- vs 1-dose recipients. Of
the children receiving 2 doses, 99% achieved a glycoprotein-based enzyme-linked
immunosorbent assay level of > or =5 units (considered a correlate of protection)
6 weeks after vaccination compared with 86% of children who received 1 dose. The 
6-week glycoprotein-based enzyme-linked immunosorbent assay level of > or =5
units has been shown to be a good surrogate for protection from natural disease. 
Ten years after the implementation of the varicella vaccination program, disease 
incidence has declined dramatically, and vaccination coverage has increased
greatly. However, varicella outbreaks continue to occur among vaccinated persons.
Although varicella disease among vaccinated persons is mild, they are contagious 
and able to sustain transmission. As a step toward better control of varicella
outbreaks and to reduce the impact on schools and public health officials, in
June 2005, the Advisory Committee on Immunization Practices recommended the use
of a second dose of varicella vaccine in outbreak settings. Early recognition of 
outbreaks is important to effectively implement a 2-dose vaccination response and
to prevent more cases. Although the current recommendation of providing a second 
dose of varicella vaccine during an outbreak offers a tool for controlling
outbreaks, a routine 2-dose recommendation would be more effective at preventing 
cases. Based on published data on immunogenicity and efficacy of 2 doses of
varicella vaccine, routine 2-dose vaccination will provide improved protection
against disease and further reduce morbidity and mortality from varicella.

PMID: 16740809 [PubMed - indexed for MEDLINE]

223: Epidemiol Infect. 2007 Jan;135(1):131-8. Epub 2006 Jun 2.

Epidemiology of hospital admissions for paediatric varicella infections: a
one-year prospective survey in the pre-vaccine era.

Dubos F, Grandbastien B, Hue V; Hospital Network for Evaluating Management of
Common Childhood Diseases, Martinot A.

Paediatric Emergency Department, Jeanne de Flandre University Hospital, Lille,
France.

To evaluate the epidemiology of hospital admissions for varicella in children, a 
1-year prospective multicentre study was done in Northern France in the
pre-varicella vaccine era. The 405 children aged <16 years seen at local
hospitals for varicella or herpes zoster were included. Among them, 143 who had
varicella and resided in the district were admitted. Admission incidence rates
were 28/100000 children aged <16 years (149/100000 infants aged <1 year,
69/100000 children aged 1-4 years, and 2/100000 children aged 5-15 years). Most
admissions (57%) were related to complications, usually skin infection (47%).
Independent risk factors for admission were place of residence outside the
district [adjusted odds ratio (aOR) 8.7], complication at admission (aOR 5.8),
recurrent fever (aOR 4.5), recent varicella in a sibling (aOR 4.0), and previous 
physician visit for the same condition (aOR 2.0).

Publication Types: 
    Multicenter Study

PMID: 16740185 [PubMed - indexed for MEDLINE]

224: Proc Biol Sci. 2006 May 22;273(1591):1229-37.

Age-structured effects and disease interference in childhood infections.

Huang Y, Rohani P.

Institute of Ecology and Center for Tropical and Emerging Global Diseases,
University of Georgia, Athens, GA 30602, USA. yhuang2@ncsu.edu

Recent studies have demonstrated that ecological interference among some
childhood diseases may have important dynamic consequences. An interesting
question is, when would we expect the interference effect to be pronounced? To
address the issue, here we develop a seasonally forced two-disease age-structured
model, using empirically derived age-specific force of infection (ASFOI) for
numerous infections of childhood. Our comparative numerical analysis shows that
when the ASFOIs for the two diseases largely overlap, the dynamics predicted by
the two-disease model are generally different from those predicted by the
analogous single-disease model, suggesting strong fingerprints of disease
interference. When the ASFOIs overlap less, on the other hand, both diseases
behave as predicted by the single-disease model, suggesting weak interference. We
conclude that age structure is an important factor that should be taken into
account in order to explore the underlying mechanisms of disease interference.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16720396 [PubMed - indexed for MEDLINE]

225: Vaccine. 2006 Jun 19;24(25):5341-8. Epub 2006 May 2.

Use of National Health Insurance database to evaluate the impact of public
varicella vaccination program on burden of varicella in Taiwan.

Tseng HF, Tan HF, Chang CK.

Institute of Medical Research, Chang-Jung Christian University, 396, Sec. l,
Chang Jung Rd, Kway Jen, Tainan 711, Taiwan, ROC. tsenghf2000@yahoo.com.tw

The aims of this study were to investigate the epidemiology of varicella and
evaluate the effect of varicella vaccination on the burden of varicella in
Taiwan. The outpatient and hospitalization claims made to the National Health
Insurance (NHI) in public and private vaccination areas were compared during
2000-2002. In 2002, the outpatient visit rates for 1- to 5-year-old children in
public vaccination areas were 66-78% lower than their counterparts in private
vaccination areas. The reduction in outpatient visit rate was the greatest among 
preschool children. The reductions also occurred in every age group including
infants and adults. This study showed significant evidence of vaccine impact with
a marked decline in clinical cases in the short term.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16713038 [PubMed - indexed for MEDLINE]

226: Eur J Pediatr. 2006 Oct;165(10):728-9. Epub 2006 May 12.

Delayed internal ophthalmoplegia and amblyopia following chickenpox.

Orssaud C, Roche O, El Dirani H, Dufier JL.

Department of Ophthalmology, Hôpital Européen Georges Pompidou, Assistance
Publique-Hôpitaux de Paris, 20, Rue Leblanc, 75015, Paris, France.
Christophe.Orssaud@hop.egp.ap-hop-paris.fr

INTRODUCTION: Chickenpox can be responsible for various ophthalmologic
complications [4]. DISCUSSION: An internal ophthalmoplegia could be observed in
this context and is responsible for a fixed pupil [2]. This complication is
extremely rare and seems to occur mainly in young children during the two weeks
following cutaneous eruption. We report an atypical observation of internal
ophthalmoplegia due to chickenpox that occurs with a particularly prolonged
interval. CONCLUSION: We would like to emphasize the consequences of the
paralysis of accommodation associated with this tonic pupil on visual acuity.

Publication Types: 
    Case Reports

PMID: 16691403 [PubMed - indexed for MEDLINE]

227: Clinics. 2006 Apr;61(2):147-52. Epub 2006 Apr 25.

Varicella zoster in children attending day care centers.

Marcitelli R, Bricks LF.

Pediatrics Department, University of Taubaté, Taubaté, SP, Brazil.

OBJECTIVE: To describe morbidity associated to varicella in children attending
day care centers. METHODS: Descriptive study carried out through inquiries with
parents of 664 children who acquired varicella after admission to day care
centers in Taubaté (population: 244,165, census of 2004), a prosperous city in
the State of São Paulo. RESULTS: The median age was 36 months (range 6 to 80
months); 8.4% of the children had varicella before 1 year of age. The main
symptoms were: exanthema (100.0%), fever (85.4%) anorexia (39.6%), and headache
(15.3%). 517 children (77.9%) had at least 1 medical visit, and 80.6% received at
least 1 medication; 73 (11.0%) received nonsteroidal antiinflammatory drugs, and 
52 (7.8%) received antibiotics. Complications occurred in 38 children (5.7%; 95% 
confidence interval: 3% - 8%); 8 (1.2%) were hospitalized, and 5 (0.7%) had
sequelae. Complications and hospitalizations rates were 3 times more frequent in 
children with less than 1 year of age than in older children. More than half of
the children and of the working parents were absent from their regular activities
for more than a week. CONCLUSIONS: Varicella was associated with significant
morbidity, affected younger children, was complicated in more than 5%, and left
sequelae in 0.7% of children. More than 10% of the children received nonsteroidal
antiinflammatory drugs, highlighting the need to warn the population about the
risks of these drugs. Although varicella vaccination is not recommended for
children younger than 12 months, vaccination of the children older than a year
could avoid by herd immunity the transmission to babies. Brazilian public health 
authorities should be alerted to this issue and offer varicella vaccine to
children attending day care centers.

PMID: 16680332 [PubMed - indexed for MEDLINE]

228: Postgrad Med J. 2006 May;82(967):351-2.

Chickenpox, chickenpox vaccination, and shingles.

Welsby PD.

Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2XU, UK.
P.Welsby@ed.ac.uk

Chickenpox in the United Kingdom, where vaccination is not undertaken, has had a 
stable epidemiology for decades and is a routine childhood illness. Because of
vaccination, chickenpox is now a rarity in the USA. In the UK vaccination is not 
done because introduction of a routine childhood vaccination might drive up the
age at which those who are non-immune get the illness (chickenpox tends to be
more severe the older you are), and the incidence of shingles may increase. The
United Kingdom is waiting to see what happens in countries where vaccination is
routine.

Publication Types: 
    Review

PMID: 16679476 [PubMed - indexed for MEDLINE]

229: Med Princ Pract. 2006;15(3):232-4.

Varicella-associated purpura fulminans: chicken pox is not always benign.

Abdulmalik A, Al-Ateeqi W, Al-Khawari M, Al-Osaimi S.

Department of Paediatrics, Al-Amiri Hospital, Safat, Kuwait.

OBJECTIVE: To report a 6-year-old boy with post-chicken pox purpura fulminans
(PF). CLINICAL PRESENTATION AND INTERVENTION: A 6-year-old boy presented with
purpura of the legs that rapidly progressed to other parts of the limbs and the
buttocks. The patient had had chicken pox 10 days prior to presentation. He was
afebrile and the chicken pox lesions were dry. He received anti-coagulants, a
large volume of fresh frozen plasma, immunoglobulin and steroids. The skin
lesions regressed but both hands and parts of the lower limbs remained necrotic; 
the patient was transferred to an orthopaedic hospital for amputation and skin
grafting. CONCLUSION: This case report shows that PF can occur as a
post-infection syndrome after primary varicella. Early and aggressive treatment
of post-chicken pox PF might reduce the mortality and morbidity associated with
this condition. Copyright 2006 S. Karger AG, Basel.

Publication Types: 
    Case Reports

PMID: 16651842 [PubMed - indexed for MEDLINE]

230: Pediatrics. 2006 May;117(5):e833-9.

Varicella-related hospitalization and emergency department visit rates, before
and after introduction of varicella vaccine, among white and black children in
Hamilton County, Ohio.

Staat MA, Meinzen-Derr J, Welch T, Roberts NE, Jamison L, Gerber MA, Morrow AL.

Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH 45229, USA. mary.staat@cchmc.org

OBJECTIVE: The American Academy of Pediatrics recommended routine use of
varicella vaccine in pediatric practice in 1995. We examined the impact of
varicella immunization on population-based rates of pediatric varicella-related
hospitalizations and emergency department (ED) visits in the years before and
after introduction of varicella vaccine. STUDY DESIGN: Discharge data for
hospitalizations and ED encounters from 1990 through 2003 were queried for
patients <20 years of age with varicella International Classification of
Diseases, Ninth Revision, Clinical Modification codes (052.0-052.9) in any
diagnostic position. Addresses were geocoded for identification of Hamilton
County, Ohio, residents. Rates were calculated according to year, age, and race, 
with census estimates. RESULTS: During the 14-year study period, there were 3983 
incident varicella cases; 335 patients were hospitalized and 3833 were treated
only in the ED. The rate of varicella-related hospitalizations decreased from
15.7 cases per 100,000 population to 5.5 cases per 100,000 population between the
prevaccine period (1990-1995) and the postvaccine period (1996-2003);
varicella-related ED use decreased from 178.2 cases per 100,000 population to
61.2 cases per 100,000 population. In the prevaccine period, hospitalization and 
ED visit rates were significantly higher for black children than for white
children. In the postvaccine period, hospitalization rates did not differ
according to race but ED visit rates remained significantly higher for black
children, compared with white children. CONCLUSIONS: Varicella-related
hospitalization and ED visit rates decreased significantly for both white and
black children in Hamilton County, Ohio, after the introduction of varicella
vaccine, and the racial disparity found before licensure decreased after
licensure.

Publication Types: 
    Comparative Study

PMID: 16651288 [PubMed - indexed for MEDLINE]

231: MMWR Morb Mortal Wkly Rep. 2006 Apr 28;55 Suppl 1:39-43.

Varicella outbreak among primary school students--Beijing, China, 2004.

Ma H, Fontaine R; Centers for Disease Control and Prevention (CDC).

Chinese Field Epidemiology Training Program, Chinese Center for Disease Control
and Prevention, Beijing, China. huilaima@sohu.com

INTRODUCTION: On June 9, 2004, a varicella outbreak was reported in a Beijing
primary school affecting approximately 80% of children in one preschool
classroom. An outbreak investigation was initiated to identify factors
contributing to the high rate of transmission and to assess the effectiveness of 
control measures. METHODS: A varicella case was defined as onset of a
generalized, vesicular pruritic rash lasting >4 days in a student at the school
during January 1-June 26, 2004. Parents of all students in the four lowest grades
(K-2) were questioned concerning varicella illness before January 1, 2004.
Exposure and vaccination histories of 111 ill students and 120 control students
with no history of varicella were compared. RESULTS: During January 1-June 26,
2004, of 1,407 students, 138 (9.8%) had varicella; 488 (35%) K-2 students had no 
history of varicella before the outbreak. In five classrooms in which attack
rates (ARs) were high (>40%), a primary-case student had remained in school 2
days while ill with a rash. The secondary attack rate (SAR) in these classrooms
was 21%, compared with 1.7% in classrooms in which the first ill student was sent
home immediately (risk ratio [RR] = 10; 95% confidence interval [CI] = 3.7-29.0).
A total of 111 (70%) ill students rode the school bus daily, compared with 120
(33%) control students (odds ratio [OR] =4.9; CI = 2.7-9.0). A total of 73 (33%) 
ill students had a history of varicella vaccination before January 1, 2004,
compared with 32 (69%) control-students (OR = 0.22; CI = 0.08-0.59). CONCLUSION: 
Students who were not excluded from school on the first day of rash were key
contributors to the spread of varicella in their classrooms. High susceptibility 
to varicella at school entry indicates that vaccination of susceptible students
might be the only effective measure to control this recurrent problem.

PMID: 16645582 [PubMed - indexed for MEDLINE]

232: J Coll Physicians Surg Pak. 2006 Apr;16(4):270-2.

Chicken pox associated thrombocytopenia in adults.

Ali N, Anwar M, Majeed I, Tariq WU.

Department of Hematology, Combined Military Hospital, Attock. nmjrm@hotmail.com

OBJECTIVE: To determine the frequency and magnitude of thrombocytopenia
associated with chicken pox in adults. DESIGN: Observational descriptive study.
PLACE AND DURATION OF STUDY: Combined Military Hospital, Attock, from July 2003
to June 2004. PATIENTS AND METHODS: All patients of age 15 years and above with
history of fever, followed by appearance of the typical vesicular chicken pox
rash, were inducted after informed consent. Two milliliters of whole blood was
collected on day 1 of admission, and blood counts were performed. Patients were
admitted and given 800 mg oral acyclovir, 5 times/day, for 7 days, in addition to
symptomatic treatment. Patients were followed till 8 weeks. RESULTS: A total of
410 patients of chicken pox were received, out of which 270 were included. Age of
patients ranged between 15 and 40 years with median age of 21 years. Platelet
count on the day of admission ranged between 29 x 10(9)/L to 513 x 10(9)/L, mean 
platelet count 178 x 10(9)/L. Platelet count < 150 x 10(9)/L was detected in
80/270 (30%) patients. Platelet count in thrombocytopenia patients was from 29 x 
10(9)/L to 149 x 10(9)/L with mean 121 x 10(9)/L. Thrombocytopenia recovered
within 02 weeks in 78/80 (97%) patients. In 2 patients, thrombocytopenia
recovered in 3 weeks. None of the patients developed purpuric spots, ecchymosis
or bleeding manifestations. CONCLUSION: Thrombocytopenia in chicken pox is a
common entity. Platelet count remains above 25 x 10(9) /L, which is usually not
associated with bleeding manifestations. None of the patients in this series
developed purpura. No specific pattern of total leukocyte counts was predictive
of the progression or regression in platelet count.

PMID: 16624190 [PubMed - indexed for MEDLINE]

233: J Med Assoc Thai. 2005 Sep;88 Suppl 4:S7-11.

The prevalence of varicella-zoster virus infection in normal healthy individuals 
aged above 6 months.

Kowitdamrong E, Pancharoen C, Thammaborvorn R, Bhattarakosol P.

Department of Microbiology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand.

The prevalence of varicella-zoster virus (VZV) infection was studied by
determining the presence of IgG antibody to VZV (anti-VZV IgG) using ELISA
method. Three hundred and fifty sera collected from Thai healthy individuals aged
above 6 months (mean age +/- standard deviation = 14.9 +/- 11.4) were tested, the
prevalence of VZV infection was 64.6% (225/350). All samples were randomly
sampling from healthy children and blood donors who visited the hospital and
clssified into 7 groups, 50 samples each, according to their age, i.e., group 1; 
6 months-3 years, group 2; 4-6 years, group 3; 7-9 years, group 4; 10-14 years,
group 5; 15-19 years, group 6; 20-24 years and group 7; above 25 years. The
prevalence of VZV infection were 12%, 42%, 64%, 70%, 78%, 84% and 100%
respectively. The mean amount of anti-VZV IgG among groups of positive VZV
infection (225 samples) was 86.8 +/- 29.7 unit/ml. The mean amount of anti-VZV
IgG was highest in 6 months-3 years age group (113.6 +/- 39.2 unit/ml).
Significant difference of the mean amount of anti- VZV IgG was found between
group 1, 3, 6 and other groups (p-value < 0.05). There was a correlation between 
history of varicella and the presence of anti-VZV IgG in the serum. 95.3% of
individuals with positive history has already had the antibody. The important
associated factors that might involve VZV infection were age, number of members
in family and place of exposure to VZV infection. Other factors, such as sex and 
income did not show any association to VZV infection.

PMID: 16622994 [PubMed - indexed for MEDLINE]

234: Southeast Asian J Trop Med Public Health. 2005 Nov;36(6):1450-8.

Varicella epidemiology and cost-effectiveness analysis of universal varicella
vaccination program in Taiwan.

Tseng HF, Tan HF, Chang CK.

Institute of Medical Research, Chang-Jung University, Taiwan.
tsenghf@yahoo.com.tw

Varicella zoster virus is highly contagious and affects people worldwide. In this
study, we collected local epidemiological data and evaluated the
cost-effectiveness of varicella vaccination program in Taiwan. To examine the
economical consequences of universal vaccination, a model of the incidence and
the associated costs in a hypothetical cohort was created each year for 30 years.
The incidence increased sharply after the infancy and peaked in children aged 5
years. The hospitalization rate among cases was the highest in infants, followed 
by adults 30 to 44 years old. The benefit-cost analysis showed that one dollar
invested in the program would cost extra 46 cents in direct medical expense, but 
would save extra 45 cents considering the societal expenses. Substantial
economical benefits can occur due to the averted unproductive days for parents.
Sensitive surveillance of both varicella and zoster is essential in countries
that have implemented or are about to implement varicella vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16610647 [PubMed - indexed for MEDLINE]

235: Expert Rev Vaccines. 2006 Apr;5(2):295-302.

Successes and remaining challenges after 10 years of varicella vaccination in the
USA.

Davis MM.

University of Michigan, Gerald R Ford School of Public Policy, 300 NIB, 6C23 Ann 
Arbor, MI 48109-0456, USA. mattdav@med.umich.edu

Beginning in 1995, universal varicella vaccination was recommended in the USA for
all children aged 12-18 months, and all susceptible adolescents and adults. Many 
physicians were initially sceptical about the need to prevent primary varicella. 
However, with passage of state daycare and school entry mandates for varicella
immunization, national varicella vaccination rates increased to approximately 90%
by 2004. Several studies have demonstrated concomitant reductions in
varicella-related healthcare utilization, costs and varicella-related mortality
among children in the vaccinated age group, as well as adults. Remaining
challenges include: first, outbreaks of 'breakthrough' varicella in vaccinated
populations, which may prompt a second-dose recommendation, and second, possible 
increases in the incidence of secondary varicella (zoster) among adults whose
natural immunity may wane in the absence of endemic varicella. The latter concern
highlights the importance of a promising new varicella vaccine for older adults
that may be licensed and recommended in the next 2 years.

Publication Types: 
    Review

PMID: 16608428 [PubMed - indexed for MEDLINE]

236: Fetal Diagn Ther. 2006;21(3):296-301.

Prenatal ultrasound diagnosis, follow-up, and outcome of congenital varicella
syndrome.

Meyberg-Solomayer GC, Fehm T, Muller-Hansen I, Enders G, Poets C, Wallwiener D,
Solomayer EF.

Department of Gynaecology and Obstetrics, University of Tuebingen, Germany.
gabriele.meyberg-solomayer@med.uni-tuebingen.de

OBJECTIVES: To report on a case of fetal varicella infection following the
diagnosis of maternal infection at 16 weeks of gestation. METHODS: Diagnosis was 
based on serology testing and prenatal ultrasound, confirmed by DNA detection in 
amniotic fluid (Lightcycler-PCR). Serial ultrasound examinations were performed. 
RESULTS: Sonographic anomalies included borderline ventriculomegaly,
intracerebral, intrahepatic and myocardial calcifications, limb deformities,
articular effusions, and intrauterine growth retardation (confirmed
postpartally). The newborn showed a severe encephalopathy and could not be
stabilized sufficiently. The child died 23 days after birth. CONCLUSION: The
outcome of an affected fetus may be very serious and prenatal ultrasound is a
helpful tool to recognize the severity of the infection. Copyright 2006 S. Karger
AG, Basel.

Publication Types: 
    Case Reports

PMID: 16601342 [PubMed - indexed for MEDLINE]

237: Pediatrics. 2006 Apr;117(4):999-1008.

Uptake of varicella vaccination among young children in the United States: a
success story in eliminating racial and ethnic disparities.

Luman ET, Ching PL, Jumaan AO, Seward JF.

National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, GA 30333, USA. ELC7@cdc.gov

OBJECTIVE: To examine uptake of varicella vaccine, a live attenuated vaccine
licensed in 1995 and recommended in 1996 for routine vaccination of US children
12 to 18 months of age. METHODS: Data were for 178,616 children (19-35 months of 
age) and were collected in the 1997 to 2004 National Immunization Survey. The
main outcome measures were estimated varicella vaccine coverage from 1997 to
2004, coverage among susceptible children (ie, those without a history of
varicella disease), racial/ethnic disparities, risk factors for nonvaccination,
missed opportunities to vaccinate simultaneously with other recommended vaccines,
and projected increases in coverage after elimination of missed opportunities for
simultaneous vaccination. RESULTS: Varicella vaccine coverage rates increased
from 26% in 1997 to 87% in 2004. State-specific coverage rates increased 44 to 80
percentage points and were >80% in 42 states and >90% in 13 states by 2004.
Coverage among susceptible children increased from 62% in 1999 to 88% in 2004.
From 1998 onward, no statistically significant differences in coverage were found
between white and black children, whereas Hispanic children had higher coverage
rates than white children in 1998 to 2001 and 2004. Risk factors for
undervaccination included living in the Midwest region, living in a household
with >1 child, living in nonmetropolitan areas, living below the poverty level,
having a mother who did not have a college degree, and having public providers.
If missed opportunities for simultaneous vaccination had been eliminated, then
coverage rates would have increased from 58% to 94% in 1999 and from 87% to 96%
in 2004. CONCLUSIONS: Uptake of varicella vaccine has been steady and is an
example of successful elimination of racial and ethnic disparities. Additional
focus should be placed on reducing missed opportunities for simultaneous
vaccination, improving coverage in rural areas and the Midwest region, and
closing remaining gaps related to maternal education, provider type, and
multiple-children households.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 16585293 [PubMed - indexed for MEDLINE]

238: Pediatr Transplant. 2006 Mar;10(2):240-3.

Specific autologous cytotoxic T lymphocytes for chronic varicella in a liver
transplanted child.

Melzi ML, Sonzogni A, Comoli P, Stroppa P, Riva S, Altobelli M, Casati A, Torre
G, Alberti D, Guizzetti M, Furione M, Spada M, Colledan M, Gridelli B.

Liver Transplant Unit, Ospedali Riuniti, Bergamo, Italy.
ctfpediatr@ospedaliriuniti.bergamo.it

Infections by herpesviruses may have severe complications in liver transplant
patients. Although prophylactic varicella zoster virus vaccination is strongly
recommended and widely applied, severe infection may still occur. We report the
case of systemic chronic varicella, which developed in a liver allograft
recipient, unresponsive to antiviral drug treatment, successfully treated by
varicella zooster-specific CTL. Graft failure ensued, likely, because of massive 
cytolysis of infected hepatocytes. The patient, who was re-transplanted in the
absence of signs of varicella zooster reactivation, is now well and disease free 
3 yr after second liver transplant.

Publication Types: 
    Case Reports

PMID: 16573614 [PubMed - indexed for MEDLINE]

239: Pediatr Infect Dis J. 2006 Apr;25(4):368-70.

Safety and immunogenicity of live varicella virus vaccine in children with human 
immunodeficiency virus type 1.

Armenian SH, Han JY, Dunaway TM, Church JA.

Division of General Pediatrics, Childrens Hospital Los Angeles, University of
Southern California, USA.

Live varicella virus vaccine was administered to 10 stable human immunodeficiency
virus type 1 (HIV-1)-infected children. Subjects were monitored for adverse
reactions, HIV-1 plasma levels, CD4 T cell counts and immune responses. The
vaccine was well-tolerated. Varicella-zoster virus-specific lymphocyte
proliferative responses were detected in all subjects by 4 weeks and in 9 of 10
subjects 1 year after vaccination.

Publication Types: 
    Clinical Trial
    Research Support, N.I.H., Extramural

PMID: 16567993 [PubMed - indexed for MEDLINE]

240: Vaccine. 2006 May 1;24(18):3946-52. Epub 2006 Feb 24.

The epidemiology of varicella and herpes zoster in The Netherlands: implications 
for varicella zoster virus vaccination.

de Melker H, Berbers G, Hahné S, Rümke H, van den Hof S, de Wit A, Boot H.

Centre for Infectious Disease Epidemiology, National Institute of Public Health
and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
h.de.melker@rivm.nl

We studied the epidemiology of varicella (chickenpox) and herpes zoster
(shingles) in The Netherlands to assess the desirability to implement routine
varicella zoster virus vaccination in The Netherlands. Data on seroprevalence of 
varicella zoster virus in the general population (1995-1996), consultations of
general practitioners for varicella (2000-2002) and herpes zoster (1998-2001) and
hospital admissions due to varicella (1994-2001) and herpes zoster (1994-2001) in
The Netherlands were analysed. The seropositivity increased sharply with age from
18.4% for both 0- and 1-year-olds, to 48.9%, 59.0%, 75.7% and 93.0% for 2-, 3-,
4- and 5-year-olds, respectively, and varied between 97.5% and 100% for older age
groups. The average annual incidence of GP-consultations amounted to 253.5 and
325.0 per 100,000 for varicella and herpes zoster, respectively. The incidence of
hospital admission due to varicella and herpes zoster was 1.3 (2.3 including side
diagnosis) and 2.7 (5.8) per 100,000, respectively. Whilst for varicella, the
incidence of GP-consultations and hospital admissions were highest in childhood, 
for herpes zoster, these were highest in elderly. Insight into epidemiology of
varicella zoster is needed for the assessment of the desirability of introduction
of routine varicella zoster vaccination.

PMID: 16564115 [PubMed - indexed for MEDLINE]

241: Clin Transplant. 2006 Jan-Feb;20(1):136-8.

Fulminating varicella despite prophylactic immune globulin and intravenous
acyclovir in a renal transplant recipient: should renal patients be vaccinated
against VZV before transplantation?

Robertson S, Newbigging K, Carman W, Jones G, Isles C; Scottish Renal Registry.

Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK.

We describe a case of fulminating varicella despite prophylactic immune globulin 
and intravenous acyclovir in a renal transplant recipient. This promoted a survey
of all 383 adult patients awaiting a renal transplant in Scotland, which showed a
low level of Varicella zoster virus (VZV) awareness but a willingness to consider
vaccination if non immune. 359/363 serum samples tested were seropositive for VZV
antibody giving a susceptibility to VZV of 1.2%. Although data on vaccination in 
adults with chronic kidney disease are limited, expert opinion is of the view
that the benefits of vaccinating immunocompetent seronegative patients before
transplantation are likely to outweigh the risks. We believe that adult patients 
awaiting a transplant in the UK should be tested for their susceptibility to VZV 
and that early vaccination should be offered to those who are both
immunocompetent and seronegative.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16556169 [PubMed - indexed for MEDLINE]

242: J Clin Virol. 2006 May;36(1):76-8. Epub 2006 Mar 20.

Use of genomic analysis of varicella-zoster virus to investigate suspected
varicella-zoster transmission within a renal unit.

Molyneaux PJ, Parker S, Khan IH, Millar CG, Breuer J.

Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill,
Aberdeen AB25 2ZN, UK. p.molyneau@arh.gramphian

BACKGROUND: The source of hospital-acquired chickenpox infection may be presumed 
from a known exposure, but has not been previously proven using genomic analysis.
OBJECTIVE: Investigation of suspected VZV transmission was done using single
nucleotide polymorphism genomic analysis. STUDY DESIGN: Comparison was made of
viral isolates from two patients with chickenpox on the same ward who were not
known to have had direct contact. RESULTS: An identical genotype in the variable 
R1 region of the VZV was isolated from the two patients. CONCLUSION: Inapparent
hospital-acquired transmission was the most likely route of infection.

Publication Types: 
    Case Reports
    Comparative Study

PMID: 16545596 [PubMed - indexed for MEDLINE]

243: J Infect Dis. 2006 Apr 1;193(7):927-30. Epub 2006 Feb 27.

Vaccine Oka varicella-zoster virus genotypes are monomorphic in single vesicles
and polymorphic in respiratory tract secretions.

Quinlivan MA, Gershon AA, Nichols RA, La Russa P, Steinberg SP, Breuer J.

Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and
the London School of Medicine and Dentistry, London, England.

We previously found that, after immunization with vaccine Oka varicella-zoster
virus, virus obtained from a single vesicle were monomorphic, and virus obtained 
from different individuals were heterogeneous. Here we show that virus obtained
from the lungs of a patient were a mixture of vaccine Oka variants. We
hypothesize that complications after immunization are unlikely to be caused by
expansion of a single, biologically more virulent clone of virus that either
pre-exists in the vaccine or develops after random mutation of different clones. 
We hypothesize that some clones are more trophic than others for skin.

Publication Types: 
    Case Reports
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16518753 [PubMed - indexed for MEDLINE]

244: MMWR Morb Mortal Wkly Rep. 2006 Mar 3;55(8):209-10.

A new product (VariZIG) for postexposure prophylaxis of varicella available under
an investigational new drug application expanded access protocol.

Centers for Disease Control and Prevention (CDC).

On October 27, 2004, the Advisory Committee on Immunization Practices (ACIP) was 
informed by the only U.S.-licensed manufacturer of varicella zoster immune
globulin (VZIG) (Massachusetts Public Health Biologic Laboratories, Boston,
Massachusetts) that the company had discontinued production of VZIG. The supply
of the licensed VZIG product is now nearly depleted. In February 2006, an
investigational (not licensed) VZIG product, VariZIG (Cangene Corporation,
Winnipeg, Canada) became available under an investigational new drug application 
(IND) submitted to the Food and Drug Administration (FDA). This product can be
requested from the sole authorized U.S. distributor, FFF Enterprises (Temecula,
California), for patients who have been exposed to varicella and who are at
increased risk for severe disease and complications.

PMID: 16511443 [PubMed - indexed for MEDLINE]

245: Am J Forensic Med Pathol. 2006 Mar;27(1):93-6.

Sudden unexpected death in a child with varicella caused by necrotizing fasciitis
and streptococcal toxic shock syndrome.

Hidalgo-Carballal A, Suárez-Mier MP.

Institute of Legal Medicine of Albacete, Cuenca y Guadalajara, Tarancon, Cuenca, 
Spain.

A 4-year-old child with chickenpox infection for 5 days prior to death complained
of swelling and pain in his right leg that required medical assistance in the
emergency department. Radiologic study was normal, and analgesic and bandage of
the leg were prescribed. Some hours later, he presented cyanosis, dizziness, and 
vomiting and collapsed. A complete forensic autopsy was performed 12 hours after 
death. External examination of the body showed numerous crusty varicella skin
lesions, especially over the trunk, and swelling and reddening of his right leg. 
The brain was swollen, with cerebellar herniation, and both adrenal glands were
hemorrhagic.Microscopically, neutrophilic infiltration and muscle fiber necrosis 
were observed in soft tissues of his right leg, and fibrin microthrombus were
numerous in capillaries of the plexus choroideus, larynx, lungs, and adrenals.
Bacterial emboli were present in most of the tissues. Microbiologic cultures of
blood and cerebrospinal fluid showed group A beta-hemolytic streptococcus
(Streptococcus pyogenes). Death was attributed to fulminant streptococcal toxic
shock syndrome, with necrotizing fasciitis as a complication of varicella.

Publication Types: 
    Case Reports

PMID: 16501360 [PubMed - indexed for MEDLINE]

246: Pediatr Transplant. 2006 Feb;10(1):78-82.

Live virus immunization after orthotopic liver transplantation.

Khan S, Erlichman J, Rand EB.

Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
19104, USA.

Viral infection is a recognized and potentially serious complication in children 
following solid organ transplantation. The risks of viral infection are
particularly important for infants who may not have completed standard childhood 
immunizations at the time of transplantation and are therefore at risk for
otherwise preventable infections. The general practice of withholding live virus 
immunization from transplant recipients has been questioned and several small
studies have looked at MMR and/or Varivax administration in children following
transplantation. This retrospective study analyzes the response to primary MMR
and varicella immunization in selected pediatric liver transplant recipients in
the largest such study to date. Nineteen of 26 children (73%) developed serologic
immunity for measles following MMR (although 18 required multiple doses).
Similarly, varicella immunization resulted in seroconversion in 20 of 31 children
(64.5%; seven required multiple doses). Only minor adverse effects reported in
the general population were observed. Live virus immunization with MMR and
Varivax was safe and immunogenic in this selected population of liver transplant 
recipients.

Publication Types: 
    Comparative Study

PMID: 16499592 [PubMed - indexed for MEDLINE]

247: Am J Prev Med. 2006 Mar;30(3):232-6.

Increasing evidence of immunity to varicella among children in Massachusetts,
1999-2003.

Lopez AS, Lett SM, Yih WK, Northrup J, Jumaan AO, Seward JF.

National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA. alopez@cdc.gov

BACKGROUND: Experiences with vaccine-preventable diseases have demonstrated the
success of school-entry requirements in increasing vaccination coverage and
decreasing disease incidence. This study examines the effect of early
implementation of daycare and school-entry requirements for varicella vaccination
on recorded varicella immunity of preschool and school-aged children in
Massachusetts. METHODS: Immunization surveys were conducted in licensed child
care centers and schools with kindergarten and/or 7th grades. Evidence of
immunity to varicella was defined as having physician verified records of
varicella vaccination or disease history from the 1999-2000 through 2003-2004
school years. RESULTS: During the 5-year study period, physician-certified
reliable history of varicella disease decreased in each grade level while
vaccination coverage increased. The increase in the number of children in each
grade level receiving varicella vaccine led to an increase in the overall
percentage of children with evidence of immunity to varicella: 85% to 97% for
children aged 2 years or more in child care, 93% to 98% for children in
kindergarten, and 88% to 92% for children in 7th grade. CONCLUSIONS: The
implementation of daycare and school-entry requirements for varicella vaccination
within 4 years of the start of the varicella vaccination program in Massachusetts
was associated with high levels of vaccination coverage in the cohorts of
children targeted by the requirements. Although evidence of immunity from
varicella disease decreased during the study period, the increase in varicella
vaccination coverage compensated for the decline in disease history, resulting in
a higher proportion of young children with evidence of immunity to varicella.

PMID: 16476639 [PubMed - indexed for MEDLINE]

248: Am J Transplant. 2006 Mar;6(3):565-8.

Safety and immunogenicity of varicella-zoster virus vaccine in pediatric liver
and intestine transplant recipients.

Weinberg A, Horslen SP, Kaufman SS, Jesser R, Devoll-Zabrocki A, Fleckten BL,
Kochanowicz S, Seipel KR, Levin MJ.

Dept. Pediatrics, University of Colorado Health Services Center, Denver, CO, USA.

Primary varicella-zoster virus (VZV) infections following organ transplantation
may cause significant morbidity. We examined the safety and immunogenicity of
Varivax after transplantation as a potential prophylactic tool. Pediatric liver
and intestine transplant recipients without history of chickenpox received one
dose of Varivax. VZV humoral and cellular immunity were assessed before and > or 
=12 weeks after vaccination. Adverse events (AE) and management of exposure to
wild type VZV were monitored. Sixteen VZV-naïve subjects, 13-76 months of age, at
257-2045 days after transplantation were immunized. Five children developed mild 
local AE of short duration. Four subjects developed fever and four developed
non-injection site rashes, three of whom received acyclovir. Liver enzymes did
not increase during the month after vaccination. Eighty-seven percent and 86% of 
children developed humoral and cellular immunity, respectively. There were five
reported exposures to varicella in four children, none of which resulted in
chickenpox. One subject received VZV-immunoglobulin and another subject with
liver enzyme elevations after exposure received acyclovir; all remained
asymptomatic. Varivax was safe and immunogenic in pediatric liver and intestine
transplant recipients. Larger studies are needed to establish the efficacy and
role of varicella vaccination after transplantation.

Publication Types: 
    Comparative Study

PMID: 16468967 [PubMed - indexed for MEDLINE]

249: Can J Ophthalmol. 2006 Feb;41(1):97-9.

Panuveitis as presenting sign of chickenpox in a young child.

Belfair N, Levy J, Lifshitz T.

Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion
University of Negev, Beer-Sheva, Israel.

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

Publication Types: 
    Case Reports

PMID: 16462882 [PubMed - indexed for MEDLINE]

250: Vaccine. 2006 Apr 12;24(16):3258-60. Epub 2006 Jan 19.

Seroprevalence of Varicella-Zoster virus IgG antibodies in Swiss children during 
the first 16 months of age.

Heininger U, Desgrandchamps D, Schaad UB.

Division of Pediatric Infectious Diseases, University Children's Hospital Basel, 
P.O. Box CH-4005, Basel, Switzerland. Ulrich.Heininger@unibas.ch

QUESTION UNDER STUDY: To investigate the persistence of maternal IgG antibodies
against Varicella-Zoster virus (VZV) in infants and young children. METHODS:
Serum specimens of children aged 0-16 months who had been hospitalized in our
institution between 1994 and 1999 were identified from our routine serum
collection. Exclusion criteria were: preterm delivery (<37 gestational weeks);
suspected varicella infection or presence of exanthema of unknown etiology at
time of serum collection; transfusion of blood products during 6 months preceding
serum collection; foreign born mother; and previous VZV immunization. Serotesting
for IgG antibodies against VZV was performed by use of a commercially available
ELISA kit. RESULTS: Two hundred and fifty three serum specimens from 240 patients
were analyzed. Age distribution of patients at time of specimen collection was:
0-3 months: n=57; >3-6 months: n=47; >6-9 months: n=47; >9-12 months: n=48;
>12-16 months: n=54. Seroprevalence rates for IgG antibodies against VZV in the
different age groups were 90% (0-3 months), 38% (>3-6 months); 0% (>6-9 and >9-12
months); and 7% (>12-16 months). CONCLUSIONS: Our results demonstrate high levels
of passively acquired humoral immunity against varicella in Swiss infants during 
the first 3 months of life. Beyond the first 3 months of life IgG antibodies
against VZV are lacking in the majority of patients and between 6 and 12 months
of age all specimens tested were negative. Beyond the first year of life
antibodies against varicella were detected in four samples, probably due to
previous VZV infection. In accordance with current recommendations, VZV
vaccination should ideally be administered to children 9 months of age and older,
although our data indicate that successful immunization may be possible at
earlier age (6 months onwards) in certain circumstances.

PMID: 16459000 [PubMed - indexed for MEDLINE]

251: Southeast Asian J Trop Med Public Health. 2005 Sep;36(5):1201-7.

A seroepidemiology study of varicella among children aged 0-12 years in Taiwan.

Tseng HF, Tan HF, Chang CK, Wang LY, Yang SE, Liau MY, Pan MJ, Chen CY, Huang SP.

Institute of Medical Research, Chang-Jung University, Taiwan.
tsenghf2000@yahoo.com.tw

The epidemiology pattern of varicella appears to vary among regions with
different climates, population densities, and degrees of development. This study 
investigated the age-specific varicella zoster virus (VZV) seroprevalence in
children aged 0 to 12 years in Taiwan and compared these seroprevalences between 
free and private vaccination areas. Residual sera were collected from 13
hospitals with 1,401 valid samples. Immunoglobulin G antibodies to VZV were
measured by enzyme-linked immunosorbent assay. Parents of 656 children answered
questions about the varicella incidence and varicella vaccination history of
their children. In the 8-12 year-olds, the seroprevance ranged between 88.0-93.8%
in northern, central, and eastern, while it was only 76.1% in southern Taiwan.
The seroprevalence of children 0-5 years old were significantly different between
free and private vaccination areas. Seropositive children who reported no history
of varicella or receiving varicella vaccine accounted for 26.1-59.3% of the total
positive cases. Our findings suggest the possible effects of climate,
geographical conditions, and lifestyle on the seroepidemiology of VZV in Taiwan. 
The efforts of implementing a varicella vaccination program in Taiwan should
focus on reaching high levels of coverage.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16438146 [PubMed - indexed for MEDLINE]

252: Leuk Res. 2006 Aug;30(8):917-22. Epub 2006 Jan 6.

Do childhood diseases affect NHL and HL risk? A case-control study from northern 
and southern Italy.

Montella M, Maso LD, Crispo A, Talamini R, Bidoli E, Grimaldi M, Giudice A, Pinto
A, Franceschi S.

Servizio di Epidemiologia, Istituto Nazionale Tumori Fondazione G. Pascale,
Naples, Italy. epidemiologia.int@tin.it

To investigate the association between non-Hodgkin lymphoma (NHL), Hodgkin
lymphoma (HL), and exposure to childhood diseases, we analyzed an Italian
case-control study that included 225 histologically-confirmed incident cases of
NHL, 62 HL cases, and 504 controls. After adjusting for confounding factors, all 
examined childhood diseases were negatively associated with HL. Measles was
negatively associated with NHL, particularly follicular B-cell NHL. Our findings 
provide additional support to the hypothesis that infections by most common
childhood pathogens may protect against HL or, at least, be correlated with some 
other early exposure, which may lower the risk of HL in adulthood. In addition,
our study shows that measles may provide a protective effect against NHL.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16406019 [PubMed - indexed for MEDLINE]

253: J Eur Acad Dermatol Venereol. 2006 Jan;20(1):75-8.

Foreign body post-varicella granulomas due to talc.

Lázaro C, Reichelt C, Lázaro J, Grasa MP, Carapeto FJ.

Department of Dermatology, Lozano-Blesa University Hospital, Zaragoza, Spain.
aclazaro@jazzfree.com

Foreign body granulomas in the skin have been described frequently and may have
various causes. Diagnosis is relatively easy in most cases, as most are related
to foreign material penetrating into the skin due to different kinds of traumas. 
We present the case of a boy with multiple facial granulomas, persisting more
than 6 months and related to the use of topical anti-pruriginous talc powder
applied to papuloexudative lesions caused by varicella. Data gathered in the
anamnesis, examination with polarized light and images seen through the electron 
microscope enabled us to identify the causal agent talc as the inducer of the
granulomatous lesions that the patient presented, discarding other types of
foreign body granulomas of exogenous origin.

Publication Types: 
    Case Reports

PMID: 16405613 [PubMed - indexed for MEDLINE]

254: Minerva Pediatr. 2005 Dec;57(6):433-9.

Microphthalmia due to congenital varicella infection: a case report.

Palano GM, Di Pietro M, Scuderi A, Praticò G.

Dipartimento di Pediatria, Università degli Studi di Catania, Catania.
graziamaria.palano@infinito.it

The authors report the clinical case of a newborn affected by congenital
varicella syndrome, occurred about the 12th gestational week, with ophthalmic
involvement. The ocular anomalies consisted in right microphthalmia, with lens
opacities and atrophic chorioretinitis, without any involvement of other
pathologies. The ophthalmic lesions and the sierological data confirmed that the 
infection occurred during the first weeks of gestation. Although the
manifestation limited to the eyes is extremely rare, the authors point out the
necessity of an appropriate prevention to avoid irreversible involvements of
important organs.

Publication Types: 
    Case Reports

PMID: 16402016 [PubMed - indexed for MEDLINE]

255: Pediatr Infect Dis J. 2006 Jan;25(1):41-4.

Comment in:
    Pediatr Infect Dis J. 2006 Jan;25(1):45-6.

Seroprevalence of varicella in the French population.

Khoshnood B, Debruyne M, Lançon F, Emery C, Fagnani F, Durand I, Floret D.

Cemka-Eval, Bourg La Reine, France.

OBJECTIVES: To assess the age-specific seroprevalence of varicella in the French 
population and to explore age-adjusted differences according to gender and
geographic region. METHODS: Data were obtained from 1257 randomly selected,
frozen serum samples, from subjects 1-30 years of age, that were sent to the
Pasteur-Cerba laboratory in November 2003 to January 2004 for the following
clinical indications: allergies, respiratory infections, herpes virus infections 
excluding varicella and endocrinologic tests. IgG concentrations were tested with
an indirect enzyme immunoassay. Statistical analyses included use of locally
weighted, scatterplot smoothers. RESULTS: Age-specific seroprevalence of
varicella increased by >6-fold between 1 and 8 years of age, ie, from 15.0% (95% 
confidence interval, 8.6-23.5%) for subjects 1-2 years of age to 89.0% (95%
confidence interval, 81.0-94.3%) for those 7-8 years of age. The smoothed curve
of age-specific seroprevalence suggested that the steepest rate of increase
occurred between 1 and 8 years of age, followed by a considerable slowing in the 
rate of increase, reaching a prevalence of approximately 95% by age 30. Varicella
seroprevalence rates were similar for the samples referred for the 4 clinical
indications, as follows: allergies, 76.2%; respiratory infections, 74.0%; herpes 
virus infections excluding varicella, 73.3%; endocrinologic tests, 73.7% (P =
0.84). CONCLUSIONS: Most varicella-zoster virus infections occur during early
childhood. Seroprevalence rates reach approximately 50% by 4 years of age and
approximately 90% by 8 years. Therefore, the best strategy to reduce the
prevalence of wild-type varicella-zoster virus in the French population would be 
to immunize children 12-18 months of age, as is currently performed in the United
States.

PMID: 16395101 [PubMed - indexed for MEDLINE]

256: Infez Med. 2005 Dec;13(4):229-34.

Varicella and its complications as cause of hospitalization.

Losurdo G, Bertoluzzo L, Canale F, Timitilli A, Bondi E, Castagnola E, Giacchino 
R.

Infectious Diseases Unit, G Gaslini Children's Hospital, Genova, Italy.

Varicella is an acute contagious disease that most commonly occurs in childhood. 
Although normally benign, varicella can occasionally develop into a more serious 
illness. Moreover, the infection can lead to serious complications, such as
Staphylococcus aureus infections, otitis media, endocarditis, pneumonia, and rare
central nervous system (CNS) events like cerebellar ataxia and encephalitis. This
study was conducted to analyze the hospitalization rate due to varicella or its
complications in a tertiary care hospital in Italy, where varicella vaccination
has not yet been implemented. The review was carried out on cases of children
with varicella identified by ICD9 and ICD9-CM diagnostic codes and admitted to
the Giannina Gaslini Children's Research Hospital of Genoa, Italy, from January
1st, 1995 to December 31st, 2004. For each case reporting complications, the
clinical report form was extracted and the events recorded. Varicella was
recorded in 346 (0,16%) out of 212,647 total hospital discharges. Chickenpox with
detailed complications and cerebrovascular diseases accounted for 56 discharges
(12.14%), for a total of 728 days. Fifteen patients needed more than one
hospitalization because of severe sequelae as result of CNS involvement. We
reported three particular cases of invasive infections and four children affected
with cerebrovascular diseases following varicella. Our retrospective data
regarding a single tertiary care pediatric hospital shows that hospitalization
due to varicella or its sequelae may present an important medical and indirect
economic problem.

Publication Types: 
    Case Reports
    Review

PMID: 16388278 [PubMed - indexed for MEDLINE]

257: J Virol. 2006 Jan;80(2):1025-31.

Varicella-zoster virus ORF63 inhibits apoptosis of primary human neurons.

Hood C, Cunningham AL, Slobedman B, Arvin AM, Sommer MH, Kinchington PR,
Abendroth A.

Centre for Virus Research, Westmead Millennium Institute, and University of
Sydney, P.O. Box 412, Westmead, 2145 NSW, Australia.

Virus-encoded modulation of apoptosis may serve as a mechanism to enhance cell
survival and virus persistence. The impact of productive varicella-zoster virus
(VZV) infection on apoptosis appears to be cell type specific, as infected human 
sensory neurons are resistant to apoptosis, yet human fibroblasts readily become 
apoptotic. We sought to identify the viral gene product(s) responsible for this
antiapoptotic phenotype in primary human sensory neurons. Treatment with
phosphonoacetic acid to inhibit viral DNA replication and late-phase gene
expression did not alter the antiapoptotic phenotype, implicating immediate-early
(IE) or early genes or a virion component. Compared to the parental VZV strain
(rOKA), a recombinant virus unable to express one copy of the diploid IE gene
ORF63 (rOka deltaORF63) demonstrated a significant induction of apoptosis in
infected neurons, as determined by three methods: annexin V staining,
deoxynucleotidyltransferase-mediated dUTP-biotin nick end label staining, and
transmission electron microscopy. Furthermore, neurons transfected with a plasmid
expressing ORF63 resisted apoptosis induced by nerve growth factor withdrawal.
These results show that ORF63 can suppress apoptosis of neurons and provide the
first identification of a VZV gene encoding an antiapoptotic function. As ORF63
is expressed in neurons during both productive and latent infection, it may play 
a significant role in viral pathogenesis by promoting neuron survival during
primary and reactivated infections.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16379003 [PubMed - indexed for MEDLINE]

258: Jpn J Infect Dis. 2005 Dec;58(6):383-6.

Seroprevalence of varicella, measles and hepatitis B among female health care
workers of childbearing age.

Yavuz T, Ozdemir I, Sencan I, Arbak P, Behçet M, Sert E.

Department of Clinical Microbiology, University of Abant Izzez Baysal, Duzce
School of Medicine, Duzce, Turkey. tyavuz@superonline.com

To evaluate the relation between infectious agents and reproductive health
hazards for health care workers (HCWs), a cross-sectional study consisting of 73 
HCWs and 65 bureau workers was conducted. The reproductive health problems of
both groups were compared using a questionnaire, and serologic examinations for
measles, varicella and hepatitis B were performed. There were no differences
between the two groups according to the rate of seropositivity of measles and
varicella (P > 0.05). The prevalence of anti-HBc seropositivity was significantly
higher among HCWs than controls (31.5 versus 16.9%). There were no differences
between seropositive and seronegative subgroups of measles, varicella and
hepatitis B regarding the rates of normal delivery time, preterm and postterm
delivery and stillbirth. Subjects seropositive for anti-HBc showed a higher
spontaneous abortion rate than those who were seronegative (38.2 versus 16.3, P =
0.009). Although these data showed that HCWs had a high rate of anti-HBc
seropositivity and that the rate of spontaneous abortion was associated with past
hepatitis B virus infection, further studies including larger populations are
needed. We considered that it should be strongly recommended that all HCWs be
vaccinated against this virus, and future studies should be focused on the
relationship between infectious diseases and reproductive health problems in
HCWs.

PMID: 16377874 [PubMed - indexed for MEDLINE]

259: Drug Ther Bull. 2005 Dec;43(12):94-5.

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

[No authors listed]

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

Publication Types: 
    Review

PMID: 16375201 [PubMed - indexed for MEDLINE]

260: Aust N Z J Public Health. 2005 Dec;29(6):544-51.

Modelling the impact of vaccination on the epidemiology of varicella zoster virus
in Australia.

Gidding HF, Brisson M, Macintyre CR, Burgess MA.

National Centre for Immunisation Research and Surveillance of Vaccine Preventable
Diseases, Royal Alexandra Hospital for Children and University of Sydney, New
South Wales. heatherg@icpmr.wsahs.nsw.gov.au

OBJECTIVE: To model the impact of universal varicella vaccination in Australia.
METHODS: The results of an Australia-wide serosurvey for varicella zoster virus
(VZV) immunity were used to parameterise realistic, age-structured deterministic 
models (RAS) developed by Brisson and colleagues. We examined the impact of a
vaccination program for one-year-olds alone, and with a catch-up campaign for
11-year-olds, on the incidence of varicella and zoster, using Australia's
population structure. Morbidity was then determined by calculating the number of 
hospital in-patient days. RESULTS: Infant vaccination is predicted to reduce the 
incidence of varicella. However, zoster incidence is expected to increase
initially, assuming exposure to varicella boosts immunity to zoster. Accumulated 
morbidity from both varicella and zoster is predicted to remain above that
expected without vaccination for the first 70 years of an infant program
(assuming 90% coverage with boosting for 20 years). However, after 70 years the
net health savings from vaccination are predicted to increase substantially.
CONCLUSIONS AND IMPLICATIONS: Infant vaccination is expected to be a successful
long-term commitment to reducing morbidity associated with VZV infection in
Australia.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16366065 [PubMed - indexed for MEDLINE]

261: J Dermatol. 2005 Sep;32(9):745-50.

Primary varicella infection associated with stevens-johnson syndrome in a Turkish
child.

Bay A, Akdeniz N, Calka O, Kösem M, Faik Oner A, Doğan M.

Department of Pediatrics, Yüzüncü Yil University, Faculty of Medicine, Van,
Turkey.

Stevens-Johnson syndrome (SJS) is defined as a severe erythema-multiforme-like
eruption of the skin and lesions of the oral, genital and anal mucosa and
hemorrhagic crusting on the lips; it is associated with fever, headache, and
arthralgia. The disease is a part of a continuum of immunologically mediated
mucocutaneous diseases at various grades of severity. SJS is often induced by
drugs, but the pathophysiologic mechanism is completely unknown. Patients and
their first degree-relatives may have genetic defects in their metabolic pathways
that lead to the accumulation of toxic metabolites. However, viral infections are
known triggers of this skin disorder. Varicella zoster virus has been only very
rarely reported as an etiological agent in SJS, despite its high incidence as a
pathogen in childhood. In this study, we report a case of primary varicella
infection associated with SJS because of its rare presentation. To the best of
our knowledge, our case is the youngest child in the literature.

Publication Types: 
    Case Reports
    Review

PMID: 16361719 [PubMed - indexed for MEDLINE]

262: Fetal Pediatr Pathol. 2005 May-Jun;24(3):169-89.

The usual childhood diseases: forgotten but not gone.

Pomerance HH.

University of South Florida College of Medicine, Tampa, Florida 33606, USA.
hpomeran@hsc.usf.edu

With the advent of vaccine protection for many diseases, many of today's
practitioners have never seen cases of what were the common childhood diseases.
If any of these diseases returns, there is a risk that the practitioner will not 
recognize it. This article tries to establish why the diseases may return and to 
describe the diseases with photographs.

Publication Types: 
    Review

PMID: 16338879 [PubMed - indexed for MEDLINE]

263: Acta Radiol. 2005 Oct;46(6):652-6.

Acute osteomyelitis as a complication of varicella.

Borgen L, Haakonsen MO, Gudmundsen TE, Solheim D, Stensvold K.

Department of Radiology, Hospital of Buskerud, Drammen, Norway.
lars.borgen@sb-hf.no

Varicella is a common viral infection in childhood, and acute osteomyelitis is
one of the rare but serious complications. We report two cases of osteomyelitis
as a complication of varicella. The possibilities and limitations of the
different imaging modalities are discussed, as well as imaging findings during
the course of this condition.

Publication Types: 
    Case Reports

PMID: 16334850 [PubMed - indexed for MEDLINE]

264: J Reprod Med. 2005 Oct;50(10):779-83.

Correlation of a reported history of chickenpox with seropositive immunity in
pregnant women.

Plourd DM, Austin K.

Department of Obstetrics and Gynecology, Naval Medical Center, San Diego,
California, USA.

OBJECTIVE: To evaluate to what degree a positive verbal history of prior
chickenpox infection correlates with current immunity. STUDY DESIGN: Patients
presenting for prenatal registration at Naval Medical Center, San Diego, from
January through June 2002 were candidates to participate in the study. Each
patient was asked about her personal history of chickenpox. A blood sample was
then obtained for an enzyme-linked immunosorbent assay IgG antibody test.
RESULTS: Results were obtained on 1,085 patients. Of the 940 evaluable patients
who reported a positive history of varicella, 904 (96.2%) were serologically
immune; 21 (2.2%) of them had a negative antibody titer, and 15 (1.6%) of them
had an equivocal titer. The overall seronegativity rate was 4.14% for all
patients enrolled. CONCLUSION: There is a strong correlation between a reported
history of chickenpox and serum immunity. Universal screening does not seem
necessary, but education of susceptible individuals is warranted.

PMID: 16320558 [PubMed - indexed for MEDLINE]

265: Liver Transpl. 2005 Dec;11(12):1563-6.

Chicken pox after pediatric liver transplantation.

Levitsky J, Kalil AC, Meza JL, Hurst GE, Freifeld A.

Department of Medicine, Division of Hepatology, Northwestern Memorial Hospital,
Feinberg School of Medicine, Chicago, IL, USA.

Previous case series have reported serious complications of chicken pox (CP)
after pediatric liver transplantation (PLT), mainly due to visceral
dissemination. The goal of our study was to determine the incidence, risk
factors, and outcomes of CP after PLT. A case-control study of all CP infections 
in pediatric transplant recipients followed at our center from September 1993 to 
April 2004 was performed. Data were collected before and after infection and at
the same time points in age-, gender-, and transplant year-matched controls.
Potential risk factors prior to CP and adverse outcomes after infection were
compared between cases and controls. Twenty (6.2%) developed CP at a median of
1.8 yr (0.6-4.8) after PLT. All CP infections were cutaneous, with no evidence of
organ involvement. Twelve were hospitalized: 9 only to receive intravenous
acyclovir and 3 stayed > or =2 weeks for other complications. Risk factors were
not statistically different among cases and controls. Of the outcomes analyzed,
cases were significantly more likely to develop non-CP infections within one year
of CP than controls (Hazard Ratio = 12.6, 95% confidence interval = 3.1-51.7; P <
0.001). These infections were often bacterial and occurred long after CP
infection. In conclusion, CP is uncommon after PLT and has a low likelihood of
organ dissemination. No risk factors were identified. Some cases required
prolonged hospitalizations. Close monitoring for the development of late
bacterial infections is warranted.

Publication Types: 
    Comparative Study

PMID: 16315312 [PubMed - indexed for MEDLINE]

266: J Infect. 2005 Nov;51(4):307-13.

Growth, morbidity and mortality after chickenpox infection in young children in
Guinea-Bissau.

Poulsen A, Cabral F, Nielsen J, Roth A, Lisse I, Aaby P.

Projecto de Saude de Bandim, Guinea-Bissau, Danish Epidemiology Science Centre,
Statens Serum Institut, Copenhagen, Denmark. anja@dadlnet.dk

OBJECTIVE: To examine whether chickenpox in children below 2 years of age is
associated with post-infection changes in growth, morbidity or mortality.
METHODS: An outbreak of chickenpox was investigated in Guinea-Bissau. An
examination, interview and anthropometry were performed 6 months after the
epidemic for a group of children and matched controls whose weight had been
measured at the time of the chickenpox episode. All children diagnosed with
chickenpox before 2 years of age were followed for survival and hospitalisations 
to the age of 3 years and compared with all other children in the community.
RESULTS: At the 6-month follow-up, skin infections tended to be more frequent in 
cases (p<0.06) and more cases had used antibiotics within the last month
(p<0.03). Although there had been no difference before chickenpox infection,
girls with chickenpox infection had significantly higher weight, height and
larger arm-circumferences than controls (all p<0.01). After chickenpox infection,
the incidence of hospitalisation and long-term mortality was the same for cases
and other children in the community (respectively, incidence rate ratio=1.16
(0.77-1.74) and mortality ratio=0.74 (0.39-1.41)). CONCLUSION: Though chickenpox 
may be associated with increased short-term morbidity, it does not appear to have
any negative long-term effect on growth, severe morbidity and survival of young
children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16291283 [PubMed - indexed for MEDLINE]

267: Acta Neurol Scand. 2005 Dec;112(6):417-9.

Frequent association of multiple sclerosis with varicella and zoster.

Perez-Cesari C, Saniger MM, Sotelo J.

Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico,
Mexico City, Mexico.

BACKGROUND: A possible association of multiple sclerosis (MS) with viral diseases
has been postulated; in previous studies we have found that in Mexican mestizos
the antecedent of varicella during childhood represents a risk factor for the
development of MS during adulthood. AIM: We conducted a retrospective search for 
varicella and zoster infections associated with the development of MS. METHODS
AND RESULTS: In a cohort of 82 consecutive patients with MS we found six cases,
four of varicella and two of zoster, that were concurrent with the development or
the progress of MS. CONCLUSIONS: The association of these pathologies is higher
than expected and suggests a possible etiological relationship of the varicella
zoster virus with MS.

PMID: 16281927 [PubMed - indexed for MEDLINE]

268: J Clin Microbiol. 2005 Nov;43(11):5614-21.

Persistent detection of varicella-zoster virus DNA in a previously healthy child 
after severe chickenpox.

Vossen MT, Gent MR, Peters KM, Wertheim-van Dillen PM, Dolman KM, van Breda A,
van Lier RA, Kuijpers TW.

Academic Medical Center, Emma Children's Hospital, Room G8-205, Meibergdreef 9,
1105 AZ Amsterdam, The Netherlands.

In immunocompetent children with primary varicella-zoster virus (VZV) infection, 
peak viral loads are detected in peripheral blood near the onset of the vesicular
rash. VZV DNA concentrations normally diminish and become undetectable within 3
weeks after the appearance of the exanthem. Here, we present a previously
healthy, human immunodeficiency virus-negative, 4-year-old boy admitted with
severe varicella. High viral loads (>340,000 copies/ml) were found in his blood, 
and the viral loads remained high for at least 1.5 years. Clinical recovery
preceded complete clearance of the virus. General and VZV-specific immune
reactivity were intact. NK cells and CD8(+) T cells were activated during acute
infection, and VZV-specific CD4(+) T cells were detected at high frequencies. VZV
DNA was initially detected in B cells, NK cells, and both CD4(+) and CD8(+) T
cells. In contrast, during the persistent phase of VZV DNA detection, the viral
DNA was primarily located in CD8(+) T cells. For the first time, we describe the 
persistent detection of VZV DNA in a previously healthy child.

Publication Types: 
    Case Reports
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16272494 [PubMed - indexed for MEDLINE]

269: Int J Infect Dis. 2006 Mar;10(2):156-61. Epub 2005 Nov 2.

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

Almuneef M, Memish ZA, Balkhy HH, Alotaibi B, Helmy M.

Department of Infection Prevention and Control, King Abdulaziz Medical City-King 
Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia.

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

PMID: 16260166 [PubMed - indexed for MEDLINE]

270: J Hosp Infect. 2005 Dec;61(4):283-6. Epub 2005 Oct 25.

Door-opening motion can potentially lead to a transient breakdown in
negative-pressure isolation conditions: the importance of vorticity and buoyancy 
airflows.

Tang JW, Eames I, Li Y, Taha YA, Wilson P, Bellingan G, Ward KN, Breuer J.

Division of Infection and Immunity, Centre for Virology, Royal Free and
University College Medical Schools, London, UK. julian.tang@cuhk.edu.hk

A patient with severe chickenpox was admitted to a negative-pressure isolation
room. He remained sedated, intubated and mechanically ventilated throughout his
admission. He was managed only by nurses immune to chickenpox. A non-immune male 
nurse occasionally handed equipment through the doorway, without entering the
room. Ten days later, he also developed chickenpox. Sequencing of viruses from
the patient and nurse showed the same rare genotype, indicating nosocomial
transmission. An experimental model demonstrated that, despite negative pressure,
opening the door could have resulted in transport of infectious air out of the
isolation room, leading to a breakdown in isolation conditions.

Publication Types: 
    Case Reports

PMID: 16253388 [PubMed - indexed for MEDLINE]

271: Vaccine. 2006 Feb 27;24(9):1298-307. Epub 2005 Oct 3.

The cost-effectiveness of antenatal varicella screening with post-partum
vaccination of susceptibles.

Pinot de Moira A, Edmunds WJ, Breuer J.

Modelling and Economics Unit, Health Protection Agency Centre for Infections,
London NW9 5EQ, UK.

Varicella infection during pregnancy or around the time of birth can result in
serious complications for the mother and/or her child. However, infection during 
pregnancy is relatively rare as most women are infected during childhood.
Immigrant mothers from certain tropical countries are at increased risk of
infection, as these countries appear to have lower rates of infection during
childhood. We used a cohort model to assess the potential costs and benefits of
screening first-time pregnant mothers and then vaccinating those who are
susceptible. The model was stratified by age and country of birth (Bangladesh or 
UK). The strategies evaluated were: (a) an initial verbal screen followed by a
serological screen for those with a negative or uncertain history; (b) universal 
serological screening; and (c) the current strategy which is to treat cases as
they arise. Post-partum vaccination was given to those who screen negative for
VZV antibodies. The model suggested that the screening and vaccination strategies
prevent cases in women compared with the current strategy. Verbal followed by
serological screening may be cost-saving to the NHS for both UK- and
Bangladesh-born women. Universal screening is more costly but more effective than
verbal screening, and it may be cost-effective to universally screen younger
immigrant mothers.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16236401 [PubMed - indexed for MEDLINE]

272: Int J Clin Pract. 2005 Nov;59(11):1326-33.

Comment in:
    Int J Clin Pract. 2005 Nov;59(11):1248-50.

Is Europe ready to embrace a policy of universal varicella vaccination?

Ramet J, Weil-Olivier C, Sedlak W; Confederation of the European Specialists of
Paediatrics (CESP)/European Academy of Paediatrics (EAP) CESP/EAP.

Universiteit Antwerpen, UZA and Paola Kinderziekenhuis ZNA, Antwerp, Belgium.
jose.ramet@zna.be

For the first time, a live attenuated varicella vaccine with an indication for
universal vaccination is licensed in all EU countries. It is now time to consider
whether in Europe there should be widespread vaccination against varicella to
prevent this common and highly infectious disease. Increasing numbers of
countries are adopting vaccination programmes against the disease. In those
countries where a routine vaccination policy has been adopted, the success of the
vaccine has been significant. The USA, which prior to the launch of a universal
vaccination programme in 1995 had 4 million cases of varicella per year, has seen
a dramatic reduction in varicella morbidity and mortality rates. A universal
varicella vaccination policy is an option that needs to be considered for Europe 
not only in medical terms but also because it would be socially and economically 
appropriate.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16236088 [PubMed - indexed for MEDLINE]

273: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002980.

Update of:
    Cochrane Database Syst Rev. 2004;(2):CD002980.

Acyclovir for treating varicella in otherwise healthy children and adolescents.

Klassen TP, Hartling L, Wiebe N, Belseck EM.

University of Alberta, Room 8213, Aberhart Centre One, Department of Pediatrics, 
11402 University Avenue, Edmonton, Alberta, Canada T6G 2J3.
terry.klassen@ualberta.ca

BACKGROUND: Acyclovir has the potential to shorten the course of illness which
may result in reduced costs and morbidity associated with chickenpox. OBJECTIVES:
1) To examine the evidence evaluating the efficacy of acyclovir in alleviating
symptoms of chickenpox and shortening the duration of illness. 2) To examine
complications of chickenpox and adverse effects associated with acyclovir as
reported in the relevant trials. SEARCH STRATEGY: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2,
2005), MEDLINE (January 1966 to June 2005), and EMBASE (1988 to June 2005). The
reference lists of all relevant articles were reviewed. The primary author of
relevant studies and the pharmaceutical company that manufactures acyclovir were 
contacted. SELECTION CRITERIA: Randomized controlled trials that evaluated
otherwise healthy children zero to 18 years of age, with chickenpox. DATA
COLLECTION AND ANALYSIS: Two authors independently reviewed the studies for
eligibility. Two authors independently assessed methodological quality of the
relevant studies using the Jadad scale and allocation concealment. Differences
were resolved by consensus. Data were extracted by one author using a structured 
form and checked by a second.Continuous data were converted to the weighted mean 
difference (WMD). Weighted mean differences were combined into an overall
estimate using random effects. There were too few studies to consider exploring
statistical heterogeneity between studies (i.e., differences in reported
effects), formally, or to assess for publication bias. MAIN RESULTS: Three
studies were included. Study quality was three (n = 2) and four (n = 1) on the
Jadad scale. Acyclovir was associated with a reduction in the number of days with
fever (-1.1 days, 95% CI -1.3 to -0.9) and in reducing the maximum number of
lesions (-76 lesions, -145 to -8). Results were less supportive with respect to
the number of days to no new lesions and the number of days to the relief of
itching. There were no clinically important differences between acyclovir and
placebo with respect to complications associated with chickenpox or adverse
effects associated with the treatment. AUTHORS' CONCLUSIONS: Acyclovir appears to
be effective in reducing the number of days with fever and the maximum number of 
lesions among otherwise healthy children with chickenpox. The results were less
convincing with respect to the number of days to no new lesions and relief of
itchiness. The clinical importance of acyclovir treatment in otherwise healthy
children remains uncertain.

Publication Types: 
    Review

PMID: 16235308 [PubMed - indexed for MEDLINE]

274: Neurol India. 2005 Sep;53(3):323-5.

Precipitation of stroke-like event by chickenpox in a child with MELAS syndrome.

Jian-Ren L.

Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang
University, China. liujianren@medmail.com.cn

The mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like
episodes syndrome (MELAS) is a rare congenital disorder of mitochondrial DNA
(mtDNA). Herein we report a case of MELAS, whose second stroke-like episode was
provoked by chickenpox. A point mutation at nucleotide (nt) 3243 in mtDNA
supported the diagnosis of MELAS in this case. History of myopathy, the presence 
of lesions that did not conform to accepted distributions of vascular territories
on cranial magnetic resonance imaging (MRI), normal result of cranial magnetic
resonance angiography, hyperintensity on diffusion weighted MRI and apparent
diffusion coefficient mapping indicating the presence of vasogenic edema in the
fresh stroke-like lesion, and mitochondrial DNA analysis helped to exclude the
diagnosis of ischemic cerebral infarction which can also be induced by
chickenpox.

Publication Types: 
    Case Reports

PMID: 16230801 [PubMed - indexed for MEDLINE]

275: Braz J Infect Dis. 2005 Jun;9(3):262-5. Epub 2005 Oct 3.

Varicella pneumonia in immunocompetent adults: report of two cases, with emphasis
on high-resolution computed tomography findings.

Gasparetto EL, Warszawiak D, Tazoniero P, Escuissato DL, Marchiori E.

Radiology Department, University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
gasparetto@hotmail.com

We report two cases of varicella pneumonia in immunocompetent patients, with
emphasis on high-resolution computer tomography manifestations. The predominant
findings consisted of multiple bilateral nodules, ranging from 1-10 mm in
diameter, with or without a surrounding halo of ground-glass attenuation. Other
findings include ground-glass opacities, focal areas of consolidation and small
pleural effusions.

Publication Types: 
    Case Reports

PMID: 16224634 [PubMed - indexed for MEDLINE]

276: Expert Rev Vaccines. 2005 Oct;4(5):629-43.

Review of the Varilrix varicella vaccine.

Chiu SS, Lau YL.

Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The
University of Hong Kong, Hong Kong SAR, China. ssschiu@hkucc.hku.hk

Varicella zoster virus causes an acute infection that affects most children
globally, but the age of infection can be greater in residents of tropical areas.
It has generally been considered a mild disease, although there are accumulating 
data to show that it can cause significant morbidity and mortality in
immunocompetent as well as immunocompromised children and adults. Oka-strain live
attenuated varicella vaccines were developed in the 1970s. Varilrix developed by 
GlaxoSmithKline Biologicals (Rixensart, Belgium), is one of the vaccines produced
and marketed in over 80 countries. Similar to the other Oka-strain vaccines,
Varilrix is safe, immunogenic and efficacious in both immunocompromised and
immunocompetent children and adults.

Publication Types: 
    Comparative Study
    Review

PMID: 16221065 [PubMed - indexed for MEDLINE]

277: J Pediatr Hematol Oncol. 2005 Oct;27(10):551-3.

Fulminant hepatitis due to varicella zoster virus in a girl with acute
lymphoblastic leukemia in remission: report of a case and review.

Mantadakis E, Anagnostatou N, Danilatou V, Markaki EA, Spanaki AM, Briassoulis G,
Kalmanti M.

Department of Pediatric Hematology/Oncology, University Hospital of Heraklion,
Heraklion, Crete, Greece.

The authors describe a 4-year-old girl with acute lymphoblastic leukemia in
remission who developed fulminant hepatic failure due to varicella-zoster virus
(VZV). Diagnosing VZV visceral infection in immunocompromised patients is often
difficult due to atypical clinical presentation with few or no skin lesions and
severe abdominal or back pain. Prompt initiation of empirical treatment with
acyclovir and VZV immunoglobulin pending results of the serum polymerase chain
reaction for VZV is warranted in this clinical setting.

Publication Types: 
    Case Reports

PMID: 16217259 [PubMed - indexed for MEDLINE]

278: Herpes. 2005 Oct;12(2):33-7.

Comment in:
    Herpes. 2005 Oct;12(2):32.

Analysis of the cost-effectiveness of varicella vaccine programmes based on an
observational survey in the Latium region of Italy.

Gialloreti LE, Divizia M, Pica F, Volpi A.

Department of Public Health, University of Rome Tor Vergata, Via Montpellier 1,
00133 Rome, Italy.

Varicella is the most widespread childhood disease in Italy. However, as in many 
parts of the world, the country does not yet have a unified approach to the
management of the disease. A cost-effectiveness analysis of varicella vaccination
strategies, using the Latium region in Italy as a case study, was undertaken.
Mass vaccination is only recommended if the immunization programme can achieve
coverage of over 85% in a short time. However, experience in Italy with
non-compulsory vaccinations has shown this is difficult to achieve. Consequently,
eradication of the disease is not seen as an attainable short-term goal. For mass
varicella vaccination to be successful, it must be run at a national as well as
regional level in combination with education programmes, and a reliable
surveillance system. The interaction between varicella and herpes zoster must
also be taken into account when considering vaccination strategies, as zoster
vaccination strategies may have an impact on varicella coverage.

PMID: 16209858 [PubMed - indexed for MEDLINE]

279: Environ Health Perspect. 2005 Oct;113(10):1373-5.

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

Ku CH, Liu YT, Christiani DC.

School of Public Health, National Defense Medical Center, National Defense
University, Taipei, Taiwan.

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

Publication Types: 
    Case Reports

PMID: 16203249 [PubMed - indexed for MEDLINE]

280: Pediatrics. 2005 Oct;116(4):e525-9.

Recent steroid therapy increases severity of varicella infections in children
with acute lymphoblastic leukemia.

Hill G, Chauvenet AR, Lovato J, McLean TW.

Department of Pediatrics, Wake Forest University School of Medicine,
Winston-Salem, NC 27157, USA.

OBJECTIVE: The varicella-zoster virus (VZV) continues to be a dangerous pathogen 
to immunocompromised children. Children with acute lymphoblastic leukemia (ALL)
are treated with intermittent steroid therapy. This study was undertaken to
examine the relationship between steroid therapy for ALL and severity of
varicella infection. METHODS: We performed a retrospective review of patients who
were on Pediatric Oncology Group Protocol 9201 and had a history of varicella
infection. Pediatric Oncology Group 9201 is a phase III study for the treatment
of children with lesser risk ALL diagnosed between 1992 and 1999. Cases of
varicella were coded 1 to 5 on the basis of severity: grade 1 caused minimal to
no symptoms, grade 2 caused mild to moderate symptoms that did not require
hospitalization, grade 3 caused symptoms severe enough to require hospitalization
and intravenous acyclovir, grade 4 caused severe disease that had complications
or that required intensive care, and grade 5 resulted in death. RESULTS: Of 697
enrolled patients, 110 (15.8%) developed primary varicella; 59% of these were
male. For analysis, disease grade was dichotomized into nonsevere (grades 1 and
2) and severe (grades 3, 4, and 5). Of the 110 patients, 56 had nonsevere
disease; 54 had severe disease, including 2 deaths. Of the patients whose
varicella was diagnosed within 3 weeks of receipt of prednisone, 70% had severe
infection, whereas only 44% of those who had not received prednisone within 3
weeks had severe infection. The odds ratio for having a severe infection within 3
weeks of prednisone versus >3 weeks is 2.9 (95% confidence interval: 1.1-7.9). By
multivariate analysis, older age at ALL diagnosis, years from ALL diagnosis to
VZV diagnosis, and VZV diagnosis within the 4-week period of interest (during or 
within 3 weeks of prednisone therapy) all were independently associated with an
increased risk for severe infection. CONCLUSIONS: This study represents the
largest study to date of varicella in children with ALL and provides convincing
evidence that prednisone therapy during the VZV incubation period significantly
increases the risk for developing severe varicella infection. In addition, older 
age is associated with more severe infection. Despite the varicella vaccine and a
dropping incidence of primary infections, VZV remains a dangerous pathogen for
pediatric patients with ALL. With the possible exception of induction therapy,
patients who are on ALL therapy and are exposed to varicella should have steroid 
therapy delayed until after the VZV incubation period. These findings may have
implications for other diseases that are treated with corticosteroids.

PMID: 16199681 [PubMed - indexed for MEDLINE]

281: Scand J Infect Dis. 2005;37(10):774-6.

Concomitant disseminated herpes simplex virus type 2 infection and varicella
zoster virus primoinfection in a pregnant woman.

Godet C, Beby-Defaux A, Landron C, Moal GL, Becq-Giraudon B, Agius G.

From the Department of Internal Medicine and Infectious Diseases, CHU La
Milétrie, Poitiers, France.

We report the first case of a HSV and VZV coinfection during pregnancy. VZV
infection was diagnosed by a seroconversion and PCR. HSV 2 infection was
diagnosed by cell culture. The mother and the newborn received no treatment and
did not develop any complication. This case report highlights the need for
increased surveillance of pregnant women with herpes virus infections.

PMID: 16191900 [PubMed - indexed for MEDLINE]

282: Drug Ther Bull. 2005 Sep;43(9):69-72.

Chickenpox, pregnancy and the newborn.

[No authors listed]

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

Publication Types: 
    Review

PMID: 16176000 [PubMed - indexed for MEDLINE]

283: Int J Legal Med. 2006 Jan;120(1):33-5. Epub 2005 Sep 13.

Sudden death in childhood due to varicella pneumonia: a forensic case report with
clinical implications.

Pfeiffer H, Varchmin-Schultheiss K, Brinkmann B.

Institute of Legal Medicine, Röngenstrasse 23, 48149, Münster, Germany.
pfeiffh@uni-muenster.de

Varicella (chickenpox) is one of the most frequent highly infectious diseases in 
childhood. It is caused by varicella-zoster virus. Lethal complications are rare.
Focused on histological findings, we present a case of a sudden unexpected death 
of an otherwise healthy 18-month-old girl due to varicella-induced pneumonia. The
histological and immunohistochemical investigations of the lung tissue revealed
typical findings of a varicella pneumonia: haemorrhagic and necrotic nodules,
intra-alveolar fibrin, numerous neutrophilic granulocytes, lymphocytes,
plasmacells, macrophages, multinucleated giant cells and hyaline membranes.
Varicella-related deaths are preventable by vaccine. To prevent complications and
lethal outcome of varicella as reported here, the recommendations concerning
vaccination against varicella must be taken into account in paediatric practice.

Publication Types: 
    Case Reports

PMID: 16160838 [PubMed - indexed for MEDLINE]

284: Int J Toxicol. 2005 Jul-Aug;24(4):205-13.

Universal varicella vaccination: efficacy trends and effect on herpes zoster.

Goldman GS.

Medical Veritas International (MVI), Pearblossom, California 93553, USA.
pearblossominc@aol.com

In 1995, the Varicella Active Surveillance Project (VASP) was established in
Antelope Valley (California), a geographically distinct high-desert community of 
300,000 residents, as one of three sites in the nation in a cooperative agreement
with the Centers for Disease Control and Prevention (CDC) to collect baseline
demographic and clinical data and to monitor trends in varicella (chickenpox)
following introduction of varicella vaccine. Herpes zoster (shingles) was added
to the active surveillance January 1, 2000. The universal varicella program has
proven effective in terms of reducing the number of reported verified varicella
cases by 85%, from 2,934 in 1995 to 412 in 2002. Prior to this dramatic
reduction, immunologic boosting due to exogenous exposures to wild-type
varicella-zoster virus (VZV) in the community (1) caused mean serum anti-VZV
levels among vaccines to increase with time after vaccination and (2) served as a
mechanism that helped suppress the reactivation of herpes zoster (HZ), especially
among individuals with a previous history of wild-type varicella.That immunologic
boosting might play a significant role in both varicella and the closely related 
HZ epidemiology is evidenced by (1) a decline in vaccine efficacy by over 20%,
from 95.7% (95% C.I., 82.7% to 98.9%) in 1999 to 73.9% (95% C.I., 57.9% to 83.8%)
in 2001 and (2) an unexpectedly high cumulative (2000 to 2003) true incidence
rate of 223 (95% C.I. 180-273) per 100,000 person-years (p-y) among children <10 
years old with a previous history of varicella. Because capture-recapture methods
demonstrate a likely lower bound of 50% underreporting, the actual rate is likely
double or 446 per 100,000 p-y, approaching the HZ rate reported among older
adults. Other recent studies based on VASP data have mitigated against discovery 
of the above trends that challenge several initial assumptions inherent to the
universal varicella program, namely, (1) a single dose confers long-term immunity
and (2) there is no immunologically mediated link between varicella and HZ
incidence. As vaccinated children replace those with a prior history of wild-type
varicella in the <10 age group, increasing HZ incidence among this cohort will be
of less concern in the near future. However, previous scientific studies,
including the present preliminary results from active surveillance indicate that 
HZ may be increasing among adults. It may be difficult to design booster
interventions that are cost-effective and meet or exceed the level of protection 
provided by immunologic boosting that existed naturally in the community in the
prelicensure era.

PMID: 16126614 [PubMed - indexed for MEDLINE]

285: Adv Exp Med Biol. 2005;568:11-24.

Chickenpox party or varicella vaccine?

Hambleton S, Arvin AM.

Columbia University, Department of Pediatrics, New York, NY 10032, USA.

The most compelling rationale for introducing universal vaccination against
varicella was the predicted benefits to healthy children. Current evidence from
the US experience indicates that these benefits are being realized. As is true
for any new vaccine, implementation of such a program necessitates disease
surveillance and modifications of the vaccine regimen as needed. In the case of
VZV, the epidemiology of herpes zoster must be tracked as well as varicella
disease trends. The prevention of herpes zoster may be another use of live
attenuated or inactivated varicella vaccines.

Publication Types: 
    Review

PMID: 16107063 [PubMed - indexed for MEDLINE]

286: JAMA. 2005 Aug 17;294(7):797-802.

Comment in:
    JAMA. 2005 Aug 17;294(7):845-6.

Impact of varicella vaccination on health care utilization.

Zhou F, Harpaz R, Jumaan AO, Winston CA, Shefer A.

National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, Ga 30333, USA. faz1@cdc.gov

CONTEXT: Since varicella vaccine was first recommended for routine immunization
in the United States in 1995, the incidence of disease has dropped substantially.
However, national surveillance data are incomplete, and comprehensive data
regarding outpatient as well as hospital utilization have not been reported.
OBJECTIVE: To examine the impact of the varicella vaccination program on medical 
visits and associated expenditures. DESIGN, SETTING, AND PATIENTS: Retrospective 
population-based study examining the trends in varicella health care utilization,
based on data from the MarketScan databases, which include enrollees (children
and adults) of more than 100 health insurance plans of approximately 40 large US 
employers, from 1994 to 2002. MAIN OUTCOME MEASURES: Trends in rates of
varicella-related hospitalizations and ambulatory visits and direct medical
expenditures for hospitalizations and ambulatory visits, analyzed using 1994 and 
1995 as the prevaccination baseline. RESULTS: From the prevaccination period to
2002, hospitalizations due to varicella declined by 88% (from 2.3 to 0.3 per
100,000 population) and ambulatory visits declined by 59% (from 215 to 89 per
100,000 population). Hospitalizations and ambulatory visits declined in all age
groups, with the greatest declines among infants younger than 1 year. Total
estimated direct medical expenditures for varicella hospitalizations and
ambulatory visits declined by 74%, from an average of 84.9 million dollars in
1994 and 1995 to 22.1 million dollars in 2002. CONCLUSION: Since the introduction
of the varicella vaccination program, varicella hospitalizations, ambulatory
visits, and their associated expenditures have declined dramatically among all
age groups in the United States.

PMID: 16106004 [PubMed - indexed for MEDLINE]

287: Eur J Haematol. 2005 Sep;75(3):234-40.

Effect of varicella zoster virus infection on bone marrow function.

Al-Anazi KA, Al-Jasser AM, Evans DA.

Section of Adult Haematology and Bone Marrow Transplant, King Faisal Cancer
Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi
Arabia. khalid_alanazi@yahoo.com

BACKGROUND: Most viral infections are known to exert adverse effects on bone
marrow function. However, certain viruses have recently been found to be
therapeutically beneficial in the treatment of some malignant disorders. METHODS 
AND MATERIALS: A retrospective study was conducted at the Armed Forces Hospital, 
Riyadh, Saudi Arabia. The changes in the hematological parameters following
varicella-zoster virus (VZV) infection in patients with a variety of
hematological disorders were compared with those in a control group having the
same spectrum of disorders and treated in the same unit over the same period of
time but never had VZV infection. Both groups of patients received the same
treatment protocols for their primary hematological disorders. Definitive
treatment (DT) such as chemotherapy alone, anti-thymocyte globulin or bone marrow
transplant was also employed in the management of patients belonging to both
groups. RESULTS: White blood cell counts, platelet counts and hemoglobin
concentrations in the study group started to increase 40 d after chickenpox or
herpes zoster infection and these increases lasted for periods as long as 1050 d.
The changes in platelet counts were more pronounced than those in other
hematological parameters. There was a significant difference (P < 0.0001) between
the two groups of patients in the values of platelet counts achieved between 280 
and 1050 d after DT (mean platelet count: 262 x 10(9)/L in the study group vs.
180 x 10(9)/L in the control group, median: 288.17 x 10(9)/L in the study group
vs. 180 x 10(9)/L in the control group, range: 102 to 415 x 10(9)/L in the study 
group vs. 26 to 365 x 10(9)/L in the control group of patients). Compared to the 
control group, the study group of patients achieved their maximum blood counts
much earlier after DT. The maximum leucocytic count was achieved at a mean
duration of 269.21 d in the study group and 349.61 d in the control group. The
maximum hemoglobin level was achieved at a mean duration of 319.5 d in the study 
group and 402.6 d in the control group. The maximum platelet count was achieved
at a mean duration of 271.4 d in the study group and 318.9 d in the control group
of patients. CONCLUSION: VZV may behave differently from other members of the
herpes group of viruses e.g. human cytomegalovirus and Epstein-Barr virus. Our
observations suggest that VZV infection causes stimulation of bone marrow
activity. Copyright Blackwell Munksgaard 2005.

PMID: 16104880 [PubMed - indexed for MEDLINE]

288: Expert Rev Mol Med. 2005 Aug 10;7(15):1-24.

Molecular and therapeutic aspects of varicella-zoster virus infection.

Quinlivan M, Breuer J.

Skin Virus Laboratory, Institute of Cell and Molecular Science, 4 Newark Street, 
Whitechapel, London, E1 28E, UK. m_quinlivan@hotmail.com

Varicella-zoster virus (VZV) is a highly species-specific member of the
Herpesviridae family. The virus exhibits multiple cell tropisms, infecting
peripheral blood mononuclear cells and skin cells before establishing latency in 
sensory neurons. Such tropisms are essential both for primary infection, which
manifests itself as chickenpox (varicella), and subsequent reactivation to cause 
herpes zoster (shingles). The highly cell-associated nature of the virus, coupled
with its narrow host range, has resulted in the lack of an animal model that
mimics its diseases in humans, thereby greatly hindering the study of events in
VZV pathogenesis. Despite this, extensive studies both in vitro and in vivo in
small-animal models have provided a fascinating insight into molecular events
that govern VZV diseases. In addition, VZV has become the first human herpes
virus for which a live attenuated vaccine has been developed.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16098235 [PubMed - indexed for MEDLINE]

289: Vaccine. 2005 Oct 17;23(43):5064-72.

Cost-effectiveness of varicella vaccination of healthcare workers.

Chodick G, Ashkenazi S, Livni G, Lerman Y.

Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, 
Tel-Aviv University, P.O. Box 39040, Tel-Aviv 69978, Israel.
chodick@post.tau.ac.il

OBJECTIVE: Although transmission of VZV is recognized as an important cause for
morbidity in health care workers (HCWs), there is no general agreement on the
recommended immunization policy. This study aimed to evaluate several of such
prevention policies in economic terms. SETTINGS: Analysis of the cost per avoided
future varicella cases among HCWs in Israel. METHODS: A cost-effectiveness
analysis was performed by comparing the cost per avoided case of varicella among 
a theoretical cohort of 63,353 physician and nurses aged less than 45 years in
Israel. Four policies were examined: (a) do nothing (status quo); (b) vaccination
of susceptible workers using VZV serotesting; with (c) or without anamnestic
history of chickenpox; and (d) presumptive mass vaccination of all eligible
workers. A Markov-based model was developed using data from our recent
seroepidemiological study in target population and from the literature. RESULTS: 
Screening and vaccination of susceptible workers using anamnestic selection is
expected to reduce future cases, within 20 years since vaccination, from 58.3 to 
33.0 with an incremental cost of 23,713 US dollars per avoided cases. Using only 
serological tests to detect susceptible workers would prevent additional 5.7
cases with an incremental cost of 206,692 US dollars per avoided case.
Vaccinating all HCWs without serotesting, raises the costs markedly, with almost 
identical effectiveness, resulting in an incremental cost of 10.4 million US
dollars per avoided case. Sensitivity analyses do not alter the ranking of the
options. CONCLUSION: From the employer's perspective, routine varicella
vaccination program for HCWs with or without selection of susceptible workers is 
extremely expensive compared to other high-cost practiced approaches. Substantial
reduction in cost of vaccination may alter this conclusion.

PMID: 16046036 [PubMed - indexed for MEDLINE]

290: Vaccine. 2005 Nov 16;23(46-47):5389-97. Epub 2005 Jun 16.

Uptake of varicella vaccine--a cross sectional survey of parental attitudes to
nationally recommended but unfunded varicella immunisation.

Marshall H, Ryan P, Roberton D.

Department of Paediatrics, Women's and Children's Hospital, 72 King William Road,
North Adelaide, SA 5006, Australia. helen.marshall@adelaide.edu.au

The aim of this study was to assess the uptake of varicella vaccine in South
Australian children under circumstances where varicella immunisation is
recommended, but is not funded by Government. The study examined the main reasons
that determined a parent's decision whether or not to have their child immunised 
with varicella vaccine. A cross-sectional survey was conducted by Computer Aided 
Telephone Interviews (CATI) in June 2004. Data were obtained from 613 households 
containing 1148 children aged from birth to 17 years of age. Statistical analyses
were performed using data weighted to the South Australian population. Six
hundred and eighty children (55.7%) had a history of varicella infection and 446 
children (42.0%) had received varicella vaccine (weighted data). The most common 
reasons cited for not having children immunised included lack of knowledge about 
the vaccine and cost. One year after inclusion of varicella vaccine in the
Australian Standard Vaccination Schedule there is evidence of incomplete coverage
in children in South Australia due to absence of government funding for vaccine
provision.

PMID: 16039020 [PubMed - indexed for MEDLINE]

291: Rev Inst Med Trop Sao Paulo. 2005 May-Jun;47(3):139-42. Epub 2005 Jul 12.

Prevalence of IgG varicella zoster virus antibodies in the Kuikuro and Kaiabi
indigenous communities in Xingu National Park, Brazil, before varicella
vaccination.

Lafer MM, de Moraes-Pinto MI, Weckx LY.

Division of Pediatric Infectious Diseases, Federal University of São Paulo, São
Paulo, SP, Brazil. manulafer@uol.com.br

The purpose of the study was to estimate the prevalence of IgG antibodies against
varicella zoster virus (VZV) in the two most populated indigenous ethnic groups
from Xingu Indigenous National Park, in Brazil, prior to the introduction of
vaccination against the disease, and to determine the positive and the negative
predictive values of a history of varicella infection. In 2001, 589 inhabitants
of two Kuikuro villages and three Kaiabi villages were evaluated and provided
information concerning previous varicella infection. An indirect immunosorbent
assay (ELISA) to detect IgG anti-VZV antibodies was performed in 224 blood
samples--volunteer selection had no interference of anamnesis. IgG prevalence was
80.8% (95% Confidence Interval: 76%-86%). The seroepidemiology of varicella in
Xingu National Park prior to varicella vaccine introduction was comparable to the
Brazilian national seroprevalence described in the literature, and so were the
positive (98%) and the negative predictive value (41%) of the referred history.

PMID: 16021286 [PubMed - indexed for MEDLINE]

292: Pediatr Hematol Oncol. 2005 Apr-May;22(3):219-22.

Familial high factor VIII level in a child with necrotizing fasciitis
complicating primary varicella infection.

Kurekci AE, Aydin HI, Atay AA, Akar N, Cetan T, Ozcan O, Gokcay E.

Gulhane Military Medical Academy, Department of Pediatric Hematology, 06018
Etlik, Ankara, Turkey. ekurecki@gata.edu.tr

This article describes an unusual association of familial high plasma factor VIII
level and necrotizing fasciitis in a 4-year-old girl with primary varicella
infection.

Publication Types: 
    Case Reports

PMID: 16020105 [PubMed - indexed for MEDLINE]

293: J Trop Pediatr. 2005 Aug;51(4):240-1. Epub 2005 Jun 24.

Henoch-Schönlein purpura in a child following varicella.

Kalman S, Ibrahim Aydin H, Atay A.

Gülhane Military Medical Academy, Departement of Pediatrics, Etlik-Ankara,
Turkey. suleymankalman@yahoo.com

Henoch-Schönlein purpura (HSP) is one of the most common vasculitis of childhood.
It is characterized by nonthrombocytopenic palpable purpura, arthritis, renal and
gastrointestinal system (GIS) involvement. HSP is usually triggered by an
antigenic stimulus including infectious agents, drugs, cold, insect bite or food.
HSP is rarely triggered by Varicella zoster infection. We herein presented a case
with HSP following varicella.

Publication Types: 
    Case Reports

PMID: 15980021 [PubMed - indexed for MEDLINE]

294: Reprod Toxicol. 2006 May;21(4):410-20. Epub 2005 Jun 23.

Chickenpox in pregnancy: revisited.

Tan MP, Koren G.

The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The
Hospital for Sick Children, University of Toronto, Ont., Canada.

Varicella infection during the first and second trimester of pregnancy may
increase the risk for congenital varicella syndrome 0.5-1.5% above the baseline
risk for major malformation. Third trimester infection may lead to maternal
pneumonia which can be life threatening if not treated appropriately.
Varicella-zoster immune globulin (VZIG) should be administered as soon as
possible preferably within 96 h from exposure to prevent maternal infection or
subsequent complications. Later than 96 h, the effectiveness of VZIG has not been
evaluated. Neonatal varicella is more severe if maternal rash appears 5 days
prior to or 2 days after delivery. The newborn should be given VZIG immediately. 
Intravenous acyclovir is recommended for maternal pneumonia and severely affected
neonate. No controlled study has yet evaluated the effectiveness of acyclovir or 
valacyclovir for postexposure prophylaxis to pregnant women or neonates. Unlike
primary varicella infection in pregnancy, herpes zoster has not been documented
to cause complications unless in the disseminated form. The advent of advanced
imaging techniques and molecular biotechniques has improved prenatal diagnosis.
With increase use of vaccination, the incidence of chickenpox in pregnancy is
expected to decline in the future.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15979274 [PubMed - indexed for MEDLINE]

295: Prescrire Int. 2005 Jun;14(77):85-91.

Chickenpox vaccines: new drugs. A favourable risk-benefit balance in some
situations.

[No authors listed]

(1) Chickenpox is generally mild. Most severe cases of chickenpox occur in
immunocompromised patients, adults, and pregnant women (and their foetuses). (2) 
Two live attenuated chickenpox vaccines derived from the same strain of varicella
virus (Oka) are marketed in France, under the trade names Varilrix and Varivax.
(3) They have not been adequately evaluated in immunocompromised children. (4)
The impact of routine vaccination of women of child-bearing age on complications 
of chickenpox during pregnancy has not been studied. (5) Immunogenicity studies
in several thousand immunocompetent children aged from 1 to 12 years show that
the vaccine is almost always immunogenic after a single injection. Other
comparative studies in adolescents and adults show that two injections are
needed, at least two months apart. (6) A double-blind placebo-controlled trial
including 513 immunocompetent children showed that Varilrix prevented 88% of
cases of chickenpox after a median follow-up of 29 months, but no data on severe 
chickenpox were reported. A study that followed up 9202 children aged 1 to 12
years for more than 13 years showed that vaccination with Varivax failed to
prevent chickenpox in 12.5% of cases and that 1.7% of these cases were severe.
(7) Immunocompetent children vaccinated within three days after exposure to the
virus are partially protected, according to one study of Varilrix (104 children) 
and two small studies of Varivax (10 and 42 children). There are no equivalent
studies in adults. (8) Local adverse effects such as fever and rash are common in
immunocompetent vaccinees. The rash is sometimes varicella-like and is due to
infection by the vaccine strain. Pharmacovigilance studies of Varivax have shown 
no serious adverse effects. (9) Disseminated and/or persistent infection caused
by the vaccine strain has been reported in immunocompromised patients. (10)
Vaccination of immunocompetent subjects does not appear to result in a risk of
chickenpox transmission to subsequent contacts. There seems to be no increase in 
the risk of herpes zoster in vaccinated children nor is there any firm evidence
that chickenpox vaccination increases the incidence of herpes zoster in the
general population. (11) Little information is available on vaccination during
pregnancy. As a precaution, however, pregnant women should not be vaccinated.
(12) Mass vaccination does not appear to be justified: chickenpox is generally
mild during childhood, and several questions concerning the effects of the
vaccine remain unanswered. (13) Chickenpox vaccination should be restricted to
specific groups of non immune immunocompetent adults who are in a position to
transmit chickenpox to immunodeficient contacts (e.g. health care personnel and
kindergarten staff); adults who have been in contact with a case of chickenpox
within the past three days; and children awaiting transplantation. The potential 
benefits and risks of vaccinating immunocompromised patients should be assessed
on a case by case basis.

Publication Types: 
    Comparative Study

PMID: 15977369 [PubMed - indexed for MEDLINE]

296: J Child Neurol. 2005 May;20(5):441-4.

Postinfectious myasthenia gravis: report of two children.

Felice KJ, DiMario FJ, Conway SR.

Department of Neurology, University of Connecticut School of Medicine,
Farmington, CT 06030-1840, USA. felice@nso.uchc.edu

We report two children with transient myasthenia gravis preceded by viral
illnesses. The first is a 5-year-old boy who developed oculobulbar weakness 2
weeks following a varicella-zoster infection. The second is a 4-year-old boy who 
developed facial diplegia and dysarthria several weeks following a viral
pharyngitis. Myasthenia gravis was diagnosed based on the substantial decremental
changes on 3 Hz repetitive motor nerve stimulation studies for the first child
and on the positive edrophonium test and complete improvement in symptoms during 
pyridostigmine therapy for both children. In both cases, the symptoms gradually
resolved and have not recurred following discontinuation of pyridostigmine.
Molecular mimicry between the acetylcholine receptor and viral proteins might
provide the nidus for the immune response in this variant of myasthenia gravis.

Publication Types: 
    Case Reports

PMID: 15968930 [PubMed - indexed for MEDLINE]

297: Swiss Med Wkly. 2005 Apr 30;135(17-18):252-5.

Reliability of varicella history in children and adolescents.

Heininger U, Baer G, Bonhoeffer J, Schaad UB.

University Children's Hospital Basel, Switzerland. Ulrich.Heininger@unibas.ch

QUESTION UNDER STUDY: Only limited data are available regarding the reliability
of the varicella zoster virus (VZV) history in children and adolescents. Our goal
was to determine positive and negative predictive values of varicella history in 
a prospective cross-sectional study. METHODS: Patients 1-18 years of age who were
hospitalised in our institution between 1999 and 2000 were eligible for
participation when a blood specimen was taken for any medical reason. Patients
with current varicella, immunodeficiency, immunoglobulin treatment in the
previous 6 months, or significant language barriers were excluded. After informed
consent had been obtained, parents were asked whether their child had a history
of varicella (categorized as definite, probable, possible, negative or unknown). 
Anti-VZV-IgG antibodies were then tested by ELISA (Enzygnost). If the ELISA
result was indeterminate, the specimen was analysed by fluorescent-antibody
staining of membrane antigen in VZV-infected cells (FAMA), the serological gold
standard. RESULTS: 449 patients (mean age 6.4 years, median 5.4 years) were
enrolled. History of varicella was definite in 234 (52%), probable in 12 (3%),
possible in 1, negative in 196 (44%) and unknown in 6 (1%) patients. Overall, 61%
(95% CI: 56-65) of patients were positive for VZV antibodies. Seroprevalence was 
25%, 68% and 95% in 1-4 year olds (group 1, n = 167), 5-8 year olds (group 2, n =
136) and 9-18 year olds (group 3, n = 146), respectively. The positive predictive
value of a definite history of varicella was 98% (95% CI: 96-100) (93%, 100%, and
98% in groups 1, 2 and 3, respectively). The negative predictive value was 85%
(95% CI: 80-90), decreasing with age (group 1: 97%; group 2: 77%; group 3: 26%). 
CONCLUSIONS: The positive predictive value of a history of varicella is high in
children and adolescents. In countries where universal immunization against
varicella is not recommended, selectively immunizing adolescents with a negative 
history can reduce the rate of susceptible individuals efficiently.

PMID: 15965827 [PubMed - indexed for MEDLINE]

298: Vaccine. 2005 Nov 16;23(46-47):5398-403. Epub 2005 Jun 8.

The changing epidemiology of chickenpox in Alberta.

Russell ML, Svenson LW, Yiannakoulias N, Schopflocher DP, Virani SN, Grimsrud K.

Department of Community Health Sciences, University of Calgary, 3330 Hospital
Drive NW, Calgary, Alberta, Canada T2N 4N1. mlrussel@ucalgary.ca

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

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15964104 [PubMed - indexed for MEDLINE]

299: J Virol Methods. 2005 Sep;128(1-2):162-7.

Development and evaluation of Varicella zoster virus ELISA for oral fluid
suitable for epidemiological studies.

Talukder Y, Gopal R, Andrews N, Glenn M, Breuer J, Brown D.

Centre for Infectious Disease, Department of Virology, Barts and The London
School of Medicine and Dentistry, 25-29 Ashfield St., London E1 1BB, UK.
ingrej@gmail.com

An enzyme-linked immunosorbent assay (ELISA) for detection of Varicella zoster
virus (VZV) antibodies in oral fluid is described. The assay was optimised and
evaluated using paired serum and oral fluid from healthy adult volunteers (n =
205) and preschool children (n = 98), oral fluid samples collected for routine
measles, mumps and rubella testing (n = 537) and samples from a study of atopic
dermatitis (n = 252). As chickenpox is predominantly a childhood disease and most
adults are immune, it was crucial to have samples from children aged 1-5 years to
evaluate the assay. Mixture modelling of the oral fluid results was used to
determine the optimum cut-off, sensitivity and specificity of the assay. Compared
to paired sera tested by the same ELISA the sensitivity of the oral fluid assay
was 93% and specificity 95.7% overall, varying slightly with age group. The assay
was shown to have good potential for use in large-scale epidemiological studies.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 15961168 [PubMed - indexed for MEDLINE]

300: BMC Public Health. 2005 Jun 16;5:68.

The incidence of varicella and herpes zoster in Massachusetts as measured by the 
Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing 
varicella vaccine coverage, 1998-2003.

Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, Seward JF.

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard 
Pilgrim Health Care, Boston, USA. katherine_yih@harvardpilgrim.org

BACKGROUND: The authors sought to monitor the impact of widespread varicella
vaccination on the epidemiology of varicella and herpes zoster. While varicella
incidence would be expected to decrease, mathematical models predict an initial
increase in herpes zoster incidence if re-exposure to varicella protects against 
reactivation of the varicella zoster virus. METHODS: In 1998-2003, as varicella
vaccine uptake increased, incidence of varicella and herpes zoster in
Massachusetts was monitored using the random-digit-dial Behavioral Risk Factor
Surveillance System. RESULTS: Between 1998 and 2003, varicella incidence declined
from 16.5/1,000 to 3.5/1,000 (79%) overall with > or = 66% decreases for all age 
groups except adults (27% decrease). Age-standardized estimates of overall herpes
zoster occurrence increased from 2.77/1,000 to 5.25/1,000 (90%) in the period
1999-2003, and the trend in both crude and adjusted rates was highly significant 
(p < 0.001). Annual age-specific rates were somewhat unstable, but all increased,
and the trend was significant for the 25-44 year and 65+ year age groups.
CONCLUSION: As varicella vaccine coverage in children increased, the incidence of
varicella decreased and the occurrence of herpes zoster increased. If the
observed increase in herpes zoster incidence is real, widespread vaccination of
children is only one of several possible explanations. Further studies are needed
to understand secular trends in herpes zoster before and after use of varicella
vaccine in the United States and other countries.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15960856 [PubMed - indexed for MEDLINE]

301: Saudi Med J. 2005 May;26(5):869-71.

Congenital varicella-zoster virus infection. A rare case of severe brain and
ocular malformations without limb or cutaneous involvement in a newborn after
maternal subclinical infection.

Al-Katawee YA, Al-Hasoun YA, Taha MN, Al-Moslem K.

Department of Neonatology Al-Yamamah Hospital, PO Box 106208, Riyadh 11666,
Kingdom of Saudi Arabia. yrshmh@hotmail.com

Although congenital varicella-zoster virus VZV infection is rare, it carries
serious morbidity and mortality to the fetus and newborn infant. We report a full
term female newborn infant, born to a multipara unbooked mother who had VZV
subclinical infection during the first trimester of pregnancy. Routine newborn
examination showed cystic malformation of the left eye, and absence of the right 
eye globe. Radiological work up revealed severe brain and eye malformations,
serological studies of both mother and baby were positive for VZV. The baby
underwent palliative surgery to the eyes, upon discharge, a plan of
multidisciplinary team was made for follow up including neurologist,
ophthalmologist, pediatrician and social worker. Congenital VZV infection can be 
severe enough to cause catastrophic fetal anomalies and damage to the vital
organs as many of those infants die in infancy.

Publication Types: 
    Case Reports

PMID: 15951887 [PubMed - indexed for MEDLINE]

302: J Thromb Haemost. 2005 Jun;3(6):1243-9.

Anti-protein S antibodies following a varicella infection: detection,
characterization and influence on thrombin generation.

Regnault V, Boehlen F, Ozsahin H, Wahl D, de Groot PG, Lecompte T, de Moerloose
P.

Inserm 734 and Hospital of Nancy, France.

Postinfectious purpura fulminans is a rare disease. Varicella is one of the
precipitating conditions and we recently observed such a case. The 4-year-old
child was found to have a severe transient protein S deficiency. By enzyme-linked
immunosorbent assay and surface plasmon resonance we first demonstrated that
anti-protein S antibodies were present and also transient. Next we characterized 
the epitopes against which these antibodies were directed and found that they
predominantly recognized the N-terminal part of protein S. Finally we showed by
thrombography a transient dramatic hypercoagulable state as a result of thrombin 
being unregulated by the dynamic protein C inhibitory system: in vitro thrombin
generation, in response to a low concentration of tissue factor, was almost
insensitive to activated protein C up to 25 nmol L(-1) on day 4 while it was
normally sensitive on day 42. For the first time, we demonstrated a temporal
relationship between protein S deficiency, antibodies to protein S and
hypercoagulability, thus supporting the pathogenic role of these antibodies.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 15946215 [PubMed - indexed for MEDLINE]

303: Pediatrics. 2005 Jun;115(6):1488-93.

Vaccine effectiveness during a varicella outbreak among schoolchildren: Utah,
2002-2003.

Haddad MB, Hill MB, Pavia AT, Green CE, Jumaan AO, De AK, Rolfs RT.

Epidemic Intelligence Service, Epidemiology Program Office, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and 
Prevention, Atlanta, Georgia 30333, USA. maryam.haddad@cdc.hhs.gov

OBJECTIVES: In the context of a chickenpox outbreak involving 2 Utah elementary
schools, we conducted an investigation to assess vaccine effectiveness, describe 
illness severity, and examine risk factors for breakthrough varicella (ie,
varicella in those who have been vaccinated). METHODS: All parents were asked to 
complete a questionnaire about their child's medical history. Parents of children
with recent varicella were interviewed, and vaccination records were verified.
Lesions were submitted for polymerase chain reaction testing. RESULTS:
Questionnaires were returned for 558 (93%) of 597 students in school A and 924
(97%) of 952 students in school B. A total of 83 schoolchildren (57 unvaccinated 
and 26 vaccinated) had varicella during the October 2002 through February 2003
outbreak period. An additional 17 cases occurred among household contacts,
including infants and adults. Polymerase chain reaction analysis recovered
wild-type varicella. Vaccine effectiveness was 87%. With 1 notable exception,
vaccinated children tended to have milder illness. Risk factors for breakthrough 
varicella included eczema, vaccination > or =5 years before the outbreak, and
vaccination at < or =18 months of age. Restricting analysis to children
vaccinated > or =5 years before the outbreak, those vaccinated at < or =18 months
of age were more likely to develop breakthrough varicella (relative risk: 9.3;
95% confidence interval: 1.3-68.9). CONCLUSIONS: The vaccine, administered by
>100 health care providers to 571 children during a 7-year time period, was
effective. Risk factors for breakthrough varicella suggest some degree of
biological interaction between age at vaccination and time since vaccination.

Publication Types: 
    Comparative Study
    Evaluation Studies
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15930208 [PubMed - indexed for MEDLINE]

304: Prev Med. 2005 Aug;41(2):575-82.

The 2002 United States varicella vaccine shortage and physician recommendations
for vaccination.

Zimmerman RK, Tabbarah M, Bardenheier B, Janosky JE, Troy JA, Raymund M, Yawn BP.

Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh
School of Medicine, Pittsburgh, PA 15261, USA. zimmer@pitt.edu

BACKGROUND: The US experienced a shortage of varicella vaccine in 2002, leading
to the concerns about its impact. METHODS: 204 Minnesota and Pennsylvania
physicians, most (164) of whom were interviewed in 1999 on the topic of varicella
vaccine, responded to a 2003 survey. RESULTS: Although 67% were aware of the 2002
varicella vaccine shortage, 24% experienced it and only 45% were aware of the
2002 temporary change in national vaccination recommendations. In response, more 
vaccinated until the supply was exhausted (59%) than postponed vaccination as
recommended (41%). Most (91%) reported that the shortage did not change their
likelihood of recommending vaccine. From 1999 to 2003, the percentage of
physicians highly likely to recommend vaccination increased from 73% to 82% for
children 12-18 months old (P < 0.01). In 2003, more physicians believed that it
was likely for secondary skin infections to occur following varicella disease and
for parents to request vaccination than in 1999 (P < 0.01). Almost all (93%)
physicians in both years believed that serious side effects were unlikely.
CONCLUSIONS: Over half of physicians were unaware of the change in vaccine
recommendations due to the shortage and many did not follow that change,
suggesting the need for a different strategy.

Publication Types: 
    Multicenter Study

PMID: 15917055 [PubMed - indexed for MEDLINE]

305: Virology. 2005 Jul 5;337(2):304-11.

Varicella-zoster virus open reading frame 47 (ORF47) protein is critical for
virus replication in dendritic cells and for spread to other cells.

Hu H, Cohen JI.

Medical Virology Section, Laboratory of Clinical Infectious Diseases, National
Institute of Allergy and Infectious Diseases, National Institutes of Health,
Bethesda, MD 20892, USA.

Varicella-zoster virus infects human dendritic cells (DCs). We found that VZV
infection of DCs resulted in down-regulation of Fas expression on the surface of 
cells. VZV ORF47 was critical for replication of virus in human immature, but not
mature DCs. Immature DCs infected with a mutant virus unable to express ORF47
expressed similar levels of a VZV immediate-early protein as cells infected with 
parental virus; however, cells infected with the ORF47 mutant expressed lower
levels of glycoprotein E. Thus, in the absence of ORF47 protein, there is a block
in viral replication between immediate-early and late gene expression. VZV unable
to express ORF47 was severely impaired for spread of virus from DCs to melanoma
cells. Infection of DCs with parental VZV resulted in a different pattern of
phosphoproteins compared with the ORF47 mutant virus. Thus, VZV ORF47 is
important for replication in immature DCs and for spread to other cells.

PMID: 15913699 [PubMed - indexed for MEDLINE]

306: Can J Public Health. 2005 May-Jun;96(3):197-200.

Varicella vaccination for grades 4 and 5 students: from theory to practice.

Rivest P, Grenier L, Lonergan G, Bédard L.

Institut national de santé publique du Québec, Ste-Foy, QC.
privest@santepub-mtl.qc.ca

BACKGROUND: In 2002-2003, as part of a pilot project, varicella vaccination was
offered to susceptible students in grades 4 and 5 in schools whose health
services are provided by a local community services centre in Montréal. This
immunization campaign was merged with the hepatitis B immunization programme.
OBJECTIVES: To calculate the proportion of grade 4 and 5 students susceptible to 
varicella; to calculate the proportion of susceptible students who agree to be
vaccinated; to compare the proportion of susceptibles who agree to be vaccinated 
when varicella vaccination is offered with the first or the second dose of
hepatitis B; and to assess whether a catch-up varicella immunization programme
would affect the vaccine coverage of a concurrent hepatitis B vaccination
programme. METHODS: The proportions of susceptible students and of parents of
susceptibles who consented to vaccination were calculated. The proportions of
parents of susceptibles who consented to vaccination were compared for both
immunization strategies: varicella vaccination given with the first or second
dose of hepatitis B vaccine. Logistic regression was performed to identify
possible associations between consent to varicella vaccination and the various
variables collected. Rates of vaccine coverage against hepatitis B after two
doses were compared for the years 2000-2001 and 2002-2003. RESULTS: Of 3,856
registered students, 3,486 (90.4%) returned consent forms. Among the 3,272
students for whom information was available, 441 (13.5%) were susceptible,
including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage
in the schools after two doses of hepatitis B vaccine were exactly the same for
the 2000-2001 and 2002-2003 school years. CONCLUSION: Varicella vaccination of
susceptible grade 4 and 5 students associated with a coincident hepatitis B
vaccination campaign can be performed without negative impact on the hepatitis B 
vaccination programme.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15913084 [PubMed - indexed for MEDLINE]

307: J Clin Virol. 2005 Jun;33(2):89-95; discussion 96-8.

Varicella vaccination of children in the United States: assessment after the
first decade 1995-2005.

Grose C.

Virology Laboratory, Department of Pediatrics, University of Iowa College of
Medicine, Iowa City, IA 52242, USA. charles-grose@uiowa.edu

Live attenuated varicella vaccine (strain Oka) was approved for administration to
healthy children in the United States in 1995. Over the past 10 years, varicella 
vaccine has been given to millions of children, usually at ages between 12 and 18
months. In states such as California, Michigan, and Texas, there has been a
marked decline in the number of reported cases of varicella. Furthermore, there
has been a 75% decrease in varicella-related hospitalizations across the United
States, as well as a similar decrease in the number of deaths caused by
complications of chickenpox. The main unanticipated result has been a growing
number of outbreaks of varicella among immunized children ("breakthrough
varicella"). The most cited risk factors for breakthrough varicella include the
following: (1) 3-5-year interval since immunization and (2) immunization at the
youngest ages, especially 12 months. Explanations for breakthrough varicella
include a lessened immune response among the youngest recipients of the vaccine. 
Another possibility is genetic variation among circulating VZV strains. VZV
strains can be separated into two geographic clades called European/North
American and Asian, based on single nucleotide polymorphisms. Two mutant North
American strains have been isolated from patients in the last 10 years. Several
genomic differences between Oka vaccine strain and other strains have also been
identified, including one site at the DNA origin of replication. Since
breakthrough disease among vaccine recipients appears to be more common in the
United States than in Japan, further comparisons between the varicella
vaccination programs in Japan and the United States are warranted. In addition,
data from varicella vaccination programs in Europe should provide further insight
into the effectiveness of varicella vaccination in different geographic and
ethnic populations.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15911422 [PubMed - indexed for MEDLINE]

308: Pediatr Int. 2005 Jun;47(3):296-9.

Complications of varicella in healthy children in Izmir, Turkey.

Koturoglu G, Kurugöl Z, Cetin N, Hizarcioglu M, Vardar F, Helvaci M, Capar Z,
Ozkinay F, Ozkinay C.

Department of Pediatrics, Faculty of Medicine, Ege University, Turkey.

BACKGROUND: The purpose of the paper was to evaluate the indications of hospital 
admissions and complications of varicella infection in immunologically healthy
children. METHODS: Between 1997 and 2001, patient records of children
hospitalized due to varicella infection were reviewed. Incidence and clinical
spectrum of complications and their distribution related to age and seasonal
variations were analyzed. RESULTS: A total of 178 immunocompetent children were
hospitalized for varicella complications during the study period. This resulted
in a crude incidence of 6.3/100 000 population at risk. All hospital admissions
were due to accompanying complications. The majority of complications occurred in
preschool-age children with a median age of 3 years. No gender predominance was
found. The most frequent complications were infectious complications, which were 
observed in 79 children (44%). Superinfections of the skin were present in 24
patients. Pneumonia was observed in 59 children: 49 had bacterial, 10 had viral
pneumonia. Pyogenic arthritis was seen in two children and one had concomitant
osteomyelitis. Group A beta-hemolytic streptococci were recovered from two
patients with invasive bacterial infections. A total of 68 (38%) neurologic
complications were observed. Cerebellar ataxia was present in 24, encephalitis
was present in 17. Infectious complications occurred more frequently in younger
children (median age: 2 years), whereas neurologic complications occurred at an
older age (median age: 6 years). Hematologic complications were seen in nine
children. There was a seasonal distribution of complications with a peak in
January. CONCLUSION: Complications of varicella requiring hospitalization in
immunocompetent children are more frequent than previously thought.

PMID: 15910454 [PubMed - indexed for MEDLINE]

309: Pediatr Transplant. 2005 Jun;9(3):311-4.

Loss of antibodies to measles and varicella following solid organ transplantation
in children.

Warmington L, Lee BE, Robinson JL.

Department of Pediatrics and Stollery Children's Hospital, University of Alberta,
Edmonton, AB, Canada.

The objective of this study was to determine if loss of antibodies to measles and
to varicella occurs in pediatric solid organ transplant recipients. Antibodies
were measured in eight hepatic, four cardiac, and six renal transplant patients
who had antibodies to measles prior to transplantation, and in six hepatic, five 
cardiac, and seven renal transplant patients who had antibodies to varicella
prior to transplantation. Within 6 months of the transplant, loss of antibodies
occurred in four of 18 patients who were seropositive for measles prior to
transplantation (22.2%) and in two of 18 patients who were seropositive for
varicella prior to transplantation (11.1%). In conclusion, serology for measles
and varicella should be considered annually following solid organ transplantation
so that appropriate advice can be given to patients who have seroreverted.

PMID: 15910386 [PubMed - indexed for MEDLINE]

310: J Infect Dis. 2005 Jun 15;191(12):2002-7. Epub 2005 May 12.

Comment in:
    J Infect Dis. 2005 Jun 15;191(12):1999-2001.

Incidence of herpes zoster, before and after varicella-vaccination-associated
decreases in the incidence of varicella, 1992-2002.

Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30345, USA.
ajumaan@cdc.gov

BACKGROUND: Varicella zoster virus (VZV) causes varicella and, later in the life 
of the host, may reactivate to cause herpes zoster (HZ). Because it is
hypothesized that exposure to varicella may boost immunity to latent VZV, the
vaccination-associated decrease in varicella disease has led some to suggest that
the incidence of HZ might increase. We assessed the impact that varicella
vaccination has on the incidence of varicella and of HZ. METHODS: Codes for cases
of varicella and of HZ in an HMO were determined in automated databases of
inpatients and outpatients, on the basis of the Ninth Revision of the
International Classification of Diseases. We calculated the incidence, during
1992-2002, of varicella and of HZ. RESULTS: The incidence of HZ remained stable
as the incidence of varicella decreased. Age-adjusted and -specific annual
incidence rates of varicella decreased steadily, starting with 1999. The
age-adjusted rates decreased from 2.63 cases/1000 person-years during 1995 to
0.92 cases/1000 person-years during 2002; among children 1-4 years old, there was
a 75% decrease between 1992-1996 and 2002. Age-adjusted and -specific annual
incidence rates of HZ fluctuated slightly over time; the age-adjusted rate was
highest, at 4.05 cases/1000 person-years, in 1992, and was 3.71 cases/1000
person-years in 2002. CONCLUSIONS: Our findings revealed that the
vaccination-associated decrease in varicella disease did not result in an
increase in the incidence of HZ. These early findings will have to be confirmed
as the incidence of varicella disease continues to decrease.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15897984 [PubMed - indexed for MEDLINE]

311: Pediatr Blood Cancer. 2005 Aug;45(2):191-4.

Comment in:
    Pediatr Blood Cancer. 2007 Jun 15;48(7):716.

Retinitis following varicella in a vaccinated child with acute lymphoblastic
leukemia.

Ross A, McLean TW, Farber R, Weaver RG Jr, Chauvenet A, Givner LB, Shetty AK.

Department of Pediatrics, Wake Forest University School of Medicine,
Winston-Salem, North Carolina 27157, USA.

Serious ocular disease following varicella (chickenpox) is rare in children. In
addition, retinitis in children with hematologic malignancies may present a
difficult diagnostic challenge because infectious retinitis may mimic leukemic
involvement of the eye. We report a 7-year-old patient with T-cell acute
lymphoblastic leukemia in remission who presented with visual complaints 2 weeks 
after developing chickenpox. Ophthalmologic evaluation revealed acute retinitis
in the right eye. Prolonged therapy with acyclovir resulted in near complete
recovery. Early diagnosis of VZV retinopathy and aggressive antiviral treatment
is critical to prevent acute and long-term ocular sequelae.

Publication Types: 
    Case Reports
    Review

PMID: 15880424 [PubMed - indexed for MEDLINE]

312: Value Health. 2005 May-Jun;8(3):209-22.

The economic value of childhood varicella vaccination in France and Germany.

Coudeville L, Brunot A, Szucs TD, Dervaux B.

CRESGE-LABORES, Catholic University of Lille, France.

OBJECTIVE: To determine the economic impact of childhood varicella vaccination in
France and Germany. METHODS: A common methodology based on the use of a varicella
transmission model was used for the two countries. Cost data (2002 per thousand) 
were derived from two previous studies. The analysis focused on a routine
vaccination program for which three different coverage rates (CRs) were
considered (90%, 70%, and 45%). Catch-up strategies were also analyzed. A
societal perspective including both direct and indirect costs and a third-party
payer perspective were considered (Social Security in France and Sickness Funds
in Germany). RESULTS: A routine vaccination program has a clear positive impact
on varicella-related morbidity in both countries. With a 90% CR, the number of
varicella-related deaths was reduced by 87% in Germany and by 84% in France. In
addition, with a CR of 90%, routine varicella vaccination induces savings in both
countries from both societal (Germany 61%, France 60%) and third-party payer
perspectives (Germany 51%, France 6.7%). For lower CRs, routine vaccination
remains cost saving from a third-party payer perspective in Germany but not in
France, where it is nevertheless cost-effective (cost per life-year gained of
6521 per thousand in the base case with a 45% CR). CONCLUSION: Considering the
impact of vaccination on varicella morbidity and costs, a routine varicella
vaccination program appears to be cost saving in Germany and France from both a
societal and a third-party payer perspective. For France, routine varicella
vaccination remains cost-effective in worst cases when a third-party payer
perspective is adopted. Catch-up programs provide additional savings.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15877593 [PubMed - indexed for MEDLINE]

313: Pediatr Infect Dis J. 2005 May;24(5):434-7.

Effectiveness of the Oka/GSK attenuated varicella vaccine for the prevention of
chickenpox in clinical practice in Israel.

Sheffer R, Segal D, Rahamani S, Dalal I, Linhart Y, Stein M, Shohat T, Somekh E.

Tel Aviv District, Ministry of Health, Tel Aviv, Israel.

BACKGROUND: The varicella Oka/Merck vaccine has been shown to be very effective
in clinical practice; however, several recent studies reported reduced
effectiveness. The varicella Oka/GSK vaccine (Varilrix; GlaxoSmithKline
Biologicals), which has been subjected to fewer effectiveness studies, was
licensed in Israel for voluntary use in 2000. This study was planned to estimate 
the effectiveness of the varicella Oka/GSK vaccine among children 1-5 years of
age. METHODS: Recent reports of varicella were retrieved from the Tel Aviv Health
District. Two age-matched control subjects who attended the same day-care center 
and/or resided in the same neighborhood and had not contracted varicella in the
past were recruited for each varicella case. The parents of case and control
subjects were interviewed regarding the history of varicella vaccination and the 
severity of illness. RESULTS: A total of 151 case subjects (mean age, 2.9 +/-1.1 
years) and 298 control subjects (mean age, 3.0 +/-1.1 years) were recruited.
Vaccination rates for case and control subjects were 6.6% and 38.3%, respectively
(P < 0.001). Disease among vaccinated children was significantly milder, as
measured by several indices, including parental perception of the illness,
presence of fever, time until the lesions dried and days of day care missed.
Vaccine effectiveness against varicella of any severity with these figures was
88% (95% confidence interval, 77-94%), and effectiveness against moderate/severe 
illness was 100%. CONCLUSIONS: Our data demonstrate that the varicella Oka/GSK
vaccine used in clinical practice is highly effective in prevention of varicella 
(especially moderate/severe disease) among children, including those attending
day-care centers.

Publication Types: 
    Comparative Study

PMID: 15876943 [PubMed - indexed for MEDLINE]

314: Am J Epidemiol. 2005 May 15;161(10):929-38.

History of chickenpox and shingles and prevalence of antibodies to
varicella-zoster virus and three other herpesviruses among adults with glioma and
controls.

Wrensch M, Weinberg A, Wiencke J, Miike R, Sison J, Wiemels J, Barger G,
DeLorenze G, Aldape K, Kelsey K.

Department of Neurological Surgery, School of Medicine, University of California,
San Francisco, CA 94102, USA. wrensch@itsa.ucsf.edu

Whether viruses or immunologic factors might cause or prevent human brain cancer 
is of interest. Statistically significant inverse associations of adult glioma
with history of chickenpox and immunoglobulin G antibodies to varicella-zoster
virus have been reported. The authors evaluate associations of immunoglobulin G
antibodies to varicella-zoster virus and three other herpesviruses among 229
adults with glioma and 289 controls in the San Francisco Bay Area Adult Glioma
Study (1997-2000). Cases were less likely than controls to report a history of
chickenpox (for self-reported cases vs. controls: the age-, gender-, and
ethnicity-adjusted odds ratio = 0.59, 95% confidence interval: 0.40, 0.86), and
they also had lower levels of immunoglobulin G to varicella-zoster virus (for
being in the highest quartile vs. the lowest quartile: the age-, gender-, and
ethnicity-adjusted odds ratio = 0.41, 95% confidence interval: 0.24, 0.70). The
inverse association with anti-varicella-zoster virus immunoglobulin G was most
marked for glioblastoma multiforme cases versus controls and was only somewhat
attenuated by excluding subjects taking high-dose steroids and other medications.
Cases and controls did not differ notably for positivity to three other
herpesviruses, Epstein-Barr virus, cytomegalovirus, and herpes simplex virus.
Cohort studies may help to clarify the nature of the association between immunity
to and/or clinical manifestations of varicella-zoster virus and glioblastoma.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15870157 [PubMed - indexed for MEDLINE]

315: Curr Opin Infect Dis. 2005 Jun;18(3):235-40.

Chickenpox.

Hambleton S.

Department of pediatrics, Columbia University, College of Physicians & Surgeons, 
New York, NY 10032, USA. sh2253@columbia.edu

PURPOSE OF REVIEW: Varicella-zoster virus (VZV) remains a public health issue
around the globe despite the availability of a live attenuated vaccine and
several highly active antiviral agents. A program of universal infant vaccination
against varicella was introduced in the US almost 10 years ago. Epidemiological
data continue to accumulate that will inform decision-making on vaccine use
elsewhere. These findings, together with relevant advances in VZV virology, form 
the substance of this review. RECENT FINDINGS: Understanding of the pathogenesis 
of varicella has significantly advanced with the demonstration that the
cation-independent mannose 6-phosphate receptor is critical to both entry and
egress of enveloped VZV. While our knowledge of intervening events remains
sketchy, the future study of VZV will be facilitated by the recent successful
cloning of the VZV genome into a bacterial artificial chromosome. Models of
latency and reactivation are also being developed, which may help us to
understand the epidemiology of herpes zoster in vaccinated populations. Continued
evidence of decline in the incidence of varicella, associated hospitalizations
and deaths suggests that the vaccine as used in the US is highly effective.
However, rates of breakthrough disease are significant and sufficient to sustain 
outbreaks, even among highly vaccinated populations. This is so despite the
generally reduced infectiousness of varicella occurring in vaccinated
individuals. There is some evidence of attrition of the immune response over time
following immunization in a small proportion of vaccinees. SUMMARY: Our ability
to prevent and treat varicella still outstrips our knowledge of pathogenetic and 
immune mechanisms. Further clinical advances are likely to arise from growing
understanding of VZV biology.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15864101 [PubMed - indexed for MEDLINE]

316: Vaccine. 2005 May 20;23(27):3519-25.

Disparities in varicella vaccine coverage in the absence of public funding.

Gustafson R, Skowronski DM.

Department of Health Care and Epidemiology, University of British Columbia, 655
West 12th Avenue, Vancouver, BC, Canada V5Z 4R4.

Varicella vaccine has been licensed in Canada since December 1998 but not
provided free in all provinces. Through a cross-sectional telephone survey to a
random sample of parents, we assessed factors associated with varicella vaccine
uptake in the absence of public funding. Parents of children aged 2-3 years
(Group I) and 6-7 years (Group II) were contacted between March and May 2003 in
British Columbia, Canada. Response rate was 82% (Group I=571; Group II=704).
Among susceptible children, varicella vaccine coverage was 21% (95% CI 18-25%)
and 28% (95% CI 22-33%), respectively. There were significant disparities in
vaccine coverage based on income and residence. Physician or nurse recommendation
was a strong determinant of vaccine uptake as were belief in the safety and
efficacy of vaccine. Among parents of susceptible children, 59% (343/582) would
vaccinate their child if it were provided free; 25% (148/582) were undecided.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15855010 [PubMed - indexed for MEDLINE]

317: Proc Natl Acad Sci U S A. 2005 May 3;102(18):6490-5. Epub 2005 Apr 25.

Varicella-zoster virus infection of human dorsal root ganglia in vivo.

Zerboni L, Ku CC, Jones CD, Zehnder JL, Arvin AM.

Department of Pediatrics,Stanford University School of Medicine, Stanford, CA
94305, USA. zerboni@stanford.edu

Varicella-zoster virus (VZV) causes varicella and establishes latency in sensory 
ganglia. VZV reactivation results in herpes zoster. We developed a model using
human dorsal root ganglion (DRG) xenografts in severe combined immunodeficient
(SCID) mice to investigate VZV infection of differentiated neurons and satellite 
cells in vivo. DRG engrafted under the kidney capsule and contained neurons and
satellite cells within a typical DRG architecture. VZV clinical isolates infected
the neurons within DRG. At 14 days postinfection, VZ virions were detected by
electron microscopy in neuronal cell nuclei and cytoplasm but not in satellite
cells. The VZV genome copy number was 7.1 x 10(7) to 8.0 x 10(8) copies per 10(5)
cells, and infectious virus was recovered. This initial phase of viral
replication was followed within 4-8 weeks by a transition to VZV latency,
characterized by the absence of infectious virus release, the cessation of virion
assembly, and a reduction in VZV genome copies to 3.7 x 10(5) to 4.7 x 10(6) per 
10(5) cells. VZV persistence in DRG was achieved without any requirement for
VZV-specific adaptive immunity and was associated with continued transcription of
the ORF63 regulatory gene. The live attenuated varicella vaccine virus exhibited 
the same pattern of short-term replication, persistence of viral DNA, and
prominent ORF63 transcription as the clinical isolates. VZV-infected T cells
transferred virus from the circulation into DRG, suggesting that VZV
lymphotropism facilitates its neurotropism. DRG xenografts may be useful for
investigating neuropathogenic mechanisms of other human viruses.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15851670 [PubMed - indexed for MEDLINE]

318: Transplant Proc. 2005 Mar;37(2):952-3.

Successful vaccination against varicella zoster virus prior to kidney
transplantation.

Geel A, Zuidema W, van Gelder T, van Doornum G, Weimar W.

Department of Internal Medicine, Section Transplantation, Rotterdam, The
Netherlands. a.geele@erasmusmc.nl

BACKGROUND: In recent years we have observed a number of severe complications of 
primary varicella-zoster virus (VZV) infections after adult kidney
transplantation. We questioned how many patients on the waiting list for kidney
transplantation had not been protected against VZV and whether patients with
renal insufficiency would be able to develop a specific immune response upon VZV 
vaccination. METHODS: We examined the VZV antibody titer of 280 patients on the
kidney transplant waiting list. Seronegative kidney transplant candidates were
vaccinated twice with a live attenuated varicella vaccine at an interval of 6
weeks. CONCLUSIONS: Approximately 3% of patients on the waiting list were
seronegative for VZV. Vaccination induced no side effects and resulted in a
positive serologic response in most patients.

PMID: 15848586 [PubMed - indexed for MEDLINE]

319: Vaccine. 2005 May 9;23(25):3349-55.

Cost-benefit analysis of universal varicella vaccination in the U.S. taking into 
account the closely related herpes-zoster epidemiology.

Goldman GS.

Medical Veritas International (MVI), Pearblossom, CA 93553, USA.
pearblossominc@aol.com

Many models concur that universal varicella vaccination of children is beneficial
from the perspective of reducing societal costs. Yet, the majority of such cost
analyses have been modeled under the assumption that varicella vaccination has no
adverse effect on the closely related herpes-zoster (HZ) epidemiology. Historical
models have assumed that asymptomatic endogenous reactivation is the chief
mechanism of boosting that suppresses the reactivation of HZ and that immunity
wanes due to the aging process. Recent studies suggest instead that periodic
exogenous exposures to wild-type varicella are the predominant factor influencing
the curve of increasing HZ incidence rate with advancing age among individuals
<50, after which an age-related decline dominates in the elderly. Based on a
realistic age-structured model, we compare differences in outcomes of the number 
of HZ cases and direct medical costs associated with the population existing in
2000 and as it ages (according to the mortality given in the 2000 U.S. census)
during the following 50 years with and without implementation of universal
varicella vaccination. Under universal varicella vaccination, we assume that 15
years post-licensure, the boosting mechanism known as asymptomatic endogenous
reactivation principally serves to limit HZ incidence to 550 per 100,000
person-years in unvaccinated individuals <50 with a previous history of natural
varicella--since there has been a vaccine-induced decline in exogenous boosting. 
We estimate universal varicella vaccination has the impact of an additional 14.6 
million (42%) HZ cases among adults aged <50 years during a 50 year time span at 
a substantial cost burden of 4.1 billion US dollars or 80 million US dollars
annually utilizing an estimated mean healthcare provider cost of 280 US dollars
per HZ case.

PMID: 15837242 [PubMed - indexed for MEDLINE]

320: Clin Infect Dis. 2005 Apr 1;40(7):1055-7. Epub 2005 Mar 4.

Varicella-associated invasive group A streptococcal disease in Alberta,
Canada--2000-2002.

Tyrrell GJ, Lovgren M, Kress B, Grimsrud K.

Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton,
Canada. g.tyrrell@provlab.ab.ca

We determined the incidence of invasive group A streptococcal (GAS) disease among
children < or =14 years of age in Alberta, Canada, with a focus on infections
associated with varicella. During 2000-2002, there were 71 cases of invasive GAS 
disease among patients in this age group. Fourteen cases occurred in children
with varicella (19.7%), for an annual incidence of 0.73 varicella-associated
cases per 100,000 children. Necrotizing fasciitis was not noted in patients with 
invasive GAS disease and varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15825001 [PubMed - indexed for MEDLINE]

321: Neuropediatrics. 2005 Apr;36(2):117-9.

Bilateral striatal lesion associated with varicella.

Liptai Z, Mihály I, Kulcsár A, Barsi P, Vásárhelyi B, Kocsis I.

Szent László Hospital for Infectious Diseases, Budapest, Hungary.

Bilateral striatal lesion is characterised by a specific clinical syndrome
(encephalopathy with rigidity, irritability, variable pyramidal, and
extrapyramidal symptoms, speech abnormalities) and symmetrical lesion of the
basal ganglia including the caudate nucleus, the putamen, and occasionally other 
nuclei. We report three cases in whom bilateral striatal lesion developed in
association with varicella. Each patient recovered completely and showed no signs
of cognitive deficiency, chorea or hyperkinetic syndrome, all of which have been 
reported as sequelae of BSL associated with other conditions. These cases suggest
that bilateral striatal lesion may be an immune-mediated complication of
varicella.

Publication Types: 
    Case Reports

PMID: 15822026 [PubMed - indexed for MEDLINE]

322: Bone Marrow Transplant. 2005 Jun;35(11):1065-9.

The effect of low-dose aciclovir on reactivation of varicella zoster virus after 
allogeneic haemopoietic stem cell transplantation.

Thomson KJ, Hart DP, Banerjee L, Ward KN, Peggs KS, Mackinnon S.

Department of Haematology, University College London Hospitals, 98 Chenies Mews, 
London WC1E 6HX, UK. kirsty.thomson@uclh.org

Patients undergoing haemopoietic stem cell transplants (HSCT) are at high risk of
varicella zoster virus (VZV) reactivation, with a significant incidence of
dissemination. This study reports a retrospective analysis of 247 allogeneic HSCT
recipients receiving anti-viral prophylaxis with low-dose oral aciclovir 400
mg/day, administered until immunosuppression was discontinued and the CD4(+) cell
count exceeded 200/mm(3). Viral reactivation was successfully suppressed by
aciclovir prophylaxis, with only one case of breakthrough infection. The
cumulative incidence of zoster infection at 1 year post transplant was 2% and at 
5 years 34%. In all, 64 patients discontinued prophylaxis. Zoster developed in 26
of these, giving a cumulative incidence of infection at 1 year after stopping
aciclovir of 39% and at 3 years 44%. Infection occurred in a localised dermatomal
distribution in 93% of cases. This supports previous findings that aciclovir
prophylaxis prevents early VZV reactivation, although the long-term incidence is 
not affected as infection occurs once prophylaxis is discontinued. Such
infection, however, is mild and localised. This study does not support the idea
that use of such low-dose aciclovir regimens reduces the zoster incidence by
permitting subclinical reactivation during prophylaxis, and therefore the
re-establishment of protective anti-viral immunity.

PMID: 15806119 [PubMed - indexed for MEDLINE]

323: Pediatrics. 2005 Apr;115(4):900-5.

Comment in:
    Pediatrics. 2005 Dec;116(6):1613.

Importance of catch-up vaccination: experience from a varicella outbreak, Maine, 
2002-2003.

Marin M, Nguyen HQ, Keen J, Jumaan AO, Mellen PM, Hayes EB, Gensheimer KF,
Gunderman-King J, Seward JF.

Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease
Control and Prevention, Atlanta, GA 30333, USA. mmarin@cdc.gov

OBJECTIVE: During December 2002 to January 2003, a varicella outbreak occurred in
an elementary school in Maine. Just 1 month before detecting the outbreak, Maine 
implemented varicella vaccine requirements for child care but did not require
vaccination for school entry. We investigated this outbreak to examine reasons
for its occurrence, including vaccine failure. METHODS: A self-administered
questionnaire was sent to all students' parents to determine student disease
status, medical conditions, and vaccination status, which was further confirmed
by review of medical records. Parental reporting of chickenpox/varicella that
occurred since September 1, 2002, in a student who attended the school was used
to define a case. Parents of cases were interviewed by telephone about disease
characteristics. Disease severity was classified on the basis of the number of
skin lesions and the occurrence of complications. Vaccine effectiveness was
calculated by comparing varicella attack rates for any disease, for moderate to
severe disease, and for severe disease among vaccinated and unvaccinated
students. RESULTS: We obtained complete information for 296 (81%) of 364
students. Varicella vaccine coverage was 74% overall and decreased by grade, from
90% in kindergarten to 60% in third grade. Attack rates increased significantly
from 14% in kindergarten to 37% in third grade. Of the 53 varicella cases, 36
(68%) were unvaccinated, 12 (22%) were vaccinated, and 5 (10%) had previous
disease history. Vaccine effectiveness was 89% (95% confidence interval [CI]:
79-94%) against disease of any severity, 96% (95% CI: 88-99%) against moderate to
severe disease, and 100% (95% CI: undefined) against severe disease. Twenty-two
percent of unvaccinated students had severe disease and 1 was hospitalized for a 
skin infection, whereas none of the vaccinated cases reported severe disease.
CONCLUSION: This outbreak was attributable primarily to failure to vaccinate,
especially among children in grades 1 through 3. Catch-up vaccination of
susceptible older children and adolescents is especially important to prevent
accumulation of susceptibility in these groups, in which the natural disease is
more severe. School entry requirements will contribute to a more rapid
implementation of the existing recommendations for vaccination.

PMID: 15805362 [PubMed - indexed for MEDLINE]

324: MMWR Morb Mortal Wkly Rep. 2005 Mar 25;54(11):274-6.

Varicella surveillance in public elementary schools--Multnomah County, Oregon,
2002-2004.

Centers for Disease Control and Prevention (CDC).

Varicella vaccination of school-aged children reduces the number of varicella
cases and lost days of school. In 1996, the Advisory Committee on Immunization
Practices (ACIP) recommended routine vaccination of all children aged 12-18
months, catch-up vaccination of all susceptible children before age 13 years, and
vaccination of susceptible persons who have close contact with persons at high
risk for serious complications and susceptible persons at high risk for exposure.
In 1999, ACIP updated these recommendations to include vaccination requirements
for child care and school entry. Since 2000, in accordance with ACIP
recommendations, varicella vaccination requirements have been phased in for
Oregon children who have not had varicella before starting out-of-home child
care, kindergarten, or seventh grade; elementary school children will be fully
covered by school year (SY) 2006-07. To monitor changes in varicella incidence,
Oregon Health Services (OHS) and Multnomah Education Service District (MESD)
started routine, individual, case-based varicella surveillance in Multnomah
County public elementary schools (kindergarten through 5th grade) beginning SY
2002-03. This report describes the surveillance system, the incidence of
varicella during SY 2002-03 and SY 2003-04, and the results of active
surveillance for unidentified cases during SY 2002-03. The findings indicate that
the number of varicella cases has decreased in Oregon and that establishing
public elementary school-based varicella surveillance is feasible and useful.

PMID: 15788993 [PubMed - indexed for MEDLINE]

325: MMWR Morb Mortal Wkly Rep. 2005 Mar 25;54(11):272-4.

Varicella-related deaths--United States, January 2003-June 2004.

Centers for Disease Control and Prevention (CDC).

During 2003 and the first half of 2004, CDC received reports of eight
varicella-related deaths. The age of the decedents ranged from 1 to 40 years. Six
of the eight deaths occurred among children and adolescents aged <20 years. The
cases were reported from Arizona (two), Maryland (two), Arkansas (one), New
Hampshire (one), Ohio (one), and New York City (one). Six deaths occurred in
unvaccinated persons. Vaccination status of the remaining two persons could not
be determined. This report describes clinical data for three of the fatal
varicella cases in children, reported from Arizona, Arkansas, and New York City; 
all three patients were susceptible and unvaccinated, but otherwise healthy. The 
three other children and adolescents, not described in detail in this report,
were immunocompromised as a result of at least one preexisting condition. The
findings in this report underscore 1) the importance of timely routine
vaccination of children aged 12--18 months and catch-up vaccination of older
susceptible children and adolescents according to current recommendations and 2) 
the need for timely and complete national varicella death surveillance.

Publication Types: 
    Case Reports

PMID: 15788992 [PubMed - indexed for MEDLINE]

326: Commun Dis Public Health. 2004 Dec;7(4):344-8.

Susceptibility to infectious rash illness in pregnant women from diverse
geographical regions.

Knowles SJ, Grundy K, Cahill I, Cafferkey MT.

Department of Microbiology, Rotunda Hospital, Parnell Square, Dublin 1, Ireland. 
sknowles@nmh.ie

Varicella-zoster (VZV), rubella (RV) and parvovirus B19 (B19V) infections are
important causes of rash illness in pregnancy, due to their potential adverse
impact on both mother and fetus. We determined susceptibility to these infections
in pregnant women attending our hospital in 2002. Age and nationality were
recorded. Sera were tested for VZV, RV, and B19V antibody by enzyme immunoassay. 
Of 7,980 women screened for VZV IgG, 11.3% were seronegative and therefore
susceptible to infection. Across different worldwide regions, 6.9% of Irish and
other Western European women were susceptible to VZV, compared to 19.7% of other 
women tested (p < 0.001), most of whom were from Central and Eastern Europe,
sub-Saharan Africa and Asia. Of 7,872 women screened for RV IgG, 2.3% were
seronegative. Few Irish (0.6%) or other Western European women (0.7%) were
rubella non-immune, but 5.5% of women from other regions tested were susceptible 
to rubella (p < 0.001). A random subset of 1,048 women were tested for B19V IgG. 
About 38% were susceptible, varying from 22% to 63% across the different regions 
studied. There are important differences in immunity to these infections and so
of potential risk of an adverse outcome in indigenous and immigrant pregnant
women in Ireland.

PMID: 15779804 [PubMed - indexed for MEDLINE]

327: Health Policy. 2005 Apr;72(1):119-24.

Seroepidemiology of varicella-zoster virus infection in a cosmopolitan city
(Erzurum) in the eastern Turkey.

Alp H, Altinkaynak S, Ertekin V, Kiliçaslan B, Giiraksin A.

Department of Pediatrics, Ataturk Universitesi, 25 240 Erzurum, Turkey.

OBJECTIVE: The aim of the study was to determine VZV seroprevalence under age 30 
and to identify the relationship of VZV seroprevalence and several
sociodemographic characteristics of the study subjects. The results were
presented in order to design a strategy for vaccination against varicella-zoster 
virus (VZV). MATERIAL AND METHOD: It was planned to include a total of 568
subjects. The sampling method of 30 clusters recommended for field studies was
used for selecting subjects of a predetermined number in the rural and urban
areas in eastern Turkey. ELISA method was used to examine the blood samples for
VZV seropositivity. Age, gender, place of living, educational level, family size 
and socioeconomic status was investigated in the study subjects. RESULTS:
Positive VZV seroprevalence was detected in 78% of 559 subjects. Seroprevalence
increased with age. Seroprevalence was 16.67% at the age of 1 year, subsequently 
increased to 57.58% at the age of 4 years, 70% at the age of 7 years, 92.31% at
the age of 10 years and then remained 86.78-96.36% in subjects over the age of 10
years. No association was found between sociodemographic variables studied and
prevalence levels of antibodies except for educational level in the 0-14 year
group. CONCLUSION: These results suggest that the majority of VZV infections
occur during the early childhood; the best option to reduce the circulation of
wild type VZV in the population would be the immunization of young children. VZV 
vaccine should be introduced into the routine childhood vaccination programme in 
Turkey.

PMID: 15760704 [PubMed - indexed for MEDLINE]

328: Expert Rev Anti Infect Ther. 2005 Feb;3(1):105-15.

Varicella-zoster vaccine in the USA: success for control of disease severity, but
what next?

Watson B.

Jefferson Medical College, Medical Specialist, Immunization Program, Division of 
Disease Control, The Philadelphia Department of Public Health, 500S Broad Street,
Philadelphia, PA 19146, USA. Barbara.Watson@phila.gov

In the period from 1990 to 1994, before the introduction of a varicella vaccine
to the USA, approximately 100 deaths in otherwise healthy individuals, children
and adolescents under 20 years of age, were attributable to varicella
complications. The administration of a single-dose vaccine has now been
widespread in the USA for nearly 10 years; however, since the effectiveness of a 
single dose in children under 13 years of age in an outbreak situation is
approximately 80%, consideration of a second booster dose is in progress although
not yet recommended. Licensure of a measles-mumps-rubella-varicella vaccine may
hasten the recommendation.

Publication Types: 
    Review

PMID: 15757461 [PubMed - indexed for MEDLINE]

329: J Pediatr. 2005 Mar;146(3):423-5.

Comment in:
    J Pediatr. 2006 Apr;148(4):563-4; author reply 564.    J Pediatr. 2006 Apr;148(4):563; author reply 564.

Fatal varicella associated with selective natural killer cell deficiency.

Etzioni A, Eidenschenk C, Katz R, Beck R, Casanova JL, Pollack S.

Meyer Children's Hospital, Department of Immunology, B. Rappaport Medical School,
Technion, Haifa, Israel. etzioni@rambam.health.gov.il

A 2-year-old girl with recurrent severe varicella infections had a fatal outcome.
Studies of cellular and humoral immunity were normal. No natural killer (NK)
cells were detected, and NK activity was markedly decreased. The interleukin
(IL)15/IL15R signaling pathway was intact. This case emphasizes the role of NK
cells in controlling herpes viral infection.

Publication Types: 
    Case Reports

PMID: 15756234 [PubMed - indexed for MEDLINE]

330: Pediatr Infect Dis J. 2005 Mar;24(3):269-70.

Recurrent papular urticaria after varicella immunization in a fifteen-month-old
girl.

Bronstein DE, Cotliar J, Votava-Smith JK, Powell MZ, Miller MJ, Cherry JD.

Department of Pediatrics, David Geffen School of Medicine, University of
California, Los Angeles, CA, USA.

Varicella-like rash after immunization with the live attenuated varicella vaccine
is relatively common. Such vaccine-associated rashes generally consist of fewer
lesions than occur in chickenpox. We describe a 15-month-old girl who experienced
the onset of recurring papular urticaria after varicella immunization. The rash
was varicella-like and thought by us to be caused by vaccine virus.

Publication Types: 
    Case Reports

PMID: 15750467 [PubMed - indexed for MEDLINE]

331: Pediatr Infect Dis J. 2005 Mar;24(3):233-6.

Vaccine effectiveness and severity of varicella among previously vaccinated
children during outbreaks in day-care centers with low vaccination coverage.

Miron D, Lavi I, Kitov R, Hendler A.

Pediatric Department A, Infectious Disease Consultation Service, HaEmek Medical
Center, Afula, Israel.

BACKGROUND: Varicella vaccine effectiveness (VE) during outbreaks has been
reported to be 71-100% against any disease and >90% against moderate/severe
disease even in day-care centers (DCCs) and schools with low vaccination rates. A
recent report suggested an effectiveness rate of 44% during a DCC outbreak
despite a high vaccination rate. AIMS: To reassess vaccination coverage, VE and
severity of disease among previously vaccinated children after exposure during
DCC outbreaks in northern Israel, where vaccination rates are low. METHODS:
During January to June 2003, active surveillance for varicella among children in 
northern Israel revealed outbreaks in 8 DCCs with children 3-6 years of age. Data
concerning symptoms of the disease and the age at vaccination (for previously
vaccinated children) were obtained from parents and health care providers for
children who contracted the disease. Analysis of VE was limited to children who
were continuously enrolled in DCCs during the outbreaks. RESULTS: The overall
vaccination rate was 37%. The incidences of natural varicella and breakthrough
varicella (BV) were 79 of 153 [52%; 95% confidence interval (CI) 44-60%] and 37
of 89 (41.5%; 95% CI 31-52%), respectively. VE was 20% (95% CI 0-40%) against
disease of any severity and 93.4% (95% CI 75-98%) against moderate/severe
disease. Ninety-four percent and 14% of children with BV and natural varicella,
respectively, had mild disease (P < 0.001). The odds ratio for BV was 17 (95% CI 
2.18-118) for children vaccinated >2 years before the outbreak. CONCLUSIONS:
During varicella outbreaks in DCCs with low vaccine coverage, previous
vaccination provided poor protection against chickenpox, mostly among children
who had been vaccinated >2 years earlier, but the disease appeared to be much
milder among children with BV than among nonvaccinated children.

Publication Types: 
    Comparative Study

PMID: 15750459 [PubMed - indexed for MEDLINE]

332: Eur J Pediatr. 2005 Jun;164(6):366-70. Epub 2005 Mar 4.

Prospective surveillance of hospitalisations associated with varicella-zoster
virus infections in children and adolescents.

Bonhoeffer J, Baer G, Muehleisen B, Aebi C, Nadal D, Schaad UB, Heininger U.

Division of Paediatric Infectious Diseases, University Children's Hospital, P.O. 
Box, 4005, Basel, Switzerland.

Our goal was to determine the epidemiology of severe varicella-zoster virus (VZV)
infections in hospitalised paediatric patients. Admissions associated with VZV
infection of patients aged 0-16 years were reported by all 38 paediatric units in
Switzerland to the Swiss Paediatric Surveillance Unit (SPSU) during 3 consecutive
years (4/2000-3/2003). We verified completeness of reporting by capture-recapture
analysis with patient records identified by ICD-10 codes. Outcome of illness was 
assessed 6 months after hospitalisation. A total of 335 cases (235 identified by 
SPSU reports, 100 by ICD-10 code) were included in this study. Mean age of
patients was 4.1 years (median 3.5 years, range 0-16 years); 54% were male. Some 
293 (87%) patients presented with chickenpox, 42 (13%) with herpes zoster and 291
(87%) patients were not immunocompromised. A total of 319 complications occurred 
in 237 (71%) patients: secondary bacterial infections (n =109); central nervous
system involvement (n =76); VZV pneumonitis (n =7); others (n =127). Eleven (3%) 
patients required intensive care and three died. On follow-up, 303 (96%) of 315
patients had completely recovered; sequelae were present in 12 (4%) patients. The
calculated hospitalisation rate was 13 per 10(4) cases. CONCLUSION: This study
describes a sizeable hospitalisation and complication rate of varicella-zoster
virus infections and provides a solid basis for future immunisation
recommendations in Switzerland.

PMID: 15747132 [PubMed - indexed for MEDLINE]

333: Can Fam Physician. 2005 Jan;51:60-5.

Predictive value of a history of varicella infection.

Holmes CN.

Department of Family and Community Medicine, University of Toronto, Ont.

OBJECTIVE: To determine whether a history of previous varicella infection
provides a reliable marker for prior infection. QUALITY OF EVIDENCE: MEDLINE was 
searched from January 1996 to May 2002 using the MeSH headings "varicella,"
"chickenpox" and "medical history taking." Recommendations in this paper are
based on evidence from well designed cross-sectional studies. MAIN MESSAGE:
Serologic testing is advised, rather than presumptive vaccination, for those with
a negative or uncertain history of varicella; most will be immune. For those with
a positive history of varicella, the advice given depends on the population. For 
populations at higher risk of varicella infection (eg, health care workers,
pregnant women), routine serum testing is recommended. For low-risk populations, 
physicians could accept a positive history of varicella as a reliable indicator
of immunity. CONCLUSION: Most studies found that patients' history of varicella
had a high positive predictive value and a low negative predictive value. These
findings suggest that a positive history of varicella is a reliable marker of
disease while a negative history does not not predict lack of immunity.

Publication Types: 
    Review

PMID: 15732223 [PubMed - indexed for MEDLINE]

334: Neurology. 2005 Feb 22;64(4):660-3.

Post-varicella arteriopathy of childhood: natural history of vascular stenosis.

Lanthier S, Armstrong D, Domi T, deVeber G.

Cerebrovascular Disease Centre, Centre hospitalier de l'Université de Montréal
and Montreal Heart Institute, Montreal, Quebec.

OBJECTIVE: To determine the course of vascular changes in childhood
post-varicella arteriopathy (PVA) and its relationship to recurrent arterial
ischemic stroke or TIA (AIS/TIA). METHODS: Subjects were children with AIS/TIA
occurring <1 year after varicella, ischemic localization consistent with
unilateral disease affecting the supraclinoid internal carotid artery or proximal
anterior or middle cerebral arteries, and no identified AIS/TIA etiology other
than PVA. Charts, brain MRI, and sequential cerebral vessel imaging (selective
cerebral angiography or MR angiography [SCA/MRA]) were retrospectively reviewed. 
RESULTS: Twenty-three children had varicella at age 1.0 to 10.4 years and had
single or multiple AIS/TIAs 4 to 47 weeks later. Initial SCA/MRA was performed
within 1 month of presentation, and each child had one to five repeat SCA/MRAs
during a 4- to 87-month period. There was vascular stenosis in 19 children,
maximal on initial studies in 15 of these. Subsequent stenosis regression
occurred in 17 children. In 11 of these, one or two additional SCA/MRAs showed
further regression as long as 48 months after presentation; there was no
restenosis. Eight of 23 children had recurrent AIS/TIA with antithrombotic
therapy within 33 weeks of presentation, including 1 of 17 children with
documented stenosis regression. CONCLUSION: Vascular stenosis of childhood
post-varicella arteriopathy takes a monophasic course, generally with subsequent 
stenosis regression and only occasional stenosis progression after arterial
ischemic stroke/TIA. Arterial ischemic stroke/TIA rarely recurs with
antithrombotic prophylaxis after stenosis regression occurs.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15728288 [PubMed - indexed for MEDLINE]

335: Pediatr Infect Dis J. 2005 Feb;24(2):102-7.

Varicella zoster in Guinea-Bissau: intensity of exposure and severity of
infection.

Poulsen A, Cabral F, Nielsen J, Roth A, Lisse IM, Vestergaard BF, Aaby P.

Projecto de Saude de Bandim, Guinea-Bissau, Statens Serum Institut, Copenhagen,
Denmark. anja@dadlnet.dk

OBJECTIVE: To describe the epidemiology of and risk factors for severe chickenpox
in Guinea- Bissau. METHODS: A prospective household study in a semiurban area of 
the capital. Severity was assessed by number of pox, fever response and presence 
of pneumonia. Severity was compared for the first case in a house, that is, the
index case, and the secondary cases infected at home. RESULT: We identified 1539 
cases of chickenpox. The median age was lower for boys and secondary cases (both 
P < 0.03); 44.6% of children were 1-4 years of age. The likely minimum interval
between index and secondary cases was 10 days; most secondary cases occurred
14-17 days after the index case. The length of the incubation period was related 
to the intensity of exposure (P < 0.01). The number of pox was higher for
secondary cases (P < 0.01) and was related to intensity of exposure (P < 0.01).
Secondary cases had higher fever and more frequently pneumonia (relative risk,
2.17; 95% confidence interval, 1.54-3.08). Children with pneumonia were younger
and had more pox. Nutritional status was not related to severity. CONCLUSIONS:
Age and intensity of exposure are important determinants for severity of
chickenpox infection. The length of the incubation period depends on intensity of
exposure, suggesting that the dose of infection might be important.

PMID: 15702036 [PubMed - indexed for MEDLINE]

336: Euro Surveill. 2005 Jan;10(1):43-5.

Varicella zoster virus vaccination policies and surveillance strategies in
Europe.

Pinot de Moira A, Nardone A; ESEN2 group.

Immunisation Department, Health Protection Agency, CDSC, London, United Kingdom.

The incorporation of varicella zoster virus (ZVV) vaccination in childhood
immunisation schedules is becoming an increasingly common option in Europe. The
current study forms part of the European Sero-Epidemiology Network 2 (ESEN2)
organisational analysis for VZV and describes current passive immunisation
policies, as well as current and proposed active immunisation strategies, and
existing surveillance systems for diseases caused by the varicella zoster virus
in ESEN countries. A questionnaire was compiled and distributed to 23
participating countries. A VZV vaccine is currently licensed in 14 of the 20
participating ESEN countries. Germany is the only country to have incorporated
VZV vaccination into its routine childhood immunisation programme. Three further 
countries currently recommend vaccination of children against VZV and five
countries are also considering introducing routine immunisation against VZV for
children. However, of the eight countries with or considering introducing
childhood VZV immunisation, only six have case-based mandatory notification of
varicella, and only two countries have primary care surveillance data available
for herpes zoster.

PMID: 15701939 [PubMed - indexed for MEDLINE]

337: N Engl J Med. 2005 Feb 3;352(5):450-8.

Comment in:
    N Engl J Med. 2005 Apr 28;352(17):1819.    N Engl J Med. 2005 Feb 3;352(5):439-40.

Decline in mortality due to varicella after implementation of varicella
vaccination in the United States.

Nguyen HQ, Jumaan AO, Seward JF.

National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, GA 30333, USA.

BACKGROUND: Varicella disease has been preventable in the United States since
1995. Starting in 1999, active and passive surveillance data showed sharp
decreases in varicella disease. We reviewed national death records to assess the 
effect of the vaccination program on mortality associated with varicella.
METHODS: Data on deaths for which varicella was listed as an underlying or
contributing cause were obtained from National Center for Health Statistics
Multiple Cause-of-Death Mortality Data for 1990 through 2001. We calculated the
numbers and rates of death due to varicella according to age, sex, race, ethnic
background, and birthplace. RESULTS: The rate of death due to varicella
fluctuated from 1990 through 1998 and then declined sharply. For the interval
from 1990 through 1994, the average number of varicella-related deaths was 145
per year (varicella was listed as the underlying cause in 105 deaths and as a
contributing cause in 40); it then declined to 66 per year during 1999 through
2001. For deaths for which varicella was listed as the underlying cause,
age-adjusted mortality rates dropped by 66 percent, from an average of 0.41 death
per 1 million population during 1990 through 1994 to 0.14 during 1999 through
2001 (P<0.001). This decline was observed in all age groups under 50 years, with 
the greatest reduction (92 percent) among children 1 to 4 years of age. In
addition, by the period from 1999 through 2001, the average rates of mortality
due to varicella among all racial and ethnic groups were below 0.15 per 1 million
population, as compared with rates ranging from 0.37 per 1 million for whites to 
0.66 per 1 million for other races in the period from 1990 through 1994.
CONCLUSIONS: The program of universal childhood vaccination against varicella in 
the United States has resulted in a sharp decline in the rate of death due to
varicella. Copyright 2005 Massachusetts Medical Society.

PMID: 15689583 [PubMed - indexed for MEDLINE]

338: Southeast Asian J Trop Med Public Health. 2004 Sep;35(3):693-6.

Economic burden of varicella in Singapore--a cost benefit estimate of
implementation of a routine varicella vaccination.

Jean-Jasmin LM, Lynette SP, Stefan M, Kai CS, Chew FT, Wah LB.

Department of Pediatrics, National University of Singapore, Singapore.

Varicella is a common childhood illness that can result in significant morbidity 
and mortality. As early as 1995, recommendations for routine varicella
vaccination have been published, but have not been universally implemented, with 
cost of vaccination as a major reason. Though available from 1996, the vaccine
has yet to be routinely implemented in Singapore. We set out to assess the
economic burden of varicella and the cost-benefit of adding a varicella vaccine
to the existing immunization schedule in Singapore. In this study, using data
from 1994--1995 the direct cost estimates were based on all levels of medical
care; inpatient care, emergency room visits, primary health care and medication. 
Indirect costs were estimated from the cost of time lost by patients and their
families attending to medical needs, as well as loss of productivity due to
absenteeism. The cost of a vaccination program targeted at 15-month old infants
receiving concomitant measles-mumps-rubella immunization was also assessed. The
cost-benefit ratio was then estimated. The total cost of varicella in Singapore
was estimated to be US$11.8 million per annum. The loss of productivity accounted
for a large proportion of the total cost as a lot of parents took leave when
their children were ill. The estimates of total cost represent approximately
US$188 per varicella case per year. In comparison, the cost of a vaccination
program was found to be US$3.3 million per annum. The cost per case averted was
US$104. From a societal point of view, for every dollar invested in a vaccination
program, we would save about US$2 dollars.

PMID: 15689089 [PubMed - indexed for MEDLINE]

339: Semin Pediatr Infect Dis. 2005 Jan;16(1):38-43.

The impact of varicella vaccination in the United States.

Hambleton S, Gershon AA.

Department of Pediatrics, Columbia University, New York, NY 10032, USA.

The addition of varicella vaccine to the universal childhood immunization
schedule in the United States in 1995 can be seen as a bold step. Shown to be
safe and efficacious against varicella in extensive prelicensure studies, it is
nonetheless the first vaccine against a herpesvirus and, furthermore, it is a
live, attenuated vaccine. Both wild-type and vaccine strain varicella zoster
virus (VZV) are noteworthy for their ability to establish latent infection within
the host, with the subsequent possibility of reactivation. Therefore, at the
population level, a successful vaccination program could result in the eventual
displacement of wild-type VZV by the attenuated vaccine virus. The immediate
objective of universal vaccination, however, was to reduce the significant
morbidity and mortality associated with primary VZV infection. Data now
accumulating suggest that the varicella vaccine as used in the United States has 
so far been highly effective. The challenge for the future is to predict how the 
resulting substantial reduction in circulation of VZV will affect immunity among 
both vaccinees and the unvaccinated. Vaccination strategies likely will need to
be adjusted as the epidemiology of VZV in the United States continues to evolve.

Publication Types: 
    Review

PMID: 15685148 [PubMed - indexed for MEDLINE]

340: West Indian Med J. 2004 Oct;53(5):346-51.

Tuberculosis, chickenpox and scabies outbreaks in an orphanage for children with 
HIV/AIDS in Jamaica.

Geoghagen M, Pierre R, Evans-Gilbert T, Rodriguez B, Christie CD.

The University of the West Indies, Kingston, Jamaica.

OBJECTIVES: The aim of this study is to describe the investigation and management
of outbreaks of acute tuberculosis, varicella zoster virus and scabies in a
residential facility for children with HIV/AIDS. METHOD: A review of the results 
and management for diagnosed cases of acute TB (four between 2001 and 2002) as
well as varicella zoster virus (15) and scabies (14) (concurrent in March--June
2003), in a residential facility housing 24 abandoned children with HIV/AIDS was 
conducted. Outbreak control methods and challenges are described The modified WHO
criteria were used for TB diagnosis. The diagnoses of varicella and scabies were 
entirely clinical. RESULTS: Of the surviving 22 children, 12 (mean age 8 years 2 
months) were female, and 10 (mean age 5 years 6 months) were male. Full
immunization (primary series) was documented for 16 children, partial in one
child, unknown status was documented in five children. One child had received
varicella vaccine previously. Eleven (50%) children had been receiving
antiretroviral triple therapy since 2002 (all in Centers for Diseases Control
immunological categories 2-3). Two of the four children with tuberculosis died
between 2001 and 2002; these were not on antiretroviral therapy--the 2 survivors 
are still on antiretroviral therapy. All staff mantoux test results were
negative. Fifteen (68%) children developed chickenpox as well as three
caregivers. The index case was a 13-year-old resident attending a nearby school
with HIV negative children. This varicella outbreak went on to affect household
members for the caregivers as well as other residential facilities nearby.
Scabies affected 14 children (no caregivers); the index cases were most likely
three new child residents who entered the institution in 2002 (from other homes) 
with histories of scabies infestation. Chickenpox and scabies dual infection
occurred in seven (31%) of residents. No cases of herpes zoster, disseminated
varicella infection or death because of varicella occurred Diagnosed cases of
chickenpox were treated with oral acyclovir Knowledge about these disease
outbreaks and their control was generally lacking. CONCLUSIONS: Improvement in
immunization coverage for children and staff as well as educating staff about
infectious disease outbreaks, is necessary for effective control. Appropriate
screening for infection/disease for all susceptible persons is essential along
with timely reporting of outbreaks/reportable diseases. There is need for
increased awareness of acute opportunistic infections in children with HIV/AIDS
living in close proximity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15675502 [PubMed - indexed for MEDLINE]

341: Vaccine. 2005 Feb 10;23(12):1434-6.

Seroprevalence of varicella antibodies in healthcare workers and health sciences 
students. Reliability of self-reported history of varicella.

De Juanes JR, Gil A, San-Martín M, González A, Esteban J, García de Codes A.

Preventive Medicine Service, 12 de Octubre University Hospital, Madrid, Spain.

The objective of this study was to assess the seroprevalence of varicella
antibodies in healthcare workers and students of healthcare professions and to
determine the validity of the self-reported varicella history for detecting
susceptible subjects. Personnel of a general hospital and students were recruited
and a 5 mL blood sample was obtained from all participants. A case report form,
including previous self-reported history of varicella, was completed. A total of 
91 healthcare workers (mean age, 30.6 years; S.D., 4.0; range, 23-40) and 92
students (mean age, 19.8 years; S.D., 2.5; range, 18-25) were recruited. The
prevalence of varicella antibodies was 91.2% in healthcare workers and 92.1% in
students. Overall, the sensitivity, specificity, positive and negative predictive
values of a self-reported history of varicella were 68.4%, 66.7%, 95.4% and
17.2%, respectively. The preferred approach in these groups at risk of varicella 
will be to undergo serologic testing before immunization in those with negative
or unknown history of varicella.

Publication Types: 
    Evaluation Studies

PMID: 15670877 [PubMed - indexed for MEDLINE]

342: J Infect. 2005 Feb;50(2):125-9.

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

Lisse IM, Qureshi K, Poulsen A, Kofoed PE, Nielsen J, Vestergaard BF, Aaby P.

Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Bissau,
Guinea-Bissau. ida.lisse@dadlnet.dk

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

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15667913 [PubMed - indexed for MEDLINE]

343: J Infect Dis. 2005 Feb 15;191(4):540-5. Epub 2005 Jan 7.

Distribution of varicella-zoster virus DNA and gene products in tissues of a
first-trimester varicella-infected fetus.

Nikkels AF, Delbecque K, Pierard GE, Wienkotter B, Schalasta G, Enders M.

Department of Dermatopathology, University Hospital Sart Tilman, Liege, Belgium. 
af.nikkels@chu.ulg.ac.be

Precise information about varicella-zoster virus (VZV) infection in
first-trimester fetuses remains sketchy. After varicella infection was diagnosed 
in a woman, her 12-week-old fetus was aborted and was investigated, by
histological examination, virus culturing, polymerase chain reaction, in situ
hybridization (ISH), and immunohistochemistry (IHC), for the presence of VZV
infection. Only the results of the histological examination suggested the
presence of alpha -herpesvirus infection, in the gastrointestinal tract and
liver; results of ISH were positive for VZV, and results of IHC staining were
positive for intermediate early protein 63 (IE63) but negative for glycoprotein E
(gE), in the dorsal root ganglia (DRG), meninges, gastrointestinal tract,
pancreas, smooth muscle, liver, and placental trophoblast, indicating the
presence of a nonproductive, latency-like VZV infection. Only the
gastrointestinal tract and liver exhibited simultaneous staining for IE63 and gE,
a result suggesting that active replication of VZV was present. In conclusion,
widespread nonproductive VZV infection in the absence of histological clues is an
early event in VZV infection in fetuses. The observed gene-expression pattern in 
most tissues resembles that of latent VZV infection in DRG. Latency-like
infection in nonneural cell types may potentially reactivate, leading to
multifocal necrosis, fibrosis, and dystrophic calcifications, as observed in
advanced congenital varicella syndrome.

Publication Types: 
    Case Reports

PMID: 15655777 [PubMed - indexed for MEDLINE]

344: Clin Microbiol Rev. 2005 Jan;18(1):70-80.

Preventing varicella-zoster disease.

Hambleton S, Gershon AA.

Columbia University College of Physicians and Surgeons, 650 W. 168th Street, New 
York, NY 10032, USA.

Varicella-zoster virus (VZV), the cause of chickenpox and shingles, is a pathogen
in retreat following the introduction of mass vaccination in the United States in
1995. The live attenuated Oka vaccine, which is safe and immunogenic, gives good 
protection against both varicella and zoster in the short to medium term. It has 
undoubtedly been highly effective to date in reducing all forms of varicella,
especially severe disease. However, the huge pool of latent wild-type virus in
the population represents a continuing threat. Both the biology and the
epidemiology of VZV disease suggest that new vaccination strategies will be
required over time.

Publication Types: 
    Review

PMID: 15653819 [PubMed - indexed for MEDLINE]

345: Intern Med. 2004 Dec;43(12):1205-9.

Comment in:
    Intern Med. 2004 Dec;43(12):1105-6.

Fulminant varicella infection complicated with acute respiratory distress
syndrome, and disseminated intravascular coagulation in an immunocompetent young 
adult.

Lee S, Ito N, Inagaki T, Okajima T, Muramatsu A, Ito Y, Dojo M, Yamazaki Y, Azuma
T, Kuriyama M.

Second Department of Internal Medicine, School of Medicine, Fukui University,
Fukui.

Primary varicella infection in immunocompetent adults is very rare, but it has a 
high mortality rate because of serious complications. We describe a case of
varicella infection in a previously healthy young adult complicated with acute
respiratory distress syndrome (ARDS), rhabdomyolysis, acute hepatitis and
disseminated intravascular coagulation (DIC). Acyclovir was administered for
varicella infection and the ARDS was successfully treated with steroidpulse
therapy, hemofiltration and a mechanical respiratory support with a positive
end-expiratory pressure. Early administration of antiviral agents and extensive
management were thought to be necessary for such patients with severe
complications.

Publication Types: 
    Case Reports

PMID: 15645661 [PubMed - indexed for MEDLINE]

346: Epidemiol Infect. 2004 Dec;132(6):1135-8.

Seroepidemiology of varicella-zoster virus antibodies among health-care workers
and day-care-centre workers.

Lerman Y, Chodick G, Tepper S, Livni G, Ashkenazi S.

Department of Epidemiology & Preventive Medicine, Sackler Faculty of Medicine,
Tel-Aviv University, PO Box 39040, Tel-Aviv, Israel.

Inclusion of live varicella vaccine in the routine occupational health
vaccination schedule requires knowledge of the natural immunity to varicella
zoster virus (VZV) among high-risk occupations. This study aims were to evaluate 
VZV antibody positivity among health-care workers (HCWs) and day-care-centre
workers (DCWs) and to assess its association with potential risk factors. Three
groups of workers were tested for VZV antibody positivity: hospitals and
community clinic HCWs (n = 335), DCWs (n = 117) and blue-collar workers as
controls (n = 121). The total VZV antibody positivity was 94.4%. There was no
significant difference in VZV antibody positivity among study groups. DCWs had
the lowest VZV seroprevalence (90.9%, 95% CI 85.7-96.1) and controls the highest 
(96.6%, 95% CI 93.2-99.9). This high VZV antibody positivity suggests that no
special occupational measures are indicated in health-care or day-care
occupational settings in Israel. On-going monitoring of the natural immunity to
VZV is necessary to detect trends over time.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15635972 [PubMed - indexed for MEDLINE]

347: Epidemiol Infect. 2004 Dec;132(6):1129-34.

Seroprevalence of antibody to varicella zoster virus in England and Wales in
children and young adults.

Vyse AJ, Gay NJ, Hesketh LM, Morgan-Capner P, Miller E.

Health Protection Agency Sero-Epidemiology Unit, Immunisation Division,
Communicable Disease Surveillance Centre, London, UK. andrew.vyse@HPA.org.uk

This is the first large-scale study to investigate the seroprevalence of
varicella zoster (VZV) in the general population of England and Wales. The study 
focused on those aged 1-20 years, that age group in whom most infections occur.
Prevalence rose rapidly with age, with 53% of children showing evidence of prior 
infection by the age of 5 years and most young adults having experienced
infection. In addition to using a fixed cut-off recommended by the manufacturer, 
a mixture modelling technique was also used to define the proportion of the
population seropositive in each age group. This was shown to be a more accurate
approach to categorizing data from an epidemiological perspective.

PMID: 15635971 [PubMed - indexed for MEDLINE]

348: Epidemiol Infect. 2004 Dec;132(6):1121-7.

Seroprevalence and force of infection of varicella-zoster virus in Luxembourg.

Mossong J, Putz L, Schneider F.

Laboratoire National de Santé, PO Box 1102, L-1011 Luxembourg.
joel.mossong@lns.etat.lu

A serological prevalence survey was carried out in Luxembourg during 2000-2001 to
determine the antibody status of the Luxembourg population against
vaccine-preventable infections including varicella-zoster virus (VZV). ELISA
tests performed on 2679 sera indicated that 96 (3.6%) of the study population
were seronegative. Age-specific seroprevalence rose rapidly from approximately
70% at age 4 years to 90% at age 6 years to 95% at age 12 years. Significant
heterogeneity of seroprevalence was observed between the six different primary
schools. For age groups 0-5, 6-11 and 12+ years, we estimated an annual force of 
infection of 0.361 [95% confidence interval (CI) 0.31-0.415)], 0.204 (95% CI
0.12-0.29) and 0.05 (95% CI 0.024-0.082) respectively. Our results indicate that 
transmission of VZV is highest in children below the age of 6 years and that much
lower levels of VZV transmission occur in secondary schools and throughout
adulthood.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15635970 [PubMed - indexed for MEDLINE]

349: Pediatrics. 2005 Jan;115(1):e112-4.

Group A streptococcal subdural empyema as a complication of varicella.

Ulloa-Gutierrez R, Dobson S, Forbes J.

Pediatric Infectious Diseases Division, Department of Pediatrics, British
Columbia's Children's Hospital, and the University of British Columbia,
Vancouver, British Columbia, Canada. rgut@cw.bc.ca <rgut@cw.bc.ca>

Group A beta-hemolytic streptococcus and Staphylococcus aureus are the 2 most
common pathogens implicated in secondary invasive bacterial disease after
varicella. We describe a 3-month-old male infant from British Columbia, Canada,
who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and
evidence of intracranial hypertension. A prominent subdural empyema was
documented, and Streptococcus pyogenes was recovered from the subdural fluid.
Central nervous system bacterial complications should be part of the differential
diagnosis for infants and children with chickenpox who present with fever,
lethargy, focal seizures, or similar neurologic findings. This case illustrates
the importance of universal varicella vaccination to prevent associated bacterial
complications of chickenpox.

Publication Types: 
    Case Reports

PMID: 15629962 [PubMed - indexed for MEDLINE]

350: Cell. 2004 Dec 29;119(7):915-26.

Mannose 6-phosphate receptor dependence of varicella zoster virus infection in
vitro and in the epidermis during varicella and zoster.

Chen JJ, Zhu Z, Gershon AA, Gershon MD.

Department of Anatomy & Cell Biology, Columbia University, P&S, New York, NY
10032, USA.

Varicella zoster virus (VZV) is a highly infectious human pathogen; nevertheless,
infectious virions are not released in vitro where infection is cell associated. 
Four VZV envelope glycoproteins contain mannose 6-phosphate (Man 6-P), and Man
6-P blocks infection of cells by cell-free VZV. Expression of antisense cDNA or
siRNA-like transcripts were used to generate five stable human cell lines
deficient in cation-independent mannose 6-phosphate receptors (MPRci). All 5
MPRci-deficient lines resisted infection by cell-free, but not cell-associated,
VZV, secreted lysosomal enzymes, and released infectious virions when infected by
cell-associated VZV. Intracellular MPRci thus appear to divert newly enveloped
VZV to late endosomes, and plasmalemmal MPRci are necessary for entry by
cell-free VZV. Biopsies from VZV-infected human skin supported the idea that
because MPRci expression is naturally lost in maturing superficial epidermal
cells, these cells do not divert VZV to endosomes and constitutively secrete
infectious VZV.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15620351 [PubMed - indexed for MEDLINE]

351: J Infect Dis. 2005 Jan 15;191(2):198-206. Epub 2004 Dec 15.

Absence of circulating natural killer and primed CD8+ cells in life-threatening
varicella.

Vossen MT, Biezeveld MH, de Jong MD, Gent MR, Baars PA, von Rosenstiel IA, van
Lier RA, Kuijpers TW.

Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
m.t.vossen@amc.uva.nl

Five pediatric patients with no history of immunodeficiency had a
life-threatening course of varicella. Strikingly, natural killer (NK) cells were 
absent from the circulation in all children, and, despite active viral infection,
up to 98% of the CD8(+) cells were naive. Primary immunodeficiencies were
excluded--NK cells and primed CD8(+) cells reappeared in the circulation,
granzymes were detectable in plasma early during infection, and no abnormalities 
could be detected in interleukin-15 receptor function. Our data indicate that
varicella-zoster virus (VZV) has a unique capability to seclude primed CD8(+)
cells and NK cells from the circulating lymphocyte pool. This may be the
consequence of an overwhelming immune response to VZV that is influenced by
factors such as infectious dose, age, and the presence of maternal antibodies
during infancy. Because both homozygous twin sisters in the study had a severe
course of varicella, particular genetic factors may contribute to severe
varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15609229 [PubMed - indexed for MEDLINE]

352: J Clin Microbiol. 2004 Dec;42(12):5698-704.

Varicella seroprevalence and molecular epidemiology of varicella-zoster virus in 
Argentina, 2002.

Dayan GH, Panero MS, Debbag R, Urquiza A, Molina M, Prieto S, Del Carmen Perego
M, Scagliotti G, Galimberti D, Carroli G, Wolff C, Schmid DS, Loparev V, Guris D,
Seward J.

Epidemiology and Surveillance Division, National Immunization Program, Centers
for Disease Control and Prevention, MS E-61, 1600 Clifton Rd., Atlanta, GA 30333,
USA. gdayan@cdc.gov

There is limited data on immunity against varicella-zoster virus (VZV) in adults 
in different parts of Argentina, and it is not known which VZV strains are
circulating in Argentina. The objectives of this study were as follows: (i) to
evaluate seroprevalence of varicella among adults, assessing the accuracy of
clinical history and determining the sociodemographic factors associated with
seropositivity; and (ii) to determine the VZV strains circulating in Argentina. A
cross-sectional serological survey enrolling 2,807 women aged 15 to 49 years
attending public health-care settings in four cities in Argentina (i.e., Buenos
Aires, Salta, Mendoza, and Rosario) and one rural area was conducted from August 
to November 2002. Specimens for identification of VZV strains were obtained from 
vesicular lesions from 13 pediatric patients with varicella from different areas 
of the country. PCR amplification was used for genotyping. The overall
seroprevalence of varicella antibodies was 98.5% (95% confidence interval, 98.0
to 98.9), ranging from 97.2% in central Buenos Aires to 99.3% in southern Buenos 
Aires and Salta. Varicella seroprevalence increased with age. Crowding and length
of residence in the same place were associated with seropositivity. The positive 
predictive value of varicella history for immunity to varicella was 99.4%;
however, the negative predictive value was 2.5%. The European genotype was
identified in all viral specimens. In Argentina, seroprevalence in women more
than 15 years old was high regardless of the area of residence. Negative or
uncertain varicella history was not a good predictor of immunity. VZV genotype
was stable in all areas of the country.

PMID: 15583301 [PubMed - indexed for MEDLINE]

353: Clin Infect Dis. 2004 Dec 15;39(12):1810-7. Epub 2004 Nov 18.

Chickenpox or smallpox: the use of the febrile prodrome as a distinguishing
characteristic.

Moore ZS, Seward JF, Watson BM, Maupin TJ, Jumaan AO.

Viral Vaccine Preventable Disease Branch, National Immunization Program, Centers 
for Disease Control and Prevention, Atlanta, GA, USA. zack_moore@oz.ped.emory.edu

BACKGROUND: The ability to differentiate chickenpox from smallpox is important
for early recognition of bioterrorism events and prevention of false alarms. The 
febrile prodrome is a clinical feature used to differentiate these conditions.
However, the prevalence of prodromal manifestations in chickenpox has not been
well established. METHODS: We evaluated prodrome characteristics of all
chickenpox cases identified through an active varicella surveillance program over
a 21-month period. The frequencies of various prodromal manifestations among
vaccinated and unvaccinated case patients were assessed, and the impact of other 
demographic features on these manifestations was evaluated. Data were analyzed to
determine what proportion met the smallpox febrile prodrome criteria as
elaborated in the Centers for Disease Control and Prevention algorithm for
evaluating patients suspected of having smallpox. Finally, we compared our data
with historical data on smallpox prodromes. RESULTS: Data on prodrome
characteristics were available for 932 chickenpox cases. Prodromal fever was
present in 37% of unvaccinated chickenpox case patients and in 25% of vaccinated 
case patients. Among unvaccinated case patients, adults were 70% more likely than
children to have fever in the prodrome period. We found that prodromes are less
common and less severe in chickenpox than in smallpox. Nevertheless, 7%-17% of
unvaccinated chickenpox case patients meet the smallpox febrile prodrome
criteria. CONCLUSIONS: Febrile prodromes occur in a significant proportion of
patients with chickenpox, particularly among unvaccinated case patients and
adults. Therefore, the febrile prodrome alone is not a sufficient marker of
smallpox risk. All major and minor smallpox criteria should be considered
together in assessing the likelihood of smallpox.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15578404 [PubMed - indexed for MEDLINE]

354: Clin Infect Dis. 2004 Dec 1;39(11):1633-9. Epub 2004 Nov 9.

Comment in:
    Clin Infect Dis. 2004 Dec 1;39(11):1640-1.

High rate of varicella complications among Mexican-born adults in Alabama.

Danovaro-Holliday MC, Gordon ER, Jumaan AO, Woernle C, Judy RH, Schmid DS, Seward
JF.

National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, GA, USA. danovarc@paho.org

OBJECTIVE: Our study examines risk factors for severe varicella in an outbreak
among Mexican-born adults, and it compares susceptibility to infection and
reliability of self-reported varicella history for these individuals with that
for adults born in the United States in the outbreak locale, which may guide
vaccination strategies. METHODS: We interviewed case patients and non-case
persons in the affected apartment complex and workplace, assessed disease history
and susceptibility by testing for varicella-zoster virus immunoglobulin G
antibodies, and reviewed the clinical data of case patients. RESULTS: Five of 18 
case patients had serious complications for which they sought medical care; 1 was
hospitalized for pneumonia, and 1 was hospitalized for Guillain-Barré syndrome.
Only intense exposure (e.g., sharing a bed) was marginally associated with severe
disease (P=.08). In the workplace, varicella susceptibility was higher among
Mexican-born workers (20%) than among workers born in the United States (3%)
(adjusted prevalence odds ratio, 5.4; 95% confidence interval, 2.3-14.8).
Mexican-born persons had the highest positive predictive value of self-reported
disease (100%) in predicting immunity, and those born in the United States had
the lowest negative predictive value of self-reported history (10%) in predicting
susceptibility. CONCLUSIONS: Varicella is a more serious disease among adults
than among children, and Mexican-born adults living in the United States might
have a higher risk of acquiring varicella than US-born adults. Varicella
outbreaks involving adults should be prioritized for control efforts. Outbreaks
can be prevented by vaccinating susceptible adults.

PMID: 15578363 [PubMed - indexed for MEDLINE]

355: J Rheumatol. 2004 Dec;31(12):2517-8.

Disseminated primary varicella infection during infliximab treatment.

Vonkeman H, ten Napel C, Rasker H, van de Laar M.

Department of Rheumatology and the Department of Internal Medicine, Medisch
Spectrum Twente, PO Box 50000, 7500 KA Enschede, The Netherlands.
H.Vonkeman@ziekenhuis-mst.nl

A young man developed a serious disseminated varicella infection, necessitating
antiviral treatment, after being treated with anti-tumor necrosis factor-alpha
therapy for rheumatoid arthritis.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 15570661 [PubMed - indexed for MEDLINE]

356: Anesth Analg. 2004 Dec;99(6):1760-2, table of contents.

Comment in:
    Anesth Analg. 2005 Oct;101(4):1248; author reply 1248.

Epidural blood patch and acute varicella.

Martin DP, Bergman BD, Berger IH.

Department of Anesthesiology, Mayo Clinic, 200 First St. S.W., Rochester, MN
55905, USA. martin.david@mayo.edu

We present the case of a 38-yr-old woman who required an epidural blood patch in 
the context of acute varicella (chickenpox). The unique risks in this case
include the possible triggering of central nervous system complications after the
introduction of viremic blood into the epidural or intrathecal space. However,
the risk was believed to be acceptable because the patient was receiving
antiviral coverage. She enjoyed complete relief of her headache but experienced
transient back and leg pain. Leptomeningeal irritation caused by acute varicella 
infection may put patients at increased risk for pain after epidural blood patch.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 15562067 [PubMed - indexed for MEDLINE]

357: J Med Virol. 2005 Jan;75(1):174-80.

An evaluation of single nucleotide polymorphisms used to differentiate vaccine
and wild type strains of varicella-zoster virus.

Quinlivan M, Gershon AA, Steinberg SP, Breuer J.

Skin Virus Laboratory, Institute of Cell and Molecular Medicine, 25-29 Ashfield
Street, White Chapel, London E1 1BB, United Kingdom.

Rashes following immunization with the vaccine strain (vOka) of varicella-zoster 
virus (VZV) may occur in up to 5% of children and 10% of adults. In 40% of cases,
the causative virus is the vaccine strain and in 60% wild type virus is found.
Several reports have identified three restriction site polymorphisms in ORF 62
and the loss of one in ORF 6, which differentiate vOka from wild type VZV,
including the parental wild type strain from which vOka, is derived. Using
polymerase chain reaction (PCR), restriction enzyme analysis, and sequencing, we 
analyzed the presence of these markers in the GlaxoSmithKline (GSK, UK) and Merck
vaccine preparations as well as in 15 vaccine virus rashes and 15 wild type UK
viruses. Our data suggest that a Sma1 positive and an Nae1 positive site in ORF
62 are present in the GSK and Merck vaccine preparations and all vaccine virus
rashes. By contrast, a BssHII positive vaccine virus restriction site in ORF 62
and an Alu1 negative site in ORF 6 were mixed in the GSK and Merck vaccines and
absent in some of the vaccine rashes. The BssHII site was also present in the
European wild type C viruses in UK. The data suggest that unlike the Biken
vaccine preparation, the Merck and GSK vaccine preparations are polymorphic for
the BssHII and Alu1 restriction sites. These sites are also present variably in
the vaccine viruses causing rashes following vaccination, and are therefore
unreliable markers for differentiating vOka and wild type VZV strains. Copyright 
2005 Wiley-Liss, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15543576 [PubMed - indexed for MEDLINE]

358: Vaccine. 2004 Dec 21;23(6):755-61.

The burden and cost of hospitalised varicella and zoster in Australian children.

Carapetis JR, Russell DM, Curtis N.

Department of Paediatrics, Murdoch Children's Research Institute, Royal
Children's Hospital, University of Melbourne, Melbourne, Australia.
jonathan.carapetis@rch.org.au

BACKGROUND: Economic analyses of varicella-zoster virus (VZV) immunisation are
sensitive to the costs of hospitalised cases, so there is a need to validate VZV 
hospitalisation data. AIMS: To assess the accuracy of hospital VZV coding data
and to apply these parameters to a population-based sample to estimate incidence 
and costs. METHODS: A 3-year retrospective chart review from one hospital to
document clinical features and validate coding data. A separate 9-year analysis
of discharge data from two hospitals draining a defined region of suburban
Melbourne, with adjustment for miscoding and estimates of direct hospital costs. 
RESULTS: After correction for miscoding, 224 patients were admitted to one
hospital over 3 years, 79% with varicella and 21% with zoster. Miscoding resulted
in a 15% underestimate of zoster cases and a 4% overestimate of varicella cases. 
Thirty-six percent of varicella admissions compared to 80% of zoster admissions
were immunocompromised and/or had chronic disease. Compared to otherwise-healthy 
patients, immunocompromised patients were admitted earlier in their illness and
had lower complication rates. Forty-two percent of immunocompromised/chronic
disease patients with varicella had a known exposure, usually from a family
member. The incidence of hospitalised varicella and zoster in under 15-year olds 
was 15.7 and 1.8 per 100,000 per year, respectively. This suggests that there are
615 varicella hospitalisations and 72 zoster hospitalisations in this age group
each year in Australia, at a total direct cost of over 2.2 million AU dollars.
CONCLUSION: These results highlight the considerable burden of hospitalised
zoster and the importance of immunising non-immune contacts of immunocompromised 
individuals. They also support previous estimates of the incidence of
hospitalised varicella in Australian children and adolescents, although direct
medical costs may be higher than those previously estimated.

PMID: 15542199 [PubMed - indexed for MEDLINE]

359: CMAJ. 2004 Nov 9;171(10):1195-6.

Predictive value of a self-reported history of varicella infection in determining
immunity in adults.

Holmes CN, Iglar KT, McDowell BJ, Glazier RH.

The recent introduction of a vaccine for varicella has raised questions about
whether, for adults, a patient's history of varicella infection is useful in
determining if vaccination is necessary. We report findings on 184 family
medicine patients aged 18 to 65 years who were asked if they had a history of
varicella infection and were subsequently tested for varicella antibodies. A
history of infection was positive for 114 (62%) of the participants and negative 
or uncertain for 70 (38%). All 114 subjects who reported a varicella infection
history were immune. All 4 subjects who were not immune reported an uncertain or 
negative infection history. Except for people who are at increased risk of
varicella infection or complications from infection, serologic testing may not be
required for adults in the general population who have a history of varicella
infection.

Publication Types: 
    Evaluation Studies
    Letter
    Research Support, Non-U.S. Gov't

PMID: 15534312 [PubMed - indexed for MEDLINE]

360: Clin Microbiol Infect. 2004 Nov;10(11):954-60.

Effects of varicella vaccination on herpes zoster incidence.

Wagenpfeil S, Neiss A, Wutzler P.

Institute for Medical Statistics and Epidemiology, Technical University of
Munich, Munich, Germany. Stefan.Wagenpfeil@imse.med.tu-muenchen.de

The effects of a general varicella vaccination programme on the incidence of
herpes zoster are of major public health importance. This review focuses on two
key aspects, namely the relationship between wild-type virus spread and the
incidence of herpes zoster, as obtained from recent surveys, surveillance and
observational studies, and the results from mathematical population models.
Although knowledge is limited, close contact with varicella cases seems to have a
protective effect. Thus, an increase in zoster incidence after varicella
immunisation is possible, but the extent is unknown because of the influence of
other factors independent of immunisation. Currently, vaccination effects
estimated from mathematical modelling depend strongly on pre-specified
assumptions. In order to obtain more precise predictions, the results of ongoing 
monitoring and clinical studies are awaited and further studies are suggested.
Vaccination recommendations can be adapted at any time to take account of further
findings in this area.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15521996 [PubMed - indexed for MEDLINE]

361: Turk J Pediatr. 2004 Jul-Sep;46(3):256-8.

Acute arterial thrombotic purpura complicating varicella and the role of
hyperbaric oxygen as an adjunctive therapy.

Siraneci R, Hatipoğlu N, Hatipoğlu H, Dündar K, Baygin L, Yildiz C, Türel O.

Department of Pediatrics, Social Security Foundation, Bakirköy Maternity and
Children's Training Hospital, Istanbul, Turkey.

Chickenpox is a common infectious disease of the pediatric age group with rare
complications such as hemorrhagic varicella and arterial thrombotic purpura.
Medical support is the mainstay of treatment in such cases but for the rescue of 
necrotic tissues, hyperbaric oxygen (HBO) therapy should be applied in addition
to anticoagulant intervention. We report an infant with acute arterial thrombotic
purpura which developed after varicella eruption and who made full recovery with 
the help of HBO as an adjunctive treatment modality. Fresh frozen plasma and low 
molecular weight heparin were given for prolonged prothrombin time and
thromboemboli on the 2nd-4th digits of his right foot. Protein C, protein S and
factor V levels were found to be normal in our patient. Necrotic lesions on the
toes regressed with repeated HBO treatment and amputation was not needed.

Publication Types: 
    Case Reports

PMID: 15503480 [PubMed - indexed for MEDLINE]

362: Intern Med. 2004 Sep;43(9):861-4.

Involvement of the esophagus and stomach as a first manifestation of varicella
zoster virus infection after allogeneic bone marrow transplantation.

Takatoku M, Muroi K, Kawano-Yamamoto C, Nagai T, Komatsu N, Ozawa K.

Division of Hematology, Department of Medicine, Jichi Medical School,
Minamikawachi-machi, Tochigi.

A 46-year-old man with myeloproliferative disorder received a stem cell
transplant from an HLA-identical unrelated donor. Eight months status post
transplantation, during the course of tacrolimus therapy, the patient developed
severe epigastric pain and fever. FGS findings showed eruptions with blisters in 
the esophagus and ulcers in the stomach. Biopsy specimens revealed acidophilic
inclusion bodies in the nuclei. Varicella zoster virus (VZV) DNA copies were
detected in the serum. No skin lesions were observed prior to hospital admission.
The diagnosis of visceral VZV infection was made and the gastric and esophageal
lesions were successfully healed with acyclovir (ACV). Severe abdominal pain is
one of the most important signs of VZV infection for recipients of stem cell
transplantation.

PMID: 15497526 [PubMed - indexed for MEDLINE]

363: J Med Virol. 2004 Dec;74(4):677-82.

Rapid detection of varicella-zoster virus infection by a loop-mediated isothermal
amplification method.

Okamoto S, Yoshikawa T, Ihira M, Suzuki K, Shimokata K, Nishiyama Y, Asano Y.

Department of Medicine, Division of Respiratory Medicine, Nagoya University
Graduate School of Medicine, Nagoya, Aichi, Japan.

The reliability of varicella-zoster virus (VZV) loop-mediated isothermal
amplification (LAMP) was evaluated for rapid diagnosis of viral infection.
VZV-specific primers only amplified VZV DNA; no LAMP products were observed in
reactions performed with other viral DNA templates. The specificity of this
method was confirmed by two independent determinations, agarose gel
electrophoresis and a turbidity assay. The sensitivity of VZV LAMP, determined by
agarose gel electrophoresis, were 500 copies/tube. Detection using the turbidity 
assay, however, gave a sensitivity of 1,000 copies/tube. After these initial
validation studies, reliability of VZV LAMP was evaluated for the detection of
viral DNA in clinical specimens. Thirty-two swab samples collected from patients 
with vesicular skin eruptions were tested for VZV DNA. VZV was confirmed in
sample numbers 10-32 by VZV real-time PCR, a previously established technique.
VZV LAMP products were detected using turbidity from samples 13 to 32
(sensitivity; 87.0%, specificity; 100%, positive predictive value; 100%, negative
predictive value; 75%). Although low levels of VZV DNA could be detected in the
three samples exhibiting divergent results (samples numbers 10-12), no VZV LAMP
product was detected in these samples, indicating a higher detection limit for
this assay. Requirement of a DNA extraction step in the VZV LAMP method was
examined in next experiment. The turbidity assay detected a VZV LAMP product in
all of the 20 positive swab samples (samples numbers 13-32), regardless of DNA
extraction. 2004 Wiley-Liss, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15484264 [PubMed - indexed for MEDLINE]

364: Commun Dis Public Health. 2004 Sep;7(3):169-71.

Comment in:
    Commun Dis Public Health. 2004 Sep;7(3):162-3.

Outbreak of chickenpox in a Scottish prison.

Wood R, Stevenson J.

Lothian NHS Board, Edinburgh, Scotland. rachael.wood@lhb.scot.nhs.uk

An outbreak of chickenpox occurred in a Scottish prison in April 2003. Three
clinical cases (one virologically confirmed) were identified, two prisoners and
one staff member. All were male and aged between 30 and 45 years. A further six
possible cases were identified. The source of the outbreak was likely to have
been a prisoner's child who visited the prison with a chickenpox rash. The
outbreak was point source in nature, and no secondary spread of infection
occurred within the prison despite the crowded conditions, possibly reflecting
high levels of natural immunity. The outbreak serves as a reminder of the prison 
environment and the vulnerability of the prison population to infectious disease,
both because of the prison environment and the clinical characteristics of the
prison population.

PMID: 15481206 [PubMed - indexed for MEDLINE]

365: Commun Dis Public Health. 2004 Sep;7(3):164-8.

Comment in:
    Commun Dis Public Health. 2004 Sep;7(3):162-3.

Fatal outbreak of chickenpox (varicella-zoster virus infection) among
institutionalised adults with learning difficulties.

Noorda J, Hoebe CJ.

Department of Infectious Diseases, Western and Eastern South Limburg Municipal
Health Service, Heerlen, The Netherlands.

Most adults are not susceptible to chickenpox. We present a report of an outbreak
of chickenpox among institutionalised adults with learning difficulties. An
inventory of exposed and possible affected residents was done after three adult
males were diagnosed with chickenpox following a case of zoster. Individuals with
a recent history of chickenpox rash or herpes zoster were included as cases.
Medical files were used to derive background information. Serum samples of the
first two patients were tested for IgM varicella-zoster virus (VZV) antibodies.
Eventually ten cases of chickenpox (eight residents and one group leader and her 
partner) and two residents with herpes zoster were registered over a period of
four months in 2001. The first two patients tested positive in serum. One
resident with chickenpox died. This outbreak suggests a higher risk from
chickenpox for institutionalised adults with learning difficulties in comparison 
with the general Dutch population, probably due to limited contacts with the
general population. Further research into varicella-zoster seroprevalence,
preferably with low-invasive diagnostic methods, is necessary to determine if
this potential risk is present elsewhere, since the risk of life-threatening
chickenpox in adults could be reduced by the now available live attenuated VZV
vaccine.

PMID: 15481205 [PubMed - indexed for MEDLINE]

366: Ann Trop Paediatr. 2004 Sep;24(3):271-4.

Deep venous thrombosis and pulmonary embolism following chickenpox.

Padmakumar B, Sun J, Satchithananthan G, Sills JA, Alwaidh MA.

Department of Paediatrics, The Royal Oldham Hospital, Oldham, UK.
beena.padmakumar@pat.nhs.uk

An 11-year-old girl developed proximal deep venous thrombosis and bilateral
pulmonary embolism associated with antiphospholipid syndrome following
chickenpox. She responded to prolonged anticoagulation therapy. Copyright 2004
Liverpool School of Tropical Medicine

Publication Types: 
    Case Reports

PMID: 15479579 [PubMed - indexed for MEDLINE]

367: Vaccine. 2004 Oct 22;22(31-32):4233-7.

Comparison of varicella history with presence of varicella antibody in refugees.

Christiansen D, Barnett ED.

Program in Epidemiology, Boston University School of Public Health, Boston, MA
02118, USA.

OBJECTIVE: To compare history of varicella with presence of varicella antibody in
refugees and to determine the number of unnecessary doses of varicella vaccine
administered to refugee children > or =7 years of age. METHODS: Cross-sectional
study of refugees > or =7 years of age evaluated between July 2000 and October
2002 by the Refugee Health Assessment Program at Boston Medical Center. We
recorded age, sex, region of origin, varicella history, and results of serologic 
testing for presence of varicella antibodies. RESULTS: Eighty-eight percent of
individuals with a positive history of clinical varicella had varicella antibody;
65% of those with negative history had varicella antibody. The positive
predictive value of a history of clinical varicella was 88%. The negative
predictive value of a negative history was 39%. CONCLUSION: History of varicella 
was not a reliable predictor of presence or absence of varicella antibody in
refugees. Strategies to protect individuals with negative histories of clinical
varicella include immediate immunization or serotesting followed by immunization 
of susceptible individuals. Relying on positive histories of clinical varicella
may leave some individuals susceptible to varicella and impede efforts to
eliminate varicella in the US.

Publication Types: 
    Comparative Study

PMID: 15474713 [PubMed - indexed for MEDLINE]

368: Trop Gastroenterol. 2004 Apr-Jun;25(2):82-3.

Erratum in:
    Trop Gastroenterol. 2004 Oct-Dec;25(4):194.

Acute pancreatitis: presenting manifestation of varicella infection.

Malhi NS, Dutta U, Sathyanarayana G, Singh K.

Department of Gastroenterology, Postgraduate Institute of Medical Education and
Research, Chandigarh 160012, India.

A 29-year-old man presented with symptoms suggestive of acute pancreatitis of 3
day's duration. No definite aetiology was identifiable at admission. The patient 
had been receiving corticosteroids for the preceding 1 month, after the
evacuation of a traumatic subdural haematoma. During the hospital stay, he
developed a macular skin rash, which evolved over a period of 48 hours to a
papulovesicular rash typical of varicella infection. Liver function tests were
suggestive of anicteric hepatitis. Acyclovir therapy was instituted. However, the
patient succumbed to an episode ventricular arrhythmia of sudden onset, possibly 
due to varicella myocarditis. A high index of suspicion for varicella infection
in immunocompromised patients presenting with acute pancreatitis is necessary for
early diagnosis. The rash may at times be atypical and may rarely appear after
the onset of pancreatitis. Whenever any rash develops in the setting of
pancreatitis of unknown aetiology, rapid diagnostic tests should be undertaken to
establish the diagnosis and start appropriate therapy.

Publication Types: 
    Case Reports

PMID: 15471323 [PubMed - indexed for MEDLINE]

369: Pediatr Ann. 2004 Sep;33(9):584-9.

Live viral vaccines in the control of highly infectious diseases: measles and
varicella.

Frenkel LD.

Office for Research Support Services, University of Illinois College of Medicine,
Rockford, IL 61107, USA.

It is possible that by the end of this decade, measles and varicella two of the
most infections and previously universal diseases of children, with massive
levels of morbidity and significant mortality, may become of historical interest 
only. To accomplish this success, it is imperative that all involved parties do
what is required. The vaccine supply must be assured, parents must be
appropriately educated and reinforced by the media to bring their children to be 
immunized, and healthcare personnel must both aggressively ascertain and
administer needed immunizations.

PMID: 15462573 [PubMed - indexed for MEDLINE]

370: Eur J Epidemiol. 2004;19(7):699-702.

The burden of severe varicella in Spain, 1995--2000 period.

Gil A, González A, Oyagüez I, Martín MS, Carrasco P.

Department of Health Sciences, Rey Juan Carlos University, Avda de Atenas s/n,
Alcorcón, Spain. a.gildemiguel@cs.urjc.es

BACKGROUND: Population-based estimates of hospitalization rates for varicella
provide data of the severe and costly end of this disease. OBJECTIVE: To estimate
the annual burden of hospitalization due to primary varicella in the 17
Autonomous Regions of Spain. METHODS: Data were obtained from the national
surveillance system for hospital data and comprises all hospital discharges for
varicella reported during the 1995--2000 period. RESULTS: The overall incidence
of hospitalizations was 2.7 per 100,000 persons per year (ranging from 3.2 in
Navarra to 1.5 in the Canary Islands). Forty-eight deaths were reported during
the period. Each year varicella was responsible for 3017 days of hospitalization 
in persons < or =10 years of age and 3333 days in persons > 10 years of age. The 
annual cost of these hospitalizations was 1.2 million and more than 500.000 euros
for persons < or =10 years and > 10 years of age, respectively. CONCLUSION:
Varicella is associated to a severe morbidity in children, adolescents and adults
in Spain. The burden of varicella is likely to be potentially reduced by
effective immunization programs.

PMID: 15461202 [PubMed - indexed for MEDLINE]

371: Eur J Health Econ. 2004 Feb;5(1):46-53.

The burden of varicella in Germany. Potential risks and economic impact.

Banz K, Wagenpfeil S, Neiss A, Hammerschmidt T, Wutzler P.

Outcomes International, Basle, Switzerland.

Varicella (chickenpox) has traditionally been regarded as a benign, inevitable
disease of childhood. In Germany information on the clinical and economic impact 
of varicella is limited. This study assessed the health risks and economic burden
of varicella with a special focus on the relevance of complications as a cost
driver. We used an age-structured, dynamic infectious disease model for the
spread of infection in the German population combined with a module modeling the 
course of disease and medical management in the case of infection. Model input
data were derived mainly from a retrospective epidemiological survey of 1,334
varicella cases in Germany. This survey included detailed information on
outpatient care, complications, inpatient treatment, and sick leave. In the base 
case analysis the model predicted approx. 740,000 varicella cases per year. Some 
40,000 experienced complications, of which 5,700 required inpatient care. Total
annual costs for payers, i.e., sickness funds, was 78 million euro, the largest
portion of which was due to the significant coverage of work loss costs incurred 
by parents caring for their sick children ("Kinderpflegekrankengeld"). For the
society total annual costs were 187.5 million euro, 82% of which was indirect.
Complications account for disproportionate 32% (25%) of cost from the payers'
(societal) perspective. However, the vast majority of costs are due to
uncomplicated cases. The burden of varicella in Germany is thus significant, not 
only in terms of morbidity but also from an economic viewpoint. Vaccination
strategies targeting groups with high risk of complications might fail to reduce 
the considerable burden of varicella substantially. Routine vaccination against
varicella would be a meaningful measure to reduce the burden of VZV infection in 
Germany.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15452764 [PubMed - indexed for MEDLINE]

372: Rev Med Virol. 2004 Nov-Dec;14(6):363-81.

Simian varicella: a model for human varicella-zoster virus infections.

Gray WL.

Department of Microbiology and Immunology, 4301 West Markham Street, University
of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
graywayne1@uams.edu

Simian varicella virus (SVV) causes a natural varicella-like disease in nonhuman 
primates. Epizootics of simian varicella occur sporadically in facilities housing
Old World monkeys. SVV is antigenically and genetically related to
varicella-zoster virus (VZV), the etiologic agent of varicella (chickenpox) and
herpes zoster (shingles) in humans. The SVV and VZV genomes are similar in size
and structure, share 70%-75% DNA homology and are co-linear with respect to gene 
organisation. Simian varicella is a highly contagious disease characterised by
fever and vesicular skin rash and may progress to pneumonia and hepatitis.
Infected monkeys may resolve the disease within 2 weeks although epizootics are
sometimes associated with high morbidity and mortality. SVV, like VZV,
establishes life-long latent infection, as indicated by detection of viral DNA
within neural ganglia. Subsequently, SVV may reactivate to cause secondary
disease and spread of the virus to susceptible monkeys. The relatedness of VZV
and SVV and the similarities in the clinical symptoms and pathogenesis of human
and simian varicella make SVV infection of nonhuman primates an excellent animal 
model to investigate VZV pathogenesis and latency, and to evaluate potential
antiviral strategies. 2004 John Wiley & Sons, Ltd.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15386593 [PubMed - indexed for MEDLINE]

373: Arch Dis Child. 2004 Oct;89(10):966-9.

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

Lowe GL, Salmon RL, Thomas DR, Evans MR.

National Public Health Service Communicable Disease Surveillance Centre, Abton
House, Cardiff CF14 3QX, UK. Gwen.lowe@nphs.wales.nhs.uk

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

PMID: 15383443 [PubMed - indexed for MEDLINE]

374: Vaccine. 2004 Sep 28;22(29-30):4002-13.

Critical prevalence of antibodies minimizing vaccination costs for hepatitis A,
hepatitis B, varicella, measles and tetanus in adults and adolescents in
Catalonia, Spain.

Plans-Rubió P.

Department of Health, General Direction of Public Health, Travessera de les Corts
131-159, 08028 Barcelona, Spain.

The prevalence of seropositive individuals that makes costs of vaccinating all
individuals equal to that for screening and vaccination of susceptible
individuals is defined as the critical prevalence of antibodies (p*). Screening
and vaccination is more efficient when the prevalence of seropositive individuals
(p) in the population is higher than p*. In this study, the formula to obtain p* 
was derived from the cost-effectiveness equations, showing that it depends on
screening and vaccination costs, programme compliance, screening test
performance, vaccine efficacy and disease costs. The formula was used to
determine the least costly vaccination strategy for hepatitis A and B, varicella,
measles and tetanus in adults and adolescents in Catalonia. The least costly
vaccination strategy was vaccination without screening (since p was lower than
p*) for hepatitis B, measles and tetanus in adults and adolescents (5-14 years)
and for hepatitis A in individuals aged 5-24 years, and screening and vaccination
(since p was higher than p*) for varicella in adults and adolescents and for
hepatitis A in adults aged >24 years. Vaccination strategies based on the
critical prevalence of antibodies could maximize the immunity level in the
community from available resources.

PMID: 15364450 [PubMed - indexed for MEDLINE]

375: Vaccine. 2004 Sep 28;22(29-30):3947-51.

Epidemiology of severe varicella-zoster virus infection in Spain.

Gil A, San-Martín M, Carrasco P, González A.

Department of Health Sciences, Rey Juan Carlos University, Avda de Atenas s/n,
28922 Alcorcón, Madrid, Spain. a.gildemiguel@cs.urjc.es

Data of hospitalizations for varicella and herpes zoster in Spain during the
1999-2000 period were obtained from the national surveillance system for hospital
data. A total of 3083 hospitalizations for varicella and 6324 for herpes zoster
were identified, representing an annual incidence of 4.1 and 8.4 per 100,000
persons per year, respectively. Almost half of patients hospitalized for
varicella were children under 5 years of age. In contrast, 78% of
hospitalizations for zoster occurred in adults >50 years of age. Hospitalizations
for varicella and herpes zoster resulted annually in 11,141 and 40,090 days of
hospitalization and a cost of 3.2 and 7.0 million, respectively.

PMID: 15364443 [PubMed - indexed for MEDLINE]

376: Pediatrics. 2004 Sep;114(3):786-92.

Decline in varicella-related hospitalizations and expenditures for children and
adults after introduction of varicella vaccine in the United States.

Davis MM, Patel MS, Gebremariam A.

Child Health Evaluation and Research Unit, Division of General Pediatrics,
University of Michigan, Ann Arbor, Michigan 48109-0456, USA. mattdav@umich.edu

OBJECTIVE: Universal childhood immunization against varicella in the United
States, first recommended in 1995, was predicted to lead to significant decreases
in varicella-related hospitalization rates and corresponding charges. Previous
studies have not found such effects. We studied trends in varicella-related
hospitalization rates and associated charges before and after introduction of
varicella vaccine. METHODS: We examined hospitalization and charge data from the 
Nationwide Inpatient Sample for the years 1993-2001, representative of national
hospitalization patterns for children and adults. We derived weighted estimates
of population-adjusted, varicella-related hospitalization rates and
inflation-adjusted, varicella-related hospital charges. RESULTS: The annual
varicella-related hospitalization rate exceeded 0.5 hospitalizations per 10,000
US population from 1993 to 1995, declined to 0.26 per 10,000 by 1999, and again
halved to 0.13 per 10,000 by 2001. Hospitalization rates declined most
substantially among individuals primarily targeted for vaccination (0- to
4-year-old children) but decreased among youths aged 5 to 19 years and among
adults as well. Concomitantly, varicella-related hospital charges declined from
161.1 million dollars (95% confidence interval: 130.5 million dollars-191.8
million dollars) in 1993 to 66.3 million dollars (95% confidence interval: 50.9
million dollars-81.7 million dollars) in 2001 (all 2001 US dollars). Among
expected primary payers, inflation-adjusted declines in varicella-related
hospital discharges-related charges accrued to Medicaid, private insurance, and
"other" payers (including uninsured and self-pay) but not to Medicare.
CONCLUSIONS: This national analysis indicates a clinically and statistically
significant reduction in varicella-related hospitalizations for children and
adults associated with childhood varicella immunization in the United States and 
a corresponding significant decrease in hospital charges.

PMID: 15342855 [PubMed - indexed for MEDLINE]

377: Biometrics. 2004 Sep;60(3):615-23.

Infections with varying contact rates: application to varicella.

Whitaker HJ, Farrington CP.

Department of Statistics, The Open University, Walton Hall, Milton Keynes MK7
6AA, UK.

We develop methods for the analysis of infectious disease data when age-specific 
contact rates vary over time. Our methods are valid when contact rates vary
slowly on the time scale of the infection process, and are applicable to a
variety of data types including serial seroprevalence surveys and case reports.
The methods exploit approximate endemic equilibria, and require numerical
solution of an associated integral equation in age and time. We also estimate
summary statistics such as time-dependent analogs of the basic reproduction
number and critical immunization threshold. We illustrate the methods with data
on varicella (chickenpox) in the United Kingdom.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15339283 [PubMed - indexed for MEDLINE]

378: Acta Paediatr Taiwan. 2004 Mar-Apr;45(2):94-6.

Kawasaki disease associated with chickenpox: report of two sibling cases.

Lee DH, Huang HP.

Department of Pediatrics, Far Eastern Memorial Hospital, Taipei, Taiwan.

Kawasaki disease is a group of acute febrile illnesses of young children.
Infectious etiology for Kawasaki disease has been long postulated, although no
single causing agent has been identified consistently by conventional methods.
This report described two sisters, soon after a primary infection by
varicella-zoster virus, manifesting fever and muco-cutaneous lesions compatible
with the feature of Kawasaki disease consecutively. Mild dilatation of the
coronary artery was revealed in both by echocardiography. Both of them received
intravenous gamma-globulin therapy and the follow-up echocardiography showed no
further progression of the coronary lesion. We suggest the possibility of
varicella-zoster virus as one of the triggering agents for Kawasaki disease in
genetically susceptible individuals. The severe cardiac complication of Kawasaki 
disease may be prevented by early treatment if clinicians are alert to this
possible association in those children with chickenpox exhibiting unusual
muco-cutaneous lesions.

Publication Types: 
    Case Reports

PMID: 15335119 [PubMed - indexed for MEDLINE]

379: East Mediterr Health J. 2001 Jul-Sep;7(4-5):604-8.

Varicella susceptibility among children and healthy adults in the United Arab
Emirates.

Uduman SA, Tahira AM, Al-Wash R, Usmani MA, Bener A.

Department of Paediatrics, Faculty of Medicine and Health Sciences, United Arab
Emirates University, United Arab Emirates.

The serological evidence of varicella zoster virus infection was determined among
healthy individuals from infancy to 47 years of age living in this region. Of 648
people, 126 (19.4%) had no detectable antibody and were susceptible to infection.
The overall adult seroprevalence rate was 81.3%. The rate among Emirati citizens 
increased with age; < 10 years, 45.8%; 11-20 years, 68.4%; 21-30 years, 89.5%;
31-40 years, 94.7%; and > 41 years, 88.9%. Adults from the Indian subcontinent
and Philippines had variable prevalence rates and Sri Lankans living in the
region were highly serosusceptible (35%). Because of the clinical impact of
varicella in adult populations, vaccine prevention might be beneficial.

PMID: 15332755 [PubMed - indexed for MEDLINE]

380: Pharmacoeconomics. 2004;22(13):839-55.

Varicella vaccination in Italy : an economic evaluation of different scenarios.

Coudeville L, Brunot A, Giaquinto C, Lucioni C, Dervaux B.

Cresge-Labores, Catholic University of Lille, Lille, France.

AIM: To determine the economic impact (cost-benefit analysis) of childhood
varicella vaccination, with the Oka/Merck varicella zoster virus vaccine live
(Varivax) in Italy. METHODS: This analysis is based on an epidemiological model
of varicella zoster virus (VZV) dynamics adapted to the Italian situation. Cost
data (Euro, 2002 values) were collected through a literature review. Several
vaccination scenarios were analysed: (i) routine vaccination programme for
children aged 1-2 years with different levels of vaccination coverage (90%, 70%
and 45%) without any catch-up programme; (ii) routine vaccination programme for
children aged 1-2 years with different levels of vaccination coverage (90%, 70%
and 45%) completed by a catch-up programme for 6-year-old children over the first
5 years of vaccine marketing; and (iii) routine vaccination programme for
children aged 1-2 years with different levels of vaccination coverage (90%, 70%
and 45%) completed by a catch-up programme during the first year of vaccine
marketing for children aged 2-11 years. PERSPECTIVES: A societal perspective,
including both direct and indirect costs, and a health-system perspective,
limited to costs supported by Italian Health Authorities, were considered.
RESULTS: A routine vaccination programme has a clearly positive impact on
chickenpox morbidity. Respectively, 68% and 57% of chickenpox-related
hospitalisations and deaths could be prevented with a 90% coverage rate. With
vaccination costs being more than offset by a reduction in chickenpox treatment
costs in the base case, such a programme could also induce savings from both a
societal and a health-system perspective (40% and 12% savings, respectively for a
90% coverage rate). A lower coverage rate reduces cost savings, but there is
still a 9% decrease in overall societal costs for a 45% coverage rate. Although
the reduction in total societal costs was robust to the sensitivity analyses
performed, a slight uncertainty remains regarding cost reduction from a
health-system perspective. However, in this latter perspective, even in the
worst-case scenario of the sensitivity analysis, routine vaccination programmes
may be cost effective, the worst-case scenario for cost parameters leading to
cost per life-year gained of Euro2853. Catch-up programmes combined with routine 
vaccination should lead to further cost reductions from a societal perspective:
15% for a massive catch-up during the first year of vaccine marketing compared
with toddlers' vaccination alone, and 11% for a catch-up focused on 6-year-old
children for a period of 5 years. However, the impact of catch-up programmes on
the costs from an Italian health-system perspective remains close to zero
(+/-1%). CONCLUSION: This model suggests, with its underlying assumptions and
data, that routine ZVZ vaccination may be cost saving from both a societal and a 
health system perspective in the base case. In the worst-case scenario of the
sensitivity analysis, vaccination remains cost effective.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15329030 [PubMed - indexed for MEDLINE]

381: Int J Infect Dis. 2004 Sep;8(5):259-70.

A review of the varicella vaccine in immunocompromised individuals.

Sartori AM.

Clinic of Infectious and Parasitic Diseases, Hospital das Clínicas, University of
São Paulo School of Medicine, São Paulo, SP, Brazil. amsartori@sti.com.br

BACKGROUND: Individuals with underlying cell-mediated immunodeficiency disorders 
are at high risk of developing severe, life-threatening illness associated with
varicella-zoster virus infection. A live-attenuated varicella vaccine is
recommended for routine childhood immunisation in some countries. In healthy
children, the vaccine is efficacious and safe but because immunocompromised
individuals may be unable to limit replication of live-attenuated vaccine
viruses, the varicella vaccine is not recommended for them and there are few
exceptions. OBJECTIVES: The purpose of this paper is to review the published
studies addressing the use of the varicella vaccine in people with cell-mediated 
immunodeficiency disorders. METHODS: A computerised search on the PubMed database
was used to collect the relevant papers published up to March 2003. RESULTS: The 
varicella vaccine has been extensively studied in susceptible children with acute
lymphoblastic leukaemia in remission, but studies involving individuals with
other immunodeficiency disorders are scarce. Some of the current recommendations 
are based on very few and small studies with short follow-up. Immunocompromised
individuals should be given the varicella vaccine only with complete knowledge of
their clinical and immunological conditions and after considering the risks of
natural infection and vaccination.

Publication Types: 
    Review

PMID: 15325594 [PubMed - indexed for MEDLINE]

382: Vaccine. 2004 Sep 9;22(27-28):3546-62.

An economic evaluation of varicella vaccination in Italian adolescents.

Thiry N, Beutels P, Tancredi F, Romanò L, Zanetti A, Bonanni P, Gabutti G, Van
Damme P.

Centre for the Evaluation of Vaccination, Epidemiology and Social Medicine,
University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
nancy.thiry@ua.ac.be

An economic evaluation was performed to assess five varicella vaccination
scenarios targeted to 11-year-old Italian adolescents. The scenarios were:
"compulsory vaccination" of all adolescents, recommended vaccination of
susceptible adolescents on the basis of an "anamnestic screening", a "blood test"
or a combination of both ("both tests") and vaccination of adolescents in the
private sector, at the parents' charge ("private vaccination"). Probabilities and
unit costs were taken from published sources and experts opinion. The accuracy of
the anamnestic screening (81.6% sensitivity and 87.3% specificity) was derived
from a separate descriptive study among 344 Italian adolescents. The costs and
benefits of each scenario were simulated using a Markov model and
cost-effectiveness, budget-impact and cost-benefit analyses were conducted. Of
all considered scenarios, "both tests" and "anamnestic screening" were the most
appealing options with an estimated net direct cost of 5058 and 8929 per
life-year gained (compared to no vaccination) versus 14,693-42,842 for the other 
scenarios. These two scenarios further resulted in substantial net savings for
society (over 600,000 per cohort, BCR: 2.17). The need for a serological
confirmation was highly dependent on the sensitivity of the anamnestic screening,
which is believed to increase once such a program is launched. For practical
considerations, "anamnestic screening" seems to be the most convenient option.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15315834 [PubMed - indexed for MEDLINE]

383: JAMA. 2004 Aug 11;292(6):704-8.

Comment in:
    J Pediatr. 2005 Jan;146(1):147.

Contagiousness of varicella in vaccinated cases: a household contact study.

Seward JF, Zhang JX, Maupin TJ, Mascola L, Jumaan AO.

Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
jseward@cdc.gov

CONTEXT: Limited data are available on the contagiousness of vaccinated varicella
cases. OBJECTIVES: To describe secondary attack rates within households according
to disease history and vaccination status of the primary case and household
contacts and to estimate varicella vaccine effectiveness. DESIGN, SETTING, AND
PATIENTS: Population-based, active varicella surveillance project in a community 
of approximately 320,000 in Los Angeles County, California, during 1997 and 2001.
Varicella cases were reported by child care centers, private and public schools, 
and health care clinicians and were investigated to collect demographic,
clinical, medical, and vaccination data. Information on household contacts' age, 
varicella history, and vaccination status was collected. MAIN OUTCOME MEASURES:
Varicella secondary attack rate among household contacts; vaccine effectiveness
using secondary attack rates in unvaccinated and vaccinated children and
adolescents. RESULTS: A total of 6316 varicella cases were reported. Among
children and adolescents aged 1 to 14 years, secondary attack rates varied
according to age and by disease and vaccination status of the primary case and
exposed household contacts. Among contacts aged 1 to 14 years exposed to
unvaccinated cases, the secondary attack rate was 71.5% if they were unvaccinated
and 15.1% if they were vaccinated (risk ratio [RR], 0.21; 95% confidence interval
[CI], 0.15-0.30). Overall, vaccinated cases were half as contagious as
unvaccinated cases. However, vaccinated cases with 50 lesions or more were
similarly contagious as unvaccinated cases whereas those with fewer than 50
lesions were only one third as contagious (secondary attack rate, 23.4%; RR, 0.32
[95% CI, 0.19-0.53]). Vaccine effectiveness for prevention of all disease was
78.9% (95% CI, 69.7%-85.3%); moderate disease, 92% (50-500 lesions) and 100%
(clinician visit); and severe disease, 100%. CONCLUSIONS: Under conditions of
intense exposure, varicella vaccine was highly effective in preventing moderate
and severe disease and about 80% effective in preventing all disease.
Breakthrough varicella cases in household settings were half as contagious as
unvaccinated persons with varicella, although contagiousness varied with numbers 
of lesions.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15304467 [PubMed - indexed for MEDLINE]

384: Infect Control Hosp Epidemiol. 2004 Jul;25(7):595-8.

Screening healthcare workers for varicella-zoster virus: can we trust the
history?

Almuneef M, Memish ZA, Abbas ME, Balkhy HH.

Department of Infection Prevention and Control and Pediatrics, King Abdulaziz
Medical City-King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVE: To determine the relationship between immunity and a history of
chickenpox based on a self-administered questionnaire. METHODS: We investigated
immunity to varicella-zoster virus in a cohort of newly recruited employees with 
different job categories and different nationalities using enzyme-linked
immunosorbent assay IgG. RESULTS: There were 1,058 new recruits. Of these, 890
(84%) were immune and 168 (16%) were susceptible. The susceptibility rate was 23%
(n = 77) for Asian, 15% (n = 14) for South African, 13% (n = 66) for Middle
Eastern, and 9% (n = 11) for Western employees. Physicians were more likely to be
immune (93%) than were nurses (85%), medical technicians (75%), or administrative
clerks (84%). Seropositivity was not affected by age or gender. The positive
predictive value of a history of chickenpox for the seropositivity was 89% (511
of 574); the negative predictive value was 22% (105 of 484). History of
chickenpox had a sensitivity of 57% (511 of 890) and a specificity of 63% (105 of
168). CONCLUSIONS: The varicella-zoster virus seroprevalence among new employees 
was low, posing an important risk to existing employees and patients. Positive or
negative history of chickenpox was an unreliable indicator of susceptibility
among healthcare workers of different nationalities. Serologic screening of all
employees and vaccination of those susceptible was recommended.

PMID: 15301033 [PubMed - indexed for MEDLINE]

385: Infect Control Hosp Epidemiol. 2004 Jul;25(7):591-4.

Prevalence of measles, rubella, mumps, and varicella antibodies among healthcare 
workers in Japan.

Hatakeyama S, Moriya K, Itoyama S, Nukui Y, Uchida M, Shintani Y, Morisawa Y,
Kimura S.

Department of Infectious Diseases, University of Tokyo Hospital, Hongo,
Bunkyo-ku, Tokyo, Japan.

OBJECTIVES: To evaluate the immune status of healthcare workers (HCWs) against
measles, rubella, mumps, and varicella in Japan, and to promote an adequate
vaccination program among HCWs. SETTING: University of Tokyo Hospital.
PARTICIPANTS: Eight hundred seventy-seven HCWs. DESIGN: Serologic screening for
measles, rubella, mumps, and varicella was performed on HCWs. Antibodies against 
measles, rubella, and mumps were detected using hemagglutination inhibition (HI) 
assay ($4.20 per test). If serum was negative by HI assay, enzyme-linked
immunosorbent assay (EIA) was performed ($12.60 per test). Anti-varicella
antibodies were detected by EIA only. RESULTS: Among tested HCWs, 98.5%, 90.4%,
85.8%, and 97.2% had immunity to measles, rubella, mumps, and varicella,
respectively. All those born before 1970 were seropositive for measles. However, 
individuals susceptible to rubella, mumps, and varicella were present in all age 
groups. The sensitivities and negative predictive values of HI assay compared
with EIA were 86.6% and 11.3% for measles, 99.1% and 92.2% for rubella, and 47.8%
and 24.1% for mumps, respectively. For measles and mumps, prevaccination
screening by HI assay in combination with EIA led to significant savings compared
with EIA only. In contrast, it was estimated that prevaccination screening using 
only HI assay would be more economical for rubella. CONCLUSIONS: Aggressive
screening and vaccination of susceptible HCWs was essential regardless of age.
Prevaccination serologic screening using a combination of HI assay and EIA was
more economical for measles and mumps.

PMID: 15301032 [PubMed - indexed for MEDLINE]

386: Prenat Diagn. 2004 Jul;24(7):498-500.

Alphafoetoprotein and acetylcholinesterase in amniotic fluid as a factor
suggesting fetal skin and nerve lesions in a case of congenital varicella
syndrome.

Mirlesse V, Duguy N, Cynober E, François Magny J, Daffos F.

Fetal Medecine Unit, Institut de puériculture et périnatalogie, Paris, France.
mirlesse.v@free.fr

BACKGROUND: Prenatal care of pregnant women exposed to varicella skin rash during
the first half of pregnancy remains a frequent concern in countries that do not
have access to systematic vaccination. The frequency of maternofetal transmission
is low. Ultrasound is the usual tool for prenatal survey of exposed fetuses. But 
many anomalies due to VZV infection are not accessible to ultrasound alone. CASE 
REPORT: We review a case in which the diagnosis of fetal infection suspected due 
to transient fetal bowel hyperechogenicity was confirmed in amniotic fluid by
molecular biology (PCR). RESULTS: An unusual elevation of alphafoetoprotein in
maternal blood and in amniotic fluid was associated with inguinal skin, muscular 
and nerve destruction. CONCLUSION: In fetuses diagnosed with in utero varicella
infection, in addition to a precise diagnosis and follow-up, we suggest that
elevated AFP levels in maternal blood and amniotic fluid together with the
presence of acetylcholinesterase in amniotic fluid may be related to lesion of
fetal skin and nerves. Copyright 2004 John Wiley and Sons, Ltd.

Publication Types: 
    Case Reports

PMID: 15300737 [PubMed - indexed for MEDLINE]

387: Rev Inst Med Trop Sao Paulo. 2004 May-Jun;46(3):165-8. Epub 2004 Jul 20.

A simple and cheaper in house varicella zoster virus antibody indirect ELISA.

Ono E, Lafer MM, Weckx LY, Granato C, de Moraes-Pinto MI.

Division of Pediatric Infectious Diseases, Federal University of São Paulo, Sao
Paulo, SP, Brazil.

We have developed a cheaper an simple in house indirect ELISA that uses the live 
attenuated VZV vaccine as a coating antigen. The alternative ELISA had an
agreement of 94% when compared with a commercial VZV ELISA kit. Moreover, our
ELISA proved to be more reliable than the kit when assessing true negative
samples. By adding a standard serum, we were able to produce results in
international units per millilitre. Also, the addition of an extra step with 8M
urea allowed the assessment of VZV IgG avidity without excessive costs. The cost 
per sample to test VZV IgG was 2.7 times cheaper with our ELISA, allowing the
testing of many samples without the burden of production of VZV antigen in the
laboratory.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15286822 [PubMed - indexed for MEDLINE]

388: Disaster Manag Response. 2004 Jul-Sep;2(3):81-6.

Triage of a febrile patient with a rash: a comparison of chickenpox, monkeypox,
and smallpox.

Seguin D, Stoner Halpern J.

Emergency Center, William Beaumont Hospital, Royal Oak, MI, USA.

The immediate and correct recognition of an infectious exanthema can be aided
with a focused history and minor assessment. False alarms can consume health care
resources and create unnecessary anxiety. Clinicians can use specific references 
to not only help with educating staff, but to ensure a more accurate diagnosis
and trigger notification of appropriate infectious disease protocols. The authors
recommend that al emergency departments have a process in place to immediately
isolate suspicious cases until a more thorough medial workup can be performed.

PMID: 15286598 [PubMed - indexed for MEDLINE]

389: Pediatrics. 2004 Aug;114(2):e273-4.

Varicella zoster virus meningitis in a previously immunized child.

Schwab J, Ryan M.

Department of Pediatrics, University of Chicago, Chicago, Illinois, USA.
jschwab@peds.bsd.uchicago.edu

We are reporting a previously well 5-year-old child with varicella-zoster
meningitis who had a history of a previous immunization against varicella. This
child also developed a transient sensorineural hearing loss. The child was
treated with acyclovir and made a full recovery.

Publication Types: 
    Case Reports

PMID: 15286270 [PubMed - indexed for MEDLINE]

390: Pediatr Clin North Am. 2004 Aug;51(4):889-908, viii.

Herpesviridae infections in newborns: varicella zoster virus, herpes simplex
virus, and cytomegalovirus.

Enright AM, Prober CG.

Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA.
EnrighA@pamf.org

Varicella zoster virus (VZV), herpes simplex virus (HSV) and cytomegalovirus
(CMV) are all members of the Herpesviridae family.Humans are the only source of
infection for these double stranded DNA viruses. Infants may acquire these
infections in utero, peripartum, or postnatally, resulting in a variety of
clinical syndromes, ranging from asymptomatic infection to severe infection,with 
high mortality rates and significant long-term morbidity.This article presents
the epidemiology, clinical characteristics, treatment,and prevention strategies
for VZV, HSV, and CMV infections in infants.

Publication Types: 
    Review

PMID: 15275980 [PubMed - indexed for MEDLINE]

391: J Infect Dis. 2004 Aug 15;190(4):793-6. Epub 2004 Jul 15.

Rashes occurring after immunization with a mixture of viruses in the Oka vaccine 
are derived from single clones of virus.

Quinlivan ML, Gershon AA, Steinberg SP, Breuer J.

Skin Virus Laboratory, Institute of Cell and Molecular Medicine, London, United
Kingdom.

Vaccination against chickenpox causes a varicella-like rash in up to 5% of
healthy children and 50% of children with leukemia. The vaccine may establish
latency and reactivate to cause herpes zoster, albeit more rarely than wild-type 
virus. All vaccine preparations are composed of a mixture of varicella-zoster
virus strains that show genotypic variation at several loci. We have shown, by
DNA sequencing of 40 polymorphic loci, that viruses sampled from vesicles in
varicella-like and herpes zoster rashes are single clones. This finding suggests 
that, between the time of inoculation of the vaccine and development of rash,
selection of single strains occurs. The results have general implications for the
pathogenesis of varicella-zoster virus.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15272408 [PubMed - indexed for MEDLINE]

392: Skinmed. 2004 Jul-Aug;3(4):216-9.

Infectious disease capsules: a pox on your house.

Burdette SD, Bernstein JM.

Veterans Affairs Medical Center, Wright State University School of Medicine,
Dayton, OH 45428, USA.

A 31-year-old, previously healthy white man presented to the emergency department
with complaints of malaise, fevers, shortness of breath, a non-productive cough, 
and a "rash." His physical exam revealed a temperature of 100.2F, a pulse of 129 
bpm, respiratory rate of 14 BPM, and blood pressure of 140/74 mm Hg. He was
alert, oriented, and in no distress. His oropharynx was dry, his neck was supple,
and cervical lymphadenopathy was absent. He had tachycardia, bilateral wheezes,
and rhonchi with prolonged expirations. There was a diffuse vesicular eruption
enveloping his entire body with involvement sparing his palms and soles (Figures 
1 and 2). Laboratory values showed a hemoglobin of 16.0 g/dL and a white blood
cell count of 7100 cells/pL, with 39%neutrophils, 23% bands, and 35% lymphocytes.
His platelet count was mildly decreased to 86,000 x 103/pL. Chest radiograph
revealed bilateral diffuse interstitial infiltrates. A diagnosis of acute
varicella-zoster virus pneumonia (varicella pneumonia) was made, and the patient 
was started on IV acyclovir (10 mg/kg every 8 hours). Upon further questioning,
the patient stated that his daughter had been diagnosed with "chickenpox" 7 days 
ago. The patient had numerous exposures to chickenpox in the past but had never
developed clinical expressions of varicella. He was not at risk for HIV
infection, not having multiple sexual partners, IV drug abuse, or blood
transfusions. During the 1 day of in-hospitalization, his fever abated and the
pulmonary signs diminished.Following discharge, IV acyclovir was replaced by
valacyclovir to complete a 7-day course of therapy.

Publication Types: 
    Case Reports

PMID: 15249783 [PubMed - indexed for MEDLINE]

393: Vaccine. 2004 Jul 29;22(21-22):2730-6.

The incidence of varicella in southern Taiwan: a life table method estimation
among susceptible population.

Tan HF, Tseng HF, Chang CK, Ke D, Lee-Hsieh J.

Department of Healthcare Administration, Chang-Jung University, Taiwan, ROC.

Previous studies have failed to estimate the size of population at risk and
underestimated the incidence of varicella among susceptible population. In this
study, we calculated the incidence of varicella and its complications in Taiwan
based on a life table method, in which the size of population at risk was taken
into account. Population-based data were obtained from the Bureau of National
Health Insurance. The age-specific incidences estimated by the uncorrected and
corrected methods were compared. The incidence of varicella increased sharply
after infancy and peaked at 16.7% in children aged 5 years. A correction which
assumes the introduction of varicella vaccine resulted in a higher incidence of
19.5% in children aged 5 years. The lifetime cumulative incidence increased to
around 76%. Sensitive surveillance of varicella and correct incidence estimate
among susceptible population are essential in countries that have implemented or 
are about to implement varicella vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15246604 [PubMed - indexed for MEDLINE]

394: J Infect Dis. 2004 Aug 1;190(3):477-83. Epub 2004 Jun 29.

An elementary school outbreak of varicella attributed to vaccine failure: policy 
implications.

Lee BR, Feaver SL, Miller CA, Hedberg CW, Ehresmann KR.

Immunization, Tuberculosis, and International Health Section, Infectious Disease 
Epidemiology, Prevention, and Control Division, Minnesota Department of Health,
Minneapolis 55414, USA. brian.lee@health.state.mn.us

BACKGROUND: Since licensure in the United States, studies have shown that
varicella vaccine's overall effectiveness ranges from 44% to 100%, with
substantial protection against moderate and severe varicella; however,
breakthrough illness has been documented in up to 56% of vaccinated individuals. 
METHODS: A varicella outbreak occurred in a Minnesota school with 319 students.
Phone surveys were conducted with students' parents. Information was collected on
students who had recent varicella infections, including onset date, rash
characteristics, duration, and underlying medical conditions. RESULTS: Fifty-four
cases occurred after a primary breakthrough case. Twenty-nine (53%) students had 
been vaccinated. Unvaccinated students had an increased risk of moderate
varicella, compared with vaccinated students (relative risk [RR], 4.4 [95%
confidence interval [CI], 2.2-9.1]; P<.001). The vaccine was 56% effective at
preventing any varicella and 90% effective against moderate illness. Students
vaccinated >or=5 years before the outbreak had a greater risk of breakthrough
varicella than did those vaccinated within <or=4 years (RR, 2.6 [95% CI,
1.3-5.4]; P<.01). CONCLUSIONS: Vaccinated students presented with milder
varicella symptoms than did unvaccinated students. Individuals with breakthrough 
illness can be highly infectious. Time since varicella vaccination was associated
with illness. Despite 29 breakthrough cases, the varicella vaccine conferred a
high degree of protection against moderate illness.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15243919 [PubMed - indexed for MEDLINE]

395: J Dermatol. 2004 Jun;31(6):477-9.

A case of varicella-associated idiopathic thrombocytopenic purpura in adulthood.

Hamada M, Yasumoto S, Furue M.

Department of Dermatology, Graduate School of Medical Sciences, Kyushu
University, Fukuoka, Japan.

We describe here an adult case of varicella-associated idiopathic
thrombocytopenic purpura (ITP). A 23-year-old Japanese male presented with
generalized hemorrhagic vesicles and fever. Laboratory examinations revealed
severe thrombocytopenia associated with anti-platelet IgG auto-antibody. The
patient rapidly recovered within a few days after antiviral agent (vidarabine)
administration, and the platelet count returned to normal with skin lesion
improvement. Idiopathic thrombocytopenic purpura associated with viral infection 
in adulthood is relatively rare.

Publication Types: 
    Case Reports

PMID: 15235188 [PubMed - indexed for MEDLINE]

396: Ir Med J. 2004 Apr;97(4):120-1.

Childhood stroke following varicella infection.

Tiah AL, Phelan E, McMenamin J, Webb D.

Department of Neurology, Our Lady's Hospital for Sick Children, Crumlin Dublin
12.

Stroke in childhood remains unexplained in a significant proportion of those
affected. We present a 4 year-old boy who presented with a stroke following a
recent uncomplicated chickenpox infection. Varicella is increasingly recognized
as a cause of acute ischaemic events in childhood and a recent history of
chickenpox should be sought in children who present with a stroke.

Publication Types: 
    Case Reports

PMID: 15200225 [PubMed - indexed for MEDLINE]

397: J Infect Dis. 2004 Jul 1;190(1):72-82. Epub 2004 May 26.

Development of virus-specific CD4+ T cells on reexposure to Varicella-Zoster
virus.

Vossen MT, Gent MR, Weel JF, de Jong MD, van Lier RA, Kuijpers TW.

Emma Children's Hospital, Department of Experimental Immunology, Academic Medical
Center, Amsterdam, The Netherlands. m.t.vossen@amc.uva.nl

Immunity to childhood diseases is maintained for decades by mechanisms that, at
present, are still unclear. We longitudinally studied immune responses in 16
adults exposed to children experiencing varicella (chicken pox). None of the
individuals showed clinical signs of infection, and varicella-zoster virus (VZV) 
DNA could not be detected in peripheral blood or cultured from nasopharyngeal
swabs. Exposure to VZV, however, induced expansion of antigen-specific CD4(+) T
cells in peripheral blood, with concomitant changes in cytotoxic CD8(+) T cells
and natural killer cells. VZV-specific memory CD4(+) T cells were uniformly
CD45RA(-) and enriched for CD27(-) cells. The virus-specific cells produced
interferon- gamma, tumor necrosis factor- alpha, and interleukin-2. These memory 
responses to VZV were compared with the primary immune responses of children
experiencing varicella. VZV-specific memory CD4(+) T cell responses largely
resemble the primary immune response to VZV.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15195245 [PubMed - indexed for MEDLINE]

398: Pediatr Infect Dis J. 2004 Jun;23(6):498-503.

Varicella-related mortality in California, 1988-2000.

McCoy L, Sorvillo F, Simon P.

Los Angeles County Department of Health Services, Los Angeles, CA, USA.
lmccoy@dhs.co.la.ca.us

BACKGROUND: Although surveillance for varicella in the United States has
documented a reduction in cases since vaccine licensure in 1995, information is
lacking on varicella-related mortality since vaccine introduction. This study
identifies varicella-related mortality in California before and after vaccine
introduction and assesses how high risk conditions and complications contributed 
to varicella deaths during this period. METHODS: California death records
mentioning varicella as either an underlying or contributing cause of death were 
selected from the 1988-2000 multiple cause-of-death files. Pre- and postvaccine
periods were compared to assess differences in varicella mortality before and
after vaccine introduction. Differences in varicella mortality by age,
race/ethnicity and gender were also examined. ICD codes were used to identify
high risk conditions and varicella-related complications. RESULTS: A total of 228
varicella-related deaths were reported between 1988 and 2000 in California.
Age-adjusted varicella mortality rates showed a downward trend during this
period, dropping from a high of 0.97 per million in 1990 to a low of 0.22 per
million in 1999. The average age-adjusted mortality rate declined from 0.67 per
million prevaccine to 0.38 per million postvaccine. Compared with the prevaccine 
period, the average rate of decline in varicella mortality was greater after
vaccine implementation. Infants had the highest mortality rate for the period. At
least one immunocompromising condition was present in 38% of varicella-related
deaths. Pneumonia was the most commonly reported complication. CONCLUSIONS:
Varicella-related mortality declined in California after vaccine implementation, 
but potentially preventable varicella-related deaths continue to occur.

Publication Types: 
    Comparative Study

PMID: 15194829 [PubMed - indexed for MEDLINE]

399: Expert Rev Vaccines. 2004 Jun;3(3):291-8.

Varicella zoster virus: vaccination and implications in children with renal
failure.

Fadrowski JJ, Furth SL.

Division of Pediatric Nephrology, Welch Center for Prevention, Epidemiology and
Clinical Research, Johns Hopkins University School of Medicine, Park 335, 600 N. 
Wolfe Street, Baltimore, MD 21287, USA. sfurth@jhmi.edu

The varicella zoster virus is associated with significant disease in those with
chronic kidney disease, both pre- and postrenal transplantation. With the advent 
of the varicella vaccine, the opportunity to prevent significant morbidity and
mortality exists. Despite the secondary immune defects associated with renal
failure, the varicella vaccine has been demonstrated to be immunogenic, safe and 
efficacious in pediatric patients with kidney disease.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15176945 [PubMed - indexed for MEDLINE]

400: J Paediatr Child Health. 2004 May-Jun;40(5-6):320-1.

Delayed disseminated Staphylococcus aureus infection following chickenpox.

Raja Lope RJ, Goldstein AR, Gray JW.

Department of Paediatrics, Birmingham Children's Hospital, Ladywood Middleway,
Birmingham. UK. sicrjrl@hotmail.com

Chickenpox is generally a benign childhood disease. Bacterial superinfection is
the commonest complication, and can be severe and life-threatening. We describe a
15-year-old boy with disseminated Staphylococcus aureus infection following
chickenpox.

Publication Types: 
    Case Reports

PMID: 15151591 [PubMed - indexed for MEDLINE]

401: MMWR Morb Mortal Wkly Rep. 2004 May 14;53(18):389-92.

Outbreak of varicella among vaccinated children--Michigan, 2003.

Centers for Disease Control and Prevention (CDC).

On November 18, 2003, the Oakland County Health Division alerted the Michigan
Department of Community Health (MDCH) to a varicella (chicken pox) outbreak in a 
kindergarten-third grade elementary school. On December 11, MDCH and Oakland
County public health epidemiologists, with the technical assistance of CDC,
conducted a retrospective cohort study to describe the outbreak, determine
varicella vaccine effectiveness (VE), and examine risk factors for breakthrough
disease (i.e., varicella occurring >42 days after vaccination). This report
summarizes the results of that study, which indicated that 1) transmission of
varicella was sustained at the school for nearly 1 month despite high vaccination
coverage, 2) vaccinated patients had substantially milder disease (<50 lesions), 
and 3) a period of > or =4 years since vaccination was a risk factor for
breakthrough disease. These findings highlight the importance of case-based
reporting of varicella and the exclusion of patients from school until all
lesions crust or fade away. Information about recognizing vaccinated patients
with mild cases should be disseminated to health-care providers, school
administrators, and parents.

PMID: 15138400 [PubMed - indexed for MEDLINE]

402: Pediatr Infect Dis J. 2004 May;23(5):379-89.

Consensus: varicella vaccination of healthy children--a challenge for Europe.

Rentier B, Gershon AA; European Working Group on Varicella.

Fundamental Virology Unit, University of Liége, Belgium. brentier@ulg.ac.be

The seriousness of varicella-zoster virus (VZV) infection as a public health
issue is becoming clearer as country-specific epidemiologic and pharmacoeconomic 
data become available. In Germany, for example, studies have shown that >5.5% of 
immunologically healthy individuals develop varicella-related complications such 
as bacterial superinfections, acute neurologic disorders, pneumonia, bronchitis
and otitis media; whereas in Italy, 3.5 to 5% of childhood cases of varicella
cause complications such as upper respiratory tract and cutaneous
infections.Varicella vaccines are now available. These live attenuated Oka strain
vaccines have been shown in extensive studies to be highly immunogenic and
well-tolerated in immunocompetent and immunocompromised children, with
seroconversion rates ranging from 94 to 100% and 53 to 100%, respectively. These 
vaccines are also highly effective against clinical disease.These considerations 
led to a reevaluation of varicella vaccination policies. A routine varicella
vaccination program targeting healthy children has already been implemented in
the US, and data produced are encouraging and valuable. Similar strategies have
not yet been adopted across Europe. The European Working Group on Varicella
(EuroVar) was formed in 1998 to address the issues surrounding varicella
epidemiology in Europe. After a series of meetings, the EuroVar members prepared 
a consensus statement recommending routine varicella vaccination for all healthy 
children between 12 and 18 months and to all susceptible children before their
13th birthday, in addition to catch-up vaccination in older children and adults
who have no reliable history of varicella and who are at high risk of
transmission and exposure. However, such a policy is recommended only if a very
high coverage rate can be achieved. This could be reached with a
measles-mumps-rubella-varicella combined vaccine.

Publication Types: 
    Consensus Development Conference
    Research Support, Non-U.S. Gov't
    Review

PMID: 15131459 [PubMed - indexed for MEDLINE]

403: Ceylon Med J. 2003 Dec;48(4):119-21.

Varicella-zoster virus infection in the Infectious Diseases Hospital, Sri Lanka.

Welgama U, Wickramasinghe C, Perera J.

Infectious Diseases Hospital, Sri Lanka.

OBJECTIVES: To determine the morbidity and mortality patterns of varicella and
risk factors affecting its outcome, and the facilities available at the
Infectious Diseases Hospital (IDH), Sri Lanka. METHODS: A retrospective study on 
all patients admitted with varicella-zoster virus (VZV) infection to the IDH from
August 2000 to July 2001. Data were collected from the hospital records. RESULTS:
Among the 1690 patients admitted during the study period, 1090 (64.9%) were due
to VZV infection. Nine hundred and eighty nine (90.7%) had varicella and 101
(9.3%) herpes zoster. Common complications were secondary bacterial infection
(62.1%), neurological complications (3.4%), pneumonia (9.1%) and carditis
(1.01%). They were significantly commoner in patients with coexisting diseases.
Hospital stay was significantly shorter in patients who received early aciclovir,
which was not available on a regular basis. Forty one patients died and mortality
was highest in the elderly. The commonest cause of death was pneumonia.
CONCLUSIONS: Varicella related complications are high in patients with coexisting
diseases. Mortality rates are higher than reported elsewhere. Health care
facilities available at IDH are quite inadequate, and should be improved.

PMID: 15125402 [PubMed - indexed for MEDLINE]

404: Dermatology. 2004;208(3):262-4.

Purpura fulminans in a child as a complication of chickenpox infection.

Campanelli A, Kaya G, Ozsahin AH, La Scala G, Jacquier C, Stauffer M, Boehlen F, 
de Moerloose P, Saurat JH.

Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland.
alexandre.campanelli@hcuge.ch

Purpura fulminans is a thrombotic disease that can occur during infections,
disseminated intravascular coagulation or in the context of an acquired or
congenital protein C or S deficiency. Here we report the case of a 4-year-old
child who developed, 5 days after a chickenpox infection, large painful
ecchymotic, necrotizing and retiform plaques on the lower extremities. Laboratory
analyses revealed very low protein S levels as well as anticardiolipin
antibodies. Aggressive treatment by low-molecular-weight heparin, steroids,
intravenous immunoglobulins and fresh frozen plasma was able to prevent the
extension of the lesions and to correct the coagulation abnormalities. No lesions
required skin grafting. As in our patient, an acquired protein S deficiency is
probably responsible for most cases of purpura fulminans occurring after
varicella, but the concomitant presence of antiphospholipid antibodies may also
play a role. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 15118384 [PubMed - indexed for MEDLINE]

405: Clin Microbiol Infect. 2004 May;10(5):425-30.

Empirical data on the varicella situation in Germany for vaccination decisions.

Wagenpfeil S, Neiss A, Banz K, Wutzler P.

Institute for Medical Statistics and Epidemiology, Technical University of
Munich, Germany. Stefan.Wagenpfeil@imse.med.tu-muenchen.de

As epidemiological data concerning varicella in Germany were not available, a
retrospective study was conducted to investigate the impact of the disease,
focusing also on economic aspects. A representative German-wide sample of 1334
unvaccinated varicella cases was obtained in 1999 from randomly selected
paediatric (P) and general, as well as internal, mainly adult (A), practices.
Following representative weighting, the median age was 5 years, with 90% of cases
aged < 12 years. The highest incidence was in children aged 5-6 years.
Varicella-related complications occurred in 5.7% of patients, and accounted for
0.1 hospital days/case on average. Certificates of sick leave were issued for 1.3
sick days/case, with 0.6 days paid by health insurance funds to parents caring
for their sick child, and 0.7 days paid by the employer. With an annual incidence
of 760,000 diagnosed cases in Germany for the year 1999, this amounts to an
annual cost of c.150 million Euro, with c. 50 million Euro paid by the statutory 
health insurance system. It was concluded that universal varicella vaccination in
Germany would provide essential clinical improvements for patients and prevent
hospital admissions. In addition, significant economic benefits can be expected, 
mainly because of the high level of indirect health costs in Germany.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15113320 [PubMed - indexed for MEDLINE]

406: Cochrane Database Syst Rev. 2004;(2):CD002980.

Update in:
    Cochrane Database Syst Rev. 2005;(4):CD002980.

Update of:
    Cochrane Database Syst Rev. 2002;(4):CD002980.

Acyclovir for treating varicella in otherwise healthy children and adolescents.

Klassen TP, Belseck EM, Wiebe N, Hartling L.

Department of Pediatrics, University of Alberta, 2C3.67 Walter C. Mackenzie,
Health Sciences Centre, Edmonton, Alberta, Canada, T6G 2R7.

BACKGROUND: Acyclovir has the potential to shorten the course of illness which
may result in reduced costs and morbidity associated with chickenpox. OBJECTIVES:
1) To examine the evidence evaluating the efficacy of acyclovir in alleviating
symptoms of chickenpox and shortening the duration of illness. 2) To examine
complications of chickenpox and adverse effects associated with acyclovir as
reported in the relevant trials. SEARCH STRATEGY: We searched The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1,
2003), MEDLINE (January 1966 to May 2003), and EMBASE (1988 to April 2003). The
reference lists of all relevant articles were reviewed. The primary author of
relevant studies and the pharmaceutical company that manufactures acyclovir were 
contacted. SELECTION CRITERIA: Randomized controlled trials that evaluated
otherwise healthy children zero to 18 years of age, with chickenpox. DATA
COLLECTION AND ANALYSIS: Two reviewers independently reviewed the studies for
eligibility. Two reviewers independently assessed methodological quality of the
relevant studies using the Jadad scale and allocation concealment. Differences
were resolved by consensus. Data were extracted by one reviewer using a
structured form and checked by a second.Continuous data were converted to the
weighted mean difference (WMD). Weighted mean differences were combined into an
overall estimate using random effects. There were too few studies to consider
exploring statistical heterogeneity between studies (i.e., differences in
reported effects), formally, or to assess for publication bias. MAIN RESULTS:
Three studies were included. Study quality was three (n = 2) and four (n = 1) on 
the Jadad scale. Acyclovir was associated with a reduction in the number of days 
with fever (-1.1 days, 95% CI -1.3 to -0.9) and in reducing the maximum number of
lesions (-76 lesions, -145 to -8). Results were less supportive with respect to
the number of days to no new lesions and the number of days to the relief of
itching. There were no clinically important differences between acyclovir and
placebo with respect to complications associated with chickenpox or adverse
effects associated with the treatment. REVIEWERS' CONCLUSIONS: Acyclovir appears 
to be effective in reducing the number of days with fever and the maximum number 
of lesions among otherwise healthy children with chickenpox. The results were
less convincing with respect to the number of days to no new lesions and relief
of itchiness. The clinical importance of acyclovir treatment in otherwise healthy
children remains controversial.

Publication Types: 
    Review

PMID: 15106185 [PubMed - indexed for MEDLINE]

407: J Pediatr Orthop B. 2004 Mar;13(2):114-7.

Septic arthritis of the elbow after chickenpox.

Konyves A, Deo SD, Murray JR, Mandalia VI, Von Arx OA, Troughton AH.

Department of Orthopaedics, Frenchay Hospital, Bristol, UK.

Musculoskeletal complications following chickenpox are rare among immunologically
normal children. Septic arthritis after varicella is caused by group A
Streptococcus and affects the knee most frequently. We present a case of septic
arthritis of the elbow caused by Staphylococcus aureus. We review the English
language literature on septic arthritis complicating chickenpox. We conclude that
diagnosis and treatment should be carried out according to guidelines on de novo 
septic arthritis including the early use of magnetic resonance imaging.

Publication Types: 
    Case Reports

PMID: 15076590 [PubMed - indexed for MEDLINE]

408: Vaccine. 2004 Mar 29;22(11-12):1480-5.

Evaluation of the impact of an HMO's varicella vaccination program on incidence
of varicella.

Mullooly JP, Maher JE, Drew L, Schuler R, Hu W.

Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate
Avenue, Portland, OR 97227-1098, USA. john.mullooly@kpchr.org

The impact of a varicella vaccination program on disease in a large HMO
population during 1996-1999 was assessed by multiple cross-sectional analyses of 
automated database records of vaccinations and varicella diagnoses for children
(0-18 years). The cumulative proportion of the population vaccinated reached 73% 
among 2-year-olds, and 22% overall. An overall 49.7% reduction in varicella
incidence was estimated to be attributable to an 18.5% point increase in the
proportion of the population vaccinated.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15063572 [PubMed - indexed for MEDLINE]

409: Nucleosides Nucleotides Nucleic Acids. 2004;23(1-2):1-5.

Synthesis and antiviral evaluation of some 3'-fluoro bicyclic nucleoside
analogues.

McGuigan C, Carangio A, Snoeck R, Andrei G, De Clercq E, Balzarini J.

Welsh School of Pharmacy, Cardiff University, Cardiff, UK. mcguigan@cardiff.ac.uk

The synthesis of 3'-fluoro analogues of recently discovered highly potent
anti-VZV furanopyrimidine deoxynucleosides (BCNAs) is herein reported, for both
the alkyl and alkylphenyl series. The compounds are tested against a range of
herpes viruses and display poor activity, strongly supporting the notion of the
importance of the presence of a 3'-OH for antiviral activity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15043132 [PubMed - indexed for MEDLINE]

410: J Med Virol. 2004 May;73(1):131-6.

Genetic variation in clinical varicella-zoster virus isolates collected in
Ireland between 2002 and 2003.

Carr MJ, McCormack GP, Crowley B.

Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland.

Analysis of genetic variation in 16 varicella-zoster virus (VZV) isolates
selected at random and circulating in the Irish population between March 2002 and
February 2003 was carried out. A 919 bp fragment of the glycoprotein E gene (open
reading frame 68) encompassing codon 150, at which a non-synonymous mutation
defines the escape mutant VZV-MSP, and including two other epitope regions e1 and
c1, was sequenced. No new single nucleotide polymorphisms (SNPs) were detected,
indicating stability of these epitopes in clinical isolates of VZV. However, when
four informative polymorphic markers consisting of defined regions from genes 1, 
21, 50, and 54 were sequenced 14 variable nucleotide positions were identified.
Phylogenetic analysis showed the presence of three highly supported clades A, B, 
and C circulating in the Irish population. Approximately one third (6/16; 37.5%) 
of the Irish VZV isolates in this study belonged to genotype C, 4/16 (25%) to
genotype A, and 4/16 (25%) to genotype B. A smaller number 2/16 (12.5%) belonged 
to genotype J1. This indicates remarkable heterogeneity in the Irish population
given the small sample size. No evidence was found to suggest any of the 16
isolates was a recombinant. These findings have implications for the model of
geographic isolation of VZV clades to certain regions as the circulating Irish
VZV population appears to comprise approximately equal numbers of each of the
main genotypes. This data is inconsistent with a model of strict geographical
separation of VZV genotypes and suggests that VZV diversity is more pronounced in
certain areas than had been thought previously. Copyright 2004 Wiley-Liss, Inc.

PMID: 15042660 [PubMed - indexed for MEDLINE]

411: Indian J Pathol Microbiol. 2003 Oct;46(4):662-3.

Aplastic anaemia following varicella infection with coexistent microfilaremia of 
Wuchereria bancrofti--a case report.

Hemachandran M, Varma N, Varma S.

Department of Haematology and Internal Medicine, Postgraduate Institute of
Medical Education and Research, Chandigarh.

Filariasis is a common public health problem in various regions of Indian
subcontinent. There are many reports describing detection of microfilaria in
different organ systems. There are limited number of reports available describing
the presence of microfilaria in bone marrow. Here we report a young patient who
developed aplastic anaemia following varicella infection. Peripheral blood and
bone marrow showed many microfilariae of Wuchereria bancrofti. There are no
reports describing this unique combination in the available literature.

Publication Types: 
    Case Reports

PMID: 15025373 [PubMed - indexed for MEDLINE]

412: Pediatr Nephrol. 2004 May;19(5):554-7. Epub 2004 Mar 10.

Comment in:
    Pediatr Nephrol. 2004 Sep;19(9):1065.

Genitourinary anomaly in congenital varicella syndrome: case report and review.

Fujita H, Yoshii A, Maeda J, Kosaki K, Shishido S, Nakai H, Awazu M.

Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.

We describe a 1-year-old boy with congenital varicella syndrome who had
vesicoureteral reflux (VUR) and neurogenic bladder. His mother had varicella
during the 3rd month of pregnancy. At birth the patient presented with right
microphthalmia, right microcornea, and persistent hyperplastic primary vitreous
of the right eye. He had chronic constipation from 3 months of age. He had
urinary tract infection at 1 year of age. Urological investigation revealed left 
grade V VUR and neurogenic bladder. His varicella zoster virus IgG titer measured
by ELISA was 39.4 antibody index (normal <0.1). He had repeated episodes of
urinary tract infection despite antibiotic prophylaxis and clean intermittent
catheterization, and underwent a uretero-vesiconeostomy at 2 years of age.
Maternal infection during early pregnancy and the serological evidence of
varicella zoster IgG antibodies without a history of varicella after birth led to
the diagnosis of congenital varicella syndrome. Urogenital anomalies have
previously been described in 14 cases of congenital varicella syndrome. Most of
these patients had neurogenic bladder, the pathophysiology of which could be
explained by the known neurotropic nature of the virus.

Publication Types: 
    Case Reports

PMID: 15015072 [PubMed - indexed for MEDLINE]

413: Pediatr Infect Dis J. 2004 Mar;23(3):221-6.

Use of a computerized database to study the effectiveness of an attenuated
varicella vaccine.

Passwell JH, Hemo B, Levi Y, Ramon R, Friedman N, Lerner-Geva L.

Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel. 
passwell@sheba.helth.gov.il

BACKGROUND: The varicella vaccine Varilrix (GlaxoSmithKline) was introduced in
Israel in June 2000 as an optional vaccination for children. METHODS: We used the
database of a single health maintenance organization that serves 25% of the
population in Israel to assess the effectiveness of the vaccine retrospectively. 
Incidence and complications of varicella were derived from the database from
January 1, 1998 until December 31, 2002. RESULTS: Since licensure >30000
individuals younger than 10 years in this health maintenance organization have
been immunized with the vaccine. Annual incidence of disease per 1000 in the
study population was 86.6 in 1998, 74.6 in 1999, 74.0 in 2000, 37.1 in 2001 and
44.6 in 2002. This declining trend in incidence of disease was statistically
significant. Complications of varicella occurred in approximately 1% of patients 
throughout the 5-year study period, but there was a parallel decline in the
number of patients with complications corresponding to the decline in disease
incidence. Vaccine effectiveness for prevention of clinical disease in this
population was 92% (95% confidence interval, 91.0 to 92.7). There were varying
rates of utilization within communities of varied socioeconomic class, so that in
the higher socioeconomic class there was an increased utilization and a
corresponding decrease of attack rate; whereas in communities where there were
lower utilization rates, corresponding increased numbers of varicella cases were 
seen. CONCLUSION: This database enables long term follow-up of the effectiveness 
of this vaccine in a large population.

PMID: 15014296 [PubMed - indexed for MEDLINE]

414: Ann Acad Med Singapore. 2004 Jan;33(1):84-8.

Severe adult chickenpox infection requiring intensive care.

Ho BC, Tai DY.

Department of General Medicine, Tan Tock Seng Hospital, Singapore.
benjamin_ho@ttsh.com.sg

INTRODUCTION: Chickenpox (varicella) in adults can be severe with increased
mortality. This study investigated the clinical presentation and outcome of 12
adult chickenpox patients requiring intensive care. MATERIALS AND METHODS: A
retrospective, observational study was performed in an adult medical intensive
care unit of a university-affiliated hospital involving consecutive patients with
varicella admitted over 4 years (1997-2000). RESULTS: The 12 patients had a mean 
+/- SD age of 40 +/- 20 (range, 15 to 86) years. Two patients were above 65 years
old (aged 73 and 86 years). All but 1 were male. None had previous varicella
vaccination. Six patients had direct exposure to persons with chickenpox
infection. Four patients had underlying pulmonary pathology: past pulmonary
tuberculosis (2), emphysema (1) and recurrent right pleural effusion from
autoimmune serositis (1). The mean APACHE II score was 14.2 (range, 6 to 26). Ten
patients had varicella pneumonia (of whom 2 had acute respiratory distress
syndrome and 5 had acute lung injury), 1 had chickenpox encephalitis and 1
patient presented concomitantly with diabetic ketoacidosis. The median duration
of stay in the intensive care unit (ICU) was 11 days (range, less than 1 day to
76 days). Nine patients (75%) required mechanical ventilation (median duration,
14 days; range, less than 1 day to 79 days). All patients were treated with
acyclovir. There were 3 deaths (25%); 2 were above 65 years old and 1 was 37
years old with acute myeloid leukaemia on chemotherapy. CONCLUSION: Patients with
varicella infection requiring intensive care carry significant mortality. In our 
series, old age appears to be associated with increased mortality (P = 0.045).

PMID: 15008570 [PubMed - indexed for MEDLINE]

415: J La State Med Soc. 2004 Jan-Feb;156(1):50-5.

A review of varicella vaccine and Louisiana vaccination requirements.

Buff AM, Welch FJ, Tapia RA.

In order to decrease the burden of disease from varicella and increase varicella 
vaccination rates nationally, all states were advised by the Advisory Committee
on Immunization Practices of the Centers for Disease Control and Prevention in
May 1999 to institute vaccination requirements or documented evidence of natural 
infection for all children entering elementary school and daycare facilities.
Beginning September 1, 2003, Louisiana law requires varicella vaccination or a
history of varicella disease prior to entry to school and daycare. In light of
these new state requirements, this article discusses the epidemiology of
varicella and addresses a number of concerns about the varicella vaccine. The
four main issues addressed via a literature review are (1) the perception of
varicella as a benign childhood disease, (2) concerns about vaccine efficacy and 
safety, (3) concerns about waning immunity, and (4) concerns about shifting
burden of disease. The article also reviews varicella vaccination recommendations
and encourages vaccination of all children in accordance with new state
requirements.

Publication Types: 
    Review

PMID: 15000215 [PubMed - indexed for MEDLINE]

416: Expert Opin Biol Ther. 2004 Feb;4(2):199-216.

Effectiveness of live varicella vaccine.

Takahashi M.

The Research Foundation for Microbial Diseases, Osaka University, Osaka, Japan.

The disease burden of chickenpox to children has been described, and a lower
force of neutralising antibody to varicella-zoster virus (VZV) than against
measles, either after natural infection or after vaccination, has been reported. 
In the case of VZV, strong cell-mediated immunity may work efficiently to prevent
the spread of the virus. The lower force of humoral antibody to VZV might be
related to the occurrence of "breakthrough" varicella cases in a small portion of
the vaccine recipients. Safety and high effectiveness of the varicella
vaccine--approximately 85% effective for all diseases and 95-100% effective for
moderate-to-severe diseases--have been reported. Vaccine-induced immunity
persists for 10-20 years. However, concerns have been raised that universal
immunisation in children may shift the susceptibility from children to adults,
whose symptoms are usually moderate-to-severe. In addition, other concerns have
been expressed that, due to lack of exposure to varicella in children, the
elderly may develop zoster infections more frequently than before. A clear answer
is difficult to give at present, although, for several reasons, such situations
may be unlikely to occur.

Publication Types: 
    Review

PMID: 14998778 [PubMed - indexed for MEDLINE]

417: Pediatrics. 2004 Mar;113(3 Pt 1):455-9.

Comment in:
    Pediatrics. 2004 Oct;114(4):1130-1; author reply 1131.    Pediatrics. 2004 Oct;114(4):1130; author reply 1131.

Chickenpox outbreak in a highly vaccinated school population.

Tugwell BD, Lee LE, Gillette H, Lorber EM, Hedberg K, Cieslak PR.

Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease
Control and Prevention, Atlanta, Georgia, USA.

OBJECTIVE: We investigated a chickenpox outbreak that started in an Oregon
elementary school in October 2001, after public schools began phasing in a
varicella vaccination requirement for enrollment. We sought to determine the rate
of varicella vaccination and effectiveness and risk factors for breakthrough
disease. METHODS: A chickenpox case was defined as an acute maculopapulovesicular
rash without other explanation occurring from October 30, 2001 through January
27, 2002 in a student without a prior history of chickenpox. We reviewed
varicella vaccination records and history of prior chickenpox, and we calculated 
vaccine effectiveness. We evaluated the effects of age, gender, age at
vaccination, and time since vaccination on risk of breakthrough disease (ie,
chickenpox occurring >42 days after vaccination). RESULTS: Of 422 students, 218
(52%) had no prior chickenpox. Of these, 211 (97%) had been vaccinated before the
outbreak. Twenty-one cases occurred in 9 of 16 classrooms. In these 9 classrooms,
18 of 152 (12%) vaccinated students developed chickenpox, compared with 3 of 7
(43%) unvaccinated students. Vaccine effectiveness was 72% (95% confidence
interval: 3%-87%). Students vaccinated >5 years before the outbreak were 6.7
times (95% confidence interval: 2.2-22.9) as likely to develop breakthrough
disease as those vaccinated </=5 years before the outbreak (15 of 65 [23%] vs 3
of 87 [3%]). CONCLUSIONS: A chickenpox outbreak occurred in a school in which 97%
of students without a prior history of chickenpox were vaccinated. Students
vaccinated >5 years before the outbreak were at risk for breakthrough disease.
Booster vaccination may deserve additional consideration.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14993534 [PubMed - indexed for MEDLINE]

418: JAMA. 2004 Feb 18;291(7):851-5.

Comment in:
    J Pediatr. 2004 Sep;145(3):416-7.

Effectiveness over time of varicella vaccine.

Vázquez M, LaRussa PS, Gershon AA, Niccolai LM, Muehlenbein CE, Steinberg SP,
Shapiro ED.

Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
06520-8064, USA.

CONTEXT: Reports of outbreaks of varicella in highly immunized groups have
increased concern about the effectiveness of varicella vaccine. OBJECTIVE: To
assess whether the effectiveness of varicella vaccine is affected either by time 
since vaccination or by age at the time of vaccination. DESIGN: Case-control
study conducted from March 1997 through June 2003. SETTING: Twenty different
group practices in southern Connecticut. PARTICIPANTS: Case subjects, identified 
by active surveillance of all practices, consisted of 339 eligible children 13
months or older who were clinically diagnosed as having chickenpox and who also
had a polymerase chain reaction (PCR) test result that was positive for
varicella-zoster virus DNA. For each case subject, 2 controls were selected,
matched by both age and pediatric practice. MAIN OUTCOME MEASURES: The
effectiveness of the vaccine, especially the effects of time since vaccination
and age at the time of vaccination, adjusted for possible confounders. RESULTS:
Although the adjusted overall effectiveness of the vaccine was 87% (95%
confidence interval, 81%-91%; P<.001), there was a substantial difference in the 
vaccine's effectiveness in the first year after vaccination (97%) and in years 2 
to 8 after vaccination (84%, P =.003). The vaccine's effectiveness in year 1 was 
substantially lower if the vaccine was administered at younger than 15 months
(73%) than if it was administered at 15 months or older (99%, P =.01), although
the difference in effectiveness overall for children immunized at younger than 15
months was not statistically significantly different than for those immunized at 
15 months or older (81% vs 88%, P =.17). Most cases of chickenpox in vaccinees
were mild. CONCLUSIONS: Although varicella vaccine is effective, its
effectiveness decreases significantly after 1 year, although most cases of
breakthrough disease are mild. If administered at younger than 15 months, the
vaccine's effectiveness was lower in the first year after vaccination, but the
difference in effectiveness was not statistically significant for subsequent
years.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14970064 [PubMed - indexed for MEDLINE]

419: Epidemiol Infect. 2003 Dec;131(3):1085-9.

The seroepidemiology and transmission dynamics of varicella in Australia.

Gidding HF, MacIntyre CR, Burgess MA, Gilbert GL.

National Centre for Immunization Research and Surveillance of Vaccine Preventable
Diseases, Royal Alexandra Hospital for Children and University of Sydney, New
South Wales 2145, Australia.

To enhance our understanding of the epidemiology and transmission dynamics of
varicella in the pre-vaccine era we performed a serosurvey using
opportunistically collected sera submitted to diagnostic laboratories across
Australia during 1997-1999. A representative sample by state and sex of 2027 sera
from persons aged 1-49 years was tested using an enzyme immunoassay method. The
average age of infection and age-specific forces of infection (the probability
that a susceptible individual acquires infection) were calculated using published
methodologies. Seropositivity increased with age, with 83% of sera positive by
ages 10-14 years. The highest force of infection was in the 5-9 years age group
(0.195 per susceptible year) followed by the 0-4 years age group (0.139 per
susceptible year) and the average age of infection was 8.15 years. These results 
provide valuable baseline information to measure the impact of vaccination and
indicate that vaccination should be aimed at children less than 5 years of age,
although further modelling using the serosurvey data is warranted.

PMID: 14959774 [PubMed - indexed for MEDLINE]

420: Pediatr Infect Dis J. 2004 Feb;23(2):132-7.

Comment in:
    Pediatr Infect Dis J. 2008 Feb;27(2):190; author reply 190-1.

Ten year follow-up of healthy children who received one or two injections of
varicella vaccine.

Kuter B, Matthews H, Shinefield H, Black S, Dennehy P, Watson B, Reisinger K, Kim
LL, Lupinacci L, Hartzel J, Chan I; Study Group for Varivax.

Merck Research Laboratories, PO Box 4, West Point, PA 19486, USA.
barbara_kuter@merck.com

BACKGROUND: The rate of varicella and persistence of varicella antibody after a
one dose vs. a two dose regimen of varicella virus vaccine live Oka/Merck
(VARIVAX; Merck & Co., Inc., West Point, PA) in approximately 2000 children were 
compared during a 9- to 10-year follow-up period. METHODS: Children 12 months to 
12 years of age with a negative history of varicella were randomized in late 1991
to early 1993 to receive either one or two injections of varicella vaccine given 
3 months apart. Subjects were actively followed for varicella, any varicella-like
illness or zoster and any exposures to varicella or zoster on a yearly basis for 
10 years after vaccination. Persistence of varicella antibody was measured yearly
for 9 years. RESULTS: Most cases of varicella reported in recipients of one or
two injections of vaccine were mild. The risk of developing varicella >42 days
postvaccination during the 10-year observation period was 3.3-fold lower (P <
0.001) in children who received two injections than in those who received one
injection (2.2% vs. 7.3%, respectively). The estimated vaccine efficacy for the
10-year observation period was 94.4% for one injection and 98.3% for two
injections (P < 0.001). Measurable serum antibody persisted for 9 years in all
subjects. CONCLUSIONS: Administration of either one or two injections of
varicella vaccine to healthy children results in long term protection against
most varicella disease. The two dose regimen was significantly more effective
than a single injection.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14872179 [PubMed - indexed for MEDLINE]

421: Front Biosci. 2004 Jan 1;9:751-62.

Varicella zoster virus latency, neurological disease and experimental models: an 
update.

Cohrs RJ, Gilden DH, Mahalingam R.

Department of Neurology, University of Colorado Health Sciences Center, Denver,
CO 80262, USA.

Varicella zoster virus (VZV), a ubiquitous neurotropic human herpesvirus, causes 
chickenpox (varicella) and then remains latent for decades in cranial nerve,
dorsal root and autonomic nervous system ganglia along the entire neuraxis. Virus
reactivation, most often after age 60, produces shingles (zoster), characterized 
by pain and rash usually restricted to 1-3 dermatomes. In elderly individuals,
zoster is frequently complicated by postherpetic neuralgia (PHN), pain that
persists for months to years after the resolution of rash. Virus may also spread 
beyond ganglia to the spinal cord to cause myelitis, as well as to blood vessels 
of the brain, producing a unifocal or multifocal vasculopathy. The increased
incidence of zoster in the elderly and immunocompromised individuals appears to
be due to a VZV-specific host immunodeficiency. Recent studies indicate that PHN 
may be due to a chronic active VZV ganglionitis, and that VZV vasculopathy is
caused by a productive virus infection in cerebral arteries. Since neurological
disease produced by VZV is due to reactivation from ganglia, the physical state
of viral nucleic acid and expression during latency as well as the possible
mechanisms by which VZV latency is maintained and reactivates are discussed.
Finally, VZV is an exclusively human herpesvirus, and experimental infection of
animals with VZV does not produce disease nor does VZV reactivate from ganglia.
Two varicella models in primates have proven useful: one that mimics varicella
latency in humans, and one that can be used to study the efficacy of antiviral
agent in driving varicella virus back to a latent state.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 14766405 [PubMed - indexed for MEDLINE]

422: Curr Opin Pediatr. 2004 Feb;16(1):80-4.

Varicella zoster virus infections in children after the introduction of live
attenuated varicella vaccine.

Vázquez M.

Department of Pediatrics, Yale University School of Medicine, New Haven,
Connecticut 06520-8064, USA. Marietta.Vazquez@yale.edu

PURPOSE OF REVIEW: Varicella zoster virus is the cause of both varicella
(chickenpox) and herpes zoster (shingles). A live attenuated varicella vaccine
was developed in 1974 and was approved in 1995 by the United States Food and Drug
Administration for administration to both healthy children (>12 months of age)
and adults who are susceptible to varicella. Many studies have shown varicella
vaccine to be highly effective. Widespread use of the varicella vaccine in the
United States has led to important changes in the epidemiology of the infection. 
The purpose of this review is to summarize the most recent and important findings
regarding the impact that the widespread use of varicella vaccine has had on the 
epidemiology of varicella zoster infections in children. RECENT FINDINGS: Data
from the United States Centers for Disease Control and Prevention have shown a
dramatic decline in the incidence of varicella (76 to 87% from 1995 to 2000),
with the greatest decline observed in preschool children, as well as a reduction 
in the number of hospitalizations for cases of varicella. However, as the
proportion of children in the United States who have received the varicella
vaccine has increased there have been several recent reports in which the
effectiveness of the vaccine was substantially lower than expected. In
particular, reports during outbreaks of varicella in children have noted
increases in breakthrough disease in children who were vaccinated before the age 
of 15 months, in children with asthma, in those who received the varicella
vaccine soon after the measles, mumps, and rubella vaccine (<28 days), and in
children who received the vaccine more than 3 years before the development of
disease. SUMMARY: Although reports of outbreaks of chickenpox in highly immunized
groups have raised questions regarding the need for changes to the current
vaccination policy, data undeniably indicate that immunization with varicella
vaccine has been and continues to be successful in reducing the burden of disease
in children and that universal immunization should continue to be a priority in
the United States

Publication Types: 
    Review

PMID: 14758119 [PubMed - indexed for MEDLINE]

423: School Nurse News. 2004 Jan;21(1):26-7.

Making chicken pox prevention a priority.

Domachowske JB.

Departments of Pediatrics, Microbiology and Immunology and Pediatric Infectious
Diseases, SUNY Upstate Medical University, Syracuse, NY, USA.

School nurses are the IDEAL professionals to catch those kids without a history
of chicken pox (varicella illness) who have not been immunized, thereby falling
into the susceptible range. We handle charts daily. We have both illness history 
(if it was provided) and immunization dates. We can call parents. We can talk to 
kids. Wouldn't it be easy if we could do that and then call (or email) the
primary care provider? But there is no longer an "easy" way to communicate health
information. Doing things the easy way could be perceived by some as "tattling"
and by others as "reporting without permission." Instead, the school nurse must
take the time-consuming (and better long range) path of education ... of the
student, and the parent. And the priority can slip down below other school nurse 
requirements such as getting kids their required immunizations, first aid and
illness care, individualized health care plans for students with medical
problems, parent and teacher phone calls, and endless conversations. It takes a
village to raise a child though, and the school nurse is a village resident. The 
following information is vital to the knowledge base of today's school nurse.
Please read it, store it and consider it when planning and intervening with your 
students in the day-to-day interaction that promotes optimal health and wellness.

PMID: 14753086 [PubMed - indexed for MEDLINE]

424: Rheumatol Int. 2004 Nov;24(6):362-4. Epub 2004 Jan 23.

Varicella glomerulonephritis mimicking microscopic polyangiitis.

Dass R, Singh S, Kumar V, Vaiphei K, Agrawal S, Saeed T, Minz RW.

Advanced Pediatric Center, Department of Pediatrics, Postgraduate Institute of
Medical Education and Research, Chandigarh, 160012, India.

Varicella in childhood is usually a self-limiting illness with few complications.
Varicella nephritis is an uncommon entity and seen mostly in immunocompromized
individuals. We report a 14-year-old boy with juvenile rheumatoid arthritis who
developed varicella nephritis and in whom the renal manifestations preceded the
skin lesions by 1 week. This is an extremely unusual occurrence, and only one
case has been described before. Such a presentation can mimic the clinical
features of microscopic polyangiitis.

Publication Types: 
    Case Reports

PMID: 14740169 [PubMed - indexed for MEDLINE]

425: Scand J Infect Dis. 2003;35(11-12):876-8.

Streptococcus pyogenes meningitis complicating varicella in a 3-month-old child.

Brandt CM, Kitz R, Lütticken R, Brade V.

Department of Medical Microbiology, University Hospital Frankfurt/Main, 69596
Frankfurt/Main, Germany. claudia.brandt@em.uni-frankfurt.de

Varicella is a common, usually self-limited infectious disease, and complications
are believed to be rare. Despite the dramatic increase in invasive Streptococcus 
pyogenes infections associated with varicella zoster virus infections in recent
years, post-varicella S. pyogenes meningitis occurs very rarely. The third case
in the literature is described here.

Publication Types: 
    Case Reports

PMID: 14723366 [PubMed - indexed for MEDLINE]

426: J Infect. 2004 Feb;48(2):119-33.

Cost containment analysis of childhood vaccination against varicella in Israel.

Ginsberg GM, Somekh E.

Department of Medical Technology Assessment, Ministry of Health, Ben Tbai 2,
Jerusalem 93591, Israel.

OBJECTIVES: The low cost of safe and effective vaccines prompted a
cost-containment evaluation of a nationwide vaccination campaign against
varicella. METHODS: A model incorporating demographic, epidemiologic and economic
data from Israeli sources (supplemented by data from International literature)
was constructed to estimate the decrease in morbidity and the consequent
reductions in treatment costs and time-off work of a nationwide programme
vaccinating children at 12 months. RESULTS: A policy of aiming to immunize a
cohort of all 1-year-olds in Israel in the year 2002, for an annual cost of $1.10
million to the health services and $1.27 million to society (including lost work 
and transport costs), would reduce the number of cases of varicella during the
lifetime of a cohort from 123,984 to 10,170 cases. This morbidity reduction would
reduce national expenditures by $1.80 million in health service resources alone
and by $24.5 million to society, mainly due to inaverted work absences. In
addition an estimated 0.93 lives, representing 38.6 life years will be saved in
the cohort. CONCLUSIONS: Under an assumption of neutrality relating to the
potential effects of vaccination on herpes zoster virus, our model based
calculations show that a national varicella vaccination programme is likely to be
cost saving, not only from a societal perspective but also from the narrower
health service perspective.

Publication Types: 
    Review

PMID: 14720487 [PubMed - indexed for MEDLINE]

427: Indian J Pediatr. 2003 Dec;70(12):961-3.

Necrotizing fasciitis with chickenpox.

Vijaykumar, Rao PS, Bhat N, Chattopadhyay A, Nagendhar MY.

Department of Pediatric Surgery, Kasturba Medical College, Manipal, India.
vijaykumar5566@yahoo.com

Necrotizing fasciitis can be observed in a wide variety of clinical settings in
the pediatric age group. But necrotizing fasciitis as a complication of
chickenpox is rare. Five cases of necrotizing fasciitis following chickenpox were
treated in the authors' institutions. Clinical signs like fever, tachycardia,
pallor, erythema, marked edema of the affected area and patchy areas of
discoloration or gangrene of the skin were present and were the important clues
to the seriousness of infection. Patients were treated with aggressive surgical
debridement, frequent dressings, broad-spectrum antibiotics, nutritional support,
and split skin grafting. Early diagnosis and aggressive surgical therapy are
critical. Literature search showed necrotizing fasciitis following chickenpox has
not been reported in India. We feel early suspicion and aggressive management can
decrease the morbidity and mortality in this rare complication.

Publication Types: 
    Case Reports

PMID: 14719784 [PubMed - indexed for MEDLINE]

428: Ocul Immunol Inflamm. 2003 Dec;11(4):315-8.

Resolution of chicken pox neuroretinitis with oral acyclovir: a case report.

Biswas J, Nagpal A, Chopra S, Karna S.

Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India.
drjb@sankaranethralaya.org

It is usual to consider chicken pox as a benign infectious disease with a few
anterior segment ocular complications like conjunctivitis, keratitis,
episcleritis, scleritis, iridocyclitis, and glaucoma. The retinal manifestations 
are necrotising retinitis, vitritis, neuroretinitis, and retinal detachments. We 
report a case of neuroretinitis following chicken pox in a 23-year-old male. The 
complication was resolved by treatment with oral acyclovir in combination with
systemic steroids. This report highlights the necessity for fundus examination in
cases of chickenpox exhibiting visual symptoms.

Publication Types: 
    Case Reports

PMID: 14704904 [PubMed - indexed for MEDLINE]

429: Int J Hematol. 2003 Nov;78(4):370-3.

Chronic graft-versus-host disease following varicella-zoster virus infection in
allogeneic stem cell transplant recipients.

Kawano N, Gondo H, Kamimura T, Aoki K, Iino T, Ishikawa F, Miyamoto T, Nagafuji
K, Shimoda K, Hayashi S, Otsuka T, Kazuyama Y, Harada M.

Medicine and Biosystemic Science, Kyushu University Graduate School of Medical
Sciences, Fukuoka, Japan. kawano@1nai.med.kyushu-u.ac.jp

We describe 2 allogeneic stem cell transplantation patients who developed chronic
graft-versus-host disease (GVHD) after dermatomal varicella-zoster virus (VZV)
infection. Localized zoster did not respond to oral valaciclovir but did resolve 
with intravenous aciclovir. However, skin eruptions, eye/oral dryness, and liver 
dysfunction were observed at the healing stage of localized zoster, suggesting
development of GVHD. Intensification of immunosuppressive therapy was required to
control GVHD. Quantitative real-time PCR for VZV DNA was used to distinguish
liver involvement by chronic GVHD from visceral dissemination of VZV in 1
patient. VZV infection may trigger chronic GVHD after allogeneic stem cell
transplantation.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 14686497 [PubMed - indexed for MEDLINE]

430: Obstet Gynecol. 2003 Nov;102(5 Pt 1):970-7.

Postpartum varicella vaccination: is the vaccine virus excreted in breast milk?

Bohlke K, Galil K, Jackson LA, Schmid DS, Starkovich P, Loparev VN, Seward JF.

Center for Health Studies, Group Health Cooperative, Seattle, Washington
98101-1448, USA. bohlke.k@ghc.org

OBJECTIVE: To evaluate whether the varicella vaccine virus is detected in breast 
milk after vaccination of breast-feeding women and whether there is serologic
evidence of exposure of the infant to varicella virus after maternal vaccination.
METHODS: We enrolled women identified as varicella seronegative during routine
prenatal screening at Group Health Cooperative. Participants received the first
dose of varicella vaccine at least 6 weeks postpartum and the second dose at
least 4 weeks later. They collected ten breast milk samples after each vaccine
dose. Breast milk samples were tested for varicella zoster virus by polymerase
chain reaction (PCR). Serum specimens were collected from the mothers 1 month
after each vaccine dose, and peripheral blood from their infants was collected
onto filter spots 1 month after the mother's second dose. These samples were
tested for varicella immunoglobulin (Ig) G by whole-virus enzyme-linked
immunosorbent assay (ELISA), or by the more sensitive glycoprotein ELISA. When
possible, filter spots from the infants were also tested by PCR for the presence 
of varicella zoster virus deoxyribonucleic acid (DNA). RESULTS: Twelve women were
enrolled; all seroconverted after the first vaccine dose. Varicella DNA was not
detected by PCR in any of the 217 postvaccination breast milk specimens. None of 
the infants was seropositive. Samples from six infants were tested for varicella 
zoster virus DNA by PCR, and all were negative. CONCLUSION: We found no evidence 
of varicella vaccine virus excretion in breast milk. These findings suggest that 
postpartum vaccination of varicella-susceptible women need not be delayed because
of breast-feeding.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14672472 [PubMed - indexed for MEDLINE]

431: Dev Med Child Neurol. 2003 Dec;45(12):837-40.

Intracerebral varicella-zoster virus reactivation in congenital varicella
syndrome.

Sauerbrei A, Pawlak J, Luger C, Wutzler P.

Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of
Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de

Patients with congenital varicella syndrome (CVS) typically present with clinical
symptoms consisting of skin lesions, neurological defects, eye diseases, and/or
limb hypoplasia. In rare cases, isolated manifestations in the brain or eye have 
been reported. The varicella-zoster virus (VZV), as the causative agent of CVS,
could only be detected in a few infants with CVS. In addition, there is little in
the literature on antiviral treatment of infants born with signs of CVS. We
report a case of CVS in a male infant who presented with generalized clonic
cerebral seizures at age 4 months. An endogenous intracerebral viral reactivation
following intrauterine VZV infection was assumed. After the diagnosis was
confirmed virologically, acyclovir was administered intravenously for 10 days and
afterwards orally for 3 weeks. This antiviral treatment was aimed at preventing
progression of the disease. We concluded from this case that infants with
intrauterine VZV infection can suffer intracerebral VZV reactivations that
require antiviral treatment.

Publication Types: 
    Case Reports

PMID: 14667077 [PubMed - indexed for MEDLINE]

432: Int J Infect Dis. 2003 Dec;7(4):274-7.

How reliable is the history of chickenpox? Varicella serology among children up
to 14 years of age.

Kavaliotis J, Petridou S, Karabaxoglou D.

Department of Pediatrics, Hospital for Infectious Diseases, Thessaloniki, Greece.
kavagr@hotmail.com

OBJECTIVES: The aim of this study was to assess the seroprevalence of antibodies 
to varicella-zoster virus (VZV) in children of northern Greece and to estimate
the reliability of varicella history. METHODS: A serosurvey of 632 children, aged
13 months to 14 years (median 5.2 years), was conducted between April 1999 and
July 2001. Serum samples were tested by enzyme-linked immunosorbent assay (ELISA)
for IgG antibodies to VZV (IgG Genzyme Virotech GmbH). A history of varicella in 
these children was obtained from the parents of all these patients. Also, a check
of state health cards of the patients was done. RESULTS: Two hundred and
forty-eight (39%) of the children were seropositive for VZV. Two hundred and
thirty (36%) of the 632 children claimed to have had previous varicella
infection; 87.8% were seropositive, and 12.2% lacked antibodies to VZV. One
hundred and seven of the 230 children with a history of varicella had the
information about the disease confirmed, as it was reported on their state health
card by a pediatrician; 10.2% were seronegative for VZV. Absence of history of
varicella was reported in 402 (63.6%) of the 632 children; 88.6% of those were
seronegative, and 11.4% were seropositive. The percentage of incorrect negative
history ranged from 6% (13-60 months of age) to 48% (120-168 months of age).
CONCLUSIONS: A large proportion of the study group (61%), mainly below 7 years of
age, is susceptible to varicella. The positive predictive value of a history of
varicella is 87.8%, whereas the negative predictive value of a negative history
is 11.4%, which means that there is an 88.6% probability of a negative history
being correct. Varicella serology may be reasonable prior to vaccination in
children >10 years old with a negative chickenpox history. However, if one
excludes cost considerations, it is also reasonable to vaccinate all children,
irrespective of serostatus.

PMID: 14656418 [PubMed - indexed for MEDLINE]

433: Can Fam Physician. 2003 Nov;49:1445-6.

Risk of varicella infection during late pregnancy.

Koren G.

Motherisk Team, Hospital for Sick Children in Toronto, Ont.

QUESTION: I have a patient who contracted varicella at 26 weeks' gestation. She
is very concerned and would consider termination if it were earlier in the
pregnancy. What are the current predictions of risk for her fetus? ANSWER: Based 
on review of all available studies, we could not detect a single case of
congenital varicella syndrome in the third trimester of pregnancy (0/208), as
compared with 5/645 (0.78%) in the first and 9/592 (1.52%) in the second
trimester (P < .01 third vs first and second). You can reassure your patient.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14649980 [PubMed - indexed for MEDLINE]

434: Value Health. 2003 Sep-Oct;6(5):551-9.

Validation of health economic models: the example of EVITA.

Hammerschmidt T, Goertz A, Wagenpfeil S, Neiss A, Wutzler P, Banz K.

GlaxoSmithKline, Munich, Germany. Thomas.Hammerschmidt@gsk.com

OBJECTIVES: The credibility of models rests on their validity. An age-structured 
decision analytic model, Economic Varicella Vaccination Tool for Analysis
(EVITA), has been developed to examine the epidemiologic and economic effects of 
universal varicella (chicken pox) vaccination in Germany. EVITA combines a
varicella transmission module describing the spread of infection in a population 
over time with a second module describing the course of disease in case of an
infection. Any vaccination strategy can be assessed dependent on coverage levels 
and targeted age group. Model input data include epidemiologic, clinical, and
economic information, which were mainly derived from actual varicella cases
(retrospective survey). The objective of this study was to illustrate the efforts
undertaken to validate the EVITA model. METHODS: We assess the descriptive
validity, i.e., whether the model provides an adequate picture of the reality and
covers all relevant aspects of the spread of varicella and the course of disease.
Analyzing the consistency of the model results with observable data does
technical verification. Face validity, i.e., the consistency with the underlying 
theoretical basis of the spread of varicella, is analyzed with respect to results
on possible age shifts and elimination of varicella. Tests of corroboration, or
convergent validity, are performed by comparisons with other models. RESULTS:
Without vaccination, the EVITA model predicts undiscounted, indirect costs of 154
million euros, nearly 40,000 complications and 5,700 hospitalizations per year
owing to varicella. These results, especially the distribution of complications
and hospitalizations, fit well with population-based survey data. The development
of the EVITA model is based on an established epidemiologic model and on
real-life data from the survey, ensuring descriptive validity. Results on age
shifts and elimination show face validity. Although other models differ
considerably with respect to methods applied, the economic results of EVITA,
i.e., a benefit-cost ratio of 4.12 when vaccinating young children, lies in the
range found in other studies. This underscores its convergent validity.
Comparable with other studies, discount rates and price of vaccine proved to be
most sensitive variables. CONCLUSIONS: EVITA provides a powerful tool to simulate
the highly complex processes associated with varicella infections and the impact 
of vaccination. The results of EVITA provide a reliable tool for informed
decision making and should enhance the acceptance of such models.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Validation Studies

PMID: 14627061 [PubMed - indexed for MEDLINE]

435: Anaesthesia. 2003 Nov;58(11):1092-5.

Anaesthetic considerations in a parturient with varicella presenting for
Caesarean section.

Brown NW, Parsons AP, Kam PC.

Department of Anaesthesia and Pain Management, University of Sydney at Royal
North Shore Hospital, St Leonards, NSW 2065, Australia.

A parturient with varicella (chickenpox) presented for an elective Caesarean
section and spinal anaesthesia was employed for surgery. A review of the
literature is presented and the anaesthetic issues are discussed.

Publication Types: 
    Case Reports
    Review

PMID: 14616595 [PubMed - indexed for MEDLINE]

436: J Pediatr. 2003 Nov;143(5 Suppl):S157-62.

Prophylaxis against respiratory syncytial virus (RSV), varicella, and
pneumococcal infections: Economic-based decision-making.

Strutton DR, Stang PE.

Galt Associates, Inc, Blue Bell, Pennsylvania 19422, USA. daves@galt-assoc.com

OBJECTIVE: To compare costs and health benefits of three prophylactic
interventions recommended by the American Academy of Pediatrics (AAP) and to help
quantify the impact of illness and enhance the physicians' ability to make
informed decisions. STUDY DESIGN: Medline search was conducted of
English-language cost-effectiveness studies of varicella and pneumococcal
conjugate vaccination recommended for all healthy infants and of respiratory
syncytial virus (RSV) prophylaxis with palivizumab (Synagis) for infants at high 
risk for severe RSV infection. Data were collected on cost-effectiveness, burden 
of illness, and efficacy and analyzed from the societal and payer perspective.
Results were discounted by 5% and costs inflated to year 2002 dollars. RESULTS:
From the societal perspective, estimates of cost per life-years saved were money 
savings for varicella, 175,300 US dollars for pneumococcal conjugate vaccination,
and 66,200 US dollars for palivizumab prophylaxis; from the payer perspective,
estimates were 28,100, 338,400, and 66,400 US dollars, respectively. CONCLUSIONS:
Cost-effectiveness estimates for varicella and pneumococcal conjugate vaccination
demonstrate that evaluating economic benefits from the societal rather than the
payer perspective makes universal prophylaxis very financially attractive. By
comparison, this same differential does not exist for the cost-effectiveness
estimates of palivizumab from the societal and payer perspectives because its use
is in a well-defined high-risk target population. From a societal perspective,
prophylaxis is a rational public policy decision, although in target populations,
incidence of serious illness and the primary cost components driving the cost
offsets vary across prophylactic measures studied.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14615715 [PubMed - indexed for MEDLINE]

437: Am J Infect Control. 2003 Oct;31(6):375-81.

Varicella zoster virus immunity in multinational health care workers of a Saudi
Arabian hospital.

Almuneef M, Dillon J, Abbas MF, Memish Z.

Department of Pediatrics, King Abdulaziz Medical City, National Guard Health
Affairs, Riyadh, Saudi Arabia.

INTRODUCTION: The health care worker (HCW) is vulnerable to hospital-acquired
varicella zoster virus (VZV) infection, and thereafter may transmit infection to 
coworkers and patients who are susceptible and hospitalized. Interventions to
prevent varicella transmission in HCW groups of uncertain immunity prove labor
intensive, costly, and disruptive. Therefore, documentation of total varicella
immunity in HCWs is desirable. SETTING: The National Guard King Abdulaziz Medical
City is a 600-bed tertiary care center in Riyadh, Saudi Arabia with a
multinational staff. MATERIAL AND METHOD: A program to assess the VZV status of
HCWs was initiated in 1999. The survey was confined to HCWs having direct patient
contact. Questions elucidated previous history of varicella (chicken pox)
infection, antibody testing against varicella, and varicella vaccination. HCWs
with a negative or unknown history were subsequently tested for varicella
antibodies (IgG). RESULTS: Seventy-six percent (2,047) of the HCWs responded to
the questionnaire. Of these, 562 (28%) were physicians, 761 (37%) were nurses,
438 (21%) were medical technicians, and 286 (14%) were involved in clerical work.
A total of 802 (39%) were from the Middle East including Saudi Arabia, 633 (31%) 
were from the Far East, 361 (18%) were from the West and from temperate areas,
138 (7%) were from South Africa, and 113 (5%) were from other nationalities. A
previous history of VZV infection was reported by 1303 (64%); 262 (13%) had a
history of positive test for varicella antibody, and only 44 (2%) had a history
of varicella vaccination. Of the 744 (36%) HCWs who had a negative or unknown
history of VZV infection, 217 (29%) underwent antibody testing. Of these, 181
(83%) proved to be immune (IgG > or = 1.10), and 36 (17%) nonimmune (IgG < 1.2). 
The latter group have completed varicella immunization. Staff from the West
(81%), Far East (78%), and South Africa (59%) reported more histories of VZV
infection compared with the employees of Middle Eastern origin (46%) (P <.001)
and disclosed a history of positive antibodies in 13%, 18%, 17%, and 8%,
respectively (P <.001). In relation to occupation, nurses reported history of
varicella infection (75%) and a history of positive varicella antibodies (16%)
more than physicians (54% and 8%, respectively) (P <.05). Conversely, serologic
immunity to VZV infection proved consistent among the different nationalities and
among the 4 occupational groups. CONCLUSION: Total varicella immunity of a
multinational workforce can be realized through screening of HCWs and vaccination
of susceptible individuals. It is preferred above repeated interventions after
varicella exposure for its simplicity, cost-effectiveness, and efficiency.
Knowledge of VZV infection varies between different nationalities and cannot be
used as a true predictor of immunity. There is no difference in the immunity by
antibody testing of staff recruited from temperate and tropical climates. Total
varicella immunity should, therefore, be achieved through screening of all HCWs
and vaccination of those susceptible.

Publication Types: 
    Comparative Study

PMID: 14608306 [PubMed - indexed for MEDLINE]

438: Vaccine. 2003 Dec 8;22(1):15-20.

Superiority of varicella skin test antigen over purified varicella-zoster virus
glycoproteins in monitoring booster response to Oka varicella vaccine.

Sato H, Yamamura J, Kageyama S, Kurokawa M, Shiraki K.

Department of Virology, Toyama Medical and Pharmaceutical University, 2630
Sugitani, 930-0194 Toyama, Japan.

Varicella skin test antigen has been developed based on the induction of
delayed-type hypersensitivity (DTH) to varicella-zoster virus (VZV). The booster 
immune response to Oka varicella vaccine was assessed by cutaneous reactivity to 
purified VZV glycoprotein complexes, gB, gE:gI, gH:gL, and varicella skin test
antigen. Skin tests with these antigens significantly augmented antibody
production to glycoproteins and VZV antigen resulting in no further augmentation 
by the subsequent vaccination. All glycoprotein complexes induced the cutaneous
reaction similarly to varicella skin test antigen. Cutaneous reaction to
glycoproteins and varicella skin test antigen was boosted after vaccination.
However, the magnitude of cutaneous reaction to each glycoprotein complex before 
and after vaccination was rich in variety. These results indicated that skin test
with varicella skin test antigen is a more suitable indicator in monitoring
cell-mediated immunity to VZV than that using purified glycoproteins.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 14604566 [PubMed - indexed for MEDLINE]

439: Viral Immunol. 2003;16(3):243-58.

Clinical and molecular pathogenesis of varicella virus infection.

Gilden DH, Cohrs RJ, Mahalingam R.

Department of Neurology, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA. don.gilden@uchsc.edu

Varicella zoster virus (VZV) is a neurotropic human herpesvirus that infects
nearly all humans and causes chickenpox (varicella). After chickenpox, VZV
becomes latent in cranial nerve, dorsal root, and autonomic nervous system
ganglia along the entire neuraxis. Virus reactivation produces shingles (zoster),
characterized by pain and rash usually restricted to 1-3 dermatomes. Zoster is
often complicated by postherpetic neuralgia (PHN), pain that persists for months 
to years after rash resolves. Virus may also spread to the spinal cord and blood 
vessels of the brain, producing a unifocal or multifocal vasculopathy,
particularly in immunocompromised individuals. The increased incidence of zoster 
in elderly and immunocompromised individuals appears to be due to a VZV-specific 
host immunodeficiency. PHN may reflect a chronic VZV ganglionitis, and VZV
vasculopathy is due to productive virus infection in cerebral arteries.
Strategies that might boost host cell-mediated immunity to VZV are discussed, as 
well as the physical state of viral nucleic acid during latency and the possible 
mechanisms by which herpesvirus latency is maintained and virus is reactivated. A
current summary of varicella latency and pathogenesis produced by simian
varicella virus (SVV), the counterpart of human VZV, points to the usefulness of 
a primate model of natural infection to study varicella latency, as well as the
experimental model of intratracheal inoculation to study the effectiveness of
antiviral agents in driving persistent varicella virus into a latent state.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 14583142 [PubMed - indexed for MEDLINE]

440: Indian Pediatr. 2003 Oct;40(10):1002-4.

Varicella complicated by scarlet fever.

Yavuz T, Parlak AH, Kocabay K.

Department of Pediatrics, Duzce School of Medicine, Abant Izzet Baysal
University, Turkey.

We report a 3-year-old boy with varicella complicated by cellulitis and scarlet
fever. He developed a typical rash of scarlet fever following the onset of
varicella. Streptococcus pyogenes was isolated from the ulcers due to varicella. 
The present case suggests that scarlet fever may rarely develop following
varicella and should be considered in children with complicated varicella.

Publication Types: 
    Case Reports

PMID: 14581741 [PubMed - indexed for MEDLINE]

441: Herpes. 2003 Aug;10(2):32-7.

Antiviral therapy in children with varicella zoster virus and herpes simplex
virus infections.

Enright AM, Prober C.

Stanford University Medical Center, Stanford, CA 94305, USA.

A small number of antiviral drugs are available for the treatment of varicella
zoster virus (VZV) and herpes simplex virus (HSV) infections in children. This
review presents pharmacokinetic data on the following selected antiviral agents: 
aciclovir, valaciclovir, famciclovir, cidofovir and foscarnet. Support and
current recommendations for the treatment of selected VZV and HSV infections in
children will also be reviewed.

Publication Types: 
    Review

PMID: 14577952 [PubMed - indexed for MEDLINE]

442: J Virol Methods. 2003 Nov;113(2):113-6.

A real-time PCR assay for the detection of varicella-zoster virus DNA and
differentiation of vaccine, wild-type and control strains.

Tipples GA, Safronetz D, Gray M.

National Microbiology Laboratory, Health Canada, 1015 Arlington Street, Winnipeg,
Man., Canada R3E 3R2. graham_tipples@hs-sc.gc.ca

Varicella-zoster vaccine is a live attenuated virus. It is, therefore, necessary 
to have a test to differentiate vaccine from wild-type varicella-zoster virus
(VZV) strains for the investigation of varicella or zoster-like rash illness in
individuals vaccinated previously. In addition, it is necessary to have a rapid
VZV assay for use in the context of smallpox bioterrorism laboratory testing.
Using specific primers and hybridization probes, a rapid method to differentiate 
vaccine strain VZV from wild-type VZV was developed based on the presence or
absence of a Pst I restriction site within open reading frame (ORF) 38. Using
this ORF 38 assay in conjunction with a similar previously described ORF 62 assay
allows for further differentiation of vaccine strain, wild-type and a laboratory 
control strain (Ellen) VZV. This is accomplished because Ellen VZV is similar to 
wild-type VZV with respect to the ORF 38 assay but is similar to vaccine strain
VZV with respect to the ORF 62 assay. The hybridization probes for each ORF are
labeled with different fluorescent tags thus allowing both assays to be run
simultaneously in a single tube. Both assays demonstrate a high degree of
specificity for VZV and can reliably detect between 10 and 100 copies of VZV DNA.
Thus, the real-time polymerase chain reaction (PCR) assay for VZV described below
provides a rapid assay allowing the simultaneous differentiation of vaccine,
wild-type and laboratory control strains of VZV.

Publication Types: 
    Evaluation Studies

PMID: 14553897 [PubMed - indexed for MEDLINE]

443: J Clin Microbiol. 2003 Oct;41(10):4904-5.

Persistent multiple pulmonary nodules in a nonimmunocompromised woman after
varicella-related myelitis treated with acyclovir.

Schvoerer E, Frechin V, Warter A, Gasser B, Jouin H, Gut JP, Stoll-Keller F.

Institut de Virologie de la Faculté de Médecine et Hôpitaux Universitaires de
Strasbourg, 67000 Strasbourg, France. Evelyne.Schvoerer@viro-ulp.u-strasbg.fr

Persistent multiple pulmonary nodules were observed on the chest X ray of a
nonimmunocompromised woman 6 months after she was treated with acyclovir for a
varicella-related myelitis without respiratory symptoms. Early antiviral therapy 
given for varicella infections might decrease the intensity of clinical symptoms 
without actually preventing the occurrence of varicella-zoster virus-related
lesions such as the persistent pulmonary nodules reported here.

Publication Types: 
    Case Reports

PMID: 14532257 [PubMed - indexed for MEDLINE]

444: Public Health. 2003 Nov;117(6):446-51.

Pox in the docks: varicella outbreak in an Australian prison system.

Levy MH, Quilty S, Young LC, Hunt W, Matthews R, Robertson PW.

Corrections Health Service, Long Bay Prison Hospital, Matraville, NSW 2036,
Australia. levym@chs.health.nsw.gov.au

OBJECTIVES: 1. Describe an outbreak of varicella in a prison system. 2. Highlight
the risks of disease transmission within the prison environment. 3. Promote
infection control guidelines for high-risk sub-groups within the prison system,
including the application of quarantine. SETTING: Four prisons, one prison
hospital, the prison transport system, one courthouse. MAIN OUTCOME MEASURES:
Number of cases of varicella infection; reported varicella immunity status of
cases and contacts; immunity status of known HIV antibody positive inmates.
RESULTS: Five cases of chickenpox were identified. There were 23 contacts of the 
Index Case occurring during transport between prison and court and whilst being
held in the court holding cells. Two of these contacts developed chickenpox
despite having given a prior history of infection. There were over 300 inmates
exposed to varicella zoster virus (VZV) during the outbreak, including one HIV
antibody positive inmate who had serologically confirmed immunity. This inmate
developed shingles following exposure to VZV from one of the cases. CONCLUSIONS: 
There is an elevated risk of respiratory transmission of infections such as
chickenpox in prisons. Clear guidelines should be in place to protect HIV
antibody positive people, pregnant women, and others who are at increased risk of
complications from such infections. In the case of varicella, all inmates and
staff without documented immunity should be screened to determine immunity, and
if non-immune, should be offered VZV vaccination. Every effort should be made to 
prevent HIV antibody positive inmates being exposed to varicella, regardless of
their varicella immunity status. If an HIV antibody positive inmate, who is known
to be non-immune is exposed to varicella, Varicella Zoster immunoglobulin should 
be given within 96 h.

Publication Types: 
    Multicenter Study

PMID: 14522161 [PubMed - indexed for MEDLINE]

445: Pediatr Infect Dis J. 2003 Sep;22(9):819-23.

Neurodevelopmental follow-up of children of women infected with varicella during 
pregnancy: a prospective study.

Mattson SN, Jones KL, Gramling LJ, Schonfeld AM, Riley EP, Harris JA, Chambers
CD.

Center for Behavioral Teratology, Department of Psychology, San Diego State
University, 6363 Alvarado Court, Suite 209, San Diego, CA 92120, USA.
smattson@sunstroke.sdsu.edu

BACKGROUND: The fetal varicella syndrome is associated with abnormal central
nervous system development, which in many cases is associated with mental
retardation. However, the incidence of neurobehavioral deficits in asymptomatic
structurally normal children whose mothers had clinically diagnosed
varicella-zoster virus infection is unknown. METHODS: Neurobehavioral outcome was
evaluated in 84 children born to women infected with varicella during pregnancy
and 40 children born to women who were not infected with varicella during
pregnancy. Children were 3 to 15 years of age at the time of testing. Clinical
features of the fetal varicella syndrome were present in only 1 of the 84
children in the varicella group. These sample sizes provide statistical power of 
0.80 (alpha = 0.05) to detect group differences of 0.54 sd (the equivalent of 8.1
IQ points). RESULTS: No differences were found in the test performance of the two
groups. In addition, within the varicella sample, no meaningful differences were 
found relative to infection-related hyperthermia or the timing of infection.
CONCLUSIONS: As a group, the children born to women infected with
varicella-zoster virus during pregnancy and who do not have structural features
characteristic of the fetal varicella syndrome are not neurodevelopmentally
different from unexposed, uninfected control children.

PMID: 14506375 [PubMed - indexed for MEDLINE]

446: Vaccine. 2003 Oct 1;21(27-30):4250-5.

Comment in:
    Vaccine. 2004 Sep 3;22(25-26):3228-31; author reply 3232-6.

Using capture-recapture methods to assess varicella incidence in a community
under active surveillance.

Goldman GS.

P.O. Box 847, Pearblossom, CA 93553, USA. pearblossominc@aol.com

The Varicella (chickenpox) Active Surveillance Project (VASP) has been conducting
active surveillance since 1 January 1995 in the high desert community known as
Antelope Valley, CA (population 300,000) among 300 public and private schools,
daycares, and healthcare providers. Capture-recapture methods were applied to
estimate reporting completeness for 1995 varicella incidence data and these were 
compared with the national average incidence rates by age reported by the
National Health Interview Survey (NHIS). Varicella cases reported among
individuals aged <20 years reflect under-reporting in excess of 50%. Despite
limitations on accuracy, capture-recapture estimates are a reasonably accurate,
quick, and inexpensive approach in epidemiologic studies.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 14505906 [PubMed - indexed for MEDLINE]

447: Vaccine. 2003 Oct 1;21(27-30):4243-9.

Comment in:
    Vaccine. 2004 Sep 3;22(25-26):3228-31; author reply 3232-6.

Incidence of herpes zoster among children and adolescents in a community with
moderate varicella vaccination coverage.

Goldman GS.

P.O. Box 847, Pearblossom, CA 93553, USA. pearblossominc@aol.com

Active surveillance for herpes zoster (HZ) was conducted for 2 years (2000-2001) 
in the Antelope Valley community of 312,000 residents among 290 public and
private schools, daycares, and healthcare providers. The true
ascertainment-adjusted HZ incidence rate is 307 per 100,000 person-years and 138 
per 100,000 person-years among children <10 and individuals aged 10-19,
respectively. The unadjusted rate among vaccinated children is 9.5 per 100,000
person-years and an estimated 22 per 100,000 vaccine doses. Unvaccinated children
with a previous history of varicella may have greater sensitivity to exogenous
exposures (boosting) and a poorer cell-mediated response following primary
infection relative to older age groups.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 14505905 [PubMed - indexed for MEDLINE]

448: Vaccine. 2003 Oct 1;21(27-30):4238-42.

Comment in:
    Vaccine. 2004 Sep 3;22(25-26):3228-31; author reply 3232-6.

Varicella susceptibility and incidence of herpes zoster among children and
adolescents in a community under active surveillance.

Goldman GS.

P.O. Box 847, Pearblossom, CA 93553, USA. pearblossominc@aol.com

Licensure of varicella vaccine by the US Food and Drug Administration in March
1995 has given rise to concerns that include a potential shift in varicella
incidence to susceptible adults and increase in herpes zoster (HZ) incidence.
Baseline values prior to widespread vaccination were obtained through
distribution of an adolescent survey to all 13 public middle (seventh and eighth 
grade) schools in the Antelope Valley, CA health district. Based on 4216
respondents aged 10-14 years, varicella susceptibility is 7.7% (95% CI, 6.9-8.5%)
and true cumulative (1987-2000) HZ incidence rate is 133 per 100,000 person-years
(95% CI, 95-182 per 100,000 person-years).

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 14505904 [PubMed - indexed for MEDLINE]

449: BMC Pediatr. 2003 Sep 23;3:11. Epub 2003 Sep 23.

Spectrum of centrosome autoantibodies in childhood varicella and post-varicella
acute cerebellar ataxia.

Fritzler MJ, Zhang M, Stinton LM, Rattner JB.

Department of Medicine, Faculty of Medicine University of Calgary, 3330 Hospital 
Dr, NW, Calgary, AB T2N 4N1, Canada. fritzler@ucalgary.ca

BACKGROUND: Sera from children with post-varicella infections have autoantibodies
that react with centrosomes in brain and tissue culture cells. We investigated
the sera of children with infections and post-varicella ataxia and related
conditions for reactivity to five recombinant centrosome proteins:
gammagamma-enolase, pericentrin, ninein, PCM-1, and Mob1. METHODS: Sera from 12
patients with acute post-varicella ataxia, 1 with post-Epstein Barr virus (EBV)
ataxia, 5 with uncomplicated varicella infections, and other conditions were
tested for reactivity to cryopreserved cerebellum tissue and recombinant
centrosome proteins. The distribution of pericentrin in the cerebellum was
studied by indirect immunofluorescence (IIF) using rabbit antibodies to the
recombinant protein. Antibodies to phospholipids (APL) were detected by ELISA.
RESULTS: Eleven of 12 children with post-varicella ataxia, 4/5 children with
uncomplicated varicella infections, 1/1 with post-EBV ataxia, 2/2 with ADEM, 1/2 
with neuroblastoma and ataxia, and 2/2 with cerebellitis had antibodies directed 
against 1 or more recombinant centrosome antigens. Antibodies to pericentrin were
seen in 5/12 children with post-varicella ataxia but not in any of the other sera
tested. IIF demonstrated that pericentrin is located in axons and centrosomes of 
cerebellar cells. APL were detected in 75% of the sera from children with
post-varicella ataxia and 50% of children with varicella without ataxia and in
none of the controls. CONCLUSION: This is the first study to show the antigen
specificity of anti-centrosome antibodies in children with varicella. Our data
suggest that children with post-varicella ataxia have unique autoantibody
reactivity to pericentrin.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14503922 [PubMed - indexed for MEDLINE]

450: Arch Dis Child. 2003 Oct;88(10):862-9.

Varicella vaccination in England and Wales: cost-utility analysis.

Brisson M, Edmunds WJ.

Immunisation Division, PHLS Communicable Disease Surveillance Centre, London NW9 
5EQ, UK.

AIMS: To assess the cost-effectiveness of varicella vaccination, taking into
account its impact on zoster. METHODS: An age structured transmission dynamic
model was used to predict the future incidence of varicella and zoster. Data from
national and sentinel surveillance systems were used to estimate age specific
physician consultation, hospitalisation, and mortality rates. Unit costs, taken
from standard sources, were applied to the predicted health outcomes. RESULTS: In
England and Wales, the annual burden of VZV related disease is substantial, with 
an estimated 651 000 cases of varicella and 189 000 cases of zoster, resulting in
approximately 18 000 QALYs lost. The model predicts that although the overall
burden of varicella will significantly be reduced following mass infant
vaccination, these benefits will be offset by a significant rise in zoster
morbidity. Under base case assumptions, infant vaccination is estimated to
produce an overall loss of 54 000 discounted QALYs over 80 years and to result in
a net cost from the health provider (NHS) and the societal perspectives. These
results rest heavily on the impact of vaccination on zoster. Adolescent
vaccination is estimated to cost approximately 18 000 pounds sterling per QALY
gained from the NHS perspective. CONCLUSION: Routine infant varicella vaccination
is unlikely to be cost-effective and may produce an increase in overall
morbidity. Adolescent vaccination is the safest and most cost-effective strategy,
but has the least overall impact on varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14500303 [PubMed - indexed for MEDLINE]

451: MMWR Morb Mortal Wkly Rep. 2003 Sep 19;52(37):884-5.

Decline in annual incidence of varicella--selected states, 1990-2001.

Centers for Disease Control and Prevention (CDC).

Varicella (chickenpox) is a common, highly infectious, and vaccine-preventable
disease. Before the introduction of the live attenuated varicella vaccine in
1995, approximately 4 million cases of varicella occurred annually in the United 
States, resulting in approximately 11,000 hospitalizations and 100 deaths. In
1996, the Advisory Committee on Immunization Practices (ACIP) recommended routine
vaccination of all children at age 12-18 months, catch-up vaccination of all
susceptible children before age 13 years, and vaccination of susceptible persons 
with close contact to persons at high risk for serious complications. In 1999,
ACIP updated these recommendations to include vaccination requirements for child 
care and school entry and for postexposure; ACIP also strengthened
recommendations for vaccination of susceptible adults and indicated that
varicella vaccine should be considered for outbreak control. Changes in the
national annual reported incidence of varicella disease during 1972-1997 have
been reported previously. This report summarizes trends in the annual reported
incidence of varicella disease in selected states during 1990-2001. The findings 
underscore the continued need to improve varicella surveillance to monitor the
impact of the varicella vaccination program and assess any changes in varicella
transmission and disease.

PMID: 13679791 [PubMed - indexed for MEDLINE]

452: Prenat Diagn. 2003 Sep;23(9):705-9.

Prenatal ultrasound and magnetic resonance imaging in fetal varicella syndrome:
correlation with pathology findings.

Verstraelen H, Vanzieleghem B, Defoort P, Vanhaesebrouck P, Temmerman M.

Department of Obstetrics and Gynaecology, Faculty of Medicine and Health
Sciences, Ghent University, Ghent, Belgium.

OBJECTIVES: To assess the diagnostic value of prenatal magnetic resonance imaging
(MRI) in addition to prenatal ultrasound in a case of fetal varicella syndrome.
METHODS: Comparison of prenatal ultrasound and MRI features obtained at 26 and 32
weeks, respectively, with neonatal imaging (ultrasound, MRI and CT) and
macroscopic and microscopic pathology findings in a fatal case of varicella
embryopathy. RESULTS: Prenatal ultrasound correlated fairly well with neonatal
imaging and pathology findings. Most lesions of thoracic, abdominal and
retroperitoneal viscera, limb involvement and even dermatologic features were
apparent on ultrasonography. Involvement of the CNS, including cerebellar
hypoplasia, was not apparent on ultrasound examination, but was clearly
demonstrated by prenatal MRI. CONCLUSION: If maternal seroconversion for the
varicella-zoster virus is suspected, combining prenatal ultrasound and magnetic
resonance imaging may document the extent of tissue damage in fetal varicella
syndrome to a larger extent than has been reported until now and therefore
contribute to due counselling following maternal varicella exposure. Copyright
2003 John Wiley & Sons, Ltd.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12975778 [PubMed - indexed for MEDLINE]

453: Aust Fam Physician. 2003 Aug;32(8):583-7.

Varicella and varicella vaccination. An update.

Litt J, Burgess M.

Department of General Practice, Flinders University, Noarlunga Hospital, South
Australia. j.litt@flinders.edu.au

BACKGROUND: Although varicella is generally mild in children, it is often more
severe in adults and overall is responsible for approximately 2000 hospital
admissions each year in Australia. Live attenuated varicella vaccines have been
available in Australia since 2000. They are safe and effective. OBJECTIVE: This
article discusses the role of varicella vaccination and management of varicella
in pregnancy. DISCUSSION: The National Health and Medical Research Council
recommends vaccination of all children at the age of 18 months and a catch up
program for nonimmune adolescents and adults. The program is not yet funded by
the commonwealth government. Varicella vaccine may be used for postexposure
prophylaxis and is most effective if given within three days after exposure, but 
can be used up to five days from exposure. Varicella in pregnancy may cause
congenital malformations; the highest risk (2%) being when maternal infection
occurs between 13-20 weeks gestation. Offer varicella zoster immunoglobulin to
nonimmune pregnant women, neonates and other high risk subjects with significant 
exposure to varicella or zoster.

Publication Types: 
    Review

PMID: 12973863 [PubMed - indexed for MEDLINE]

454: Transplant Proc. 2003 Aug;35(5):1758-9.

Disseminated varicella infection in adult renal allograft recipients: role of
mycophenolate mofetil.

Lauzurica R, Bayés B, Frías C, Fontseré N, Hernandez A, Matas L, Jimenez A, Bonet
J, Romero R.

Nephrology Department, Kidney Transplant Unit, Hospital Universitari Germans
Trias i Pujol, Badalona, Spain. rlauzu@ns.hugtip.scs.es

Disseminated varicella zoster virus (VZV) infection is a rare complication after 
renal transplantation in adults. We report 4 cases diagnosed in our transplant
patients. One of which was a primary infection (chicken pox) with multivisceral
involvement (hepatitis, pneumonitis, myocarditis, and disseminated intravascular 
coagulation). The other 3 patients VZV-seropositive before transplantation
suffered from disseminated zoster. No immunosuppressive drug was significantly
associated with a higher risk of disseminated VZV infection. However, from our
experience, we believe that mycophenolate mofetil (MMF), plays a part in the
clinical presentation of the disease. Early treatment with high doses of
acyclovir is fundamental in infection control. It is essential to perform a
pretransplantation serological VZV study on all patients.

PMID: 12962784 [PubMed - indexed for MEDLINE]

455: Epidemiol Infect. 2003 Aug;131(1):675-82.

Use of hospitalization and pharmaceutical prescribing data to compare the
prevaccination burden of varicella and herpes zoster in Australia.

MacIntyre CR, Chu CP, Burgess MA.

National Center for Immunisation Research and Surveillance of Vaccine Preventable
Diseases, Children's Hospital at Westmead, Westmead, NSW, Australia 2145.

The aims of the study were to compare the burden of varicella and herpes zoster
in Australia. No national surveillance exists for varicella or herpes zoster. We 
used hospital morbidity data from 1993-9 and pharmaceutical prescribing data from
1995-9. In the financial year 1998/99, there were 4718 hospitalizations for
zoster compared to 1991 for varicella. For varicella the mean age of patients was
15 years compared to 69 years for zoster. The mean length of stay in hospital was
4.2 days for varicella and 12.7 days for zoster. Varicella accounted for 8396
(3726 with principal diagnosis varicella) bed days compared to 26 266 (5382 with 
principal diagnosis of zoster) for zoster. The in-hospital case-fatality rate was
0.4% for varicella and 1% for zoster. In 1999, 59 200 community-based cases of
zoster were treated with antivirals. We estimate that 157 266 cases of zoster
occurred in the community in 1999, a rate of 830 per 100 000 population. Herpes
zoster has a higher burden of disease than varicella, and must be a component of 
disease surveillance in order to determine the full impact of vaccination on the 
epidemiology of varicella zoster virus (VZV).

PMID: 12948367 [PubMed - indexed for MEDLINE]

456: J Travel Med. 2003 Jul-Aug;10(4):203-7.

Cost-effectiveness of serotesting compared with universal immunization for
varicella in refugee children from six geographic regions.

Figueira M, Christiansen D, Barnett ED.

Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center,
Boston, MA 02118, USA.

BACKGROUND: It is unknown whether it is more cost-effective to test for varicella
antibody or to immunize without testing in immigrant populations. The reliability
of history of varicella disease is also unclear. METHODS: The prevalences of
varicella antibody in immigrant children from six regions of the world were used 
in a cost-effectiveness model to calculate the antibody prevalence above which it
is more cost-effective to test rather than to immunize. History of varicella
disease was obtained from chart review. We calculated the positive and negative
predictive values of varicella history by age group and region. RESULTS: The
prevalence of varicella antibody above which it is more cost-effective to test
than to immunize was 34% for children less than 13 years old and 17% for those
aged 13 years and older. Overall, the positive predictive value of varicella
history was 93-100% and the negative predictive value of varicella history was
28-66% among the six geographic regions. CONCLUSION: Immunization without
serotesting was cost-effective in children <5 years of age. Testing prior to
immunization was cost-effective in children 5 years of age and older. History of 
varicella was a good predictor of the presence of antibody to varicella, whereas 
a negative history was a poor predictor of the absence of antibody to varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12946297 [PubMed - indexed for MEDLINE]

457: J Med Virol. 2003 Oct;71(2):313-9.

Molecular characterisation of varicella-zoster virus strains in Germany and
differentiation from the Oka vaccine strain.

Sauerbrei A, Eichhorn U, Gawellek S, Egerer R, Schacke M, Wutzler P.

Institute of Virology and Therapy, Friedrich-Schiller University of Jena, Jena,
Germany. Andreas.Sauerbrei@med.uni-jena.edu

With the introduction of varicella vaccination, surveillance of varicella-zoster 
virus (VZV) strains occurring in cases of chickenpox or zoster should be
considered. Differentiating Oka vaccine strain from wild-type VZV can be achieved
only using molecular genotyping. In the present study, the VZV genotype was
examined in 53 VZV strains isolated from patients with varicella or zoster and in
73 samples from skin eruptions, cerebrospinal fluid, and throat swabs obtained
from patients with VZV infections in Germany. The polymerase chain reaction and
restriction fragment length polymorphisms analysis using DNA fragments of the
open reading frames 38, 54, 62, and the R5 repeat region were used. Whereas all
VZV isolates could be typed, direct genotyping of viral DNA in patients' samples 
was achieved in 63 of 73 cases (86.3%). The dominant genotype of VZV found in
88.8% of 116 patients had the wild-type pattern PstI(+) BglI(-) R5A followed by
the wild-genotype PstI(+) BglI(+) R5A in 6.0%, the wild-genotype PstI(+) BglI(-) 
R5B in 3.4%, the wild-genotype PstI(+) BglI(-) R5C and the Oka vaccine genotype
PstI(-) BglI(+) R5B in 0.9% of patients each. BglI(-) wild-types were found in
90.7% of patients with zoster and in 9.3% of patients with varicella. By
contrast, the BglI(+) wild-type was diagnosed in five patients with varicella and
in two patients with zoster. In conclusion, VZV strains found in Germany are
similar to strains circulating in the United States and the United Kingdom. VZV
wild-type strains containing a BglI restriction site in ORF 54 as well as Oka
vaccine strains can rarely be detected. Copyright 2003 Wiley-Liss, Inc.

PMID: 12938208 [PubMed - indexed for MEDLINE]

458: Leg Med (Tokyo). 2003 Mar;5 Suppl 1:S233-6.

Fatal outcome of varicella in children.

Kernbach-Wighton G, Oehmichen M, Saternus KS.

Institute of Legal Medicine, University of Göttingen, Windausweg 2, D-37073
Göttingen, Germany. gkernba@gwdg.de

Varicella or chicken-pox are one of the most frequent diseases in childhood.
Severe or even lethal complications are rare (in about 0.03 per thousand ). Our
paper presents two cases of varicella infections leading to sudden deaths (3- and
7-year-old children). In one of these cases, the paediatrician in charge was
accused of an impaired medical treatment. Both of the children showed multiple
typical efflorescences in different stages. Furthermore were observed affections 
of the respiratory tracts and serious involvements of the hearts, the lungs, and 
the livers. In one case an immunological identification could be made of an acute
varicella infection. Based on autoptical, histological, bacteriological,
virological, and neuropathological findings is given an analysis of such uncommon
and severe courses of chicken-pox in children being identified as haemorrhagic
form and massive abscess-forming varicella pneumonia.

Publication Types: 
    Case Reports

PMID: 12935598 [PubMed - indexed for MEDLINE]

459: Asian Pac J Allergy Immunol. 2003 Mar;21(1):63-8.

Varicella infection in a pediatric AIDS patient presenting as umbilicated
papules.

Umpuchineewan J, Wananukul S, Sakulwira K, Poovoravan Y.

Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand.

An 8-year-old girl with acquired immunodeficiency syndrome presented with fever
and alteration of consciousness. She had a history of persistent cryptococcal
meningitis. She developed multiple discrete umbilicated papules that resembled
cutaneous cryptococcosis on the second day of admission. Skin biopsy revealed an 
ulcer with a wedge-shaped necrosis of the dermis. The edge of the ulcer showed
intracellular edema, margination of nucleoplasm and multinucleated cells,
consistent with herpes infection. The diagnosis of varicella-zoster virus
infection was confirmed by the identification of herpesvirus DNA from the lesion 
and differentiation from other herpesviruses by restriction fragment length
polymorphism (RFLP) method. Intravenous acyclovir was given at a dose of 500
mg/m2, three times daily for 14 days which resulted in resolution of the skin
lesions within 2 weeks.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12931753 [PubMed - indexed for MEDLINE]

460: Anticancer Res. 2003 May-Jun;23(3C):3061-8.

Varicella zoster virus infections in neuroblastoma patients: a 31-year clinical
study.

Izbicki T, Mazur J, Izbicka E.

Departments of Surgical Oncology and Epidemiology, National Research Institute of
Mother and Child, Kasprzaka 17A Street, 01-211 Warsaw, Poland. eizbicka@saci.org

BACKGROUND: The oncogenic potential of viruses was demonstrated in some human
cancers. The oncogenic role of chickenpox (Cp) infection caused by varicella
zoster virus has not been investigated to date. PATIENTS AND METHODS: Among 333
children with neuroblastoma, 50 had Cp infection. The correlation of Cp infection
with selected prognostic factors was analyzed. RESULTS: One Cp patients was
neuroblastoma stage I, 1-II, 2-IVS, 9-III and 37-IV. Cp was more frequent in
stages III (18%) and IV (74%) than stages I + II + IVS (8%). The frequency of Cp 
in children < 2 years was 42% and > 2 years was 40%. The adrenal (42%) and
extra-adrenal (40%) abdominal localizations were most common. The progression of 
neuroblastoma in stage IV occurred in 86.5% of Cp children in comparison to 43.6%
of the population without Cp. CONCLUSION: The risk of progression in
neuroblastoma is higher in neuroblastoma children with Cp than in neuroblastoma
patients without Cp.

PMID: 12926162 [PubMed - indexed for MEDLINE]

461: Vaccine. 2003 Sep 8;21(25-26):3982-7.

Cost-benefit analysis of routine childhood vaccination against chickenpox in
Taiwan: decision from different perspectives.

Hsu HC, Lin RS, Tung TH, Chen TH.

Institute of Preventive Medicine, College of Public Health, National Taiwan
University, Room 207, No. 19, Su-Chow, Taipei, Taiwan, ROC.

Cost-benefit analysis was conducted to determine whether it is worthwhile to
initiate a routine varicella vaccination program in Taiwan from different
perspectives. Using the human capital approach, the discounted net cost for
vaccination program was New Taiwan Dollars (NTD) 281 million from health care
payer's perspective. Taking indirect costs into account, the net saving due to
vaccination program was NTD 425 million from the societal perspective. In terms
of benefit-cost ratio, a mass varicella vaccination program could only save NTD
0.34 in discounted costs for each dollar incurred in a vaccination program from
health care payer's perspective whereas save NTD 2.06 from the societal
viewpoint. Results based on the willingness-to-pay (WTP) method showed the Net
Present Value (NPV) of the vaccination program was estimated as -NTD 272 million.
We conclude that a routine varicella vaccination program is worthwhile from the
societal perspective but neither from health care payer's nor from consumer
decision based on the perspective of WTP.

PMID: 12922134 [PubMed - indexed for MEDLINE]

462: Vaccine. 2003 Sep 8;21(25-26):3845-53.

Enhancement of immunity against VZV by giving live varicella vaccine to the
elderly assessed by VZV skin test and IAHA, gpELISA antibody assay.

Takahashi M, Okada S, Miyagawa H, Amo K, Yoshikawa K, Asada H, Kamiya H, Torigoe 
S, Asano Y, Ozaki T, Terada K, Muraki R, Higa K, Iwasaki H, Akiyama M, Takamizawa
A, Shiraki K, Yanagi K, Yamanishi K.

Research Foundation for Microbial Diseases of Osaka University, Suita, Osaka,
Japan. mtakahashi@mail.biken.or.jp

The enhancement of immunity against varicella-zoster vaccine (VZV) by
subcutaneous injection of a live varicella vaccine was assessed by the VZV skin
test for cell-mediated immunity (CMI), and immunoadherence hemagglutination assay
(IAHA) and gpELISA antibody assays in the elderly people of 50-79 years of age. A
total of 127 subjects were examined: 79 aged 50-59, 25 aged 60-69, and 25 aged
70-79. All were seropositive by the gpELISA assay (one was seronegative in the
IAHA antibody assay). In contrast, a notable decline was observed in the VZV skin
test with increasing age. Negative reaction was observed in 16/79 (20.2%) of the 
subjects in their 50s, 12/25 (48.0%) in their 60s and 14/25 (56.0%) in the 70s.
After the vaccination, the results of the VZV skin test changed from negative to 
positive in 15/16 (91.8%) of subjects in their 50s, 11/12 (91.7%) in their 60s
and 12/14 (85.7%) in their 70s. The mean antibody titer in the IAHA and the
gpELISA increased approximately two-fold after the vaccination in each group.
Immunity to VZV in 35 elderly subjects who were vaccinated previously was
followed up for 4 years. All were positive by the VZV skin test after the
previous vaccination. After 4 years, 31 (88.6%) were positive by the skin test, 4
were negative and became positive after revaccination. Although this study was
uncontrolled open study, the results suggest that administering live varicella
vaccine to the elderly is effective for enhancing immunity, particularly CMI to
VZV.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 12922118 [PubMed - indexed for MEDLINE]

463: Vaccine. 2003 Sep 8;21(25-26):3614-22.

Varicella in French adolescents and adults: individual risk assessment and
cost-effectiveness of routine vaccination.

Hanslik T, Boëlle PY, Schwarzinger M, Carrat F, Freedberg KA, Valleron AJ,
Flahault A.

Department of Public Health, Hôpital Saint Antoine, INSERM U444, Université Paris
6, Assistance Publique-Hôpitaux de Paris, Paris, France.
thomas.hanslik@apr.ap-hop-paris.fr

Age-specific force of varicella infection, hospitalisation and death rates in
non-immune persons were calculated using an age-based mathematical model and
national data for France. A cost-effectiveness model was then applied to
hypothetical cohorts of persons aged 15-45 years with a negative or uncertain
history of varicella. Vaccination strategies with and without prior serotesting, 
and healthcare payer perspective and societal perspective were considered. A
sensitivity analysis was performed. Vaccination prevented more than one third of 
all varicella-related deaths. With serotesting, compared with no intervention,
the cost per case avoided and per year of life saved for subjects aged 15 years
were 335 and 55,100 Euro, respectively. When work-loss costs were also included, 
savings were associated with screening and vaccination of subjects less than 30
years old. Without serotesting, the costs raised markedly, with an almost
identical effectiveness, resulting in an unfavourable incremental
cost-effectiveness. Based on medical costs, routine serotesting and varicella
vaccination for French adolescents and young adults with a negative or uncertain 
history of varicella affords health benefits at a cost comparable to those of
other very expensive therapies considered worthwhile. From the societal
perspective, such screening and vaccination might save costs.

PMID: 12922090 [PubMed - indexed for MEDLINE]

464: Indian J Pediatr. 2003 Jun;70(6):503-7.

Controversies in chicken-pox immunization.

Bhave SY.

Indraprastha Apollo Hospital & Max Health Care, New Delhi, India.
sybhave@vsnl.com

Chicken-pox is one more newer vaccine in our armamentarium against infectious
diseases. Due to its extremely contagious nature, varicella is experienced by
almost every child or young adult in the world. Each year from 1990 to 1994,
prior to availability of varicella vaccine, about 4 million cases of varicella
occurred in the United States. Of these cases approximately 10,000 required
hospitalization and 100 died. Although varicella is not commonly perceived as an 
important public health problem, the socioeconomic consequences in industrialized
countries of a disease that affects practically every child and causes the
carrier absence from work should not be underestimated. The varicella vaccines
available in the market are safe and effective. A recent cost-benefit analysis in
USA showed that routine chicken-pox vaccination is likely to save five times the 
investment. Even when only direct costs were considered, benefits almost balanced
the costs. At present similar studies from developing countries are not
available. The public health impact of varicella and zoster may be increasing in 
regions with high endemic rates of HIV infection. Varicella vaccine may be used
either at an individual level to protect susceptible adolescents and adults, or
at a population level, to cover all children as part of a national immunization
programme. Vaccination of adolescents and adults will protect at-risk
individuals, but will not have a significant impact on the epidemiology of the
disease on a population basis. On the other hand, extensive use as a routine
vaccine in children will have a significant impact on the epidemiology of the
disease. If sustained high coverage can be achieved, the disease may virtually
disappear. If only partial coverage can be obtained, the epidemiology may shift, 
leading to an increase in the number of cases in older children and adults.
Hence, routine childhood varicella immunization programmes should emphasize high,
sustained coverage. At present, this vaccine will have a lower priority in the
National Immunization Schedule that does not have MMR and typhoid, which have a
greater socioeconomic impact. Hence, at the present time WHO does not recommend
the inclusion of varicella vaccination into the routine immunization programmes
of developing countries.

PMID: 12921321 [PubMed - indexed for MEDLINE]

465: ASAIO J. 2003 Jul-Aug;49(4):378-82.

Extracorporeal membrane oxygenation for chickenpox pneumonia: a single
institution's experience.

White RW, Peek GJ, Jenkins DR, Killer HM, Firmin RK.

Heartlink ECMO Centre, Department of Cardiothoracic Surgery, Glenfield Hospital, 
Leicester, United Kingdom.

The experience of extracorporeal membrane oxygenation (ECMO) use for severe
chickenpox pneumonia was reviewed. Case notes of all patients treated with ECMO
for this disease between 1992 and 1997 were reviewed. Of 405 patients referred
for ECMO during this period, the diagnosis was chickenpox pneumonia in 14 (3.5%);
all 14 were treated with ECMO. The median age of patients was 32.5 years (range 5
to 61 years). The median duration of extracorporeal support was 164 hours (range 
45 to 652). Ten of 14 patients (71%) required hemofiltration. Overall survival of
patients supported with ECMO was 57% (8 of 14). Deaths were caused by sepsis (5
patients, source identified in 4) and multiorgan failure (1 patient). Pneumonia
as a complication of chickenpox can rapidly become severe and life threatening.
Extracorporeal respiratory support may be helpful in patients refractory to
conventional ventilation.

PMID: 12918577 [PubMed - indexed for MEDLINE]

466: Pediatr Int. 2003 Aug;45(4):458-60.

Spread of varicella-zoster virus DNA to the environment from varicella patients
who were treated with oral acyclovir.

Suzuki K, Yoshikawa T, Ihira M, Ohashi M, Suga S, Asano Y.

Department of Pediatrics, Fujita Health University School of Medicine, Toyoake,
Aichi, Japan.

OBJECTIVE: The purpose of the present study was to determine the degree of spread
of varicella-zoster virus to the environment (VZV) from varicella patients who
received oral acyclovir treatment. METHODS: Over a period of 8 months, seven
healthy children (two girls and five boys, 23-64 months of age) with varicella
who visited Fujita Health University School of Medicine were treated with routine
doses of oral acyclovir (ACV) for 5 days, commencing within 24 h after onset of
the disease. Swab samples from the throats of patients and their family members
as well as from air purifier filters in their houses were collected for 7 days as
frequently as possible after starting treatment for the disease. The VZV DNA in
the samples was identified by a sensitive polymerase chain reaction amplification
assay. RESULTS: The VZV DNA was detected in 33-100% of throat swab samples from
varicella patients by day 7 of the disease, in 17-32% of throat swab samples from
family members by day 4 and in 29% of filters from air purifiers by day 3.
CONCLUSIONS: The results suggest a broad spread of VZV, probably by the airborne 
route, from the patients with varicella even after the administration of oral
ACV.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12911484 [PubMed - indexed for MEDLINE]

467: Sex Transm Infect. 2003 Aug;79(4):298-300.

Detection of varicella zoster virus in genital specimens using a multiplex
polymerase chain reaction.

Birch CJ, Druce JD, Catton MC, MacGregor L, Read T.

Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia.
chris.birch@mh.org.au

OBJECTIVE: To compare the relative proportions of varicella zoster virus (VZV)
and herpes simplex viruses in specimens obtained from the genital lesions of
adults presenting with presumed genital herpes infection. METHODS: Swabs of
genital lesions from 6210 patients attending general practices, infectious
diseases clinics within hospitals, or sexual health centres for treatment of
their genital lesions were tested using polymerase chain reaction (PCR)
technology. The multiplexed PCR was capable of detecting herpes simplex virus
types 1 and 2 (HSV-1, HSV-2), VZV, and cytomegalovirus in a single sample.
RESULTS: A total of 2225 patients had viruses detected by PCR. HSV-1 was detected
in 36%, HSV-2 in 61%, and VZV in 2.9% of PCR positive samples. Of the 65 patients
with VZV genital infection, many were thought to have HSV infection before
laboratory testing. CONCLUSIONS: The finding of VZV in nearly 3% of virus
positive genital specimens demonstrates that this virus needs to be considered as
a differential diagnosis for genital herpetic lesions. Advice provided to
patients with VZV genital infection regarding the source of infection, likelihood
of recurrence, and potential for transmission of the virus will be different from
that given to patients with HSV infection.

Publication Types: 
    Comparative Study

PMID: 12902579 [PubMed - indexed for MEDLINE]

468: Pediatrics. 2003 Aug;112(2):e98-103.

A retrospective cohort study of the association of varicella vaccine failure with
asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination.

Verstraeten T, Jumaan AO, Mullooly JP, Seward JF, Izurieta HS, DeStefano F, Black
SB, Chen RT; Vaccine Safety Datalink Research Group.

Epidemic Intelligence Service Program, Epidemiology Program Office, Centers for
Disease Control and Prevention, Atlanta, Georgia, USA.
thomas.verstraeten@gskbio.com

OBJECTIVE: Varicella breakthrough, the occurrence of varicella disease >42 days
after vaccination, is indicative of vaccination failure. A sevenfold increased
risk of breakthrough among vaccinated children with asthma was observed in a 1996
varicella outbreak in a child care center. More recent outbreak investigations
have also identified age at vaccination as a potential risk factor for
breakthrough. We assessed the association of varicella breakthrough with asthma, 
steroids, age at varicella vaccination, and timing of measles-mumps-rubella (MMR)
vaccination. METHODS: We performed a retrospective cohort study among children
born after 1993 and followed up through 1999 at 2 health maintenance
organizations ([HMOs] A and B) in the United States. Information was obtained
from automated vaccination, clinic, hospital discharge, and pharmacy records.
RESULTS: We identified 268 and 97 breakthrough cases among 80 584 and 8181
children vaccinated against varicella at HMOs A and B, respectively. Varicella
breakthrough was not associated with asthma, inhaled steroids prescribed at any
time, and oral steroids prescribed before vaccination. An increased risk of
varicella breakthrough was found in the 3 months immediately after prescription
for oral steroids at HMO A (adjusted relative risk [aRR]: 2.4; 95% confidence
interval [CI]: 1.3-4.4) and HMO B (aRR: 2.8; 95% CI: 1.0-7.8), when varicella
vaccine was given before 15 months of age at HMO A (aRR: 1.4; 95% CI: 1.1-1.9),
and when varicella vaccination followed MMR vaccine within 28 days at HMO A (aRR:
3.1; 95% CI: 1.5-6.4). CONCLUSIONS: Varicella vaccine failure in children was not
associated with asthma or the use of inhaled steroids, but with the use of oral
steroids. Administration of varicella vaccine before the age of 15 months may be 
associated with a slightly increased risk of breakthrough disease. As currently
recommended, varicella vaccination should not be administered for 28 days after
MMR vaccination.

PMID: 12897314 [PubMed - indexed for MEDLINE]

469: J Paediatr Child Health. 2003 Jul;39(5):368-71.

Barriers to immunization: attitudes of general practitioners to varicella, the
disease and its vaccine.

Milledge JT, Cooper CD, Woolfenden S.

The Children's Hospital at Westmead, Westmead, Australia.

OBJECTIVES: To investigate the attitudes of general practitioners (GPs) to
varicella disease and varicella vaccine. METHODS: A cross-sectional questionnaire
was mailed to GPs in Fairfield (located in the south-western suburbs of Sydney,
NSW, Australia) to identify attitudes about varicella vaccine, previous
experience with varicella disease and the likelihood of prescribing varicella
vaccine. RESULTS: Of 239 questionnaires issued, 160 were returned (67%). The
majority (72%) of respondents agreed that varicella vaccine should become part of
the immunization schedule. However 12% of GPs did not support vaccination for
varicella as they considered it to be a benign self-limiting disease. Respondents
who had experience with varicella complications were significantly more likely to
recommend universal vaccination (OR 3.36; 95% confidence interval (CI) 1.38-8.19)
whereas those respondents who were concerned about side effects of the vaccine
were less likely to recommend universal vaccination (OR 0.31; CI 0.15-0.63).
CONCLUSIONS: The majority of GPs are receptive to varicella vaccination becoming 
part of the immunization schedule. Experience with varicella complications is
associated with recommending universal varicella vaccination. General
practitioners in this cohort do not consider varicella to be a benign disease,
but they are concerned about possible unknown side effects of the vaccine. Public
health measures for introducing universal vaccination need to address these
concerns.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12887668 [PubMed - indexed for MEDLINE]

470: J Pediatr Gastroenterol Nutr. 2003 Aug;37(2):183-6.

Varicella in pediatric liver transplant patients: a retrospective analysis of
treatment and outcome.

Pacini-Edelstein SJ, Mehra M, Ament ME, Vargas JH, Martin MG, McDiarmid SV.

Department of Pediatrics, Mattel Children's Hospital at UCLA Medical Center, Los 
Angeles, California, USA. spacini@mednet.ucla.edu

BACKGROUND: Varicella is a common childhood disease that can cause morbidity and 
mortality among immunosuppressed patients. There have been few previous studies
monitoring the course of pediatric liver transplant patients with acute
varicella. The aim of this study was to evaluate the treatment, outcomes, and
complications of pediatric liver transplant patients admitted with acute
varicella infection. METHODS: A retrospective chart review was carried out based 
on discharge diagnoses of orthotopic liver transplant and varicella among
pediatric patients (age range, birth-18 years) admitted to the UCLA Medical
Center between 1985 and 2001. RESULTS: Five hundred fifty-six pediatric patients 
received liver transplantations between 1985 and 2001. Twenty-two of these
patients were admitted to the UCLA Medical Center with varicella (11 females, 11 
males). No patients were treated on an outpatient basis. Mean age of the patients
was 6 years (range, 1-16 years). None of these patients received the varicella
vaccine before hospitalization. On admission, 5 of 22 patients (23%) had received
varicella zoster immunoglobulin within 96 hours of exposure. The mean length of
hospitalization was 6 days (range, 2-11 days). All immunosuppression dosages were
reduced during the admissions. None of the patients had been treated with
high-dose corticosteroids for acute rejection before the onset of the varicella
infection. Patients were treated until defervescence with intravenous acyclovir
and until their varicella lesions crusted. Patients were discharged with oral
acyclovir to complete a 10-day course (including the intravenous treatment). No
patients had complications from the varicella infection. A complication of an
elevated serum creatinine for one patient was noted with the intravenous
acyclovir treatment. This patient had associated headache and nausea that
resolved when the creatinine level returned to normal. CONCLUSIONS: There were no
complications or dissemination of varicella infection among our pediatric liver
transplant patients. Further prospective randomized trials are required to
evaluate the management of pediatric liver transplant patients infected with
varicella.

PMID: 12883306 [PubMed - indexed for MEDLINE]

471: J Infect. 2003 Aug;47(2):133-8.

Quantification of circulating varicella zoster virus-DNA for the early diagnosis 
of visceral varicella.

Ishizaki Y, Tezuka J, Ohga S, Nomura A, Suga N, Kuromaru R, Kusuhara K, Mizuno Y,
Kasuga N, Hara T.

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University,
Fukuoka, Japan

Varicella zoster virus (VZV)-DNA was quantified in peripheral blood of 2 patients
with visceral varicella due to endogenous reactivation. An 18-year-old male
contracted varicella following the courses of chemotherapy for T cell lymphoma.
Another 18-year-old male suffered from varicella 16 months after the complete
engraftment of hematopoietic stem cell transplantation. Both patients had past
VZV infection, but no recent contact with the disease. Paralytic ileus and
ascites preceded the skin lesions. Quantitative real-time polymerase chain
reaction revealed >200 copies of VZV per 1 ml of whole blood before or at the
time when cropping vesicles emerged. The viral load reflected their prolonged
clinical courses. Similar levels of VZV-DNA were detected in primary varicella
patients, but not in herpes zoster patients or immunocompromised children without
varicella or zoster. Quantitative monitoring of circulating VZV-DNA may be useful
for the diagnosis and assessing the treatment response of visceral varicella in
immunocompromized hosts.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12860147 [PubMed - indexed for MEDLINE]

472: Vaccine. 2003 Jul 4;21(23):3236-9.

Epidemiology and economic impact of varicella in immunocompetent children in
Spain. A nation-wide study.

Díez-Domingo J, Aristegui J, Calbo F, Gonzalez-Hachero J, Moraga F, Peña Guitian 
J, Ruiz Contreras J, Torrellas A.

Vaccine Institute of Valencia (VIVA), C.S. Nazaret, G.V. Fernando el Católico 76 
E6 Izda, 46008, Valencia, Spain. diez_jav@gva.es

The epidemiology and burden of varicella was assessed through the prospective
study of 683 children under 15 years, by 58 primary care paediatricians working
on seven autonomous communities of Spain.The mean age was 4.5+/-2.7 years, and
566 (83%) were secondary cases. There were 111 complications in 101 children
(14.8%), skin superinfection being the most frequent (8.9%), followed by
respiratory tract (4.5%) and eye (2.2%) infections. The mean number of visits to 
the paediatric clinic was 1.42 (95% C.I. 1.37-1.47), and 5.6% of the children
were attended in the emergency department of a hospital previously. All children 
had at least one prescription, being antihistamines and antipyretics the most
prescribed. Thirteen percent received systemic antibiotics and 11% acyclovir.
Children were mainly cared by grandparents, and parents were off work for a mean 
of 0.97 days (1.61 if children under 5 years attended day-care facilities; 0.51
if they did not). Costs derived from medical attention totalled 32.5, and social 
indirect costs were 63.77.

PMID: 12804853 [PubMed - indexed for MEDLINE]

473: MMWR Morb Mortal Wkly Rep. 2003 Jun 13;52(23):545-7.

Varicella-related deaths--United States, 2002.

Centers for Disease Control and Prevention (CDC).

Varicella is a vaccine-preventable disease that can be fatal. During 2002, state 
health departments notified CDC about nine fatal cases of varicella in adults and
children. This report summarizes clinical data for one adult and one child,
reported from Kansas and Illinois, respectively. Both patients were susceptible, 
unvaccinated, and exposed to unvaccinated children with varicella. These deaths
highlight the importance of implementing strategies recommended for varicella
disease prevention (1,2), including child care and school vaccination
requirements, and underscore the need for improving varicella death surveillance.

Publication Types: 
    Case Reports

PMID: 12803193 [PubMed - indexed for MEDLINE]

474: Acta Paediatr Taiwan. 2003 Jan-Feb;44(1):25-8.

Neonatal varicella frequently associated with visceral complications: a
retrospective analysis.

Yu HR, Huang YC, Yang KD.

Division of Clinical Immunology & Allergy, Chang Gung Children's Hospital, No.
123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.

Neonates are very susceptible to varicella, which usually causes high mortality
and morbidity rates among that age group. We analyzed the prognosis and
complications of neonates with varicella in a retrospective study that assessed
the clinical features, laboratory data, and clinical outcomes of twelve neonates 
who either had the illness or who were at risk. Based on exposure history, twelve
babies were separated into prenatal and postnatal infection groups. Seven cases
were categorized as having prenatal infections and five had postnatal varicella
infection. Results showed that the major complications in the prenatal infection 
group included three cases of hepatitis, two of pneumonia, one of pyoderma and
one of sepsis. The presence of fever was a good indicator for predicting
complications among the prenatal infection group. These complications were not
found in the postnatal infection group. We found that prenatal varicella
infections appear to have a higher visceral complication rate. However, our
patients had a much lower mortality rate than those reported in previous studies.
This may be attributed to the administration of acyclovir after delivery.

PMID: 12800380 [PubMed - indexed for MEDLINE]

475: J Immunol Methods. 2003 Jun 1;277(1-2):17-25.

Development and evaluation of a flow-cytometric assay of specific cell-mediated
immune response in activated whole blood for the detection of cell-mediated
immunity against varicella-zoster virus.

Svahn A, Linde A, Thorstensson R, Karlén K, Andersson L, Gaines H.

Department of Virology, Swedish Institute for Infectious Disease Control, S-171
82, Solna, Sweden.

A new assay for the detection of specific cell-mediated immune (CMI) responses is
described. Whole blood, diluted 1/10 in medium, was cultured in the presence or
the absence of specific antigens. Results were assessed by flow cytometric
analysis with or without immunophenotyping to detect proliferating lymphoblasts
among cultured cells. Interferon-gamma, IL-10, and IL-5 in culture supernatants
are measured by ELISAs. The assay was evaluated using samples from 37
VZV-antibody-positive children with a history of chickenpox and samples from 15
seronegative children without a history of chickenpox; it displayed a sensitivity
of 95% and a specificity of 100% for the detection of varicella-zoster virus
(VZV)-specific CMI. The intraassay and interassay variations of the new test were
lower than with the conventional assay for CMI, detecting thymidine incorporation
in peripheral blood mononuclear cells (PBMCs). Cytokines were detected in only
70% of cultures from VZV-antibody-positive subjects. The cytokine response was
restricted to IFN-gamma in most cases. The Flow-cytometric Assay of Specific
Cell-mediated Immune response in Activated whole blood (FASCIA) is a precise and 
accurate yet simple and convenient test that can be readily employed for the
examination of single samples as well as for large-scale studies.

PMID: 12799036 [PubMed - indexed for MEDLINE]

476: Br J Plast Surg. 2003 Mar;56(2):194-5.

Idiopathic purpura fulminans and varicella gangrenosa of both hands, toes and
integument in a child.

Alexander G, Basheer HM, Ebrahim MK, Ghoneim I.

Al-Babtain Centre for Plastic Surgery and Burns, Ibn-Sina Hospital, Safat,
Kuwait.

Chicken pox is a common childhood illness and, though a vaccine is readily
available, it is not routinely included in the vaccination schedule of most
countries owing to its mild clinical nature. However, varicella gangrenosa is a
rare complication of this disease, infrequently reported in the literature. We
report the case of a child who developed purpura fulminans in the convalescent
phase of chicken pox and subsequently presented with peripheral gangrene of both 
hands and the toes of the right foot, and skin gangrene. To our knowledge,
bilateral gangrene of the hands has rarely been reported, and we present this
case to highlight the serious nature of complications following varicella
infection.

Publication Types: 
    Case Reports

PMID: 12791376 [PubMed - indexed for MEDLINE]

477: Mil Med. 2003 May;168(5):404-7.

Varicella susceptibility and validity of history among U.S. Coast Guard recruits:
an outbreak-based study.

Zimmerman L, Fajardo M, Seward J, Ludwig S, Johnson J, Wharton M.

Epidemiology and Surveillance Division, National Immunization Program, Centers
for Disease Control and Prevention, 1600 Clifton Road, MS E-61, Atlanta, GA
30333, USA. laz5@cdc.gov

During a varicella outbreak among U.S. Coast Guard recruits, we examined
varicella susceptibility serologically and evaluated validity of disease history.
Recruits completed a questionnaire to obtain information on demographics, history
of varicella disease, and varicella vaccination. Serological testing for
varicella-zoster virus immunoglobulin G antibodies was conducted using an
enzyme-linked immunosorbant assay. Among 513 recruits, 21 (4.1%) were
seronegative to varicella-zoster virus. Recruits born in Puerto Rico were more
likely than recruits born in the U.S. states to be susceptible (prevalence ratio,
4.3; 95% confidence interval, 1.4%, 13.1%). A positive disease history was highly
predictive of positive serology (99.1%); however, 73% of those with a negative or
uncertain history were also immune. Four (19%) susceptible recruits reported a
positive varicella history. Although immunity among recruits was high, varicella 
outbreaks may occur in closed adult settings due to the high risks of exposure
and transmission. Varicella vaccination can prevent these costly, disruptive
outbreaks.

PMID: 12775178 [PubMed - indexed for MEDLINE]

478: Arch Gynecol Obstet. 2003 Jun;268(2):128-30. Epub 2003 Mar 19.

The primary varicella infection near term: a case report.

Mori T, Komori S, Fukuda Y, Naito S, Tanaka H, Koyama K.

Department of Obstetrics and Gynecology, Hyogo College of Medicine, 1-1
Mukogawa-cho, 663-8501 Nishinomiya, Hyogo, Japan.

A 33-year-old pregnant woman developed skin rash at the 40 weeks' gestation. She 
was diagnosed as primary varicella zoster infection. Upon hospitalization, she
was administered acyclovir and also a tocolytic agent (ritodorine hydrochloride) 
to postpone labor. The patient delivered a female baby 7 days after she developed
skin lesions. Serological tests conducted after delivery showed that the mother
was positive for IgG and IgM against varicella zoster. The baby was observed in a
neonatal intensive care unit and found to be free of varicella zoster symptoms.

Publication Types: 
    Case Reports

PMID: 12768304 [PubMed - indexed for MEDLINE]

479: Diagn Mol Pathol. 2003 Jun;12(2):103-7.

Rapid diagnosis of smallpox infection and differentiation from its mimics.

Nuovo GJ, Plaza JA, Magro C.

Department of Pathology, The Ohio State University Medical Center S305E Rhodes
Hall, 450 W 10th Avenue Columbus, OH 43210, USA. gnuovomd@pol.net

The potential for a bioterrorism-induced smallpox outbreak has been much
discussed of late. The literature of the late 1960s stressed that the distinction
between smallpox and the other viral-induced vesicle-forming diseases, namely
varicella zoster and disseminated herpes simplex, was difficult to make. Given
that the cutaneous manifestations of smallpox would be among the initial
symptoms, we reviewed 2 cases of smallpox diagnosed in South America in the 1970s
in conjunction with 9 cases of multiple skin vesicles diagnosed as either
disseminated herpes simplex or varicella-zoster. These were examined by routine
hematoxylin and eosin stain (H&E) as well as by in situ hybridization. A blind
review of the cases demonstrated that each showed striking intraepithelial
vesicles containing multinucleated squamous cells exhibiting a ground glass
appearance of the nuclear chromatin. Thus, as expected, routine H&E examination
could not differentiate the 2 smallpox cases from the other 9 samples. In situ
hybridization easily distinguished the 2 cases of smallpox from the other 9
samples, 5 of which contained varicella-zoster (two had been misdiagnosed as
herpes) and the other 4 were disseminated herpes simplex. The in situ test,
readily accomplished in any histology-based molecular laboratory in 4 hours,
allows for the rapid and specific identification of smallpox infection and,
importantly, its distinction from its mimics. Formalin fixation, which is optimal
for in situ hybridization, guarantees the inactivation of the smallpox virus.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12766615 [PubMed - indexed for MEDLINE]

480: Eur Respir J. 2003 May;21(5):886-91.

Varicella pneumonia in adults.

Mohsen AH, McKendrick M.

The Guys, Kings' and St Thomas' School of Medicine, Western Education Centre,
Kings' College, London, UK. Abdul.Mohsen@kcl.ac.uk

Varicella is a common contagious infection in childhood with increasing incidence
in adults. Pneumonia, although rare, is the most serious complication that
commonly affects adults. Over the last two decades there have been major advances
in the understanding of Varicella infections, management and prevention. This
review discusses the epidemiology, pathogenesis, pulmonary manifestation,
morbidity, long-term clinical consequences and current state of management of
Varicella pneumonia in adults. Prevention and other disease-modifying therapy are
also discussed.

Publication Types: 
    Review

PMID: 12765439 [PubMed - indexed for MEDLINE]

481: Asian Pac J Allergy Immunol. 2002 Dec;20(4):241-5.

Flexibility in the administration schedule of varicella vaccination in healthy
adolescents and young adults.

Kosuwon P, Wasi C, Sutra S, Kositanont U, Hutagalung Y, Bock HL.

Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen,
Thailand.

A clinical trial to assess the immunogenicity and reactogenicity of two doses of 
varicella vaccine (live attenuated Oka-strain, GlaxoSmithKline Biologicals), when
either given 8 or 4 weeks apart in healthy seronegative adolescents and young
adults, was conducted in Khon Kaen and Bangkok, Thailand. Contrary to
seroconversion rates generally reported for this age group, in our study all
subjects were already seropositive after the first vaccine dose. After the first 
vaccine dose, geometric mean titers (GMTs) for anti-varicella antibodies were
78.4 (median 64) for the adolescent group and 136.5 (median 128) for the young
adult group. Six weeks after administration of the second dose, anti-varicella
GMTs reached 331.7 (median 256) and 636.9 (median 512) for the adolescent and
young adult groups, respectively, with a 4.2-4.7-fold increase from
pre-vaccination titers. The difference in GMTs between post-dose I and dose II
was statistically significant for each group. The reactogenicity after the first 
and second doses of vaccination was low: no varicella rash was seen, in either
the shorter or longer schedule. GlaxoSmithKline Biologicals varicella vaccine
(Varilix) offered a high flexibility, administration possible at either 4 or 8
weeks interval, whilst eliciting good immunogenicity and good tolerability.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12744625 [PubMed - indexed for MEDLINE]

482: Commun Dis Public Health. 2003 Apr;6(1):59-62.

Monitoring virus strain variation following infection with VZV: is there a need
and what are the implications of introducing the Oka vaccine?

Breuer J.

Skin Virus Laboratory, Department of Cutaneous Research, School of Medicine,
Queen Mary College, 25-29 Ashfield Street, London E1 1BB. j.breuer@qmul.ac.uk

Varicella zoster virus (VZV) is a stable virus showing relatively little
variation. Nevertheless, recent data have shown there to be at least four
distinct viral strains. For the most part these are geographically segregated,
but in areas of the world such as the UK, where mixed populations live, there is 
evidence for spread of all the genotypes. Little is known about the biological
differences, if any, between these strains, yet recent data have shown that even 
a single nucleic acid change can affect the biological behaviour of the virus.
The Oka vaccine has been licensed for mass vaccination in the US and for limited 
use in the UK, particularly in seronegative healthcare workers. Virological
surveillance is needed to support these programmes and study the effect on virus 
spread. Evidence for VZV superinfection of latently infected individuals with
different strains, and the increasing detection of VZV in association with
clinical conditions such as viral meningitis, suggest more data are needed on the
transmissibility and biological properties of the virus.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12736975 [PubMed - indexed for MEDLINE]

483: Am J Infect Control. 2003 May;31(3):157-62.

Seroprevalence survey of measles, rubella, varicella, and mumps antibodies in
health care workers and evaluation of a vaccination program in a tertiary care
hospital in Japan.

Asari S, Deguchi M, Tahara K, Taniike M, Toyokawa M, Nishi I, Watanabe M, Iwatani
Y, Makimoto K.

Department of Infection Control and Prevention, Osaka University Hospital, Suita 
City, Japan.

Vaccine-preventable viral infections in health care workers (HCWs) have been on
the rise for the past 10 years in Japan. To reduce the viral infections and the
burden of exposure follow-up surveys at a tertiary care hospital in Osaka, Japan,
a seroprevalence survey was conducted, and free vaccinations for measles,
rubella, varicella, and mumps were offered to newly hired HCWs (199 physicians
and 72 nurses and nursing assistants) who had negative serologic results for
antibodies against these viruses. Negative antibody titers were obtained from
7.4% of the newly hired HCWs for measles, 12.5% for rubella, 4.1% for varicella, 
and 15.9% for mumps. The vaccination program for HCWs improved the
vaccine-preventable infection rates and resulted in fewer exposure follow-up
surveys, fewer lost work days, and fewer HCWs requiring hospitalization for these
viral infections compared with those counted for the previous year. These data
indicate that all HCWs should be strongly recommended to be vaccinated against
(or have documented immunity to) these viruses in Japan, as is the case in the
United States.

PMID: 12734521 [PubMed - indexed for MEDLINE]

484: Am J Infect Control. 2003 May;31(3):151-6.

Varicella vaccine safety, incidence of breakthrough, and factors associated with 
breakthrough in Taiwan.

Tseng HF, Tan HF, Chang CK.

Department of Healthcare Administration, Fooyin University, Taiwan, Republic of
China.

BACKGROUND: Varicella vaccine was first available in Taiwan in 1997. The aims of 
this study were to investigate varicella vaccine safety and occurrence of
breakthrough in Taiwan during the first 3 years. The adverse events, incidence of
breakthrough, and factors associated with breakthrough were analyzed. METHODS: A 
personal interview using a structured questionnaire was conducted for the parents
of 1248 children less than 12 years old who were vaccinated between 1998 and
2000. Incidence of adverse events and breakthrough were presented and factors
associated with breakthrough were estimated by logistic regression. RESULTS:
There were 27 (2.16%) breakthrough cases occurring during the maximum follow up
period of 31 months, including 22 very mild or mild cases, 3 moderately severe
cases, and 2 severe cases. Compared with those who did not have confirmed history
of varicella exposure after vaccination, children with such exposure were
approximately 28 times as likely to have breakthrough varicella develop (adjusted
odds ratio = 27.75, 95% confidence interval: 6.12-125.78, P =.00). There were 91 
(7.3%) reported cases of adverse events, including rash, fever, and pain or
swelling, occurring within 2 weeks of vaccination. CONCLUSIONS: Although rare
adverse events cannot be well-quantified in this study, the results suggest that,
at least in the short term, varicella vaccine is well-tolerated and effective in 
Taiwan. Long-term monitoring program is necessary to ensure the safety of this
vaccine.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12734520 [PubMed - indexed for MEDLINE]

485: Pediatr Surg Int. 2003 Apr;19(1-2):91-5. Epub 2003 Mar 28.

Mutilations due to medical disorders in children.

Palácios J, Serafim Z, Leal MJ.

Hospital de Dona Estefânia, Rua Jacinta Marto, 1150-192 Lisboa, Portugal.
jpalacios@clix.pt

Soft-tissue and bone necrosis, although rare in childhood, occasionally occur in 
the course of infectious diseases, either viral or bacterial, and seem to be the 
result of hypoperfusion on a background of disseminated intravascular
coagulation. Treatment consists in correction of septic shock and control of
necrosis. Necrosis, once started, shows extraordinarily rapid evolution, leading 
to soft-tissue and bone destruction and resulting in anatomic, functional,
psychological, and social handicaps. Ten mutilated children were treated from
January 1986 to January 1999 in Hospital de Dona Estefânia, Lisbon, Portugal. One
was recovering from hemolytic-uremic syndrome with a severe combined
immunodeficiency, another malnourished, anemic child had malaria, and three had
chicken pox (in one case complicated by meningococcal septicemia). There were
three cases of meningococcal and two of pyocyanic septicemia (one in a burned
child and one in a patient with infectious mononucleosis). The lower limbs (knee,
leg, foot) were involved in five cases, the face (ear, nose, lip) in four, the
perineum in three, the pelvis (inguinal region, iliac crest) in two, the axilla
in one, and the upper limb (radius, hand) in two. Primary prevention is based on 
early recognition of risk factors and timely correction. Secondary prevention
consists of immediate etiologic and thrombolytic treatment to restrict the area
of necrosis. Tertiary prevention relies on adequate rehabilitation with
physiotherapy and secondary operations to obtain the best possible functional and
esthetic result.

PMID: 12721735 [PubMed - indexed for MEDLINE]

486: Scand J Infect Dis. 2003;35(1):74-6.

An unusual varicella zoster infection complicated by purpura fulminans and
multiorgan failure in a healthy infant.

Kalyoncu M, Odemis E, Aynaci M, Karaçal UN, Okten A.

Departments of Pediatrics, Karadeniz Technical University, Faculty of Medicine,
Trabzon, Turkey. mkalyon@meds.ktu.edu.tr

The case is reported of a 2-y-old boy who developed purpura fulminans,
meningoencephalitis, pneumonia complicated by adult respiratory distress syndrome
and acute renal failure after varicella. These complications of varicella are
extremely rare in a healthy infant.

Publication Types: 
    Case Reports

PMID: 12685891 [PubMed - indexed for MEDLINE]

487: Infect Control Hosp Epidemiol. 2003 Mar;24(3):202-6.

A cluster of primary varicella cases among healthcare workers with false-positive
varicella zoster virus titers.

Behrman A, Schmid DS, Crivaro A, Watson B.

Hospital of the University of Pennsylvania, Division of Occupational Medicine,
University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.

BACKGROUND: Five cases of primary varicella zoster virus (VZV) we re diagnosed
among hospital healthcare workers (HCWs). All had complied with a pre-employment 
VZV screening program and had been considered immune. OBJECTIVES: To summarize
the investigation of VZV among un-immunized HCWs and to provide recommendations
for avoiding false-positive serologic tests. DESIGN: Risk of transmission of VZV 
to susceptible HCWs is minimized through serologic screening. Varicella vaccine
is recommended for susceptible HCWs. A commercially available latex bead
agglutination assay (LA) is widely used because it is rapid and easy to perform. 
LA was compared with the whole-cell varicella ELISA standardized in the Centers
for Disease Control and Prevention (CDC) National Herpes Laboratory.
SETTING/POPULATION: Large inner-city, tertiary-employee population. RESULTS: In a
year, 5 HCWs presented with laboratory-confirmed primary varicella infection.
Four had VZV exposures 2 weeks prior to presentation. All had documented positive
VZV titers by LA performed at hire. None were offered VZV vaccination. The
original LAs were judged false-positives. INTERVENTION/FOLLOW-UP INVESTIGATION:
Fifty-three consecutive VZV LA samples from the hospital laboratory were retested
at the CDC. Forty-four samples concurred. Of the remaining 9, 4 were positive by 
hospital LA but negative by CDC IgG ELISA. Four were equivocal by hospital LA but
negative by CDC IgG ELISA and LA. One was positive by hospital LA but negative by
LA and equivocal by ELISA at the CDC. CONCLUSION: LA may be prone to
false-positive results and inappropriate for screening hospital HCWs.

Publication Types: 
    Case Reports

PMID: 12683513 [PubMed - indexed for MEDLINE]

488: Int J Dermatol. 2003 Mar;42(3):193-6.

A seroepidemiologic survey of the prevalence of varicella-zoster virus in the
pediatric population in two university hospitals in Brazil.

Semenovitch I, Lupi O.

Department of Internal Medicine (Dermatology), Antonio Pedro University Hospital,
Fluminense Federal University, Rio de Janeiro, Brazil.

BACKGROUND: Varicella-zoster virus (VZV) is an alpha-herpesvirus causing
varicella (chickenpox) and herpes zoster (shingles). Varicella results from
primary VZV infection, and is a common childhood illness associated with fever
and a generalized, pruritic, vesicular eruption. Herpes zoster is caused by VZV
reactivation later in life (most cases after the fifth decade), and is
characterized by a localized, painful, and vesicular eruption involving one or
adjacent dermatomes. The incidence of herpes zoster increases with age and
immunosuppression. OBJECTIVE: To estimate the seroprevalence of VZV in the
Brazilian pediatric population by evaluating the prevalence of specific
antibodies to VZV in children from two university hospitals in the state of Rio
de Janeiro. METHODS: A population composed of 160 children derived from two
university hospitals in the state of Rio de Janeiro was included in the study.
All patients completed a questionnaire regarding their socio-epidemiologic
characteristics, and a complete physical examination was performed. All blood
samples were screened using a commercial enzyme-linked fluorescent assay (ELFA)
kit, specific for the detection of immunoglobulin G (IgG) antibodies to VZV.
RESULTS: The seroprevalence of VZV was 58.1% in the overall population, with a
statistically significant correlation between seroprevalence and increasing age
(P < 0.0001). A previous history of measles infection (P < 0.04), previous
history of varicella infection (P < 0.0001), and the presence of skin lesions (P 
< 0.05) were significantly associated with seropositivity to VZV. CONCLUSIONS:
Further studies should be performed in order to evaluate the endemicity of VZV
infections and to establish criteria for the use of the specific vaccine in
Brazil.

PMID: 12653913 [PubMed - indexed for MEDLINE]

489: J Am Acad Dermatol. 2003 Mar;48(3):442-7.

Atypical recurrent varicella in 4 patients with hemopathies.

Nikkels AF, Simonart T, Kentos A, Liesnard C, Sadzot-Delvaux C, Feremans W,
Piérard GE.

Department of Dermatopathology, University Medical Center of Liâgege, Belgium.
af.nikkels@chu.ulg.ac.be

Relapsing varicella may occur in children with HIV infection and more rarely in
younger adults. Our aim was to report unusual clinical, histologic, and virologic
aspects of 4 elderly patients with malignant hemopathies who had an unusual form 
of recurrent varicella develop. Conventional microscopy, immunohistochemistry,
and in situ hybridization were applied to smears and skin biopsy specimens. The
patients presented a few dozen, scattered, large, papulovesicular lesions with
central crusting. No zoster-associated pain or dermatomal distribution of the
lesions was noted. Conventional microscopy revealed vascular changes and
epidermal alterations typical for alpha-herpes virus infection. The varicella
zoster virus major viral envelope glycoproteins gE and gB, and the
immediate-early varicella zoster virus IE63 protein and the corresponding genome 
sequence for gE were detected on Tzanck smears; they were localized in
endothelial cells and keratinocytes on skin biopsy specimens. The varicella
zoster virus infection in endothelial cells, the vascular involvement, and the
widespread distribution of the lesions suggest that the reported eruptions are
vascular rather than neural in origin. These findings invalidate the diagnosis of
herpes zoster but strongly support the diagnosis of recurrent varicella in an
indolent and yet unreported presentation. Furthermore, these eruptions differ
from relapsing varicella in children and young adults by the age of the patients,
the paucity of clinical lesions, the larger diameter of the lesions and their
peculiar clinical aspect, the significantly longer time interval between primary 
varicella and the recurrence, the prolonged healing time of the lesions, their
mild disease course, and the fact that all the lesions are in the same stage of
development.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 12637928 [PubMed - indexed for MEDLINE]

490: Clin Cancer Res. 2003 Mar;9(3):976-80.

Development of Varicella-Zoster virus infection in patients with chronic
myelogenous leukemia treated with imatinib mesylate.

Mattiuzzi GN, Cortes JE, Talpaz M, Reuben J, Rios MB, Shan J, Kontoyiannis D,
Giles FJ, Raad I, Verstovsek S, Ferrajoli A, Kantarjian HM.

Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, 1515
Holcombe Boulevard, Houston, TX 77030, USA. gmattiuz@mdanderson.org

PURPOSE: Infection with Varicella-Zoster virus (VZV) is an exceptionally rare
complication of chronic myelogenous leukemia (CML) without stem cell
transplantation. We report 16 patients with CML who developed VZV infection
during imatinib mesylate therapy. PATIENTS AND METHODS: From July 1998 until
February 2002, 771 patients were included in 11 imatinib mesylate studies for all
CML phases in the Departments of Leukemia and Bioimmunotherapy at The University 
of Texas M. D. Anderson Cancer Center. Sixteen patients developed VZV infection. 
Charts and follow-up information of were reviewed and analyzed. RESULTS: Sixteen 
patients (2%) developed a VZV infection [15 episodes of herpes zoster (HZ), 1
varicella]. The baseline characteristics of the 16 patients with infection do not
differ significantly from those who did not develop VZV infection, except for
time from diagnosis of CML to imatinib (median: 55 versus 25 months, P = 0.0056) 
and the number of prior therapies (3 versus 1, P < 0.001). All patients received 
therapy with antiviral agents with good response. Six patients developed
postherpetic neuralgia. CONCLUSIONS: Our results suggest that imatinib therapy in
CML is associated with low incidence of HZ infection. VZV infection is more
frequent with longer duration of CML disease and with prior therapy, does not
disseminate, responds well to therapy, and does not mandate a recommendation for 
HZ prophylaxis in such patients.

PMID: 12631595 [PubMed - indexed for MEDLINE]

491: J Med Virol. 2003;70 Suppl 1:S111-8.

Varicella in Americans from NHANES III: implications for control through routine 
immunization.

Kilgore PE, Kruszon-Moran D, Seward JF, Jumaan A, Van Loon FP, Forghani B,
McQuillan GM, Wharton M, Fehrs LJ, Cossen CK, Hadler SC.

International Vaccine Institute, Kwanak PPO Box 14, Seoul, Republic of Korea.
pkilgore@ivi.int

At the time of varicella vaccine introduction in the United States, an estimated 
4 million episodes of varicella occurred annually. This survey of varicella
seroprevalence is the first to describe immunity to a vaccine-preventable disease
prior to vaccine introduction in the United States population. The objective of
this analysis is to describe patterns of naturally-acquired varicella and
understand characteristics associated with infection in the varicella
vaccine-naive United States population. A nationally representative
cross-sectional health examination survey that included venipuncture was
conducted among 21,288 U.S. participants aged 6 years and older from 1988 through
1994. Serologic evidence of varicella-zoster virus infection was measured by
enzyme immunoassay of varicella-zoster virus-specific IgG antibody. The
seroprevalence of IgG antibody to varicella-zoster virus increased from 86.0% in 
children aged 6 through 11 years to 99.6% in adults aged 40 through 49 years.
Immunity to varicella remained at 99% or higher in Americans aged 50 years and
older. Among persons aged 6 through 19 years, non-Hispanic black children were
40% less likely to be seropositive compared with white children (odds ratio [OR],
0.6; 95% confidence interval [CI], 0.4-0.8). Among young adults aged 20 through
39 years, women with a history of live birth (OR, 4.3; 95% CI, 2.1-8.7) and
married men (OR, 2.7; 95% CI, 1.2-5.7) were more likely to have
naturally-acquired immunity to varicella. This study found that, prior to use of 
varicella vaccine in the United States, age, race, and marital characteristics
were independently associated with naturally acquired varicella. Future varicella
serosurveys in Americans will provide essential information to interpret the
population impact of varicella vaccine. Copyright 2003 Wiley-Liss, Inc.

PMID: 12627498 [PubMed - indexed for MEDLINE]

492: J Med Virol. 2003;70 Suppl 1:S31-7.

Varicella vaccination: impact of vaccine efficacy on the epidemiology of VZV.

Brisson M, Edmunds WJ, Gay NJ.

Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61
Colindale Avenue, London NW9 5EQ, United Kingdom. mbrisson@phls.org.uk

In 1995, varicella vaccination was introduced into the infant immunization
schedule of the United States. Currently, many other countries are considering
mass varicella vaccination. Mass vaccination has two dangers: it could increase
the number of varicella cases in adults, where severity is greater, and increase 
cases of zoster. A deterministic, realistic, age-structured model (RAS) was built
to study these concerns. Model parameter estimates were derived from a review of 
the literature and surveillance data from England and Wales. Different vaccine
efficacy scenarios, vaccine coverages, and vaccination strategies were
investigated. The model predicts that, although an upward shift in the age at
infection occurs, the overall morbidity due to varicella is likely to decrease
following mass infant vaccination. On the other hand, cases of zoster may
significantly increase in the first 50 years following vaccination. The model
predicts that, in a population similar to England and Wales (50 m people),
varicella vaccination with 90% coverage would prevent 0.6 m inpatient days due to
varicella but would generate an extra 1.1 m inpatient days due to zoster over the
first 65 years. Thus, under base-case model assumptions, the gain in reduction of
varicella morbidity from infant vaccination is offset in the short-term by the
increases in zoster morbidity (using inpatient days as a proxy). Paradoxically,
less effective vaccines or vaccine programmes can be more effective in reducing
overall morbidity (varicella + zoster) by allowing the virus to circulate more,
which produces a smaller shift in the age at infection and a smaller increase in 
zoster cases. Copyright 2003 Wiley-Liss, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12627484 [PubMed - indexed for MEDLINE]

493: J Med Virol. 2003;70 Suppl 1:S15-9.

Varicella susceptibility and vaccine use among young adults enlisting in the
United States Navy.

Ryan MA, Smith TC, Honner WK, Gray GC.

US Department of Defense Center for Deployment Health Research, Naval Health
Research Center, PO Box 85122, San Diego, CA 92186-5122, USA. ryan@nhrc.navy.mil

Primary varicella infection, or chicken pox, is a threat to all young adults who 
join the United States (U.S.) military if they fail to develop immunity prior to 
enlistment. Historically, outbreaks of chicken pox have caused marked morbidity
and impaired military readiness. In December 1996, the U.S. Navy began performing
serologic testing for varicella among all new recruits, and vaccinating those
found to be sero-negative. We evaluated results of the screening program in its
first 4 years, and used multivariable logistic regression modeling to describe
factors associated with varicella susceptibility. Cases of chicken pox were
tracked among all military services before and after program implementation. More
than 190,000 young adults enlisted in the U.S. Navy between 1997 and 2000.
Recruits originated from all 50 states and several foreign countries; 84% were
male, and their average age was 19 years. Seven percent were found to be
susceptible (sero-negative) to varicella. In multivariable modeling,
race/ethnicity was associated with susceptibility, but age, gender, and home
state were not. The overall incidence of chicken pox in the Navy was reduced by
more than 80% after initiation of the screening-vaccination program. A successful
varicella screening-vaccination program has been implemented in the U.S. Navy.
Results of serologic screening undertaken on this large number of young adults
may be useful in tracking the changing epidemiology of varicella in the general
population in the post-vaccine era. Copyright 2003 Wiley-Liss, Inc.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 12627481 [PubMed - indexed for MEDLINE]

494: J Med Virol. 2003;70 Suppl 1:S9-14.

Epidemiology of Varicella-Zoster Virus in England and Wales.

Brisson M, Edmunds WJ.

Immunisation Division, PHLS Communicable Disease Surveillance Centre, 61
Colindale Avenue, London NW9 5WQ, United Kingdom. mbrisson@phls.org.uk

Many countries are studying currently the possibility of mass vaccination against
varicella. The objective of this study was to provide a complete picture of the
pre-vaccine epidemiology of the Varicella-Zoster Virus in England and Wales to
aid in the design of immunisation programs. Population-based data including
general practitioner sentinel surveillance, hospitalisation data, and death
certificates from England and Wales were analysed. The average incidence rates
for varicella and zoster between 1991 and 2000 were 1,291 and 373 per 100,000
years, respectively. Overall hospitalisation rates were equal for varicella and
zoster (4.5 vs. 4.4 hospitalisation per 100,000 population) with 5 and 8%,
respectively, having underlying immunosuppressive conditions. The age-specific
proportion of cases hospitalised and length of stay were similar between the two 
diseases. However, the overall burden of disease is considerably higher for
zoster. The number of inpatient days and case-fatality due to zoster are roughly 
4 to 6 times greater than for varicella (11 vs. 3 days and 25 vs. 4 deaths per
100,000 case). These results provide base-line estimates should mass varicella
vaccination be introduced in England and Wales. Copyright 2003 Wiley-Liss, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12627480 [PubMed - indexed for MEDLINE]

495: Infect Dis Obstet Gynecol. 2002;10(3):159-60.

Varicella vaccination during early pregnancy: a cause of in utero miliary fetal
tissue calcifications and hydrops?

Apuzzio J, Ganesh V, Iffy L, Al-Khan A.

Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical
School, Newark, New Jersey 07103-2714, USA. apuzzijj@umdnj.edu

BACKGROUND: It is the purpose of this article to describe a suspected association
of inadvertent vaccination with varicella vaccine during early pregnancy with the
subsequent development of in utero miliary fetal tissue calcifications and fetal 
hydrops detected by sonogram at 15 weeks of gestation. CASE: This is a case
presentation of a pregnant patient who received varicella vaccination during the 
same menstrual cycle that she became pregnant, and is supplemented by a literary 
review. The fetus developed miliary fetal tissue calcifications and fetal hydrops
detected by a targeted sonogram at 15 weeks gestation. CONCLUSION: Varicella
vaccination during early pregnancy may be a cause of miliary fetal tissue
calcifications and fetal hydrops.

Publication Types: 
    Case Reports

PMID: 12625972 [PubMed - indexed for MEDLINE]

496: Indian J Pediatr. 2003 Jan;70(1):101-3.

Congenital varicella syndrome.

Sasidharan CK, Anoop P.

Department of Pediatrics & Neonatology, Institute of Maternal and Child Health,
Medical College, Calicut, Kerala. aparnathira@satyam.net.in

The fetal consequences of chickenpox complicating pregnancy depends on the period
of gestation at which the infection is contracted. The extremely rare classical
form of congenital varicella syndrome, resulting from maternal varicella
infection in the first trimester of pregnancy, is being reported here. The
unusual features in this baby are bilateral hypoplastic lower extremities,
fracture of bones, a normal electroencephalogram and phantom hernias of the
anterior abdominal wall.

Publication Types: 
    Case Reports

PMID: 12619963 [PubMed - indexed for MEDLINE]

497: CMAJ. 2003 Mar 4;168(5):561-3.

Severe hydrocephalus associated with congenital varicella syndrome.

Mazzella M, Arioni C, Bellini C, Allegri AE, Savioli C, Serra G.

Servizio di Patologia Neonatale, Dipartimento di Pediatria, Università di Genova,
Istituto Giannina Gaslini, Italy.

Congenital varicella syndrome refers to the spectrum of fetal anomalies
associated with maternal varicella zoster virus (VZV) infection during the first 
trimester of pregnancy. The syndrome is rare and the risk to the fetus uncertain.
We describe an unusual case of congenital varicella syndrome in which
hydrocephalus was the main consequence and likely represented VZV reactivation in
utero.

Publication Types: 
    Case Reports

PMID: 12615748 [PubMed - indexed for MEDLINE]

498: Math Biosci. 2003 Apr;182(2):113-26.

A qualitative analysis of a model for the transmission of varicella-zoster virus.

Schuette MC.

Department of Mathematics and Computer Science, Georgia Southern University,
Statesboro, GA 30460-8093, USA. schuette@gasou.edu

Varicella-zoster virus (VZV) is a herpesvirus which is the known agent for
causing varicella (chickenpox) in its initial manifestation and zoster (shingles)
in a reactivated state. The standard SEIR compartmental model is modified to
include the cycle of shingles acquisition, recovery, and possible reacquisition. 
The basic reproduction number R(0) shows the influence of the zoster cycle and
how shingles can be important in maintaining VZV in populations. The model has
the typical threshold behavior in the sense that when R(0)</=1, the VZV
disappears from the population, and when R(0)>1, the virus persists over time and
so chickenpox and shingles remain endemic.

PMID: 12591619 [PubMed - indexed for MEDLINE]

499: J Hosp Infect. 2003 Feb;53(2):117-9.

Varicella and paediatric staff: current practice and vaccine cost-effectiveness.

O'Neill J, Buttery J.

Oxford Vaccine Group, University Department of Paediatrics, John Radcliffe
Hospital, Oxford, UK.

This study was undertaken to audit staff varicella policy for UK paediatric
centres, and to estimate the cost-effectiveness of implementing a staff varicella
vaccine policy. A telephone survey of 22 hospitals was performed to determine the
policy regarding varicella immune status among healthcare workers (HCWs). All
hospitals surveyed except one recorded immune status of informed HCWs, and had a 
policy of exclusion from work if they developed chickenpox. The total cost of
vaccine implementation for nurses at the John Radcliffe Hospital neonatal unit
over 5 years was estimated at 1601 pounds sterling versus 2474 pounds sterling
for the estimated total cost of varicella exposure. Therefore it is likely that
vaccination represents a cost-effective intervention. Copyright 2003 The Hospital
Infection Society

PMID: 12586570 [PubMed - indexed for MEDLINE]

500: Can J Surg. 2003 Feb;46(1):9-14.

Necrotizing fasciitis secondary to chickenpox infection in children.

Clark P, Davidson D, Letts M, Lawton L, Jawadi A.

Division of Orthopaedics, Children's Hospital of Eastern Ontario, University of
Ottawa, Ottawa Ont.

BACKGROUND: Necrotizing fasciitis is an uncommon but serious complication of
chickenpox infection in young children. Because many of these infections affect
the musculoskeletal tissues, orthopedic surgeons are often the first caregivers
to be involved in diagnosis and treatment. Our objective was to review the
diagnostic features of necrotizing fasciitis and analyze treatment methods to
control and eradicate the musculoskeletal infection. DESIGN: A review. SETTING:
The Children's Hospital of Eastern Ontario, Ottawa, a major Canadian pediatric
trauma and referral centre. PATIENTS: Five children who presented with
necrotizing fasciitis secondary to chickenpox infection. INTERVENTION: Surgical
debridement of the involved area of necrotizing fasciitis and intravenous
antibiotic treatment with clindamycin and penicillin. MAIN OUTCOME MEASURES:
Complications outcome. RESULTS: The average age of the 5 children at presentation
was 3.8 years (range from 2.9-5.8 yr). The necrotizing fasciitis involved the
lower extremity in 5 children, the upper extremity in 3, and the abdomen, chest, 
neck and back in 1 child each. One child presented with involvement of all 4
extremities. In 4 children, culture specimens grew group A beta-hemolytic
Streptococcus. They all survived and all limbs were salvaged, although secondary 
closure and skin grafting were required. At an average follow-up of 1 year, each 
child had fully recovered with no loss of muscle function. CONCLUSIONS:
Necrotizing fasciitis should be suspected in any child with a history of
varicella infection and an increasing complaint of pain and swelling in an
extremity or other body area associated with increasing fever, erythema, lethargy
and irritability. Emergent surgical debridement and intensive antibiotic therapy 
are essential to prevent muscle necrosis, major limb dysfunction and death.

PMID: 12585787 [PubMed - indexed for MEDLINE]

501: Vaccine. 2003 Mar 7;21(11-12):1256-67.

The cost-effectiveness of routine childhood varicella vaccination in Germany.

Banz K, Wagenpfeil S, Neiss A, Goertz A, Staginnus U, Vollmar J, Wutzler P.

Outcomes International, Malzgasse 9, CH-4052 Basel, Switzerland.
kurt.banz@outcomes.ch

This study explores the economic value of a routine varicella vaccination program
for Germany. An age-structured decision analytic model was used to assess the
benefits, costs and cost-effectiveness of an immunization program for a period of
30 years. Three interventions were compared with no vaccination: universal
vaccination of around 15 months old healthy children, vaccination of susceptible 
adolescents (11-12 years of age), and the combined strategy. The analysis was
conducted from both the societal perspective and the payers', i.e. sickness
funds, perspective. Input data were mainly derived from a retrospective survey
(analyzed were 1334 patient records) and from a seroprevalence study (n = 4602
sera). Using a coverage rate of 85% and a vaccine efficacy rate of 86% routine
children vaccination could prevent around 611,000 varicella cases and over 4700
major complications per year. Average yearly cost savings for the society are
51.3 million Euro. The benefit-cost ratio (BCR) is 4.12. From the third-party
payer's perspective, the BCR is 1.75 which is a consequence of significant
reimbursement of parent's lost earnings by German sickness funds. The adolescent 
vaccination strategy has a favorable BCR ratio of 8.44 from the societal
perspective, but clearly inferior medical effects. The combined vaccination
strategy showed similar results as the children strategy. Routine childhood
varicella vaccination appears to be a highly efficient strategy to reduce the
burden of varicella and results in significant savings for both the society and
the payers. Copyright 2002 Elsevier Science Ltd.

Publication Types: 
    Comparative Study

PMID: 12559807 [PubMed - indexed for MEDLINE]

502: Epidemiol Infect. 2002 Dec;129(3):607-15.

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

Musharrafieh UM, Nuwayhid IA, Hamadeh GN, Steitieh SW, Bizri AR.

Department of Family Medicine, American University of Beirut, PO Box 113-6044,
Beirut, Lebanon.

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

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12558345 [PubMed - indexed for MEDLINE]

503: Epidemiol Infect. 2002 Dec;129(3):599-606.

Varicella in non-immune persons: incidence, hospitalization and mortality rates.

Boëlle PY, Hanslik T.

Department of Public Health, Hôpital Saint Antoine, Université Pierre et Marie
Curie, Assistance Publique-Hôpitaux de Paris, INSERM U444, France.

This study was conducted to estimate the varicella morbidity and mortality rates 
per age group among the non-immune population in France. Morbidity and mortality 
data for the years 1990-9 were derived from nationwide databases and surveillance
systems. An incidence/prevalence model was designed to quantify the non-immune
population per age group. The incidence of varicella in the non-immune population
peaks during childhood and again in the 25-35 years age group. For children aged 
1-4 years, adults aged 25-34 years and those older than 65 years, the
hospitalization rates are respectively 235, 1,438 and 8,154 per 100,000 cases,
and the death rates are respectively 7, 104 and 5,345 per million cases. Case
fatality or case hospitalization rates were not evenly distributed among adults
and increased dramatically with age.

PMID: 12558344 [PubMed - indexed for MEDLINE]

504: Epidemiol Infect. 2002 Dec;129(3):593-7.

The role of solar ultraviolet irradiation in zoster.

Zak-Prelich M, Borkowski JL, Alexander F, Norval M.

Department of Dermatology, Medical University of Lodz, Lodz, Poland.

Ultraviolet radiation (UVR) suppresses many aspects of cell-mediated immunity but
it is uncertain whether solar UV exposure alters resistance to human infectious
diseases. Varicella-zoster virus (VZV) causes varicella (chickenpox) and can
reactivate from latency to cause zoster (shingles). The monthly incidence of
chickenpox and zoster in a defined Polish population over 2 years was recorded
and ground level solar UV was measured daily. There was a significant seasonality
of UVR. Evidence of seasonal variation was found for all zoster cases and for
zoster in males, with the lowest number of cases in the winter. The number of
zoster cases with lesions occurring on exposed body sites (the face) demonstrated
highly significant seasonality with a peak in July/August. Seasonal models for
UVR and zoster cases showed similar temporal patterns. By contrast, for
varicella, the maximum number of cases was found in March and the minimum in
August/September, probably explained by the respiratory spread of VZV. It is
tempting to speculate that the increase in solar UVR in the summer could induce
suppression of cellular immunity, thus contributing to the corresponding rise in 
the incidence of zoster.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12558343 [PubMed - indexed for MEDLINE]

505: Cleve Clin J Med. 2002 Dec;69(12):1000-1.

Which children and adults should receive the chickenpox vaccine?

Sabella C.

Division of Pediatrics, Section of Pediatric Infectious Diseases, The Children's 
Hospital at The Cleveland Clinic Foundation, OH 44195, USA. sabellc@ccf.org

Chickenpox vaccine is safe and effective and elicits long-standing immunity.
Primary care physicians caring for children and adults should be aware of its
benefits.

PMID: 12546274 [PubMed - indexed for MEDLINE]

506: Vaccine. 2003 Jan 17;21(5-6):399-400.

Immigration flows and new epidemiological evidence in southern Italy.

Gabutti G, Fedele A, Aprile V, Guido M, Lopalco P.

Department of Biological and Environmental Sciences and Technologies (DiSTeBA),
University of Lecce, Via Provinciale Lecce-Monteroni, 73100 Lecce, Italy.
gabutti@ilenic.unile.it

Since 1991, immigration flows have had a relevant impact on the area of Salento, 
in southern Italy, with thousands of landings every year. For this reason, both
temporary and permanent shelters were created. At these centres a team of doctors
works permanently and full-time, carefully evaluating the immigrants' state of
health and performing the sanitary interventions needed and/or provided by the
law. Recently, 55 chickenpox cases were reported among Sri Lankan immigrants,
four cases among subjects already sheltered in the centres who became infected
after the arrival of the Sri Lankan group, and one in an Italian child. The Sri
Lankan immigrants affected by chickenpox were aged 18-41 years and all recovered 
without sequelae. A seroepidemiological study was also performed.This was the
first chickenpox epidemic ever occurred in a shelter for immigrants in Italy.
This should induce attention towards the new and unpredictable sanitary
emergencies that may occur in such contexts.

PMID: 12531638 [PubMed - indexed for MEDLINE]

507: Int J Dermatol. 2002 Dec;41(12):903-5.

Atypical varicella with palm and sole involvement.

Auvin S, Catteau B, Ganga-Zandzou PS, Ythier H.

Department of Pediatric, Roubaix University Children's Hospital and Faculty of
Medicine, Lille, France. stephane.auvin@free.fr

Varicella is a common disease characterized by a typical presentation. We report 
a case of an atypical presentation of varicella with a centrifugal distribution, 
eruption with many vesicles, no pustular stage in evolution and distal
involvement. There were none of the known modifying factors (immunosuppression,
skin disease, injury or sun exposure). To explain the distal involvement we
suggest intraepidermic lesions caused by a pre-existing B1 coxsackie infection.

Publication Types: 
    Case Reports

PMID: 12530357 [PubMed - indexed for MEDLINE]

508: Ann Trop Paediatr. 2002 Dec;22(4):341-5.

Seroepidemiology of varicella-zoster virus in Bangladesh.

Saha SK, Darmstadt GL, Hanif M, Khan R.

Department of Microbiology, Dhaka Shishu Hospital, Bangladesh Institute of Child 
Health, Popular Diagnostic Centre, Dhaka, Bangladesh. sksaha@bangla.net

Data on the seroprevalence of antibodies protective against the varicella-zoster 
virus are needed to develop strategies to prevent varicella infections in
Bangladesh. Of 1209 patients evaluated at referral-level health facilities in
Dhaka, 943 (78%) had no known history of chickenpox and were tested by latex
agglutination for the presence of varicella-zoster antibody in serum. Forty-one
per cent (386) of the 943 specimens tested were negative. Seropositivity was
highest among neonates (83%), declined sharply to 19% in those aged 7-12 months, 
and thereafter rose steadily with age until a plateau of 85% was reached after
the age of 16 years. This first report of varicella-zoster antibody
seroprevalence in Bangladesh suggests that, as in other tropical areas, a
significant proportion of children, adolescents and adults are susceptible.
Children aged from 15 months to early adolescence might be the most important
group to target with the vaccine currently available. However, to ensure
successful immunisation, further, population-based seroprevalence data are
needed, as are an assessment of the vaccine's acceptability and the accessibility
of the target population. Incomplete coverage of young children could result in
delayed acquisition, and, ultimately, in more severe disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12530284 [PubMed - indexed for MEDLINE]

509: Cochrane Database Syst Rev. 2002;(4):CD002980.

Update in:
    Cochrane Database Syst Rev. 2004;(2):CD002980.

Acyclovir for treating varicella in otherwise healthy children and adolescents.

Klassen TP, Belseck EM, Wiebe N, Hartling L.

Department of Pediatrics, University of Alberta, 2C3.67 Walter C. Mackenzie,
Health Sciences Centre, Edmonton, Alberta, Canada, T6G 2R7.
terry.klassen@ualberta.ca

BACKGROUND: Acyclovir has the potential to shorten the course of illness which
may result in reduced costs and morbidity. OBJECTIVES: 1) To examine the evidence
evaluating the efficacy of acyclovir in alleviating symptoms and shortening the
duration of illness. 2) To examine complications of chickenpox and adverse
effects associated with acyclovir as reported in the relevant trials. SEARCH
STRATEGY: We searched the Cochrane Controlled Trials Register (2002, Issue 2),
MEDLINE (January 1966 to October 2001), EMBASE (1988 to September 2001). The
reference lists of all relevant articles were reviewed. The primary author of
relevant studies and the pharmaceutical company that manufactures acyclovir were 
contacted. SELECTION CRITERIA: Randomized controlled trials that evaluated
otherwise healthy children 0-18 years of age with chickenpox. DATA COLLECTION AND
ANALYSIS: Two reviewers independently reviewed the studies for eligibility. Two
reviewers independently assessed methodological quality of the relevant studies
using the Jadad scale and allocation concealment. Differences were resolved by
consensus. Data were extracted by one reviewer using a structured form and
checked by a second. Continuous data were converted to the weighted mean
difference (WMD). Weighted mean differences were not combined into an overall
estimate due to the varied age groups between studies. There were too few studies
to consider statistical heterogeneity between studies (i.e., differences in
reported effects), to perform subgroup or sensitivity analyses, or to assess for 
publication bias. MAIN RESULTS: Three studies were included. Study quality was
three (n=2) and four (n=1) on the Jadad scale. Acyclovir was associated with a
reduction in the number of days with fever, from -1.0 (95% CI -1.5,-0.5) to -1.3 
(95% CI -2.0,-0.6). Results were inconsistent with respect to the number of days 
to no new lesions, the maximum number of lesions and the number of days to the
relief of itching. There were no clinically important differences between
acyclovir and placebo with respect to complications associated with chickenpox or
adverse effects associated with the drug. REVIEWER'S CONCLUSIONS: Acyclovir
appears to be effective in reducing the number of days with fever among otherwise
healthy children with chickenpox. The results were inconsistent with respect to
the number of days to no new lesions, relief of itchiness and maximum number of
lesions. The clinical importance of acyclovir treatment in otherwise healthy
children remains controversial.

Publication Types: 
    Meta-Analysis
    Review

PMID: 12519581 [PubMed - indexed for MEDLINE]

510: Pharmacoepidemiol Drug Saf. 2002 Dec;11(8):651-4.

Pharmacoepidemiologic implications of erroneous varicella vaccinations in
pregnancy through confusion with Varicella zoster immune globulin.

Wise RP, Braun MM, Seward JF, Mootrey GT, Shields KE, Salive ME, Krause PR.

Division of Epidemiology, Office of Biostatistics and Epidemiology, Center for
Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA),
1401 Rockville Pike, Rockville, MD 20852-1448, USA. wise@cber.fda.gov

A series of case reports to the varicella vaccine Pregnancy Registry described
inadvertent administrations during pregnancy of this live virus product instead
of the intended Varicella zoster immune globulin. Cases continued to accrue
despite an early publication about the pattern. The persistent problem warrants
specific educational efforts to prevent further repetitions. It also has more
general implications for medical product safety surveillance. First, this
problem's original detection depended on the Pregnancy Registry's open-ended
collection of information about pregnancy exposures. It could have escaped
recognition through surveillance limited to pre specified potential risks. This
need for unrestricted reporting and human vigilance to sift through case stories 
has particular relevance for efforts to re-think methods to monitor gestational
drug exposures. In addition, the problem's persistence despite initial publicity 
suggests that diligent surveillance may require continued follow-up of identified
safety issues. Periodic reassessments of selected preventable problems might
strengthen efforts to minimize product risks.

PMID: 12512240 [PubMed - indexed for MEDLINE]

511: Epidemiology. 2003 Jan;14(1):99-102.

The incidence of varicella: correction of a common error.

Nicolosi A, Sturkenboom M, Mannino S, Arpinelli F, Cantarutti L, Giaquinto C.

Department of Epidemiology and Medical Informatics, Institute of Biomedical
Technologies, National Research Council, Milan, Italy. nicolasi@itba.mi.cnr.it

BACKGROUND: Interest in the incidence of varicella (chickenpox) has increased
since the discovery of an effective vaccine, but calculations to date have
incorrectedly ignored the question of susceptibility. METHODS: We studied the
occurrence of varicella in Italy on the basis of 33,343 children (age 0-14 years)
cared for by 35 pediatricians between 1 October 1997 and 30 September 1998. The
life-table technique was used to calculate the number of susceptible children. On
this basis, we estimated the corrected age-specific and cumulative incidence.
RESULTS: We identified 1749 cases among the estimated 21,783 susceptible
children, for a crude incidence of 8.0% (95% confidence interval [CI] = 7.7-8.4).
The rate age-standardized to the Italian population 0-14 years old was 6.8 (CI = 
6.5-7.2). The incidence was more than 16% among children age 3-4 years and more
than 4% for those age 1-10 years. Comparison of the usual method and our
corrected method showed that the uncorrected method underestimates the crude
annual incidence (5.2% 8.0%), shifts the peak incidence to earlier ages, and
underestimates cumulative incidence (at age 14, 49% 67%). CONCLUSIONS: The use of
our corrected method provides more valid estimates of the incidence of varicella 
than the ones that are currently available. Corrected estimates should be
preferred to uncorrected ones in models to study the cost-effectiveness of
universal vaccination against varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12500056 [PubMed - indexed for MEDLINE]

512: Pharmacoeconomics. 2003;21(1):13-38.

Comment in:
    Pharmacoeconomics. 2004;22(2):133-6; author reply136-8.

Economic evaluations of varicella vaccination programmes: a review of the
literature.

Thiry N, Beutels P, Van Damme P, Van Doorslaer E.

Department of Epidemiology and Social Medicine, Centre for the Evaluation of
Vaccination, University of Antwerp, Antwerp, Belgium. nancy.thiry@ua.ac.be

Chickenpox infections are generally mild but due to their very high incidence
among healthy children they give rise to considerable morbidity and occasional
mortality. With the development of a varicella vaccine in the early 1970s and its
progressive licensing in many countries, interest in the efficiency of varicella 
immunisation programmes grew. The objective of this review was to discuss the
methodological aspects and results of published economic evaluations of varicella
vaccination. From this, we attempted to make recommendations. A computerised
search was carried out; 17 full economic evaluations of varicella vaccination
were retrieved. The review identified the methodological divergences and
similarities between the articles in four areas: study design, epidemiological
data, economic data and model characteristics. We assessed to what extent the
applied methods conform to general guidelines for the economic evaluation of
healthcare interventions and compared the studies' results. The desirability of a
universal vaccination programme depends on whose perspective is taken. Despite
variability in data and model assumptions, the studies suggest that universal
vaccination of infants is attractive to society because large savings occur from 
averted unproductive days for parents. For the healthcare payer, universal
vaccination of infants does not generate savings. Vaccination of susceptible
adolescents has been proposed by some authors as a viable alternative; the
attractiveness of this is highly dependent on the negative predictive value of
anamnestic screening. Targeted vaccination of healthcare workers and
immunocompromised individuals appears relatively cost effective. Findings for
other target groups are either contradictory or provide insufficient evidence for
any unequivocal recommendations to be made. High sensitivity to vaccine price was
reported in most studies. This review highlights that some aspects of these
studies need to be further improved before final recommendations can be made.
First, more transparency, completeness and compliance to general methodological
guidelines are required. Second, because of the increasing severity of varicella 
with age, it is preferable and in some cases essential to use dynamic models for 
the assessment of universal vaccination strategies. Third, most studies focused
on the strategy of vaccinating children only while their results depended heavily
on disputable assumptions (regarding vaccine effectiveness and impact on herpes
zoster). Since violation of these assumptions could have important adverse public
health effects, we suggest pre-adolescent vaccination as a more secure
alternative. This option deserves more attention in future analyses.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12484801 [PubMed - indexed for MEDLINE]

513: N Engl J Med. 2002 Dec 12;347(24):1909-15.

Comment in:
    N Engl J Med. 2002 Dec 12;347(24):1962-3.    N Engl J Med. 2003 Apr 3;348(14):1405-7; author reply 1405-7.    N Engl J Med. 2003 Apr 3;348(14):1405-7; author reply 1405-7.

Outbreak of varicella at a day-care center despite vaccination.

Galil K, Lee B, Strine T, Carraher C, Baughman AL, Eaton M, Montero J, Seward J.

Centers for Disease Control and Prevention, Atlanta, USA. karin.galil@cubist.com

BACKGROUND: In seven studies of the effectiveness of the varicella vaccine
conducted since it was licensed, the effectiveness was 71 to 100 percent against 
disease of any severity and 95 to 100 percent against moderate and severe
disease. We investigated an outbreak of varicella in a population of children
with a high proportion of vaccinees who were attending a day-care center in a
small community in New Hampshire. METHODS: Using standardized questionnaires, we 
collected information about the children's medical and vaccination history from
parents and health care providers. The analysis of the effectiveness of the
vaccine and of risk factors for vaccine failure was restricted to children who
were enrolled in the day-care center continuously during the outbreak and
attended for one week or more and who were cared for in the building that
represented the epicenter of the outbreak, since transmission was not documented 
in a second building. RESULTS: Varicella developed in 25 of 88 children (28.4
percent) between December 1, 2000, and January 11, 2001. The index case occurred 
in a healthy child who had been vaccinated three years previously and who
infected more than 50 percent of his classmates who had no history of varicella. 
The effectiveness of the vaccine was 44.0 percent (95 percent confidence
interval, 6.9 to 66.3 percent) against disease of any severity and 86.0 percent
(95 percent confidence interval, 38.7 to 96.8 percent) against moderate or severe
disease. Children who had been vaccinated three years or more before the outbreak
were at greater risk for vaccine failure than those who had been vaccinated more 
recently (relative risk, 2.6 [95 percent confidence interval, 1.3 to 5.3]).
CONCLUSIONS: In this outbreak, vaccination provided poor protection against
varicella, although there was good protection against moderate or severe disease.
A longer interval since vaccination was associated with an increased risk of
vaccine failure. Breakthrough infections in vaccinated, healthy persons can be as
infectious as varicella in unvaccinated persons. Copyright 2002 Massachusetts
Medical Society

PMID: 12477940 [PubMed - indexed for MEDLINE]

514: Int J Clin Pract. 2002 Nov;56(9):720.

Acute cerebellar ataxia associated with chickenpox.

Saab M, Wadhwa V.

Department of Accident & Emergency, Fairfield General Hospital, Bury, UK.

A case of a child with acute cerebellar ataxia associated with chickenpox virus
infection is described. Acute cerebellar ataxia associated with chickenpox is a
well-recognised complication and the pertinent features of this condition are
discussed.

Publication Types: 
    Case Reports

PMID: 12469990 [PubMed - indexed for MEDLINE]

515: Bull Soc Belge Ophtalmol. 2002;(285):19-23.

Postherpetic ophthalmic neuralgia.

Devulder JE.

Ghent University Hospital, Department of Anesthesia-Section Pain Clinic, B-9000
Ghent, Belgium. jacques.devulder@rug.ac.be

Postherpetic ophthalmic neuralgia is the final stage of a varicella zoster
infection. Many years after chickenpox infection, patients can develop herpes
zoster in one or more specific dermatomal regions. The ophthalmic branch of the
trigeminal nerve and the thoracic nerves are most commonly affected. Younger
patients are less prone to postherpetic neuralgia than the older. Patients with a
depression in cell-mediated immunity are more susceptible to develop postherpetic
pain. Postherpetic ophthalmic neuralgia is a neuropathic pain and can be treated 
by anticonvulsants and tricyclic antidepressants. Neurodestructive procedures are
not recommended as they enhance destruction and neuropathic pain. Sympathetic
nerve blocks can be helpful. Neurostimulation is the last therapeutic resort.

Publication Types: 
    Review

PMID: 12442339 [PubMed - indexed for MEDLINE]

516: Am J Perinatol. 2002 Oct;19(7):387-94.

Evaluation of varicella immune status in an obstetric population in relation to
place of birth.

Goldberg JM, Ziel HK, Burchette R.

Department of Obstetrics, Kaiser Permanente Medical Center, Los Angeles, USA.

Obstetric populations born in tropical or subtropical regions are likely to be
seronegative for varicella virus; obstetric populations containing a large
proportion of women born in tropical or subtropical regions will benefit greatly 
from being screened for varicella immunity. Physicians should therefore know the 
geographic origin of the community they serve and should consider testing
varicella immunity in their obstetric patients born in tropical or subtropical
regions. To ensure that passive immunization is received when indicated,
physicians should obtain serostatus without relying on patients' recollection of 
their exposure to varicella virus.

Publication Types: 
    Review

PMID: 12442228 [PubMed - indexed for MEDLINE]

517: Eur J Pediatr. 2002 Nov;161(11):588-93. Epub 2002 Sep 24.

The seroepidemiology of primary varicella-zoster virus infection in Flanders
(Belgium).

Thiry N, Beutels P, Shkedy Z, Vranckx R, Vandermeulen C, Wielen MV, Damme PV.

Centre for the Evaluation of Vaccination, Department of Epidemiology and
Community Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp,
Belgium. nancy.thiry@ua.ac.be

The age-specific seroprevalence of varicella-zoster virus (VZV) antibodies was
assessed in a sample of the Flemish (Belgian) population. ELISA tests were used
to analyse 1673 sera from subjects aged 1 to 44 years (October 1999-April 2000). 
Chickenpox infections in Flanders appear to affect children at a younger age than
in other European countries since 47.37% (95% CI: 37.33-57.41) is already immune 
at 2 years of age. For older age-groups, the prevalence is similar to that of
most European countries: 80.19% (95% CI: 72.60-87.78) at 5 years, 92.52% (95% CI:
87.54-97.51) at 9 years and 100%> or =40 years. The accuracy of non-positive
recollections of varicella histories among Flemish 10 to 17-year olds was
examined on the basis of a second (residual) serum bank. In this group, VZV
seroprevalence was almost always 100% (or nearly 100%), irrespective of age,
degree of reliability (negative or uncertain answers) or level of ascertainment
(child personally or parents). The limited size of this second data set did not
allow for an accurate assessment of the negative predictive value of such
recollections. CONCLUSION: since varicella-zoster virus predominantly affects
very small children and is generally perceived as benign, the required high
coverage rate of a universal childhood varicella vaccination programme may be
hard to attain. Adolescent strategies can minimise the population risks involved 
but the accuracy of non positive antecedents of chickenpox needs to be documented
to assess the efficiency of such strategies.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12424583 [PubMed - indexed for MEDLINE]

518: J Clin Virol. 2002 Dec;25(3):293-301.

Acute central nervous system complications in varicella zoster virus infections.

Koskiniemi M, Piiparinen H, Rantalaiho T, Eränkö P, Färkkilä M, Räihä K, Salonen 
EM, Ukkonen P, Vaheri A.

Department of Virology, Haartman Institute, Helenski University, Finland.
marjaleena.koskiniemi@helsinki.fi

BACKGROUND: In a previous multicenter study on central nervous system (CNS) viral
infections varicella zoster virus (VZV) appeared the most frequent etiologic
agent and appeared often without rash. OBJECTIVE: To evaluate the appearance and 
diagnostics of VZV in CNS more thoroughly, we studied the cases systematically by
using sensitive and specific methods to learn the best diagnostic approach in
order to start specific therapy. STUDY DESIGN: We analyzed all serum and
cerebrospinal fluid samples of 174 patients, 88 females and 86 males, with acute 
CNS symptoms associated with VZV infection diagnosed in the multicenter study on 
viral CNS infections. RESULTS: About 38 patients (22%) had chickenpox, 59 (34%)
had shingles, and 77 (44%) had no cutaneous symptoms at all. The mean age of
chickenpox patients was 8.6 years, of the others 46.6 and 41.4 years.
VZV-specific nucleic acid was detected in the CSF in one fourth of the patients
in all groups, primarily during the first week of illness. In serum specimens,
specific IgM was present in two thirds of the patients with chickenpox, whereas
in the others in one third of the cases. In CSF, specific IgM was present in
15-17% of patients with skin manifestations, compared with 6% of those without
rash. CONCLUSIONS: The role of VZV infections in CNS complications seems
remarkable, often presenting without rash. Even these cases should be promptly
recognized in order to conduct proper antiviral therapy. In children, a
combination of PCR and IgM tests is the best approach. In adults, PCR, together
with the measurement of intrathecal antibody production yields best results.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12423693 [PubMed - indexed for MEDLINE]

519: J Infect. 2002 Nov;45(4):237-42.

A household study of chickenpox in Guinea-Bissau: intensity of exposure is a
determinant of severity.

Poulsen A, Qureshi K, Lisse I, Kofoed PE, Nielsen J, Vestergaard BF, Aaby P.

Projecto de Saude de Bandim, Guinea-Bissau, Denmark. anja@dadlnet.dk

OBJECTIVE: To determinate the relative importance of state of nutrition and
intensity of exposure for clinical severity of chickenpox in a developing
country. METHODS: A prospective household study was performed in a semi-urban
area in Bissau, the capital of Guinea-Bissau, between December 1994 and June
1995. Antibodies were measured in the acute and the convalescence phase to assess
validity of clinical diagnoses. The clinical severity of infection was assessed
by number of pox, fever response and skin infections. Severity was compared for
index cases, i.e. the first case in the house, and secondary and tertiary cases
infected following exposure at home. RESULT: Chickenpox was diagnosed in 165
persons. The clinician's and the mothers' diagnoses corresponded well with the
serological results. Median age was 36 months (range 3 months to 30.3 years).
There was no correlation between nutritional status measured by arm-circumference
and severity of infection. The number of pox was higher for secondary cases than 
for index cases (median 106 vs. 89, P<0.01), the difference being more pronounced
for girls (P=0.018) than for boys (P=0.575). The risk of skin infection as a
complication was correlated with the number of pox (P<0.001). CONCLUSION:
Chickenpox was recognised correctly by Guinean mothers. The age distribution in
Guinea-Bissau resembled the pattern in developed countries. The intensity of
exposure was a major determinant of severity, especially for girls.

PMID: 12423611 [PubMed - indexed for MEDLINE]

520: J Infect. 2002 Nov;45(4):233-6.

The burden of uncomplicated cases of chickenpox in Israel.

Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O.

The Pediatric Infectious Diseases and Immunology Unit, E. Wolfson Medical Center,
Holon, 58100, Israel. esomeh@post.tau.ac.il

OBJECTIVE: The aim of this study was to assess the direct medical burden and work
loss associated with uncomplicated chickenpox in Israel. METHODS: A total of 155 
otherwise healthy children and adolescents with chickenpox were recruited from 10
physician offices in central Israel. Direct and indirect medical burdens were
determined by caregiver interview. RESULTS: Mean age was 3.3+/-2.3 years. 51% of 
the patients were under 3 years of age. Each patient made on average 1.15 visits 
to a general practitioner. Most patients were taken to the Doctor's office only
once during the illness while 23 patients (15%) were seen twice. Three patients
were referred to the emergency room. Antihistamines (39%) and Calamine lotion
(28%) were the most frequently prescribed medications, followed by acyclovir
(17%) and antibiotics (6%). Following the patient's illness there were 72 cases
of secondary spread of varicella to household members. The individuals who cared 
for the child missed a combined total of 2.5 days from work (on average per
varicella episode). CONCLUSIONS: Israeli children acquire chickenpox at a younger
age than children in North America and England and consume more prescribed
medications. While the work loss in the present study was comparable to previous 
reports, the direct medical costs inflicted by this infection in Israel are not
negligible even for uncomplicated cases.

PMID: 12423610 [PubMed - indexed for MEDLINE]

521: Med Microbiol Immunol. 2002 Oct;191(2):89-96. Epub 2002 Aug 29.

Can varicella be eliminated by vaccination? Potential clinical and economic
effects of universal childhood varicella immunisation in Germany.

Wutzler P, Neiss A, Banz K, Goertz A, Bisanz H.

Institute for Antiviral Chemotherapy, Friedrich-Schiller University of Jena,
Winzerlaer Strasse 10, Germany. peter.wutzler@med.uni-jena.de

Varicella is a potentially serious infection not only in immunocompromised
individuals but also in otherwise healthy adults and children. Vaccination plays 
an important role in preventing the disease and its sequelae. A universal
vaccination in childhood is expected to reduce substantially the number of
uncomplicated cases of varicella and decrease the number of complicated cases
requiring hospitalisation. To generate data as basis for decisions of the health 
authorities concerning prevention of varicella, epidemiological and
health-economic data were collected in two studies. Using an age-structured
decision analytic model the benefits, costs and cost effectiveness of a varicella
immunisation program for a period of 30 years were assessed. It was shown that
after the first year of life seroprevalence rates increased steadily and reached 
62% among the 4- to 5-year olds and 94% among the 10- to 11-year olds,
respectively; 90% of varicella patients were younger than 12 years. A severe
course was assessed for 16.3% of the cases. Overall incidence of complications
was estimated to be 5.7%. A routine varicella vaccination program targeting
healthy children could prevent 82.7% of varicella cases and over 4,700 major
complications per year provided the coverage level was 85%. Under these
conditions the elimination of varicella is predicted to be achievable within 18
years. It is expected that a combined measles, mumps, rubella and varicella
vaccine could provide the required coverage. Average yearly discounted net cost
savings of universal childhood vaccination are 51 million Euro with a
benefit-cost ratio of 4.12. Childhood vaccination with catch-up of adolescents
provides additional clinical benefits. The break-even point indicating first net 
savings could be achieved already 3 years after the implementation of the
vaccination program. In summary, routine childhood varicella vaccination appears 
to be a highly efficient strategy to significantly reduce the sizeable burden of 
varicella and would lead to net savings from both the societal but also the payer
perspective.

PMID: 12410347 [PubMed - indexed for MEDLINE]

522: Stat Med. 2002 Nov 30;21(22):3411-30.

Use of statistical models for evaluating antibody response as a correlate of
protection against varicella.

Chan IS, Li S, Matthews H, Chan C, Vessey R, Sadoff J, Heyse J.

Clinical Biostatistics, Merck Research Laboratories, Merck & Co., West Point, PA 
19486, USA. Ivan_Chan@Merck.com

In vaccine clinical trials, humoral antibody responses are often used to measure 
the effect of a vaccine because they correlate with a vaccine's protective
efficacy against the target disease. While the concept of a correlate of
protection usually refers to establishing a protective level of antibody titre,
identifying a clear-cut value is often impossible because vaccine efficacy is not
related solely to the antibody titre. We propose examining the relationship
between disease protection and the whole distribution of antibody responses
rather than a single cut-off level. In particular, we use failure-time models to 
estimate the relationship between long-term disease breakthroughs and primary
antibody responses after vaccination. We apply these models to show that the
varicella antibody response measured by glycoprotein enzyme-linked immunosorbent 
assay 6 weeks after vaccination strongly correlate with protection against
varicella (chickenpox); we used 7-year follow-up data from children who received 
one dose of a live attenuated varicella (Oka/Merck) vaccine. In addition, we
explore the potential use of these models to predict long-term disease
breakthrough rates and to estimate the predicted vaccine efficacy of a similar
varicella vaccine made with a modified manufacturing process. Copyright 2002 John
Wiley & Sons, Ltd.

Publication Types: 
    Comparative Study

PMID: 12407681 [PubMed - indexed for MEDLINE]

523: J Pediatr Surg. 2002 Nov;37(11):1632-3.

Fournier's gangrene as a complication of varicella in a 15-month-old boy.

Güneren E, Keskin M, Uysal OA, Aritürk E, Kalayci AG.

Division of Plastic and Reconstructive Surgery, Faculty of Medicine, Ondokuz
Mayis University, Samsun, Turkey.

An inguinal and perianal localization of Fournier's gangrene (FG) in a
15-month-old boy as a complication of the varicella infection is discussed. This 
is the first presentation of the disease as a complication of the varicella
rashes. There were already 57 pediatric FG cases resulting from other causes that
had been presented in the medical literature. Copyright 2002, Elsevier Science
(USA). All rights reserved.

Publication Types: 
    Case Reports

PMID: 12407555 [PubMed - indexed for MEDLINE]

524: Eur J Paediatr Neurol. 2002;6(6):331-3.

Focal cerebral vasculitis and stroke after chickenpox.

Alehan FK, Boyvat F, Baskin E, Derbent M, Ozbek N.

Department of Paediatrics, Başkent University, Ankara, Turkey.
falehan@hotmail.com

Cerebral infarcts are rather rare in children and can be caused by a number of
diverse conditions. We report a case of cerebral infarct associated with a recent
varicella infection. A 5-year old girl presented with an acute central facial
palsy 1 month after a chickenpox infection. The infarction was revealed by
magnetic resonance imaging and laboratory studies ruled out all known causes of
stroke. Cerebral angiogram demonstrated segmental narrowing and irregularity of
the wall of the right internal carotid artery, compatible with focal vasculitis. 
With the presumed diagnosis of varicella-associated focal angiitis, the patient
was treated with high-dose methylprednisolone, acyclovir and aspirin. Magnetic
resonance angiogram performed 6 weeks after the stroke demonstrated the
resolution of the vasculitis. Varicella infection should be considered one of the
possible causes of acute ischaemic strokes in children.

Publication Types: 
    Case Reports

PMID: 12401459 [PubMed - indexed for MEDLINE]

525: Pediatr Infect Dis J. 2002 Oct;21(10):931-5.

Hospitalizations for varicella in the United States, 1988 to 1999.

Galil K, Brown C, Lin F, Seward J.

Centers for Disease Control and Prevention, Atlanta, GA, USA.

BACKGROUND: Varicella epidemiology is changing with increasing use of the
varicella vaccine. METHODS: To describe the epidemiology of severe varicella
disease before and after vaccine introduction, data from the National Hospital
Discharge Survey (NHDS) for 1988 to 1999 were analyzed. Incidental cases of
varicella in persons hospitalized for a different indication were excluded.
RESULTS: In the prevaccination era (1988 to 1995), there were 10 632 varicella
hospitalizations annually. The most common complications were viral pneumonitis
(20.9%), fluid/electrolyte disturbances (19.3%) and soft tissue infections
(17.8%). Most (89.1%) persons had no severe underlying immunocompromising
conditions. The mean length of hospitalization was 5.4 days, corresponding to
approximately 57 000 days of hospitalization annually. In the first years after
vaccine licensure (1996 to 1999), vaccine coverage reached 59%. Although not
statistically significant, there was a trend toward decreased hospitalizations
and a decline in mean length of hospitalization. CONCLUSIONS: Varicella morbidity
was higher in the prevaccination era than previously reported. Although no
significant decline is evident, a trend toward decreased hospitalizations is
emerging in the first years after vaccine introduction.

Publication Types: 
    Comparative Study

PMID: 12394815 [PubMed - indexed for MEDLINE]

526: Pediatr Infect Dis J. 2002 Oct;21(10):927-31.

Varicella-related hospitalizations in the vaccine era.

Ratner AJ.

Division of Infectious Diseases, Children's Hospital of Philadelphia,
Philadelphia, PA, USA.

BACKGROUND AND AIM: Varicella is normally a self-limited disease of childhood
that does not require hospitalization. In the prevaccine era varicella caused
>9000 hospitalizations per year. To determine whether the varicella vaccine,
licensed in 1995, has decreased hospitalizations because of varicella, we
examined national rates of varicella-related hospital discharges (VRHD) covering 
a 12-year period that included pre- and postvaccine data. METHODS: Data from the 
1988 to 1999 National Hospital Discharge Survey and population estimates from the
National Center for Health Statistics were used to calculate biennial rates of
VRHD. To control for coding consistency, rates of invasive disease caused by were
calculated for the same time period. RESULTS: The rate of VRHD for 1998 to 1999
(4.42 hospitalizations per 100 000 person-years) was the lowest of any of the
periods measured, but this difference was not statistically significant. The same
was true of VRHD limited to cases with varicella coded as the primary diagnosis. 
A trend toward a decrease in VRHD was observed in all age groups examined,
although none was statistically significant. Calculated rates from this national 
data set were in agreement with prior studies using active surveillance, and the 
previously documented fall in hospitalizations caused by invasive disease was
demonstrated using these methods. CONCLUSIONS: Although it is uncommon for
children with varicella to require hospitalization, these cases are an important 
contributor to cost and morbidity of varicella. In contrast to predictions of
prelicensure mathematical models, there has not been a significant decrease in
total or first diagnosis VRHD since the vaccine became available. Current
coverage levels are below those used in prelicensure models. Increased acceptance
of the varicella vaccine by parents and practitioners may aid in the further
decrease of varicella-related hospitalizations.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12394814 [PubMed - indexed for MEDLINE]

527: Am J Transplant. 2002 Oct;2(9):880-2.

Varicella infection following varicella vaccination in a liver transplant
recipient.

Levitsky J, Te HS, Faust TW, Cohen SM.

Center for Liver Diseases. Section of Gastroenterology, University of Chicago
Hospitals, IL, USA.

Varicella infection may result in significant morbidity and mortality in patients
who have received an orthotopic liver transplant (OLT). It is unclear if
vaccinating these patients against varicella-zoster virus (VZV) infection is safe
or effective. We report on a liver transplant recipient with no prior history of 
VZV infection who was given the varicella vaccine after an indirect VZV exposure.
The patient was subsequently hospitalized twice for treatment of cutaneous
varicella infection. We will discuss VZV infection, particularly in relation to
liver transplantation, and review the prophylaxis and management of VZV infection
after OLT.

Publication Types: 
    Case Reports

PMID: 12392296 [PubMed - indexed for MEDLINE]

528: J Virol. 2002 Nov;76(22):11447-59.

Erratum in:
    J Virol. 2003 Mar;77(5):3351..

Comparison of the complete DNA sequences of the Oka varicella vaccine and its
parental virus.

Gomi Y, Sunamachi H, Mori Y, Nagaike K, Takahashi M, Yamanishi K.

Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka
University, Kanonji, Kagawa, Japan.

The DNA sequences of the Oka varicella vaccine virus (V-Oka) and its parental
virus (P-Oka) were completed. Comparison of the sequences revealed 42 base
substitutions, which led to 20 amino acid conversions and length differences in
tandem repeat regions (R1, R3, and R4) and in an origin of DNA replication. Amino
acid substitutions existed in open reading frames (ORFs) 6, 9A, 10, 21, 31, 39,
50, 52, 55, 59, 62, and 64. Of these, 15 base substitutions, leading to eight
amino acid substitutions, were in the gene 62 region alone. Further DNA sequence 
analysis showed that these substitutions were specific for V-Oka and were not
present in nine clinical isolates. The immediate-early gene 62 product (IE62) of 
P-Oka had stronger transactivational activity than the mutant IE62 contained in
V-Oka in 293 and CV-1 cells. An infectious center assay of a plaque-purified
clone (S7-01) from the V-Oka with 8 amino acid substitutions in ORF 62 showed
smaller plaque formation and less-efficient virus-spreading activity than did
P-Oka in human embryonic lung cells. Another clone (S-13) with only five
substitutions in ORF 62 spread slightly faster than S7-01 but not as effectively 
as P-Oka. Moreover, transient luciferase assay in 293 cells showed that
transactivational activities of IE62s of S7-01 and S7-13 were lower than that of 
P-Oka. Based on these results, it appears that amino acid substitutions in ORF 62
are responsible for virus growth and spreading from infected to uninfected cells.
Furthermore, the Oka vaccine virus was completely distinguishable from P-Oka and 
54 clinical isolates by seven restriction-enzyme fragment length polymorphisms
that detected differences in the DNA sequence.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 12388706 [PubMed - indexed for MEDLINE]

529: Infection. 2002 Oct;30(5):320-2.

Rapid molecular discrimination between infection with wild-type varicella-zoster 
virus and varicella vaccine virus.

Lässker U, Harder TC, Hufnagel M, Suttorp M.

Dept. of Pediatrics, Christian-Albrechts-University, Schwanenweg 20, D-24105
Kiel, Germany. laessker@pediatrics.uni-kiel.de

Varicella-zoster virus (VZV) infection is immunocompromised patients may cause
life-threatening complications. Prevention measures include administration of VZV
immuloglobulin, acyclovir and live attenuated varicella vaccine. After
vaccination, a mild varicella-like exanthem appears in up to 5% of vaccinees.
Morphologically this exanthem cannot be differentiated from wild-type (wt)
varicella. The risk of virus transmission after varicella vaccination, in
contrast to wt varicella, is low, even in immunocompromised patients. We report
on a 2-year-old girl with relapse of cereral anaplastic ependymoma, who received 
one dose of varicella vaccine. Two weeks later, a maculopapular rash developed
while she was an inpatient on the oncology ward. Using VZV-specific PCR and
restriction fragment length polymorphism (RFLP) analysis, we were able to
diagnose wt varicella infection. Thus, appropriate prevention measures (VZV
immunoglobulin and acyclovir) were justified for close contacts to prevent virus 
transmission. No secondary cases occurred.

Publication Types: 
    Case Reports

PMID: 12382096 [PubMed - indexed for MEDLINE]

530: Eur J Epidemiol. 2001;17(11):1023-7.

The incidence of chickenpox in the community. Lessons for disease surveillance in
sentinel practice networks.

Fleming DM, Schellevis FG, Falcao I, Alonso TV, Padilla ML.

Birmingham Research Unit, Royal College of General Practitioners, Harborne,
England. dfleming@rcgp-bru.demon.co.uk

Sentinel practice networks have been established in many European countries to
monitor disease incidence in the community. To demonstrate the value of sentinel 
networks an international study on the incidence of chicken pox has been
undertaken. Chickenpox was chosen as an acute condition for which incidence data 
are important to the determination of health policy on vaccine use. The project
examined the incidence of chickenpox reported in sentinel networks in England and
Wales, The Netherlands, Portugal and Spain (two regional networks) in
January-June 2000 and the potential underestimate from patients who did not
consult. An investigation of secondary household contact cases was undertaken.
Reported incidence of chickenpox (all ages) in England and Wales was 25 per
10,000, in The Netherlands 13 per 10,000, in Portugal 21 per 10,000, in Spain
Castilla y Leon 27 per 10,000 and in Spain Basque 55 per 10,000. Analysis of
secondary contact cases suggested underestimation of incidence between 2.4% in
Spain Castilla y Leon and 32.2% in The Netherlands. There was a trend towards
incidence at an earlier age in England and Wales and in The Netherlands compared 
with Portugal and Spain. Whilst there was little problem in reliably identifying 
the number of incident cases in the recording networks and relating the
non-consulting contact cases to them, the security of the denominator remains a
problem where networks are comprised of differing categories of health care
provider. It is essential that numerator and denominator information are made
available specifically for each category.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12380716 [PubMed - indexed for MEDLINE]

531: BMC Pediatr. 2002 Sep 30;2:9.

Acyclovir for treating varicella in otherwise healthy children and adolescents: a
systematic review of randomised controlled trials.

Klassen TP, Belseck EM, Wiebe N, Hartling L.

Alberta Research Center for Child Health Evidence, Department of Pediatrics,
University of Alberta, 2C3,00 WMC, Edmonton, Alberta, T6G 2R7, Canada.
terry.klassen@ualberta.ca

BACKGROUND: Acyclovir has the potential to shorten the course of chickenpox which
may result in reduced costs and morbidity. We conducted a systematic review of
randomised controlled trials that evaluated acyclovir for the treatment of
chickenpox in otherwise healthy children. METHODS: MEDLINE, EMBASE, and the
Cochrane Library were searched. The reference lists of relevant articles were
examined and primary authors and Glaxo Wellcome were contacted to identify
additional trials. Two reviewers independently screened studies for inclusion,
assessed study quality using the Jadad scale and allocation concealment, and
extracted data. Continuous data were converted to a weighted mean difference
(WMD). Overall estimates were not calculated due to differences in the age groups
studied. RESULTS: Three studies were included. Methodological quality was 3 (n = 
2) and 4 (n = 1) on the Jadad scale. Acyclovir was associated with a significant 
reduction in the number of days with fever, from -1.0 (95% CI -1.5,-0.5) to -1.3 
(95% CI -2.0,-0.6). Results were inconsistent with respect to the number of days 
to no new lesions, the maximum number of lesions and relief of pruritus. There
were no clinically important differences between acyclovir and placebo with
respect to complications or adverse effects. CONCLUSION: Acyclovir appears to be 
effective in reducing the number of days with fever among otherwise healthy
children with chickenpox. The results were inconsistent with respect to the
number of days to no new lesions, the maximum number of lesions and the relief of
itchiness. The clinical importance of acyclovir treatment in otherwise healthy
children remains controversial.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12356336 [PubMed - indexed for MEDLINE]

532: South Med J. 2002 Sep;95(9):1074-5.

Comment in:
    South Med J. 2003 Jul;96(7):726; author reply 726.

Acute lymphocytic leukemia after fulminant varicella associated with severe
neutropenia.

Helft DA, Correa H, Rojas P, Warrier RP.

Department of Pediatrics, Children's Hospital of New Orleans, LA 70118, USA.

Acute lymphocytic leukemia developed within 3 weeks after a fulminant case of
varicella complicated by pneumococcal sepsis and severe bone marrow suppression
in a child treated with filgrastim (human granulocyte colony-stimulating factor).

Publication Types: 
    Case Reports

PMID: 12356115 [PubMed - indexed for MEDLINE]

533: J Infect Dis. 2002 Oct 15;186 Suppl 1:S91-8.

Varicella-zoster virus: atypical presentations and unusual complications.

Gnann JW Jr.

University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham,
Alabama 35294-2170, USA.

Varicella-zoster virus (VZV) is the etiologic agent of varicella (primary
infection) and herpes zoster (reactivation of latent infection). Although
varicella is most often a relatively benign and self-limited childhood illness,
the disease can be associated with a variety of serious and potentially lethal
complications in both immunocompetent and immunocompromised persons. One
complication of varicella that appears to be increasing in frequency is serious
bacterial soft tissue infections caused by group A streptococci. Issues related
to management of varicella become especially complex when varicella involves
pregnant women or susceptible neonates. Herpes zoster can be associated with a
variety of neurologic complications, including a syndrome of delayed
contralateral hemiparesis. Neurologic complications of herpes zoster, including
chronic encephalitis, occur with increased frequency in AIDS patients. VZV
retinitis is a potentially sight-threatening complication that occurs in both
immunocompetent and immunocompromised persons. Current knowledge regarding
pathogenesis and antiviral therapy is reviewed.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12353193 [PubMed - indexed for MEDLINE]

534: Pediatr Infect Dis J. 2002 Jul;21(7):615-7.

Chickenpox and the geniculate ganglion: facial nerve palsy, Ramsay Hunt syndrome 
and acyclovir treatment.

Grose C, Bonthius D, Afifi AK.

Department of Pediatrics, University of Iowa College of Medicine, Iowa City
52242, USA. charles-grose@uiowa.edu

Facial nerve palsy has long been considered to have an infectious etiology.
Recent diagnostic analyses in children and adults have provided convincing
evidence that reactivation of varicella-zoster virus (VZV), sometimes during
infectious mononucleosis, can lead to cranial nerve VII palsy. The site of
reactivation from latency is the geniculate ganglion. Virus most likely enters
the ganglion during chickenpox, via the sensory branches of the facial nerve
located on the ear and tongue. Retrospective reviews suggest that patients with
VZV-related facial nerve palsy have poorer outcomes than other cases of Bell's
palsy. Therefore treatment with acyclovir is suggested when VZV reactivation i
slikely.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12237590 [PubMed - indexed for MEDLINE]

535: J Infect Dis. 2002 Oct 1;186(7):888-94. Epub 2002 Sep 13.

The molecular epidemiology of varicella-zoster virus: evidence for geographic
segregation.

Quinlivan M, Hawrami K, Barrett-Muir W, Aaby P, Arvin A, Chow VT, John TJ,
Matondo P, Peiris M, Poulsen A, Siqueira M, Takahashi M, Talukder Y, Yamanishi K,
Leedham-Green M, Scott FT, Thomas SL, Breuer J.

Department of Medical Microbiology, School of Medicine, Queen Mary College,
London, United Kingdom.

Of 75 varicella-zoster virus (VZV) isolates obtained from patients in Africa,
Asia, and the Far East, 74 (98.6%) were found to be positive for a BglI
restriction site in gene 54. By contrast, <22% of strains from patients in the
United Kingdom and in North and South America were positive for the BglI
restriction site. Viruses positive for BglI were significantly more common in
zoster occurring in patients of nonwhite origin (P<.05). Irrespective of the
country in which the sample was obtained, 98% of strains positive for BglI
clustered within a single phylogenetic group, which we termed "group A"; the
exception was 1 strain that appeared to be recombinant genotype C/A. We used the 
BglI site to examine both the spread of type A viruses in the United Kingdom and 
the patterns of VZV infections within persons from different ethnic groups who
grew up in the United Kingdom or abroad.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12232828 [PubMed - indexed for MEDLINE]

536: J Infect. 2002 Jul;45(1):54-7.

The burden of uncomplicated cases of chickenpox in Israel.

Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O.

The Pediatric Infectious Diseases and Immunology Unit, E. Wolfson Medical Center,
Holon, Israel. esomeh@post.tau.ac.il

OBJECTIVE: The aim of this study was to assess the direct medical burden and work
loss associated with uncomplicated chickenpox in Israel. METHODS: A total of 155 
otherwise healthy children and adolescents with chickenpox were recruited from 10
physician offices in central Israel. Direct and indirect medical burdens were
determined by caregiver interview. RESULTS: Mean age was 3.3 +/- 2.3 years. 51%
of the patients were under three years of age. Each patient made on average 1.15 
visits to a general practitioner. Most patients were taken to the Doctor's office
only once during the illness while 23 patients (15%) were seen twice. Three
patients were referred to the emergency room. Antihistamines (39%) and Calamine
lotion (28%) were the most frequently prescribed medications, followed by
acyclovir (17%) and antibiotics (6%). Following the patient's illness there were 
72 cases of secondary spread of varicella to household members. The individuals
who cared for the child missed a combined total of 2.5 days from work (on average
per varicella episode). CONCLUSIONS: Israeli children acquire chickenpox at a
younger age than children in North America and England and consume more
prescribed medications. While the work loss in the present study was comparable
to previous reports, the direct medical costs inflicted by this infection in
Israel are not negligible even for uncomplicated cases. Copyright 2002 The
British Infection Society

PMID: 12217733 [PubMed - indexed for MEDLINE]

537: Prev Med. 2002 Aug;35(2):135-42.

Understanding physician agreement with varicella immunization guidelines.

Zimmerman RK, Mieczkowski TA, Mainzer HM, Medsger AR, Nowalk MP.

Department of Family Medicine and Clinical Epidemiology, School of Medicine,
University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. zimmer@pitt.edu

BACKGROUND: Although varicella vaccine was licensed in 1995, immunization rates
are only moderate. This study identifies factors associated with physician
self-reported likelihood of recommending varicella vaccination to patients.
METHODS: Two hundred eighty-one Minnesota and Pennsylvania primary care
physicians who participated in surveys on barriers to vaccination in 1990-1991
and 1993 were surveyed in 1999, assessing physicians' beliefs about varicella
disease and vaccine and their self-reported likelihood of recommending varicella 
vaccine to three age groups of children. RESULTS: Most (79, 80, and 83%) were
likely to recommend varicella vaccine for 12- to 18-month old, 4- to 6-year-old, 
and 11- to 12-year old children, respectively, and most (78%) agreed with
national recommendations to vaccinate. If physicians believed that the vaccine
would fail, they were less likely to recommend varicella vaccination for 12- to
18-month-old (70% vs 85%, P = 0.001) and 4- to 6-year-old (83% vs 85%, P = 0.001)
children, than if they believed in its efficacy. Pediatricians were more likely
to recommend varicella vaccine than were family physicians and general
practitioners (P < 0.01). CONCLUSIONS: Physicians, especially pediatricians,
report that they recommend varicella vaccination when they agree with national
recommendations, believe in the efficacy of the vaccine, and perceive that
parents want the vaccine for their children.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12200098 [PubMed - indexed for MEDLINE]

538: Psychiatry Clin Neurosci. 2002 Oct;56(5):585-8.

Serial magnetic resonance angiography in cerebral infarction after varicella
infection.

Kimura M, Hasegawa Y, Sejima H, Inoue M, Yamaguchi S.

Department of Pediatrics, Shimane Medical University, Enya Izumo, Japan.
kimura@shimane-u.ac.jp

The case of a 1-year-8-month-old-boy with cerebral infarction after varicella
infection is reported here. Brain magnetic resonance (MR) angiography revealed
segmental narrowing of the left middle cerebral artery which became normal 8
months later. The MR angiography well demonstrated the time course of the
vascular involvement in the present patient. In cerebral infarction after
varicella infection, the proximal portion of the main cerebral arteries were
frequently damaged therefore MR angiography is useful for diagnosis and
therapeutic decision-making. Moreover, serial MR angiographic studies can clarify
the natural course of vascular changes in varicella virus-related cerebral
infarction.

Publication Types: 
    Case Reports

PMID: 12193251 [PubMed - indexed for MEDLINE]

539: Pediatr Infect Dis J. 2002 Aug;21(8):763-8.

Pediatric sentinel surveillance of vaccine-preventable diseases in Italy.

Ciofi Degli Atti ML, Salmaso S, Bella A, Arigliani R, Gangemi M, Chiamenti G,
Brusoni G, Tozzi AE; Pediatric Sentinel Surveillance Study Group.

Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome,
Italy. ciofi@iss.it

BACKGROUND: Planning and evaluating vaccination programs depend on reliable
systems of monitoring disease incidence in the community. In Italy
vaccine-preventable diseases are subject to statutory notification, but they are 
often unreported. In January, 2000, a pediatric sentinel network was launched,
with the aim of monitoring in a timely and accurate way the geographic and
temporal trends of vaccine-preventable diseases. METHODS: The network consists of
National Health System primary care pediatricians; participation is voluntary.
The diseases under surveillance include measles, mumps, rubella, pertussis and
varicella. Case definitions are based on specific clinical criteria, and
pediatricians report cases on a monthly basis. Incidence rates are estimated and 
compared with those obtained by statutory notifications. The proportion of
vaccinated cases is also computed. RESULTS: In 2000 an average of 468
pediatricians participated each month of a total of 7276 pediatricians under
contract for primary care by the National Health System. The population under
surveillance consisted of 371 670 children younger than 15 years (of a national
total of 8.347.804 children of the same age). The annual national incidence per
100.000 children was estimated at 5345 for varicella, 1972 for mumps, 279 for
pertussis, 108 for rubella and 62 for measles, although wide variations were
observed among geographic areas. The national estimates are 3 to 7 times higher
than those obtained through statutory notifications. For all of the diseases the 
ratio between the two sources of data was significantly higher in southern Italy,
compared with the rest of the country. The proportion of vaccinated cases was
similar for measles and rubella (21 and 17%) but was approximately 3 times higher
for mumps (59%). Most (74%) of the vaccinated mumps cases had received the Rubini
vaccine strain. CONCLUSIONS: The sentinel surveillance system is considerably
more sensitive than statutory notifications, particularly in southern Italy. The 
high percentage of mumps cases vaccinated with the Rubini strain indicates a
reduced effectiveness of this vaccine. Although further improvements are needed, 
pediatrician-based sentinel surveillance is a useful tool for evaluating
vaccine-preventable disease trends.

PMID: 12192166 [PubMed - indexed for MEDLINE]

540: Pediatr Infect Dis J. 2002 Aug;21(8):739-43.

Antiviral treatment of varicella in pediatric practice in the Latium region of
Italy: results of an observational study.

Volpi A, Gentile G, Pica F, Suligoi B; Slavip study group.

Department of Public Health, University of Rome "Tor Vergata", Rome, Italy.
volpi@uniroma2.it

BACKGROUND: The optimal management of chickenpox in children is a controversial
issue, at least in Europe. This study was designed to describe chickenpox in
children and its reported management by pediatricians working for the National
Health Service in the Latium region of Italy. METHODS: A questionnaire collected 
information on the duration, complications and treatment of the disease between
September, 1998, and May, 1999, by participant pediatricians who enrolled 1094
patients in community pediatric practice. RESULTS: Secondary and tertiary cases
of the disease in the same household were more severe than the primary cases.
Acyclovir was given to 50% of the children, with a tendency to treat more
severely ill children. The duration of the disease was significantly less in
children receiving acyclovir within the first 24 h of rash (7.6 days 9.0). No
complications requiring hospitalization were reported. CONCLUSIONS: The use of
antiviral drugs is not consistent among pediatricians. Clear guidelines are
needed to minimize the use of drugs and to identify children who are likely to
benefit most from antiviral therapy.

PMID: 12192161 [PubMed - indexed for MEDLINE]

541: Mil Med. 2002 Aug;167(8):639-42.

Positive predictive value of a health history questionnaire.

Burnham BR, Thompson DF, Jackson WG.

AFRL/HEDB, Brooks Air Force Base, TX 78235-5250, USA.

The U.S. Air Force Academy (USAFA) is one of the nation's military universities, 
with the mission to educate and motivate cadets to be career Air Force officers. 
This diverse population arrives at the USAFA with varying immunization records
and disease histories. Analyses of costs and benefits regarding immunization
strategies rely on accurate data and assumptions used in their calculation.
Health history questionnaires are a low-cost way of evaluating immunization and
disease history. However, this requires a good estimate of the questionnaire's
positive predictive value, which may vary among populations. This study attempts 
to provide a more accurate estimate of the positive predictive value of health
history questionnaires regarding varicella and rubella disease and vaccination
strategies for the population of fourth degree (freshman) cadets at the USAFA. We
found positive predictive values of 99% for rubella and 86% for varicella. These 
data emphasize the importance of analyzing the specific population for which a
program is intended rather than broadly applying recommendations that were
developed in other populations.

Publication Types: 
    Evaluation Studies

PMID: 12188233 [PubMed - indexed for MEDLINE]

542: Pediatr Infect Dis J. 2002 Jun;21(6):555-61.

Vaccination with measles, mumps and rubella vaccine and varicella vaccine:
safety, tolerability, immunogenicity, persistence of antibody and duration of
protection against varicella in healthy children.

Shinefield HR, Black SB, Staehle BO, Matthews H, Adelman T, Ensor K, Li S, Chan
I, Heyse J, Waters M, Chan CY, Vessey SJ, Kaplan KM, Kuter BJ; Kaiser Permanente 
Medical Team for Varivax.

Kaiser Permanente Vaccine Study Group, Oakland, CA 94612, USA.
Henry.Shinefield@kp.org

BACKGROUND: Administration of M-M-R II (Measles, Mumps and Rubella Virus Vaccine,
Live) and VARIVAX [Varicella Virus Vaccine Live (Oka/Merck)] given concomitantly 
at separate injection sites during the same office visit could increase vaccine
compliance by reducing the number of health care visits for immunizations. We
compared the safety and immunogenicity of M-M-R II and VARIVAX given
concomitantly at separate sites (Group A) with administration of the two vaccines
6 weeks apart (Group B) as well as the persistence of varicella antibody and the 
duration of protection afforded by varicella vaccine. METHODS: A total of 603
healthy children, ages 12 months to 6 years, with no history of measles, mumps,
rubella, varicella and zoster or vaccination against these diseases, were
randomized to either Group A or B and were followed for clinical reactions and
serologic responses to all four viral components. Children were enrolled from
August through December, 1993. Subjects were followed for 5 years to evaluate
persistence of varicella antibody and breakthrough varicella rates. We compared
breakthrough rates to expected attack rates in unvaccinated children to produce
estimates of vaccine efficacy. RESULTS: Both vaccine regimens were generally
well-tolerated. There were no significant differences between the groups in the
rates of fever, injection site reactions or rashes after vaccination.
Seroconversion rates and geometric mean titers for measles, mumps and rubella
were not significantly different between groups. The varicella seroconversion
rate and percentage with glycoprotein-based ELISA titers > or = 5.0 units were
similar between the two groups (99.5 and 92.5% vs. 100 and 94.8% for Groups A and
B, respectively), but the geometric mean titers were statistically significantly 
different (13.2 for Group A and 17.9 for Group B). Varicella antibody persistence
rates were >98 to 100% during 6 years of follow-up in both groups. Compared with 
historical rates, varicella vaccine efficacy during 5 years was estimated to be
90.5% (95% confidence interval, 86.2%, 95.0%) and 88.9% (95% confidence interval,
83.7%, 93.7%) in Groups A and B, respectively. CONCLUSIONS: Administration of
M-M-R II and VARIVAX concomitantly at separate injection sites or 6 weeks apart
was generally well-tolerated and immunogenic in healthy children 12 months to 6
years of age. VARIVAX administered with M-M-R II induced persistent immunity and 
long-term protection against breakthrough varicella infection.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12182381 [PubMed - indexed for MEDLINE]

543: Respiration. 2002;69(4):330-4.

Severity of illness and outcome in adult patients with primary varicella
pneumonia.

Gregorakos L, Myrianthefs P, Markou N, Chroni D, Sakagianni E.

Athens University School of Nursing, Intensive Care Unit at Trauma Hospital of
Athens, Kifisia, Athens, Greece. ektelestiko@pasok.gr

BACKGROUND: Varicella pneumonia is a serious complication of primary varicella
infection in adults that often results in respiratory failure and death.
OBJECTIVE: To analyze the clinical and laboratory manifestations of primary
varicella pneumonia in patients admitted to our intensive care unit (ICU).
METHODS: Retrospective study on patients treated in our ICU with a diagnosis of
primary varicella pneumonia during a period of 15 years. We recorded age, gender,
smoking habits, clinical and laboratory findings, arterial blood gases, chest
radiograph, illness severity (SAPS II), length of stay, necessity for mechanical 
ventilation, complications, therapy and survival. We examined the influence of
the duration of respiratory symptoms and rash prior to admission, and the
influence of illness severity on outcome. RESULTS: There was a statistically
significant difference in duration of respiratory symptoms, duration of rash and 
SAPS II on admission between: (a) mechanically ventilated patients vs.
spontaneously breathing patients (p < 0.007, p < 0.00, p < 0.00), (b) patients
who survived vs. patients with poor outcome (p < 0.001, p < 0.000, p < 0.000),
and (c) mechanically ventilated patients with poor outcome vs. mechanically
ventilated patients who survived (p < 0.001, p < 0.00, p < 0.000). Overall
mortality was 13.6%; death occurred only in mechanically ventilated patients
(mortality 33.3%). CONCLUSIONS: Primary varicella pneumonia remains a critical
problem with significant mortality. When recognized before respiratory failure
ensues and mechanical ventilation becomes mandatory, patients could have an
excellent outcome. Adult patients who delay asking for medical support, the
disease may lead to the need for mechanical ventilation and severe complications 
with a fatal outcome. Copyright 2002 S. Karger AG, Basel

PMID: 12169746 [PubMed - indexed for MEDLINE]

544: Neth J Med. 2002 May;60(4):174-6.

Acute idiopathic thrombocytopenic purpura in adults following viral infection:
report of two cases.

Kooter AJ, Van der Linden PW, De Klerk C.

Kennemer Gasthuis, Location Elisabeth, Department of Internal Medicine, Haarlem, 
The Netherlands.

Idiopathic thrombocytopenic purpura (ITP) can follow a viral infection. We
describe severe thrombocytopenia in two adult patients preceded by varicella
zoster and Epstein-Barr virus infection, respectively. The differences between
acute and chronic ITP are discussed, as well as therapeutic options.

Publication Types: 
    Case Reports

PMID: 12164396 [PubMed - indexed for MEDLINE]

545: Clin Infect Dis. 2002 Aug 15;35(4):403-8. Epub 2002 Jul 24.

Seroprevalence of measles, rubella, and varicella in refugees.

Barnett ED, Christiansen D, Figueira M.

Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center,
Boston, MA 02118, USA. ebarnett@bu.edu

Immigrant children who enter the United States without immunization records may
be required to receive vaccines for diseases to which they are already immune or 
for which they have previously received immunization. We tested 669 newly arrived
refugees (age range, 0-20 years) for antibody to measles, rubella, and varicella,
to determine the seroprevalence of antibodies to these diseases in this group of 
immigrants. Five hundred forty-nine (82%) of 669 patients had antibody to
measles, 545 (82%) of 668 had antibody to rubella, and 430 (64%) of 668 had
antibody to varicella. Antibody to all 3 diseases increased with increasing age. 
No clinically significant differences in presence of antibody were noted by
region of origin.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12145723 [PubMed - indexed for MEDLINE]

546: J Pediatr Hematol Oncol. 2002 Jun-Jul;24(5):413-6.

Postvaricella purpura fulminans caused by acquired protein s deficiency resulting
from antiprotein s antibodies: search for the epitopes.

van Ommen CH, van Wijnen M, de Groot FG, van der Horst CM, Peters M.

Department of Pediatrics (Pediatric Hematology), Emma Children's Hospital AMC,
Amsterdam, The Netherlands. c.h.vanommen@amc.uva.nl

Postvaricella purpura fulminans is a rare disease in children that is probably
caused by an acquired protein S deficiency resulting from antiprotein S
antibodies. The epitope of these antibodies is unknown. A 5-year-old girl is
described with postvaricella purpura fulminans and an acquired protein S
deficiency. In this patient and in her 3-year-old sister with uncomplicated
varicella, the concentrations of antiprotein S antibodies were measured and
followed with enzyme-linked immunosorbent assay techniques. The epitope of the
antiprotein S antibodies was studied using miniprotein S, a recombinant variant
of protein S that consists of the first 242 amino acids of protein S, lacking the
sex hormone binding globulin-like domain. In the patient's plasma, concentrations
of free protein S antigen and total protein S antigen reached normal levels in 4 
months and 5 weeks, respectively. The concentrations of the antiprotein S
antibodies decreased to 25% of the initial level in the course of 5 months. In
the sister, antiprotein S antibodies were present as well, but the concentrations
were lower than those in the patient. Most of the antiprotein S antibodies were
directed against the first 242 amino acids of protein S. After varicella, a
heterozygous autoantibody response may develop that may result in severe acquired
protein S deficiency leading to purpura fulminans. Epitopes of these antiprotein 
S antibodies are situated on both the first 242 amino acids of protein S and the 
sex hormone binding globulin-like domain.

Publication Types: 
    Comparative Study

PMID: 12142795 [PubMed - indexed for MEDLINE]

547: Dermatol Clin. 2002 Apr;20(2):267-82.

Clinical manifestations of varicella-zoster virus infection.

Chen TM, George S, Woodruff CA, Hsu S.

Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.

Infections by VZV, the virus that causes chickenpox and herpes zoster, usually
are diagnosed by the classic clinical presentations. In immunocompromised
patients, however, the atypical presentation can make the diagnosis more
challenging. Although varicella typically follows an uncomplicated course in
children, adults and immunocompromised patients can develop complications
involving several organs; some complications may be fatal. Prevention of disease 
with the vaccine is ideal. When varicella or zoster infection does occur, proper 
treatment should be initiated, depending on the age and immune status of the
patient.

Publication Types: 
    Review

PMID: 12120440 [PubMed - indexed for MEDLINE]

548: Semin Pediatr Infect Dis. 2002 Jan;13(1):12-21.

Antiviral therapy for varicella and herpes zoster.

Arvin AM.

Department of Pediatrics and Microbiology and Immunology, Stanford University
School of Medicine, CA 94305, USA. aarvin@stanford.edu

Varicella-zoster virus (VZV) causes 2 clinical illnesses, varicella (chickenpox) 
and herpes zoster (shingles). The purpose of this review is to describe the role 
of antiviral therapy in the treatment of VZV infections in healthy and
immunocompromised children. Acyclovir is the drug of choice for varicella and
herpes zoster. The route of administration may be intravenous or oral, depending 
on the immunocompetence of the host. The clinical impact of acyclovir therapy is 
related directly to its use early in the clinical course and to the likely
susceptibility of the patient to severe or life-threatening VZV infection.
Patients who have the most clinical benefit are otherwise healthy adolescents
with varicella infection and high-risk populations of immunocompromised children 
who have varicella or herpes zoster. The morbidity and mortality of VZV
infections are reduced substantially by initiating acyclovir treatment early in
the course of the disease.

Publication Types: 
    Review

PMID: 12118839 [PubMed - indexed for MEDLINE]

549: Epidemiol Infect. 2002 Jun;128(3):479-84.

Assessment of varicella underreporting in Italy.

Ciofi degli Atti ML, Rota MC, Mandolini D, Bella A, Gabutti G, Crovari P, Salmaso
S.

Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome,
Italy.

We conducted a study to assess the degree of varicella underreporting in Italy,
and its distribution by age group and geographical area. Underreporting in
individuals from 6 months to 20 years of age was computed as the ratio between
the varicella seroprevalence in 1996 and the 1996 lifetime cumulative incidence
based on statutory notifications. The degree of underreporting at the national
level was 7.7 (95% CI 7.4-7.9); underreporting was greater in older age groups
and in southern Italy. Quantification of underreporting can contribute to better 
understanding of the burden of varicella and to evaluating the potential impact
of mass vaccination.

PMID: 12113493 [PubMed - indexed for MEDLINE]

550: Health Econ. 2002 Jul;11(5):457-65.

Using stated preference discrete choice modelling to evaluate the introduction of
varicella vaccination.

Hall J, Kenny P, King M, Louviere J, Viney R, Yeoh A.

Centre for Health Economics Research and Evaluation (CHERE), Central Sydney Area 
Health Service and University of Techology, Sydney, Australia.
janeh@chere.usyd.edu.au

Applications of stated preference discrete choice modelling (SPDCM) in health
economics have been used to estimate consumer willingness to pay and to broaden
the range of consequences considered in economic evaluation. This paper
demonstrates how SPDCM can be used to predict participation rates, using the case
of varicella (chickenpox) vaccination. Varicella vaccination may be cost
effective compared to other public health programs, but this conclusion is
sensitive to the proportion of the target population immunised. A choice
experiment was conducted on a sample of Australian parents to predict uptake
across a range of hypothetical programs. Immunisation rates would be increased by
providing immunisation at no cost, by requiring it for school entry, by
increasing immunisation rates in the community and decreasing the incidence of
mild and severe side effects. There were two significant interactions; price
modified the effect of both support from authorities and severe side effects.
Country of birth was the only significant demographic characteristic. Depending
on aspects of the immunisation program, the immunisation rates of children with
Australian-born parents varied from 9% to 99% while for the children with parents
born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM
can be used to understand the levels of attributes that will induce a change in
the decision to immunise, the modification of the effect of one attribute by
another, and subgroups in the population. Such insights can contribute to the
optimal design and targeting of health programs. Copyright 2002 John Wiley &
Sons, Ltd.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12112494 [PubMed - indexed for MEDLINE]

551: J Infect. 2002 May;44(4):220-5.

Varicella: a vaccine preventable disease?

Watson B.

Department of Pediatrics, Albert Einstein Hospital, Division of Disease Control, 
Philadelphia Department of Public Health, PA, USA. barbara.watson@phil.gov

OBJECTIVES: To present a review of varicella disease, vaccine development and
implementation of universal vaccination, discuss common questions about the
vaccine and the epidemiology of the disease since licensure of the varicella
vaccine. METHODS: Review the incidence of complications from varicella disease
prior to vaccine licensure, safety of the varicella vaccine from clinical trials 
and post-marketing surveillance data, the impact of the vaccine on disease
incidence where high vaccine coverage has been achieved, and address some
barriers to vaccination. Raise issues that developed since 1995. RESULTS: The
safety data gathered during the 20-year-gestation period of this vaccine prior to
licensure has been confirmed. The vaccine works-in areas where vaccine coverage
is over 70%, there has been a decline in disease, most marked in the age group
with the best vaccine coverage (the 1-4-year olds), leading to a concern that
unexposed susceptible children may reach adulthood and remain susceptible unless 
better practice of universal vaccination of ALL susceptible is practiced.
CONCLUSIONS: Varicella disease has declined in areas with moderate vaccine
coverage. Continued implementation of existing vaccine policies will lead to
further reductions of varicella morbidity and mortality throughout the USA.
Copyright 2002 The British Infection Society.

PMID: 12099727 [PubMed - indexed for MEDLINE]

552: J Infect. 2002 May;44(4):211-9.

The effect of vaccination on the epidemiology of varicella zoster virus.

Edmunds WJ, Brisson M.

Immunisation Division, Colindale, London NW9 5EQ, UK. jedmunds@phls.org.uk

Varicella zoster virus (VZV) causes chickenpox (varicella) on primary exposure
and can reactivate later in life to cause shingles (zoster). As primary infection
is more serious in adults than children, and exposure to the virus might boost
the immune response to both chickenpox and shingles, there are two main concerns 
regarding infant VZV vaccination: that it could lead to an increase in adult
disease; and/or that it could lead to a temporary increase in the incidence of
shingles. This paper reviews the evidence for such outcomes. The consensus view
of mathematical modelling studies is that the overall varicella associated burden
is likely to decrease in the long term, regardless of the level of vaccine
coverage. On the other hand, recent evidence suggests that an increase in zoster 
incidence appears likely, and the more effective vaccination is at preventing
varicella, the larger the increase in zoster incidence. Targeted vaccination of
susceptible adolescents and/or the contacts of high-risk individuals can be
effective at preventing disease in these individuals with minimal risk to the
community. However, targeted strategies would not prevent most disease (including
most severe disease), and will not lead to a long-term reduction in the incidence
of zoster. Understanding the mechanisms for maintaining immunity against
varicella and zoster is critical for predicting the long-term effects of
vaccination. Meanwhile sensitive surveillance of both chickenpox and shingles is 
essential in countries that have implemented, or are about to implement,
varicella vaccination. Copyright 2002 The British Infection Society.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12099726 [PubMed - indexed for MEDLINE]

553: J Infect Dis. 2002 Jul 1;186(1):102-5. Epub 2002 Jun 5.

Younger age at vaccination may increase risk of varicella vaccine failure.

Galil K, Fair E, Mountcastle N, Britz P, Seward J.

Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
kgalil@cdc.gov

To determine vaccine effectiveness (VE), a varicella outbreak in a highly
vaccinated day-care center (DCC) population in Pennsylvania was investigated. In 
Pennsylvania, proof of immunity is required for children >or=12 months old for
DCC enrollment. Questionnaires were administered to parents of children who had
attended the DCC continuously during the study period (1 November 1999-9 April
2000) to determine history of varicella disease or vaccination and for
information about any recent rash illnesses. VE was calculated for children
>or=12 months old without a history of varicella. There were 41 cases of
varicella among 131 attendees, with 14 cases (34%) among vaccinated children. VE 
was 79% against all varicella and 95% against moderate or severe varicella.
Vaccination at <14 months was associated with an increased risk of breakthrough
disease (relative risk, 3.0; 95% confidence interval, 0.9-9.9). Despite varicella
vaccination coverage of 80%, a sizeable outbreak occurred. Early age at
vaccination may increase the risk of vaccine failure.

PMID: 12089668 [PubMed - indexed for MEDLINE]

554: Pediatr Infect Dis J. 2002 Apr;21(4):337-42.

Inverse relationship between six week postvaccination varicella antibody response
to vaccine and likelihood of long term breakthrough infection.

Li S, Chan IS, Matthews H, Heyse JF, Chan CY, Kuter BJ, Kaplan KM, Vessey SJ,
Sadoff JC.

Merck Research Laboratories, Merck & Co, Inc, West Point, PA 19486, USA.

BACKGROUND: We used the large clinical database that supported the development of
Oka/ Merck varicella vaccine to study the relationship between the primary
varicella antibody response, as determined by gpELISA, an enzyme-linked
immunosorbent assay that detects antibodies to varicella-zoster virus (VZV)
glycoprotein, and the subsequent risk of postvaccination breakthrough varicella. 
METHODS: We vaccinated 1,164 healthy children with a single dose of varicella
vaccine containing 2900 to 9000 plaque-forming units/dose. The primary immune
response to vaccination was determined by gpELISA 6 weeks after vaccination.
Subjects were followed annually for 7 years to ascertain cases of breakthrough
varicella. RESULTS: The estimated vaccine efficacy among children with a 6-week
postvaccination antibody titer of > or = 5 gpELISA units was 95.5% (95%
confidence interval, 94.2%, 96.8%) compared with 83.5% (95% confidence interval, 
76.9%, 89.5%) for subjects with a titer of <5 gpELISA units. Children with a
6-week postvaccination antibody titer of <5 gpELISA units were 3.5 times more
likely than those with a titer of > or = 5 gpELISA units to develop breakthrough 
varicella. CONCLUSIONS: We identified a 6-week postvaccination antibody titer of 
> or = 5 gpELISA units as an approximate correlate of protection. In addition we 
established an accelerated failure time model based on log normal hazard that
predicted varicella breakthrough rates based on the distribution of 6-week
postvaccination varicella antibody titers.

PMID: 12075766 [PubMed - indexed for MEDLINE]

555: Clin Infect Dis. 2002 Jul 1;35(1):102-4. Epub 2002 Jun 5.

An Outbreak of Varicella among children attending preschool and elementary school
in Illinois.

Dworkin MS, Jennings CE, Roth-Thomas J, Lang JE, Stukenberg C, Lumpkin JR.

Division of Infectious Diseases, Illinois Department of Public Health,
Springfield, IL, USA. mdworkin@idph.state.il.us

In our investigation of a varicella outbreak among students in preschool,
kindergarten, and grades 1-3 in Winnebago County, Illinois, we found an overall
varicella vaccine efficacy of 88%, evidence that the circulating virus was a
wild-type strain (as determined by polymerase chain reaction analysis), and
evidence that vaccination of children </=15 months of age was associated with an 
increased risk for breakthrough varicella (relative risk, 3.7; 95% confidence
interval, 1.1-13.1; P=.04). The efficacy of varicella vaccine might be improved
if administration of the initial vaccine dose is delayed until children are >/=15
months of age.

PMID: 12060885 [PubMed - indexed for MEDLINE]

556: Vaccine. 2002 Jun 7;20(19-20):2500-7.

Exposure to varicella boosts immunity to herpes-zoster: implications for mass
vaccination against chickenpox.

Brisson M, Gay NJ, Edmunds WJ, Andrews NJ.

Immunisation Division, PHLS Communicable Disease Surveillance Centre, London, UK.
mbrisson@phls.org.uk

We present data to confirm that exposure to varicella boosts immunity to
herpes-zoster. We show that exposure to varicella is greater in adults living
with children and that this exposure is highly protective against zoster
(Incidence ratio=0.75, 95% CI, 0.63-0.89). The data is used to parameterise a
mathematical model of varicella zoster virus (VZV) transmission that captures
differences in exposure to varicella in adults living with and without children. 
Under the 'best-fit' model, exposure to varicella is estimated to boost
cell-mediated immunity for an average of 20 years (95% CI, 7-41years). Mass
varicella vaccination is expected to cause a major epidemic of herpes-zoster,
affecting more than 50% of those aged 10-44 years at the introduction of
vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12057605 [PubMed - indexed for MEDLINE]

557: Curr Opin Investig Drugs. 2002 Jan;3(1):54-7.

Varivax (Merck & Co).

Jones T.

Intellivax International Inc, Ville St-Laurent, Quebec, Canada.
tjones@intellivax.com

Varivax is a live-attenuated varicella vaccine developed and launched in the US
by Merck & Co for the treatment of chickenpox [413319]. The vaccine uses the Oka 
strain of the varicella virus licensed from the Biken Institute at Osaka
University in Japan [178223]. By June 2001, Merck was also developing the vaccine
for use in adults for herpes zoster infection [413319]. The FDA required
post-marketing studies as a condition for its approval of Varivax, which was
granted in March 1995 [174416]. The Centers for Disease Control & Prevention
Advisory Committee on Immunization Practices recommended that Varivax should be
administered at the same time as the measles, mumps and rubella vaccine.
Unvaccinated children between the ages of 19 months and 13 years should be
vaccinated by the time they are 13 years old [180148]. Varivax, from its launch
in the spring of 1995 to the end of the third quarter 1995, produced sales of US 
$60 million [196542]. In June 2000, a second generation of Varivax, Varivax II,
was launched for vaccination against chickenpox in individuals 12 months of age
and older. Varivax II prevents the transmission of chickenpox with exactly the
same safety and efficacy profile as Varivax; however, the new Varivax II has the 
advantage of being refrigerator-stable [371871].

Publication Types: 
    Review

PMID: 12054073 [PubMed - indexed for MEDLINE]

558: J Neurovirol. 2002 Jun;8(3):191-203.

Simian varicella virus DNA is present and transcribed months after experimental
infection of adult African green monkeys.

White TM, Mahalingam R, Traina-Dorge V, Gilden DH.

Department of Neurology, University of Colorado Health Sciences Center, Denver
80262, USA.

To study the pathogenesis of simian varicella virus (SVV) infection in its
natural primate host, we inoculated adult SVV-seronegative African green monkeys 
intratracheally with 10(3)-10(4) PFU of SVV, sacrificed them 11 days, 2, 5, 10,
and 12 months postinfection (p.i.), and examined lung, liver, and ganglia for SVV
DNA and RNA. PCR analysis revealed SVV DNA in ganglia and viscera at 11 days and 
2, 5, and 10 months p.i. Similarly, SVV transcripts corresponding to immediate
early (IE), putative early (E), and late (L) SVV open-reading frames (ORFs) were 
found in liver, lung, and ganglia of most monkeys at multiple intervals for the
12-month study period. SVV-specific antigens were detected in ganglia and liver
during acute varicella, but not in ganglia 12 months p.i. Analysis of control
tissue (ganglia, lung, and liver) from uninfected SVV-seronegative adult African 
green monkeys did not reveal SVV DNA, SVV RNA, SVV-specific antigen, or
varicella-specific pathological changes. Overall, intratracheal inoculation of
SVV in African green monkeys resulted in the presence of viral DNA and
transcription of multiple viral genes in many tissues for months after
experimental infection.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12053274 [PubMed - indexed for MEDLINE]

559: Int J Infect Dis. 2002 Mar;6(1):6-8.

Varicella pneumonia in patients with HIV/AIDS.

Popara M, Pendle S, Sacks L, Smego RA Jr, Mer M.

Sizwe Tropical Diseases Hospital, Rietfontein, Republic of South Africa.

OBJECTIVE: To determine the potential role of steroid therapy combined with early
antiviral and supportive care in patients infected with human immunodeficiency
virus (HIV) with varicella pneumonia. MATERIALS AND METHODS: A retrospective
review was conducted of the incidence, clinical course, and outcome of varicella 
pneumonia in patients with HIV or acquired immunodeficiency syndrome (AIDS).
RESULTS: Seven of 12 patients (58%) who were hospitalized with chickenpox
developed clinically severe varicella pneumonia. All patients had advanced
immunosuppression and all developed diffuse reticulonodular radiographic
abnormalities, although two patients had normal chest radiographs on admission.
All patients received antiviral therapy within 12 hours of hospital admission.
The overall mortality rate was 43%. Six patients were treated with systemic
corticosteroids in addition to antiviral agents, including all four of the
survivors. CONCLUSIONS: Hospitalized patients with HIV or AIDS with chickenpox
are at high risk for developing varicella pneumonia. There is a potentially high 
rate of death despite prompt initiation of appropriate antiviral therapy.
Intensive care management and adjunctive use of systemic corticosteroids may
improve outcome.

PMID: 12044294 [PubMed - indexed for MEDLINE]

560: Pediatrics. 2002 Jun;109(6):1068-73.

Second varicella infections: are they more common than previously thought?

Hall S, Maupin T, Seward J, Jumaan AO, Peterson C, Goldman G, Mascola L, Wharton 
M.

Department of Epidemiology, School of Public Health, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, USA.

OBJECTIVE: To describe the epidemiology and clinical characteristics of varicella
reinfections reported to a surveillance project. METHODS: We investigated
varicella cases reported to a surveillance project between January 1, 1995, and
December 31, 1999--with more extensive investigation of cases reporting previous 
varicella with onset between January 1, 1998, and September 30, 1998--to provide 
a more detailed description of first and second varicella infections. A simple
decision tree was used to assess the likelihood that reported first and second
infections were varicella. RESULTS: Among varicella cases reported to the
surveillance project, 4.5% of cases in 1995 and 13.3% of cases in 1999 reported
previous varicella. More than 95% of first infections were physician diagnosed,
epidemiologically linked to another case, or had a rash description consistent
with varicella; the same was true for reported second infections. People who
reported reinfections were generally healthy. There was a family history of
repeat infections in 45% of people who reported reinfections. CONCLUSIONS:
Clinical varicella reinfections may occur more commonly than previously thought. 
Additional studies of the predictive value of a positive varicella history and
laboratory studies of reported reinfections are indicated to guide varicella
vaccination policy.

Publication Types: 
    Case Reports

PMID: 12042544 [PubMed - indexed for MEDLINE]

561: Trop Med Int Health. 2002 Jun;7(6):512-7.

Seroprevalence of varicella zoster and rubella antibodies among rural populations
of the Chaco region, south-eastern Bolivia.

Bartoloni A, Bartalesi F, Roselli M, Mantella A, Dini F, Carballo ES, Barron VP, 
Paradisi F.

Clinica di Malattie Infettive, Università di Firenze, Firenze, Italia.
bartolonia@ao-careggi.toscana.it

OBJECTIVE: To determine the seroprevalence of antibodies against varicella zoster
virus (VZV) and rubella virus among the population of two rural areas, Camiri and
Villa Montes, Chaco region, south-eastern Bolivia. METHODS: In a cross-sectional 
study, serum samples from randomly selected subjects were screened for VZV- and
rubella antibodies using enzyme-linked immunosorbent assay (ELISA). RESULTS: The 
prevalence of VZV antibodies was 80% (391 of 489). No significant differences
were observed between genders and study areas. The prevalence increased with age 
with a seropositivity rate of 21.2% in the 1-4-year-old children, 56.9% in the
5-9 age group and 83.7% in the 10-14 age group, and reached 98.2% in over 45-year
olds. The prevalence of rubella virus antibodies was 76.9% (377 of 490), without 
significant differences between genders and study areas. Similar to the trend
observed for VZV antibodies, the seroprevalence increased with age with a
seropositivity rate of 18.1% in the 1-4-year-old children, 53.9% in the 5-9 age
group and 78.4% in the 10-14 age group, and reached 94.7% in over 45-year-old
subjects. Among the 95 women of childbearing age (15-44 years) the susceptibility
rate was 11.6%. CONCLUSIONS: A common seroimmunological profile was evidenced for
the two infections. The age-specific profile of VZV seropositivity differs from
that reported for other tropical countries where higher median age of
seroconversion and lower seroprevalence among adults are observed. Data
concerning the prevalence of immunity to rubella may be useful to evaluate the
impact of the recently introduced rubella immunization programme.

PMID: 12031073 [PubMed - indexed for MEDLINE]

562: Turk J Pediatr. 2002 Apr-Jun;44(2):148-51.

Comment in:
    Turk J Pediatr. 2003 Jan-Mar;45(1):83; author reply 84.

A case of purpura fulminans secondary to transient protein C deficiency as a
complication of chickenpox infection.

Canpolat C, Bakir M.

Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul,
Turkey.

Purpura fulminans is a rare but dramatic disease which occurs most commonly
during or after an infection. It is characterized by extensive involvement of the
skin and extremities and involvement of visceral organs. Purpura fulminans, when 
occurring after a viral infection such as varicella, is usually characterized by 
purpuric lesions involving the trunk, usually with sparing of the visceral
organs. In this report we describe a child with purpura fulminans due to a
transient protein C deficiency as a complication of chickenpox infection. A
seven-year-old girl developed bruise-like lesions on her extremities on the fifth
day after eruption of varicella exanthem. She had no previous history of bleeding
tendency or thrombosis. Family history was also negative. On the seventh day of
her illness she was admitted to Marmara University Hospital with widespread
echymotic an partially crusted chickenpox lesions. CBC, urinalysis and blood
chemistries were within normal limits. She had a prolonged aPT and apt with low
serum fibrinogen and high D-dimers suggestive disseminated intravascular
coagulation (DIC). Protein C activity was low. Punch skin biopsy was consistent
with purpura fulminans. She was treated with heparin and fresh frozen plasma
which helped her to recover clinically as well as hematologically. She was
discharged with still low protein C activity that returned to normal by the next 
follow-up visit.

Publication Types: 
    Case Reports

PMID: 12026205 [PubMed - indexed for MEDLINE]

563: Pediatr Transplant. 2002 Apr;6(2):97-100.

Varicella vaccination in pediatric kidney transplant candidates.

Furth SL, Fivush BA.

Department of Pediatrics, the Welch Center for Prevention, Epidemiology and
Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, Maryland,
USA. sfurth@jhmi.edu

Existing studies support the use of varicella vaccine in a two-dose regimen in
patients with renal disease prior to transplantation. Levels of anti-varicella
zoster virus antibody should be monitored on a regular basis after immunization, 
and where a loss of a previously protective antibody titer occurs, a third
booster dose should be considered pretransplant. Further data need to be
collected regarding the use of the vaccine in seronegative patients who have
already undergone transplantation.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12000463 [PubMed - indexed for MEDLINE]

564: Can J Public Health. 2002 Mar-Apr;93(2):114-6.

Impact of vaccine cost and information about complications of varicella on
parental decision regarding varicella vaccine.

De Serres G, Duval B, Boulianne N.

Institut national de santé publique, Public Health Research Unit, CHUL Research
Centre, Laval University, Quebec, Quebec. gaston.deserres@ssss.gouv.qc.ca

BACKGROUND: The influence of providing information about complications of disease
and vaccine cost on parental decision to vaccinate against varicella was
assessed. METHOD: During telephone interviews of 330 parents of infants aged 9
months, parents were asked if they would agree to have their child vaccinated and
were presented information first about varicella complications and then about
cost of the vaccine. RESULTS: When complications were explained but information
about cost was not, 94% of parents were favourable toward having their child
vaccinated. When complications were not explained but cost was presented, this
percentage was only 34%. When both cost and complications were presented, 60% of 
parents were favourable toward the vaccine. INTERPRETATION: In improving
receptivity towards varicella vaccine, parents should always be presented data
regarding varicella complications by their health care provider.

PMID: 11963514 [PubMed - indexed for MEDLINE]

565: Pediatr Nephrol. 2002 Mar;17(3):181-3.

Varicella vaccination in children with steroid-sensitive nephrotic syndrome.

Alpay H, Yildiz N, Onar A, Temizer H, Ozçay S.

Department of Pediatric Nephrology, Marmara University, Faculty of Medicine,
Istanbul, Turkey.

We have studied serological and clinical response to live, attenuated varicella
zoster virus (VZV) vaccine (Varilrix, SmithKline Beecham) in 20 patients with
steroid-sensitive nephrotic syndrome (SSNS) in remission and 22 normal controls
who had no history of varicella and no detectable antibody to VZV. Nephrotic
patients included 15 boys and 5 girls, with a mean age of 4.7 years (range 2-11.4
years). The controls were healthy age-matched children (13 girls and 9 boys).
Seventeen patients with SSNS (85%) and 19 healthy controls (86%) seroconverted 8 
weeks after vaccination. One patient with SSNS had a relapse 20 days after
vaccination, and 1 child in the control group had a rash. Two years after
vaccination, antibodies to VZV were detected in 12 of 17 responders, 2 of 3
non-responders, and 13 of 22 controls. Within 2 years of vaccination, 3 of the
vaccine responder children with SSNS had a mild varicella infection. Two
responder and 1 non-responder nephrotic children and 9 controls were lost to
long-term follow-up. Our results show that immunization with a single dose of VZV
vaccine is safe and effective in children with SSNS in remission.

PMID: 11956856 [PubMed - indexed for MEDLINE]

566: Indian J Pediatr. 2002 Feb;69(2):195-6.

Complications of varicella zoster.

Gücüyener K, Citak EC, Elli M, Serdaroğlu A, Citak FE.

Department of Pediatric Neurology, Gazi University Faculty of Medicine, Besevler,
Ankara, Turkey.

Primary infection with varicella zoster is characterzed by a generalized
vesicular rash usually without significant systemic illness. Encephalitis,
pneumonitis, pancreatitis, nephritis, Reye and Guillan-Barre syndrome transvers
myelitis, myocarditis have been reported before, but there is not any case having
all these system to be involved during the same infection in a sequential manner 
ending up with multiorgan failure. We wanted to represent 21-month-old boy had a 
multiorgan failure due to varicella zoster infection.

Publication Types: 
    Case Reports

PMID: 11929039 [PubMed - indexed for MEDLINE]

567: J Investig Dermatol Symp Proc. 2001 Dec;6(3):183-7.

Varicella-zoster virus: a re-emerging infection.

LaGuardia JJ, Gilden DH.

Department of Neurology, University of Colorado Health Sciences Center, Denver
80262, USA.

Varicella-zoster virus (VZV) causes chickenpox (varicella), becomes latent in
cranial nerve and dorsal root ganglia, and can reactivate many years later to
produce shingles (zoster) and postherpetic neuralgia (PHN). Elderly and
immunocompromised individuals are also at risk for complications of VZV
reactivation involving the central nervous system (CNS), including myelitis,
large-vessel encephalitis/granulomatous arteritis, small-vessel encephalitis,
meningoencephalitis, and ventriculitis. Peripheral nervous system (PNS)
complications range from zoster and postherpetic neuralgia to postinfectious
polyneuritis (Guillain-Barre syndrome, GBS). These complications can occur with
or without cutaneous manifestations. An increase in elderly and immunocompromised
individuals will likely result in a higher prevalence of these conditions;
therefore, VZV can be seen as a "re-emerging" infection of the early twenty-first
century. In this review, we summarize our experience and the existing literature 
on CNS and PNS complications of VZV reactivation. Special attention is paid to
reports of complications without rash, as these entities are more difficult to
diagnose.

Publication Types: 
    Review

PMID: 11924825 [PubMed - indexed for MEDLINE]

568: Curr Opin Neurol. 2002 Apr;15(2):159-64.

Infectious and inflammatory disorders of the circulatory system and stroke in
childhood.

Takeoka M, Takahashi T.

Child Neurology Service, Department of Pediatrics, School of Medicine, Keio
University, Tokyo, Japan. maxtakeoka@aol.com

The role of infectious and inflammatory causes of stroke is much more significant
in children than in adults. Conversely, that of atherosclerotic disease,
ischaemic heart disease and hypertensive haemorrhages has a lesser prominence in 
children. Bacterial meningitis caused by Streptococcus pneumoniae, Haemophilus
influenzae, or Neiserria meningitidis has been known to cause stroke in children.
The mechanism appears to be the spread of meningeal inflammation to involve the
walls of intracranial vessels, resulting in arterial thrombosis with ischaemia or
rupture with haemorrhage. Other infections caused by atypical bacterial agents
such as Mycoplasma tuberculosis and viral agents such as varicella-zoster virus
have also been well documented as causes of stroke. Non-infectious, inflammatory 
causes of stroke, such as collagen vascular disease and primary angiitis of the
central nervous system, have been reported in children as well as adults. In this
review, we will focus on recent advances in the field of childhood stroke caused 
by infectious and inflammatory disorders.

PMID: 11923629 [PubMed - indexed for MEDLINE]

569: J Gen Virol. 2002 Apr;83(Pt 4):841-6.

Viral gene expression during acute simian varicella virus infection.

Gray WL, Mullis L, Soike KF.

Department of Microbiology and Immunology, University of Arkansas for Medical
Sciences, 4301 W. Markham St, Little Rock, Arkansas 72205, USA.
graywaynel@uams.edu

Simian varicella virus (SVV) causes a natural varicella-like disease in nonhuman 
primates. Outbreaks of simian varicella occur sporadically in primate facilities.
Simian varicella is used as a model for investigation of varicella-zoster virus
(VZV) pathogenesis and latency. In this study, SVV gene expression and
histopathology were analysed in tissues of acutely infected vervet monkeys.
RT-PCR analysis demonstrated expression of specific SVV immediate early, early
and late genes in the skin, lung, liver and ganglia tissues of acutely infected
monkeys. Viral antigen expression and histopathology, including necrosis and
inflammation, were detected in the skin, lungs, liver and spleen of infected
monkeys by immunohistochemical analysis. Viral antigen expression, but little or 
no histopathology, was evident in the neural ganglia, the eventual site of viral 
latency. The study provides a foundation for further investigation on the role of
viral genes in varicella pathogenesis and latency.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11907334 [PubMed - indexed for MEDLINE]

570: Acta Neurol Scand. 2002 Feb;105(2):88-94.

Varicella, ephemeral breastfeeding and eczema as risk factors for multiple
sclerosis in Mexicans.

Tarrats R, Ordoñez G, Rios C, Sotelo J.

Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico,
Mexico City, Mexico.

OBJECTIVE: It has been suggested that the incidence of multiple sclerosis (MS) in
Mexico and other countries of Latin America has increased steadily for the last
two decades. We made a thorough search of antecedents on MS patients that could
be potential risk factors. METHODS: A case-control study was conducted using a
questionnaire that included demographic, nutritional, infectious and personal
antecedents previously identified in other reports as possible risk factors for
MS. RESULTS: The frequency of varicella, ephemeral breastfeeding and eczema in
the medical history of MS patients were significant when compared with controls; 
all appeared to be mutually additive. However, they were unrelated with clinical 
characteristics or disease severity. CONCLUSION: During the last decades,
breastfeeding has been abandoned in large segments of society and the incidence
of varicella and childhood eczema keeps a north-south gradient similar to that
described for MS. These factors may participate in the sharp increase of MS in
countries like Mexico traditionally considered as an area of very low incidence.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11903117 [PubMed - indexed for MEDLINE]

571: Herpes. 2001 Jul;8(2):32-6.

Prevention and treatment of VZV infections in patients with HIV.

Gershon AA.

Department of Pediatrics, Columbia University College of Physicians and Surgeons,
650West 168th Street, New York, NY, USA. aag1@columbia.edu

Varicella zoster virus (VZV) infections in human immunodeficiency virus
(HIV)-infected patients are known to have a different disease spectrum from that 
seen in other types of patients. Varicella in children with HIV infection is
likely to be more serious than in otherwise healthy children and routine
antiviral therapy is recommended. There is evidence that the development of
varicella in HIV-infected children is not associated with progression to AIDS,
suggesting that it may be safe to immunize HIV-infected children with live
attenuated varicella vaccine. There are no published data on varicella in
HIV-infected adults, however, probably because most adults have already
experienced varicella prior to HIV infection. Zoster in HIV-infected children
differs somewhat from that in HIV-infected adults. In particular, HIV-infected
children who develop varicella in the setting of severe immunodeficiency are at
an especially high risk to develop zoster. Given the low rate of toxicity of
aciclovir as well as its ease of administration and its efficacy in hastening the
healing of VZV infections, prompt treatment with this antiviral agent is
recommended for both HIV-infected children and adults. Foscarnet should be used
for zoster that is strongly suspected or proven to be caused by
aciclovir-resistant VZV. Patients with HIV for whom there is no evidence of
significant immunosuppression and who have not had varicella should be immunized 
with live attenuated varicella vaccine as a preventative measure for both
varicella and zoster. It is hoped that immunization of VZV seropositive
HIV-infected patients will decrease the incidence of zoster. Studies to determine
this are under way.

Publication Types: 
    Review

PMID: 11867015 [PubMed - indexed for MEDLINE]

572: J Infect Dis. 2002 Feb 15;185(4):422-7. Epub 2002 Jan 17.

Comment in:
    J Infect Dis. 2002 Oct 1;186(7):1053; iauthor reply 1053-4.

Risk factors and outcome of varicella-zoster virus pneumonia in pregnant women.

Harger JH, Ernest JM, Thurnau GR, Moawad A, Momirova V, Landon MB, Paul R,
Miodovnik M, Dombrowski M, Sibai B, Van Dorsten P; National Institute of Child
Health and Human Development, Network of Maternal-Fetal Medicine Units.

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213-3180, USA.
jharger+@pitt.edu

To determine the factors associated with an increased risk of developing
varicella-zoster virus (VZV) pneumonia during pregnancy, a case-control analysis 
was done in which 18 pregnant women with VZV pneumonia were compared with 72
matched control subjects. VZV infection was identified clinically, and VZV
pneumonia was diagnosed by dyspnea and findings on chest radiographs. Of 347
pregnant women with VZV infection, 18 (5.2%) had pneumonia treated with
acyclovir, and none died. Mean gestational age at rash onset was 25.8 plus minus 
8.8 weeks for patients with pneumonia and 17.7 +/- 10.3 weeks for control
subjects, which was not significant in the multivariable model. Women with VZV
pneumonia were significantly more likely to be current smokers (odds ratio [OR], 
5.1; 95% confidence interval [CI], 1.6-16.7) and to have > or = 100 skin lesions 
(OR, 15.9; 95% CI, 1.9-130.2). Pregnant women with VZV infection may be more
likely to develop varicella pneumonia if they are smokers or manifest > or = 100 
skin lesions.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11865393 [PubMed - indexed for MEDLINE]

573: J Clin Pathol. 2002 Feb;55(2):154-5.

Changes in age related seroprevalence of antibody to varicella zoster virus:
impact on vaccine strategy.

Kudesia G, Partridge S, Farrington CP, Soltanpoor N.

Public Health Laboratory, Northern General Hospital, Herries Road, Sheffield S5
7AU, UK.

AIM: To study changes in the seroprevalence of varicella zoster virus (VZV)
antibody over the past 25 years with a view to determining the target age group
for any future vaccination strategy. METHODS: Stored sera collected from
different age groups over a period of 25 years were tested by a commercial VZV
IgG enzyme immunoassay at a four year time interval. Data were analysed by
logistic regression to investigate the evidence for changes in incidence and
hence seroprevalence over that period. RESULTS: There was a significant rise in
VZV antibody prevalence in the 1-4 year age group during the study period.
CONCLUSIONS: A universal childhood VZV vaccination strategy will need to take
account of the increase in incidence of VZV infection in children under the age
of 4 years; hence, the suggested target age would be between 12 and 18
months---soon after the disappearance of maternal antibody.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11865016 [PubMed - indexed for MEDLINE]

574: Vaccine. 2002 Feb 22;20(11-12):1593-602.

Immunogenicity of a recombinant varicella-zoster virus gE-IE63 fusion protein, a 
putative vaccine candidate against primary infection and zoster reactivation.

Jacquet A, Haumont M, Massaer M, Garcia L, Mazzu P, Daminet V, Grégoire D, Jacobs
P, Bollen A.

Department of Applied Genetics, Institut de Biologie et de Médecine Moléculaires,
Université Libre de Bruxelles, Rue des Professeurs Jeener et Brachet 12, B-6041
Gosselies, Belgium. ajacquet@sga.ulb.ac.be

The varicella-zoster virus (VZV) envelope glycoprotein E (gE) and immediate early
protein 63 (IE63) are well known targets for specific humoral and cell-mediated
immune responses during VZV infection and latency, respectively. The present
study evaluated the immunogenicity of an engineered chimeric recombinant gE-IE63 
(recgE-IE63) protein secreted from CHO cells, wherein a soluble form of gE,
deleted of its anchor and cytoplasmic domains was fused to IE63. Guinea pig
vaccinations with adjuvanted recgE-IE63 elicited a strong and specific humoral
immune response directed to each counterpart. Sera from recgE-IE63-immunized
animals neutralized cell-free VZV. This neutralizing capacity was dependent only 
on the recgE moiety as serum depletions on recgE-immobilized sepharose totally
abolished VZV neutralization. The cell-mediated immune response induced by
recgE-IE63 was evaluated in lymphoproliferation assays. An antigen-specific
proliferative response was demonstrated after lymphocyte stimulation with recIE63
but not with recgE. We conclude that recombinant chimeric recgE-IE63 induced both
humoral and cell-mediated immune responses and thus could constitute a putative
subunit vaccine candidate against VZV primary infection and zoster reactivation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11858867 [PubMed - indexed for MEDLINE]

575: Pediatr Dermatol. 2001 Nov-Dec;18(6):516-8.

Gianotti-Crosti syndrome preceded by oral polio vaccine and followed by varicella
infection.

Erkek E, Senturk GB, Ozkaya O, Bükülmez G.

Department of Dermatology, Kirikkale University, Ankara, Turkey.
emelerkek@hotmail.com

Gianotti-Crosti syndrome (papular acrodermatitis of childhood) is considered a
nonspecific cutaneous host response to a variety of infectious agents,
particularly viruses. Herein we report a case of Gianotti- Crosti syndrome
preceded by oral polio vaccine and followed by varicella infection. The present
case may support the hypothesis of initial immunization and following viral
infection as a possible mechanism for Gianotti-Crosti syndrome.

Publication Types: 
    Case Reports

PMID: 11841642 [PubMed - indexed for MEDLINE]

576: Clin Infect Dis. 2002 Mar 15;34(6):774-9. Epub 2002 Feb 4.

Persistence of immunity to live attenuated varicella vaccine in healthy adults.

Ampofo K, Saiman L, LaRussa P, Steinberg S, Annunziato P, Gershon A.

Department of Pediatrics, Columbia University, College of Physicians and
Surgeons, New York, NY, 10032, USA.

The varicella vaccine was approved in 1995 for use in healthy
varicella-susceptible children and adults. Long-term immunity in 461 healthy
adults who were enrolled in varicella vaccine trials in 1979-1999 were studied.
Forty vaccinees (9%), including 19 (21%) of 89 vaccinees with household exposure 
(HHE) to chickenpox, developed breakthrough chickenpox 8 weeks to 11.8 years
(mean, 3.3 years) after vaccination. The median number of skin lesions among the 
36 untreated vaccinees was 20 (range, 1-240 lesions), and the number of lesions
was essentially the same with time since vaccination. Breakthrough chickenpox was
mild, even among vaccinees who did not have seroconversion or those recipients
who lost detectable antibody. Lower varicella-zoster virus (VZV) antibody titers 
measured within 3 months of vaccination as well as at the time of HHE were
associated with an increased risk of breakthrough disease. This study
demonstrated that the varicella vaccine was effective in providing adults with
long-term protection from serious VZV disease.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 11830801 [PubMed - indexed for MEDLINE]

577: JAMA. 2002 Feb 6;287(5):606-11.

Comment in:
    JAMA. 2002 May 1;287(17):2211; author reply 2211-2.

Varicella disease after introduction of varicella vaccine in the United States,
1995-2000.

Seward JF, Watson BM, Peterson CL, Mascola L, Pelosi JW, Zhang JX, Maupin TJ,
Goldman GS, Tabony LJ, Brodovicz KG, Jumaan AO, Wharton M.

Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-62,
Atlanta, GA 30333, USA. jseward@cdc.gov

CONTEXT: Before licensure of varicella vaccine in 1995, varicella was a universal
childhood disease in the United States, causing 4 million cases, 11,000
hospitalizations, and 100 deaths every year. OBJECTIVE: To examine
population-based disease surveillance data in 3 communities to document the
impact of the varicella vaccination program. DESIGN, SETTING, AND SUBJECTS:
Active surveillance for varicella conducted among the populations of Antelope
Valley, Calif; Travis County, Tex; and West Philadelphia, Pa; from January 1,
1995, to December 31, 2000. Reporting sites included child care centers, schools,
universities, physicians, public health clinics, hospitals, emergency
departments, and households. MAIN OUTCOME MEASURES: Trends in number and rate of 
varicella cases and hospitalizations; varicella vaccine coverage. RESULTS: From
1995 through 1998, in each surveillance area, the number of verified varicella
cases varied from year to year with marked springtime seasonality. In 1999, the
number and rates of varicella cases and hospitalizations declined markedly. From 
1995 through 2000, in Antelope Valley, Travis County, and West Philadelphia,
varicella cases declined 71%, 84%, and 79%, respectively. Cases declined to the
greatest extent among children aged 1 to 4 years, but cases declined in all age
groups, including infants and adults. In the combined 3 surveillance areas,
hospitalizations due to varicella declined from a range of 2.7 to 4.2 per 100,000
population in 1995 through 1998 to 0.6 and 1.5 per 100,000 population in 1999 and
2000, respectively (P =.15). By 2000, vaccine coverage among children aged 19 to 
35 months was 82.1%, 73.6%, and 83.8% in Los Angeles County, Texas, and
Philadelphia County, respectively. CONCLUSIONS: Varicella disease has declined
dramatically in surveillance areas with moderate vaccine coverage. Continued
implementation of existing vaccine policies should lead to further reductions of 
varicella disease in these communities and throughout the United States.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11829699 [PubMed - indexed for MEDLINE]

578: Vaccine. 2002 Jan 31;20(9-10):1425-8.

Varicella seroprevalence in a random sample of the Turkish population.

Kanra G, Tezcan S, Badur S; Turkish National Study Team.

Pediatric Infectious Disease Unit, Department of Pediatrics, Faculty of Medicine,
Hacettepe University, 06100, Ankara, Turkey.

Chicken pox highly contagious and common throughout the world, is an infectious
disease caused by varicella zoster virus (VZV). This study was conducted to
determine the seroprevalence of VZV in a population under age 30 and to identify 
the relationship of VZV seroprevalence and several characteristics of the study
subjects in nine provinces of Turkey. The sampling method of 30 clusters
recommended for field studies was used for selecting subjects of a pre-determined
number in the rural and urban areas in each province. For this, a total of 60
groups, 30 clusters in the rural and 30 in the urban areas were determined. It
was planned that a total of 4800 subjects, including 600 subjects from five big
provinces (Istanbul, Ankara, Izmir, Adana, Diyarbakir) and 450 subjects from the 
remaining smaller provinces (Samsun, Erzurum, Trabzon, Edirne), be included in
the study. ELISA method was used to examine the blood samples for VZV
seropositivity. Positive VZV seroprevalence was detected in 77.8% of 4387
subjects under age 30 in nine provinces of Turkey. There was no difference in
seroprevalence rate between rural and urban areas. Seroprevalence was found to be
79.0% in urban areas and 76.3% in rural areas. Seroprevalence increased with age.
Seroprevalence was 20% at the age of 1 year, subsequently increased to 40% at the
age of 4 years, 60% at the age 6 years, 80% at the age of 8 years, 85% at the age
of 10 years, and then remained at 85-90% in subjects over the age of 10 years. In
order to develop vaccination protocols and take appropriate preventive health
care measures against diseases in different countries, it is very important to
know the seroprevalence of any disease for an individual country.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11818162 [PubMed - indexed for MEDLINE]

579: Cardiol Young. 2001 Nov;11(6):647-52.

Cardiac complications in children following infection with varicella zoster
virus.

Abrams D, Derrick G, Penny DJ, Shinebourne EA, Redington AN.

Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK.

Infection with varicella zoster virus, leading to chicken pox in susceptible
hosts, is usually a benign self-limiting disease conferring immunity in those
affected. Cardiac complications are rare, but when present may lead to severe
morbidity or mortality. We have recently encountered three children, all of whom 
developed significant cardiac complications secondary to infection with
varicella. Myocarditis has long been associated with such infection. The
pathological mechanism is presumed similar to other cardiotropic viruses, where
both direct cytopathic and secondary auto-immune effects contribute to myocardial
cellular destruction and ventricular dysfunction. Complications include
arrhythmias and progression to dilated cardiomyopathy. Pericarditis, and
secondary pericardial effusion, related to infection with the virus is most
commonly associated with secondary bacterial infiltration. Both cardiac tamponade
and chronic pericardial constriction may result. Endocarditis complicating
varicella has only been described in the last fifteen years, and is associated
with the emergence of virulent strains of both streptococcus and staphylococcus, 
the two organisms most commonly associated with endocarditis. The exact mechanism
by which varicella causes secondary bacterial endocarditis remains unclear.
Whilst cardiac complications of infection with the varicella zoster virus are
rare, the resulting complications are potentially life threatening. Evidence of
varicella-induced carditis must be aggressively pursued in any child with signs
of acute cardiac decompensation in whom chicken pox is confirmed or suspected.

Publication Types: 
    Case Reports

PMID: 11813917 [PubMed - indexed for MEDLINE]

580: Epidemiol Infect. 2001 Dec;127(3):501-7.

Estimated varicella incidence on the basis of a seroprevalence survey.

Muñoz MP, Domínguez A, Salleras L.

Department of Statistics and Operational Research, Universitat Politècnica de
Catalunya, Barcelona, Spain.

Varicella is a disease caused by varicella-zoster virus. It is transmitted via
the respiratory route, is highly communicable and mainly affects young children. 
An effective vaccine is now available, whose routine use is advised by health
authorities in the USA and which can prevent severe disease, although
breakthrough infections do occur. In deciding whether or not to include a vaccine
in the routine vaccination schedule, knowledge of the morbidity of the disease in
question is fundamental. Although reporting of varicella is compulsory in
Catalonia, doctors only have to report the weekly number of cases diagnosed, and 
not their age distribution. Given that recent data on the prevalence of the
infection in Catalonia according to age groups is available, it was considered
that, using these data, an estimation of age-related incidence could be made. The
objective of the present study was to estimate the incidence of varicella in
Catalonia on the basis of the available seroprevalence data. A curve was fitted
to the observed prevalence and point prevalence estimates for all ages were
obtained. The incidence was derived by smoothed prevalence for each of these age 
groups. Estimated variance of the estimated incidence was obtained by the delta
method. Predicted prevalence in the 0-4 years age group was calculated by the
smoothed prevalence. The model that best fitted the sample prevalence was the
exponential function. The estimated number of varicella cases in this study was
46,419 (95% CI 40,507-52,270). As the population in Catalonia in 1996 was
6,090,040, the previous results give an incidence rate of 762.2 per 100,000
persons/year with their 95% CI (666.1-858.3). The method described may be applied
to the study of incidence rates in relation to the prevalence of diseases if we
accept that the infection produces permanent immunity; the risk of mortality is
the same for infected and non-infected subjects and that the disease incidence
and population remain constant in time.

PMID: 11811884 [PubMed - indexed for MEDLINE]

581: Epidemiol Infect. 2001 Dec;127(3):493-500.

Varicella transmission in two samples of children with different social behaviour
in the State of São Paulo, Brazil.

Yu AL, Amaku M, Burattini MN, Massad E, Azevedo RS.

LIM 01/HCFMUSP, School of Medicine, University of São Paulo, Brazil.

In order to establish the differences in transmission pattern of varicella-zoster
virus (VZV), a comparative seroepidemiological study was carried out in two
different children samples. Children aged 1-11 years, were randomly selected from
state schools of São Paulo city, Brazil. Individuals aged 1-15 years were sampled
by cluster from Caieiras city. Children aged 3 years or under from Caieiras were 
not attending school, while those from São Paulo were attending all-day nurseries
or kindergarten. The presence of antibodies to VZV was analysed by ELISA
technique. The force of infection and contact rate were determined by
mathematical techniques. The average age of first infection was 2.87 +/- 0.14
years and 4.07 +/- 0.47 years for Sao Paulo and Caieiras, respectively. The
average force of infection estimated was 0.29 year(-1) for São Paulo and was 0.26
year(-1) for Caieiras. The proportion of seropositivity and the force of
infection were higher in São Paulo school children up to 3 years of age compared 
with Caieiras children, where the social contact starts later. In conclusion,
social changes affecting contact among children may influence varicella
epidemiology.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11811883 [PubMed - indexed for MEDLINE]

582: Vaccine. 2002 Jan 15;20(7-8):1113-25.

The cost-effectiveness of varicella vaccination in Canada.

Brisson M, Edmunds WJ.

Immunisation Division, PHLS Communicable Disease Surveillance Center, 61
Colindale Avenue, NW9 5EQ, London, UK. mbrisson@phls.org.uk

A deterministic realistic age-structured model was used to predict the impact of 
vaccination on the incidence of varicella and zoster. Unit costs, estimated from 
literature, were applied to the predicted health outcomes. Various vaccination
programs were investigated and a sensitivity analysis was performed. Assuming no 
impact of vaccination on zoster, varicella vaccination is estimated to cost
45,000 dollars, 51,000 dollars and 18,000 dollars per life-year gained from the
health payer's perspective for infant, infant with catch-up campaign, and preteen
programs, respectively. From the societal perspective, mass infant varicella
vaccination was estimated to be highly cost saving in Canada. Importantly, infant
varicella vaccination could result in a short- to medium-term increase of zoster 
incidence and thus cause vaccination to be highly cost-ineffective (118,000
dollars per life-year gained) under the health payer's perspective. From a health
payer's perspective the preteen vaccination is the only strategy that is deemed
cost-effective. The cost-effectiveness of infant vaccination rests heavily on the
unknown relationship between varicella and zoster.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11803072 [PubMed - indexed for MEDLINE]

583: J Virol. 2002 Feb;76(4):1971-9.

Phylogenetic analysis of varicella-zoster virus: evidence of intercontinental
spread of genotypes and recombination.

Muir WB, Nichols R, Breuer J.

School of Medicine, Queen Mary College, University of London, London E1 1BB,
England.

A heteroduplex mobility assay was used to identify variants of varicella-zoster
virus circulating in the United Kingdom and elsewhere. Within the United Kingdom,
58 segregating sites were found out of the 23,266 examined (0.25%), and
nucleotide diversity was estimated to be 0.00063. These are an order of magnitude
smaller than comparable estimates from herpes simplex virus type 1. Sixteen
substitutions were nonsynonymous, the majority of which were clustered within
surface-expressed proteins. Extensive genetic correlation between widely spaced
sites indicated that recombination has been rare. Phylogenetic analysis of
varicella-zoster viruses from four continents distinguished at least three major 
genetic clades. Most geographical regions contained only one of these three
strains, apart from the United Kingdom and Brazil, where two or more strains were
found. There was minimal genetic differentiation (one or fewer substitutions in
1,895 bases surveyed) between the samples collected from Africa (Guinea Bissau,
Zambia) and the Indian subcontinent (Bangladesh, South India), suggesting recent 
rapid spread and/or low mutation rates. The geographic pattern of strain
distribution would favor a major influence of the former. The genetic uniformity 
of most virus populations makes recombination difficult to detect. However, at
least one probable recombinant between two of the major strains was found among
the samples originating from Brazil, where mixtures of genotypes co-occur.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11799191 [PubMed - indexed for MEDLINE]

584: J Perinatol. 2001 Dec;21(8):545-9.

Neonatal varicella.

Sauerbrei A, Wutzler P.

Institute for Antiviral Chemotherapy, Klinikum of the Friedrich-Schiller
University Jena, Winzerlaer Strasse 10, D-07745 Jena, Germany.

Neonatal varicella is mostly caused by maternal chickenpox acquired during the
last 3 weeks of pregnancy. Transplacentally transmitted infections occur in the
first 10 to 12 days of life, whereas chickenpox after that time is most likely
acquired by postnatal infection. If the mother develops rash between days 4 and 5
antepartum to day 2 postpartum, generalized neonatal varicella leading to death
occurs in up to 20% of affected cases. Neonatal chickenpox within the first 4
days after birth has usually been found to be mild. A fatal outcome has been
reported in 23% of cases if neonatal chickenpox occurs between 5 and 10 to 12
days of age. Serological methods have been widely used to confirm clinical
diagnosis. For rapid virological diagnostics, amplification of viral DNA in skin 
swabs by polymerase chain reaction is the method of choice. To prevent severe
neonatal chickenpox, passive immunization is indicated. If varicella occurs,
acyclovir treatment has to be administered promptly.

Publication Types: 
    Review

PMID: 11774017 [PubMed - indexed for MEDLINE]

585: Pediatrics. 2002 Jan;109(1):E14.

Group a streptococcus spinal epidural abscess during varicella.

Quach C, Tapiero B, Noya F.

Division of Infectious Disease, Department of Pediatrics, Sainte-Justine
Hospital, University of Montreal, Quebec, Canada.

Multiple complications of varicella have been described. Musculoskeletal
complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as
well as neurologic complications (ataxia, encephalitis, and transverse myelitis) 
are well-known. We describe the cases of 2 children, ages 18 months and 5 years, 
who were admitted recently to 2 pediatric hospitals in Montreal with a resolving 
varicella, abdominal and lumbar pain, and a refusal to walk and in whom a
diagnosis of epidural abscess caused by group A streptococcus (GAS) was
established. No previous case of epidural abscess caused by GAS in the context of
varicella has been reported. Epidural abscesses are rare in pediatrics and are
caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in
pediatrics is challenging because it is rare and does not present as classically 
as in adults. The prognosis is related to the presence of neurologic deficits
before surgery and to the rapidity with which the diagnosis and the intervention 
are made. These cases highlight a new clinical association in children of
epidural abscess caused by GAS and varicella. An early clinical diagnosis
requires a high index of suspicion when back or abdominal pain with or without
neurologic signs and symptoms occurs during or soon after varicella.

Publication Types: 
    Case Reports

PMID: 11773582 [PubMed - indexed for MEDLINE]

586: Int J Clin Pract. 2001 Nov;55(9):643-4.

Concurrent myelitis and Guillain-Barré syndrome after varicella infection.

Chua HC, Tjia H, Sitoh YY.

Department of Neurology, National NeuroScience Institute, Singapore.

Myelitis and Guillain-Barré syndrome occurring concurrently after varicella
infection is very rare. A 34-year-old man presented with progressive flaccid
tetraparesis, facial palsy, respiratory failure, sensory loss and urinary
incontinence one week after varicella infection. Clinical, imaging and
electrodiagnostic studies supported the diagnosis of myelitis and Guillain-Barré 
syndrome. He improved with intravenous acyclovir and gammaglobulin.

Publication Types: 
    Case Reports
    Review

PMID: 11770365 [PubMed - indexed for MEDLINE]

587: Can Fam Physician. 2001 Nov;47:2299-304.

Varicella zoster virus. Recent advances in management.

Rajan P, Rivers JK.

Division of Dermatology, University of British Columbia, Vancouver Hospital and
Health Sciences Centre.

OBJECTIVE: To provide an update on strategies for managing varicella zoster virus
(VZV) and for preventing and treating established postherpetic neuralgia (PHN).
QUALITY OF EVIDENCE: Treatment guidelines are based on randomized clinical
trials. Recommendations concerning other aspects of VZV management (e.g.,
vaccination) are based mainly on expert opinion. MAIN MESSAGE: Varicella and
herpes zoster caused by VZV can give rise to serious morbidity and mortality and 
should be treated. For preventing chickenpox, safe and effective immunization is 
widely recommended. Treating varicella-exposed seronegative pregnant women
requires special attention because the virus can harm expectant mothers, fetuses,
and newborns. The antiviral drugs, acyclovir, valacyclovir, and famciclovir, have
been approved for treating herpes zoster and have a role in reducing the duration
of PHN. Established PHN can be managed with analgesics, tricyclic
antidepressants, and other agents. CONCLUSION: Vaccination and antiviral and
other systemic agents can substantially reduce the morbidity associated with VZV 
infection.

Publication Types: 
    Review

PMID: 11768928 [PubMed - indexed for MEDLINE]

588: Eur J Paediatr Neurol. 2001;5(6):259-60.

Lack of association between childhood stroke after varicella and human leukocyte 
antigen (HLA)-B51.

Kluger G, Hubmann M, Vogler L, Berz K.

Neuropediatric Department, BHZ Vogtareuth, Germany. g.kluger@bhz-vogtareuth.de

Human leukocyte antigen (HLA)-B51 has been suggested as an immunogenetic marker
for a genetic predisposition to vascular occlusion in response to an
immunological stimulus. Varicella has been reported to be a possible risk factor 
for stroke. We performed DNA-based HLA typing in 11 young patients (mean age: 5.2
years) with unexplained ischaemic stroke. In eight of them varicella had occurred
before their stroke. HLA-B51 was negative in all 11 patients and we did not find 
any significant accumulation of other HLA-subgroups. Our study does not support
an association between susceptibility to stroke after varicella and HLA-B51.

PMID: 11764184 [PubMed - indexed for MEDLINE]

589: Pediatr Dermatol. 2001 Sep-Oct;18(5):378-80.

Scarring resulting from chickenpox.

Leung AK, Kao CP, Sauve RS.

Department of Pediatrics, University of Calgary and Alberta Children's Hospital, 
Calgary, Alberta, Canada.

Nine hundred and eighty-six children (519 boys, 467 girls) who had chickenpox at 
least 1 year previously were examined for the presence of scars resulting from
this disease. Ninety-six (18.5%) boys and 88 (18.8%) girls had chickenpox scars, 
giving rise to an overall prevalence of 18.7%. The scars were found on the face
in 75 (40.8%), neck 2 (1.1%), shoulders 8 (4.3%), upper limbs 15 (8.2%), anterior
thorax 50 (27.2%), abdomen 106 (57.6%), back 65 (35.3%), buttocks 9 (4.9%), and
lower limbs 12 (6.5%) affected children. The mean number of scars in the 184
children was 2.8 (standard deviation 1.9). The scars were hyperpigmented in 32,
hypopigmented in 160, depressed in 38, and hypertrophic in 32 children. Keloids
were noted in two children.

PMID: 11737678 [PubMed - indexed for MEDLINE]

590: Pediatr Infect Dis J. 2001 Sep;20(9):915-6.

Comment in:
    Pediatr Infect Dis J. 2002 Feb;21(2):178-9.    Pediatr Infect Dis J. 2003 Mar;22(3):295-6.

Herpes zoster during varicella.

Lau BH, Lin MI, Lin HC.

Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
laukawei@kimo.com.tw

A 4-year-old boy had varicella infection. Two days later vesicular lesions
clustered within the left 10th thoracic dermatome. Varicella-zoster virus IgM
antibody in serum was positive. He was diagnosed with varicella infection
combined with herpes zoster. This is the first case report in the medical
literature.

Publication Types: 
    Case Reports

PMID: 11734778 [PubMed - indexed for MEDLINE]

591: Pediatr Infect Dis J. 2001 Aug;20(8):775-8.

Seroprevalence of varicella-zoster virus immunoglobulin G antibodies in Swiss
adolescents and risk factor analysis for seronegativity.

Heininger U, Braun-Fahrländer C, Desgrandchamps D, Glaus J, Grize L, Wutzler P,
Schaad UB; SCARPOL Team.

University Children's Hospital, Basel, Switzerland. Ulrich.Heininger@unibas.ch

BACKGROUND: Little is known about the seroprevalence of anti-varicella-zoster
virus (VZV) serum antibodies in adolescents in Switzerland as in most other
European countries. METHODS: Serum specimens from 13- to 15-year-old students
from eight urban and rural areas in Switzerland, obtained as part of an allergy
risk assessment study project (SCARPOL), were available for analysis of IgG
antibodies against VZV by enzyme-linked immunosorbent assay (ELISA) and
confirmation by fluorescent antibody staining of membrane antigen in a subcohort.
Serum specimens and comprehensive sociodemographic data had been collected during
two study periods between 1992 and 1995. RESULTS: Data and serum specimens were
available from 1709 and 1788 subjects, respectively. Seroprevalence of anti-VZV
antibodies as measured by ELISA was 95.5% (95% confidence interval, 94.5 to
96.4). When serum specimens that were indeterminate by ELISA were tested by FAMA,
seroprevalence was 96.5% (95% confidence interval, 95.7 to 97.4). After logistic 
regression analysis, the number of siblings was the only factor that
significantly influenced the presence of VZV antibodies (90.1% in those with no
siblings, >96% with 1 or more siblings), whereas residence (urban vs. rural),
parental education, nationality and gender did not. CONCLUSIONS: Seroprevalence
of anti-VZV serum antibodies is comparatively high among Swiss adolescents.
Individuals who grow up without siblings have a significant risk of evading
natural VZV infection in childhood, and they therefore form a potential target
group for varicella immunization in Switzerland.

PMID: 11734740 [PubMed - indexed for MEDLINE]

592: Pediatr Infect Dis J. 2001 Nov;20(11):1087-8.

Comment in:
    Pediatr Infect Dis J. 2003 Jul;22(7):672.

Most ten-year-old children with negative or unknown histories of chickenpox are
immune.

Boulianne N, Duval B, De Serres G, Deceuninck G, Massé R, Couillard M.

Institut National de Santé Publique du Québec, Quebec, Canada.
nicole.boulianne@ssss.gouv.qc.ca

To evaluate the proportion of children to vaccinate against varicella in a
catch-up program targeting 9- to 10-year-old children, a study was conducted
among children age 10 years to assess the age-specific incidence of varicella and
document the immunity against varicella in those with negative or unknown
chickenpox history. Of the latter 62% were seropositive for varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11734718 [PubMed - indexed for MEDLINE]

593: J Obstet Gynecol Neonatal Nurs. 2001 Nov-Dec;30(6):667-73.

Varicella infection in pregnancy.

McCarter-Spaulding DE.

Boston College, School of Nursing, Chestnut Hill, MA 02467-3812, USA.
mccartdw@bc.edu

Varicella (chickenpox) is a common childhood illness. Most adults are immune to
the virus because of previous exposure. Pregnant women who contract varicella
risk complications such as pneumonia. Varicella may be transmitted from mother to
fetus and could cause congenital varicella syndrome or perinatal infection.
Susceptibility to varicella should be determined before pregnancy. Varicella
zoster immune globulin may be considered for the mother or newborn if exposure
occurs. Acyclovir may decrease the risk of maternal complications from infection.

Publication Types: 
    Review

PMID: 11724203 [PubMed - indexed for MEDLINE]

594: Clin Exp Dermatol. 2001 Nov;26(8):661-3.

Pemphigus vulgaris following varicella infection.

Goon AT, Tay YK, Tan SH.

National Skin Centre, Mandalay Road, Singapore 308205. anthonygoon@nsc.gov.sg

We describe a 26-year-old Indian man who presented with chickenpox and
subsequently developed pemphigus vulgaris 17 days after initial resolution of
lesions. The mechanism of progression from one disease to the other is postulated
to be that of epitope spreading or molecular mimicry.

Publication Types: 
    Case Reports

PMID: 11722450 [PubMed - indexed for MEDLINE]

595: Arch Dis Child. 2001 Dec;85(6):484-6.

An intradermal skin test for determination of immunity to varicella.

Somekh E, Bujanover Y, Tal G, Dalal I, Tanay A, Lehman D.

Section of Pediatric Infectious Diseases and Immunology, The Edith Wolfson
Medical Center, Holon, and the Sackler School of Medicine, Tel Aviv University,
Israel. esomeh@post.tau.ac.il

AIMS: To evaluate the usefulness of a diluted, inactivated solution of attenuated
varicella vaccine in predicting susceptibility to varicella and its correlation
with specific antibody titre to varicella. METHODS: In a prospective blinded
study, 63 healthy subjects (aged 2-43 years) were studied. Skin test solution was
prepared from vials of OKA strain virus which was inactivated by exposure of the 
vials to room temperature for 10 days; solution was diluted at 1/50 with normal
saline and kept at 4 degrees C until used for skin testing. The material was
injected intradermally. Serum samples were drawn prior to skin testing and kept
at -70 degrees C until analysis for antibody assay by the indirect fluorescent
antibody (IFA) method. RESULTS: Forty three patients were IFA antibody positive; 
41 of them reacted to the skin test. One of the 20 IFA negative patients reacted 
to the skin test. Sixteen patients had two serological tests performed, one month
apart. Four out of these 16 patients tested negative with the skin test. All four
had negative serology on both samples. Six of the 12 IFA positive patients showed
a boost in the antibody titre one month after application of the skin test. The
specificity and sensitivity of the skin test compared to the IFA assay were both 
95%, and the positive and negative predictive values were 97% and 90%
respectively. CONCLUSIONS: Results suggest that a varicella skin test prepared
using this simple and relatively cheap method is a safe, sensitive, and specific 
tool by which to assess immunity to varicella.

PMID: 11719333 [PubMed - indexed for MEDLINE]

596: BMJ. 2001 Nov 10;323(7321):1091-3.

Comment in:
    BMJ. 2002 Mar 9;324(7337):609.    BMJ. 2002 Mar 9;324(7337):610.    BMJ. 2002 Mar 9;324(7337):610.    BMJ. 2002 Mar 9;324(7337):610.    BMJ. 2002 Mar 9;324(7337):610-1.

Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality
data.

Rawson H, Crampin A, Noah N.

Guy's King's College, St. Thomas's Hospital School of Medicine and Dentistry,
London, UK.

OBJECTIVE: To evaluate the epidemiology and impact of mortality from chickenpox
in England and Wales. DESIGN: Review of death certificates from the Office for
National Statistics on which codes for "chickenpox" or "varicella" were
mentioned. Further information ascertained from certifying physician.
PARTICIPANTS: Those certified as having died from chickenpox in England and
Wales, 1995-7. MAIN OUTCOME MEASURES: Diagnosis and age and sex distributions of 
deaths from chickenpox. RESULTS: On average, 25 people a year die from
chickenpox. Overall case fatality was 9.22 per 100 000 consultations for
chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths
were twice as common in men as in women. More of those who died were born outside
United Kingdom than expected (12% v 4%). CONCLUSIONS: Chickenpox is not a mild
disease. Deaths in adults are increasing, both in number and proportion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11701571 [PubMed - indexed for MEDLINE]

597: Fetal Diagn Ther. 2001 Nov-Dec;16(6):423-6.

Reported exposure to chickenpox: a predictor of positive anti-varicella-zoster
antibodies in parturient women.

Linder N, Ferber A, Kopilov U, Smetana Z, Barzilai A, Mendelson E, Sirota L.

Department of Neonatology, Schneider Children's Medical Center of Israel, Petah
Tikva, Israel.

OBJECTIVE: To determine the positive and negative predictive values of recalled
exposure to chickenpox for identifying anti-varicella-zoster virus (VZV)
seropositive parturient women. METHODS: Blood samples were taken from laboring
women during February 1998: All women completed questionnaires concerning a
history of chickenpox in themselves and their children. Anti-VZV antibodies were 
determined by the immunofluorescent antibodies to membrane antigen (IFAMA)
technique. RESULTS: Three hundred and twenty-seven women formed the study
population; 239 women (73.1%) recalled chickenpox in themselves or their
children, of which 229 (95.8%) were seropositive for anti-VZV antibodies. Of the 
88 women who gave a negative/uncertain history of chickenpox 82 (93.2%) were
seropositive and 6 (6.8%) were seronegative. All 87 mothers who were certain
their children had had chickenpox were seropositive, including all 16 mothers who
had a negative personal history. Thus, a woman with a history of chickenpox had a
positive predictive value of 95.8%, and a woman with a lack of history had a
negative predictive value of 6.8% (sensitivity 73.6%, specificity 37.5%), while a
positive history of chickenpox in a child had a positive predictive value of
100%. CONCLUSIONS: Most women with no known history of VZV infection have
evidence of prior exposure by serologic testing. Moreover, 100% of women with a
negative history who were exposed to VZV in their children were protected from
the disease. Therefore, mothers exposed to VZV during pregnancy can be reassured 
that most likely they are protected. However, the practice of testing all
pregnant women exposed to the disease should be continued. Copyright 2001 S.
Karger AG, Basel

PMID: 11694750 [PubMed - indexed for MEDLINE]

598: Pediatrics. 2001 Nov;108(5):E80.

Varicella in a pediatric heart transplant population on nonsteroid maintenance
immunosuppression.

Dodd DA, Burger J, Edwards KM, Dummer JS.

Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University
School of Medicine, Nashville, Tennessee, USA. debra.dodd@mcmail.vanderbilt.edu

OBJECTIVE: Varicella-zoster virus has been reported to produce serious, often
life-threatening, disease in immunosuppressed patients with a variety of
diagnoses. The impact of this virus on the young child after heart
transplantation has not been reported. METHODS: We reviewed the charts of 28
children who were <10 years of age at heart transplantation and had at least 1
year of follow-up. The median follow-up period was 7 years (1.4-13.0 years). All 
were seronegative for varicella-zoster virus before transplantation. Fourteen
(50%) developed varicella at a median time posttransplantation of 3.3 years. The 
first 7 were admitted for intravenous acyclovir for 3 days followed by oral
acyclovir for 7 days. The last 7 were treated as outpatients with oral
valacyclovir for 7 days (n = 6) or with oral acyclovir for 10 days (n = 1).
RESULTS: Intravenous and oral regimens both were well tolerated and were without 
complications. No patient was receiving steroids at the time that they developed 
their initial episode of varicella. One patient was receiving steroids for
therapy of posttransplantation lymphoproliferative disease when she developed
recurrent varicella or generalized zoster. No episodes of rejection were
attributed to the varicella-zoster virus infection. There were no episodes of
localized zoster. All patients experienced seroconversion from undetectable to
detectable antibody titers early after varicella, and 12 of the 14 patients
continued to have persistent detectable titers in late follow-up. Two of the 14
who received chemotherapy or enhanced immunosuppression after retransplantation
transiently lost detectable varicella-zoster virus antibodies but currently have 
detectable titers. CONCLUSIONS: Primary varicella-zoster infection was well
tolerated in our young pediatric heart transplant recipients, with no serious
complications. We now reserve inpatient/intravenous therapy for those who are
unable to tolerate oral medications or those who are receiving enhanced
immunosuppression.

PMID: 11694664 [PubMed - indexed for MEDLINE]

599: Pediatrics. 2001 Nov;108(5):E79.

Erratum in:
    Pediatrics. 2004 May 5;113(5):1470.

Severe complications of varicella in previously healthy children in Germany: a
1-year survey.

Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ.

Pediatric Infectious Diseases, Zentrum für Präventive Pädiatrie, Johannes
Gutenberg University Mainz, Mainz, Germany.

OBJECTIVE: Varicella is a common infectious disease, usually benign and
self-limited, and complications are believed to be rare. The purpose of this
study was to describe the epidemiology of severe varicella complications in
immunologically healthy children in Germany. METHODS: Information on any
admission of children with a severe complication associated with chickenpox was
solicited throughout 1997 from all 485 pediatric hospitals in Germany using an
established surveillance system. The case definition included
nonimmunocompromised individuals who were up to 16 years of age and hospitalized 
with neurologic complications, bacterial superinfections, or hematologic
complications. RESULTS: The response rate to the surveillance questionnaire
during the observation period was high: 93.4%. Of the 153 reported cases, 119 met
the case definition. There was a seasonal distribution of reported complications 
with a peak in March. The majority of complications occurred in preschool-age
children with a maximum age of 4 years. No gender predominance was found with a
distribution of 56 female and 63 male patients. Multiple entries for
complications were allowed. The most frequent complications were neurologic,
which were reported in 73 children (61.3%); cerebellitis was the leading
diagnosis (n = 48), followed by encephalitis (n = 22), meningitis (n = 2), and
central facial palsy (n = 1). A total of 46 (38.6%) infectious complications were
identified. Superinfections of the skin were present in 31 (26.0%), pyogenic
arthritis was present in 5 (4.2%), osteomyelitis was present in 4 (3.3%),
necrotizing fasciitis was present in 3 (2.5%), orbital cellulitis was present in 
2 (1.6%), and pneumonia was present in 1 (0.8%). Streptococcus pyogenes was the
leading cause of bacterial infections (18 cases [15.1%]), with invasive disease
in 6 patients (8.4%) and linked to 4 of 8 cases with defect healing. Infectious
complications were reported in the majority in younger children up to 4 years of 
age, whereas neurologic complications occurred more frequently in an older age
range. Five children experienced thrombocytopenia or severe anemia. There was no 
bleeding disorder, no fatality, and no case of Reye syndrome reported during the 
1-year observation period. In total, 8 (6.7%) of 119 patients reported having
long-term sequelae, 6 attributable to infectious complications and 2 to
persistent deficits after neurologic complications. CONCLUSION: This is the first
prospective nationwide study of severe complications of varicella in
immunologically healthy children. Related to 14 025 867 children up to the age of
16, a crude incidence of severe chickenpox complications of 0.85/100 000 could be
calculated [corrected]. The actual hospitalization rate attributable to
complicated chickenpox is probably much higher, because this calculation refers
to a population theoretically at risk and not the truly susceptible individuals. 
The results of this study demonstrate considerable morbidity with a comparatively
high rate of encephalitis, osteomyelitis, and pyogenic arthritis. Although
infectious complications were present in only 38.6% of the reported cases, they
contributed disproportionately to the cases with chronic sequelae. Looking at
these cases in more detail, S pyogenes involvement was identified as the major
risk factor for invasive disease with an unfavorable long-term outcome.
varicella-zoster virus, chickenpox/epidemiology, chickenpox/complications,
encephalitis, cellulitis, osteomyelitis, necrotizing fasciitis, group A
beta-hemolytic streptococci, Europe.

PMID: 11694663 [PubMed - indexed for MEDLINE]

600: Epidemiol Infect. 2001 Oct;127(2):315-25.

Multiple sclerosis and varicella zoster virus infection: a review.

Marrie RA, Wolfson C.

Montreal Neurological Institute, Quebec.

We have evaluated the epidemiological evidence for an aetiological role of
varicella zoster virus (VZV) infection in the development of multiple sclerosis
(MS). A MEDLINE search of the English language literature for 1965-99 identified 
40 studies. These studies were categorized as seroepidemiological (13),
case-control (23), historical cohort (2) or ecological (2). One study used both
case-control and historical cohort methodologies. Studies were then classified
according to methodological rigour, using criteria derived from published
guidelines for the epidemiological study of MS. There was a large variability in 
the quality of evidence. The five studies with the best methodology failed to
show an increased risk of MS associated with varicella or zoster infections. At
the present time there is insufficient evidence to support an important
aetiological role of VZV infection in the development of MS.

Publication Types: 
    Review

PMID: 11693509 [PubMed - indexed for MEDLINE]

601: Epidemiol Infect. 2001 Oct;127(2):305-14.

Epidemiology of varicella zoster virus infection in Canada and the United
Kingdom.

Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, Roos L, De Serres G.

PHLS CDSC, and City University, London.

Many countries are currently studying the possibility of mass vaccination against
varicella. The objective of this study was to provide a comprehensive picture of 
the pre-vaccine epidemiology of the varicella zoster virus (VZV) to aid in the
design of immunization programs and to adequately measure the impact of
vaccination. Population-based data including physician visit claims, sentinel
surveillance and hospitalization data from Canada and the United Kingdom were
analysed. The key epidemiological characteristics of varicella and zoster (age
specific consultation rates, seasonality, force of infection, hospitalization
rates and inpatient days) were compared. Results show that the overall
epidemiology of varicella and zoster is remarkably similar between the two
countries. The major difference being that, contrary to Canada, the epidemiology 
of varicella seems to be changing in the United Kingdom with an important
decrease in the average age at infection that coincides with a significant
increase in children attending preschool. Furthermore, differences exist in the
seasonality between the United Kingdom and Canada, which seem to be primarily due
to the school calendar. These results illustrate that school and preschool
contact patterns play an important role in the dynamics of varicella. Finally,
our results provide baseline estimates of varicella and zoster incidence and
morbidity for VZV vaccine effectiveness and cost-effectiveness studies.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11693508 [PubMed - indexed for MEDLINE]

602: Scand J Urol Nephrol. 2001 Sep;35(4):330-3.

Varicella infection in a renal transplant recipient associated with abdominal
pain, hepatitis, and glomerulonephritis.

Os I, Ström EH, Stenehjem A, Gudmundsdottir H, Langberg H, Draganov B, Godøy J,
Dunlop O, von der Lippe B.

Department of Nephrology, Ulleval University Hospital, Oslo, Norway.
ingrid.os@ioks.uio.no

A 36-year-old renal transplant patient developed 9 years after a successful
transplantation a fatal secondary varicella infection. The disseminated varicella
infection was associated with hepatitis with liver necrosis, disseminated
intravascular coagulation and fibrinolysis and glomerulonephritis. To our
knowledge this is the first description of glomerulonephritis associated with
varicella infection in a renal transplanted patient. The autopsy showed
morphologically a mesangial glomerulonephritis with minor proliferative activity 
and extensive deposits by electronmicroscopy, mainly in the mesangium. The
ongoing immunosuppression may have modified the mesangial cell response to the
deposition of immune complexes.

Publication Types: 
    Case Reports

PMID: 11676362 [PubMed - indexed for MEDLINE]

603: Vaccine. 2001 Nov 12;20(3-4):295-8.

Epidemiology of primary varicella hospitalizations in Spain.

Gil A, Oyagüez I, Carrasco P, González A.

Department of Health Sciences, Rey Juan Carlos University, Avda de Atenas s/n,
28922 Alcorcón, Madrid, Spain. a.gildemiguel@cs.urjc.es

An approach to the burden of varicella can be obtained from information on the
hospitalizations. Data were obtained from the national surveillance system for
hospital data. All hospital discharges for varicella were analyzed for the
1995-1998 period. A total of 3632 primary varicella-related discharges were
identified, representing an annual incidence of 2.8 per 100,000 population. A
total of 58% of cases were <10 years of age and 33% were 21-50 years old. Each
year primary varicella will be responsible for 6174 days of hospitalization,
representing an annual cost of 1.6 million euros. There is substantial severe
morbidity each year from varicella that, to reduce, would require vaccination of 
infants and susceptible adults.

PMID: 11672890 [PubMed - indexed for MEDLINE]

604: Pediatr Infect Dis J. 2001 Oct;20(10):919-26.

Controlled trial of acyclovir for chickenpox evaluating time of initiation and
duration of therapy and viral resistance.

Balfour HH Jr, Edelman CK, Anderson RS, Reed NV, Slivken RM, Marmor LH, Dix L,
Aeppli D, Talarico CL.

University of Minnesota Medical School, Minneapolis 55455-0392, USA.
balfo001@umn.edu

BACKGROUND: Chickenpox is prevalent in the US despite the availability of an
effective vaccine. Acyclovir treatment is limited by concerns about efficacy if
given after the first day of rash and by concerns about induction of viral
resistance. OBJECTIVE: Evaluate initiation and duration of acyclovir treatment of
chickenpox and its effect on viral resistance. STUDY DESIGN: Randomized,
placebo-controlled, double blind trial in immunocompetent patients who were
stratified by age at enrollment (children, 2 to 11 years; adolescents, > or = 12 
to 18 years; adults, > or = 19 years) and duration of rash (< or = 24 h vs. >24
to 48 h). Lesions were staged, counted and cultured; temperatures and symptoms
were recorded daily. INTERVENTION: Subjects presenting within 24 h of rash onset 
(Group A) were randomly assigned to 5 or 7 days of oral acyclovir treatment, 80
mg/kg/day up to a maximum of 3,200 mg/day in four divided doses. Subjects whose
rash was >24 to 48 h old were randomized to receive 5 days of acyclovir treatment
beginning on the first (Group B1) or second study day (Group B2). Matching
placebos were used to ensure that subjects uniformly received 28 doses of study
compound. RESULTS: Of the 177 subjects recruited Group A patients who were
treated on the first day of rash had the greatest number of significantly
shortened event times with 5 days of therapy being equivalent to 7 days. There
also were some shorter times to events for Group B1 patients who began therapy on
the second day of rash vs. Group B2 patients who started acyclovir on the third. 
These included: time to maximum lesion formation (adolescents, P = 0.007;
children, P = 0.03); 50% healing in adolescents (P = 0.005); and residual facial 
lesions in adults (P = 0.047). The probability of viral shedding was
significantly reduced for Group A subjects vs. Group B1 subjects (P = 0.006).
Viruses shed during therapy remained susceptible to acyclovir and retained normal
thymidine kinase function. CONCLUSIONS: Immunocompetent children, adolescents and
adults with chickenpox displayed a gradation in their clinical responses to
acyclovir that correlated with the time from onset of rash to initiation of
therapy. Five days of therapy is sufficient because a 7-day course provided no
additional benefit. The susceptibility to acyclovir of viruses shed during
treatment did not change; however, the effect of therapy on resistance of latent 
virus was not assessed.

Publication Types: 
    Clinical Trial
    Evaluation Studies
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11642624 [PubMed - indexed for MEDLINE]

605: J Am Acad Dermatol. 2001 Nov;45(5):770-2.

Varicella complicated by group A streptococcal facial cellulitis.

Santos-Juanes J, Medina A, Concha A, Galache C, Sánchez del Río J, Rey C.

Service of Dermatology II, Department of Pediatrics, Hospital Central de
Asturias, University of Oviedo, Spain.

An increase has been recently noted in the incidence of life-threatening group A 
beta-hemolytic streptococcal (GABHS) infections in children recovering from
varicella. We report our experience with a patient who required pediatric
intensive care unit admission because of a serious GABHS infection 1 week after
the onset of varicella. Emergency physicians must look for this complication in
patients with varicella remaining abnormally febrile and presenting unusual
manifestations.

Publication Types: 
    Case Reports

PMID: 11606933 [PubMed - indexed for MEDLINE]

606: Int J Clin Pract. 2001 Sep;55(7):484-5.

Rhabdomyolysis associated with varicella infection.

al-Langawi M, al-Marri MR, al Soub H.

Division of Internal Medicine, Hamad General Hospital, Doha, Qatar.

Varicella infection is a common childhood disease that usually resolves without
complications. However, children under 2 months of age, adolescents, some adults 
and immunocompromised individuals are at high risk of certain rare
life-threatening complications. We report a case of primary varicella infection
in an immunocompetent adult complicated by rhabdomyolysis. Recognition of this
complication and aggressive fluid therapy with an antiviral agent helped to
improve the outcome.

Publication Types: 
    Case Reports

PMID: 11594261 [PubMed - indexed for MEDLINE]

607: Am J Ophthalmol. 2001 Oct;132(4):584-5.

Retinal vasculitis associated with chickenpox.

Kuo YH, Yip Y, Chen SN.

Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Shing St.,
Guei-Shan Hsian, Taoyuan, Taiwan. yahuikuo@tpts5.seed.net.tw

PURPOSE: To report retinal vasculitis in a young, immunocompetent Asian female
adult with chickenpox. METHODS: Interventional case report. A 32-year-old woman
had chickenpox 2 weeks before blurred vision in the left eye. The visual acuity
was 20/20 for the right eye and 30/50 for the left eye. The left eye presented
keratic precipitates, moderate (2+) cells in the anterior chamber and numerous
cells (3+) in the vitreous. The disk was normal. Perivenous exudation was noted
mainly in the inferior retina. The sheathed retinal vessels showed late staining 
but no remarkable leakage on fluorescein angiography. The right eye was normal.
RESULTS: After treatment with acyclovir for 10 days, the visual acuity in the
left eye improved to 20/20, and the vasculitis resolved. CONCLUSION: Retinal
vasculitis may present as a complication of primary varicella infection in an
immunocompetent adult.

Publication Types: 
    Case Reports

PMID: 11589889 [PubMed - indexed for MEDLINE]

608: J Clin Pathol. 2001 Oct;54(10):743-7.

Comment in:
    J Clin Pathol. 2002 May;55(5):399; author reply 399.

Vaccination to prevent varicella and shingles.

Breuer J.

Department of Virology, St Bartholomew's and the Royal London School of Medicine 
and Dentistry, Queen Mary and Westfield College, 37 Ashfield Street, London E1
1BB, UK. j.breuer@mds.qmw.ac.uk

Vaccination of healthy children against varicella using the live attenuated Oka
vaccine has been available in Japan and south Korea for several years. In 1996, a
programme of universal vaccination of children to prevent varicella was
introduced in the USA and other countries, including Canada, Germany, and Sweden,
have licensed the vaccine for use in healthy children. This article reviews the
origin of the Oka vaccine and the evidence for vaccine safety and efficacy in
children and adults. Universal vaccination of children and targeted vaccination
of groups at risk of severe varicella are discussed. The possible use of the Oka 
vaccine to prevent zoster is reviewed, and initiatives to develop new varicella
zoster virus vaccines are outlined.

PMID: 11577118 [PubMed - indexed for MEDLINE]

609: Vaccine. 2001 Oct 12;20(1-2):121-4.

Seroprevalence of varicella-zoster virus in the German population.

Wutzler P, Färber I, Wagenpfeil S, Bisanz H, Tischer A.

Institute for Antiviral Chemotherapy, Friedrich-Schiller University of Jena,
Winzerlaer Strasse 10, D-07745, Jena, Germany. peter.wutzler@med.uni-jena.de

The present study was conducted to generate data on the epidemiology of
varicella-zoster virus (VZV) infections in Germany as a basis for health economic
evaluations of varicella vaccination strategies. The survey was designed as a
cross-sectional, age-stratified study of the VZV seroprevalence in the German
population. The status of immunity of 4602 individuals a aged 0 to >70 years was 
investigated by means of an indirect enzyme immunoassay and the fluorescent
antibody to membrane assay. After waning of maternal antibodies over the period
of 6-9 months seropositivity rates remained low by the end of the 1st year of
life. By the age of 4-5 years 62.5% (95% CI; 56.0-68.5) of the pre-school
children had already been infected with VZV and at the age of 10-11 years 94.2%
(95% CI; 91.0-96.0) of children were positive for anti-VZV antibodies. Among the 
age-group of >40 years old, only few individuals were susceptible for VZV. The
median antibody levels to VZV did not significantly decline with increasing age. 
In comparison with figures of previous studies the age-specific seroprevalence
data presented here do not provide evidence for an upward shift in the age
distribution of varicella in Germany. Since the majority of VZV infections occurs
during the early childhood, the best option to reduce the circulation of
wild-type VZV in the population would be the immunization of young children.

PMID: 11567755 [PubMed - indexed for MEDLINE]

610: J Pediatr Health Care. 2001 Sep-Oct;15(5):236-43.

Parental decision-making for the varicella vaccine.

Niederhauser VP, Baruffi G, Heck R.

University of Hawaii School of Nursing, Honolulu, USA. vpnieder@msn.com

INTRODUCTION: With the advent of new vaccines, improvements in established
vaccines, and the availability of new combination vaccines, parents' decisions
about vaccinating their children have become more complicated. This study
examined parents' decision-making processes pertaining to whether to have their
children vaccinated for varicella to gain a better understanding about how
parents make vaccination decisions for their children. The "Awareness-to-Action
Model" was used to examine parents' decision-making process before the action to 
vaccinate or refuse vaccination occurs. METHOD: This study used a cross-sectional
design and logistic regression to test the explanatory power of several factors
related to the parental decision-making process. A stratified random sample of
262 members of Kaiser Permanente Hawaii participated in the study. Data were
collected through telephone interviews. RESULTS: In the "Awareness-to-Action
Model," the decision construct was statistically significant in explaining
parents' decisions to have their child vaccinated. The overall model correctly
classified 80% of the sample as accepters or nonaccepters of the vaccination for 
their child. This study provides a model that enables health care providers to
understand parental decisions about vaccines. This knowledge can help target
interventions to increase vaccine compliance, thus minimizing the risk of
diseases preventable by vaccine.

PMID: 11562641 [PubMed - indexed for MEDLINE]

611: Thorax. 2001 Oct;56(10):796-9.

Lung function tests and risk factors for pneumonia in adults with chickenpox.

Mohsen AH, Peck RJ, Mason Z, Mattock L, McKendrick MW.

Department of Infection & Tropical Medicine, Royal Hallamshire Hospital,
Sheffield S10 2JF, UK. Abdul.Mohsen@kcl.ac.uk

BACKGROUND: Varicella is 25 times more likely to be complicated by pneumonia in
adults than in children. Data on changes in lung function following pneumonia are
limited. This study was undertaken to describe the epidemiological factors
associated with pneumonia and to investigate lung function up to 1 year following
chickenpox. METHODS: Thirty eight consecutive suitable patients admitted to a
university hospital were enrolled in the study; 19 had pneumonia and 19 did not. 
Epidemiological data and density of rash were recorded, spirometric tests were
performed, and carbon monoxide transfer factor was measured. RESULTS: Varicella
pneumonia was associated with the presence of respiratory symptoms (p=0.006),
current smoking (p=0.003), and history of close contact (p=0.009). There was a
trend towards patients with pneumonia having a more severe rash. No association
was observed between pneumonia and age or sex. Current smokers had a higher mean 
number of spots than non-smokers (p=0.005). Carbon monoxide transfer factor at
hospital discharge was reduced in 27 patients (71%), more markedly in the group
with pneumonia (p=0.009). Nine patients (seven with pneumonia) still had a
reduced carbon monoxide transfer factor (mean reduction 36%) at 12 months.
CONCLUSION: Chickenpox may result in a defect in carbon monoxide transfer factor 
for at least a year after acute illness.

Publication Types: 
    Comparative Study

PMID: 11562520 [PubMed - indexed for MEDLINE]

612: Brain Pathol. 2001 Oct;11(4):475-9.

An animal model of varicella virus infection.

White TM, Gilden DH, Mahalingam R.

Department of Neurology, University of Colorado Health Sciences Center, Denver
80262, USA.

Varicella-zoster virus (VZV) causes chickenpox in children; establishes latency
in cranial nerve, dorsal root, and autonomic ganglia; and reactivates decades
later to produce zoster. VZV produces disease only in humans. Although attempts
to produce disease and study VZV latency in experimentally infected animals have 
resulted in virus in trigeminal or dorsal root ganglia, no clinical signs of
infection or reactivation developed. In contrast, simian varicella virus (SVV)
produces a naturally occurring exanthematous disease in non-human primates that
mimics human varicella. Experimental inoculation of non-human primates causes
similar, if not identical, clinical and pathological changes observed in monkeys 
naturally infected with SVV. Like VZV, SVV becomes latent in ganglia and
reactivates, often with entire body rash. SVV and VZV encode antigenically
related polypeptides. Both virus genomes have been sequenced and shown to be
colinear, sharing up to 75% DNA homology. During latency, an SVV homolog of one
of the five VZV genes transcribed in latently infected human ganglia has been
detected in monkey ganglia. Preliminary studies in which monkeys were inoculated 
intratracheally with SVV revealed the presence of viral DNA and RNA in multiple
tissues, including blood mononuclear cells, months after experimental infection. 
These findings differed from the expected restricted localization of the virus
DNA to ganglia only and the expected limited viral gene expression, and probably 
reflect the high virus load delivered intratracheally compared to natural SVV
infection in monkeys. Nevertheless, clinical, pathological, and molecular
similarities between SVV and VZV indicate that SVV infection in non-human
primates has considerable potential as an animal model for human varicella.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11556693 [PubMed - indexed for MEDLINE]

613: Acta Paediatr Taiwan. 2001 Jul-Aug;42(4):239-42.

Congenital varicella syndrome as an unusual cause of congenital malformation:
report of one case.

Huang CS, Lin SP, Chiu NC, Hung HY.

Department of Pediatrics, MacKay Memorial Hospital, 92, Sec. 2, Chung Shan North 
Road, Taipei 104, Taiwan.

Intrauterine infections with varicella-zoster virus following maternal varicella 
in early pregnancy and resulting in congenital malformations are rare. Herein we 
report a child with congenital varicella syndrome characterized by low birth
weight, cicatricial scarring, hypoplasia of both lower extremities with joint
contracture, congenital hip dislocation, corneal opacity, atresia of the sigmoid 
colon and a rarely associated cloaca anomaly. The varicella IgG remained positive
after she was seven months old. Her mother developed chickenpox at the 14th week 
of gestation. The purpose of this article is to raise pediatricians' index of
suspicion for congenital varicella syndrome when an infant is born with multiple 
congenital malformations with an apparent history of maternal varicella
infection.

PMID: 11550414 [PubMed - indexed for MEDLINE]

614: Vaccine. 2001 Sep 14;19(32):4700-2.

Comment in:
    Vaccine. 2002 Feb 22;20(11-12):1480.

The utility of serologic testing for varicella in an adolescent population.

Ronan K, Wallace MR.

Department of Pediatrics, Naval Medical Center San Diego, Pediatrics Suite 100,
34520 Bob Wilson Drive, San Diego, CA 92134-2100, USA.

The purpose of this study was to determine what proportion of adolescents without
a history of varicella are seropositive, and if serologic testing of this
adolescent subpopulation is cost-effective. We identified 122 patients with 'no' 
or 'unknown' histories of chicken pox from our adolescent clinic. Of these, 58
(48%) were found to be Varicella Zoster Virus (VZV) seropositive. Cost to the
government for batched serologic testing of all unknowns was $682.65, while each 
adolescent vaccinated cost $59.60. Serologic testing prior to routine
immunization of adolescents with unclear varicella histories saved $2774.15 (38% 
of routine immunization costs). In this population, serologic testing is more
cost effective than routinely immunizing all unknowns.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 11535319 [PubMed - indexed for MEDLINE]

615: Indian J Pediatr. 2001 Jul;68(7):649-54.

Anti-herpes viruses agents.

Abdel-Haq NM, Asmar BI.

Devision of Infectious Diseases, Children's Hospital of Michigan, Wayne State
University, School of Medicine, Detroit, Michigan, USA.

Antiviral agents with demonstrated efficacy are currently available for the
management of infections in children caused by the herpes viruses including
herpes simples type 1 (HSV1) and type 2 (HSV2), varicella-zoster virus (VZV), and
cytomegalovirus (CMV). Recently, progress has been made in the development of
newer agents with enhanced activity against these viruses including resistant
strains. This review focuses on the activity, clinical pharmacology, and clinical
indications of antiviral agents used in the treatment of infections caused by the
different herpes viruses in children.

Publication Types: 
    Review

PMID: 11519289 [PubMed - indexed for MEDLINE]

616: Pediatr Res. 2001 Sep;50(3):345-52.

The varicella-autoantibody syndrome.

Josephson C, Nuss R, Jacobson L, Hacker MR, Murphy J, Weinberg A, Manco-Johnson
MJ.

Departments of Pediatrics, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA.

This cross-sectional study was conducted to determine the incidence of
autoantibodies to phospholipids and coagulation proteins in children with acute
varicella zoster virus (VZV) infection. Study groups included children with VZV
alone or complicated by purpura fulminans and/or thromboembolism. VZV naïve
children and children who had VZV >1 y before sample collection formed a control 
group. Blood was assayed for the following: free protein S (PS), protein C,
antithrombin, and prothrombin; antibody binding to these proteins; lupus
anticoagulant; anticardiolipin antibody; antiphospholipid antibodies; and
prothrombin fragment 1+2. Data regarding coinfections was collected. Forty-three 
VZV-infected children showed an increased frequency of lupus anticoagulant,
anticardiolipin antibody, antiphospholipid antibodies, and autoantibodies to PS, 
protein C, prothrombin, and antithrombin in comparison to 52 children without
acute VZV (p < 0.0001). Seventeen children with VZV and purpura fulminans and/or 
thromboembolism showed a statistically significant decrease in free PS,
significantly increased PS IgG antibody, and significantly increased prothrombin 
fragment 1+2 (p < 0.0001) compared with the group without acute VZV and the group
with uncomplicated VZV. Twenty-six children with uncomplicated VZV showed
increased PS IgG antibody (p < 0.001) compared with the children without acute
VZV. For all groups combined, elevated PS IgG antibody showed negative
correlation with free PS (p < 0.0001) and positive correlation with prothrombin
fragment 1+2 (p = 0.0002). Autoantibodies were transient. Transient
antiphospholipid and coagulation protein autoantibodies were common with VZV
infection, but were not predictive of thrombotic complications.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11518821 [PubMed - indexed for MEDLINE]

617: Pediatr Neurol. 2001 May;24(5):387-9.

Postvaricella angiopathy: report of a case with pathologic correlation.

Hayman M, Hendson G, Poskitt KJ, Connolly MB.

Division of Neurology, Department of Pediatrics, University of British Columbia, 
Vancouver, BC, V6H 3V4, Canada.

Varicella is a common childhood illness, and central nervous system complications
occur frequently. Delayed angiopathy has been described, although there are few
reports of clinicopathologic correlation. A previously well 4-year-old male is
presented. He suffered varicella 2 months before presentation with extensive
right middle cerebral artery (MCA) territory infarction. Cerebral angiography
demonstrated an isolated 89% stenosis of the right proximal MCA. He developed
cerebral edema refractory to medical treatment and progressed to transtentorial
herniation. Right frontal temporoparietal craniotomies were performed with
evacuation of infarcted brain tissue. Pathologic studies revealed small vessel
vasculitis with lymphocytic infiltration of the vessel wall. Areas of
demyelination were present within the white matter. Polymerase chain reaction for
varicella was negative on brain tissue. Postvaricella angiopathy, although an
uncommon complication, may affect both small and large blood vessels, with
catastrophic results.

Publication Types: 
    Case Reports

PMID: 11516617 [PubMed - indexed for MEDLINE]

618: J Child Neurol. 2001 Aug;16(8):595-7.

Congenital varicella syndrome: case with isolated brain damage.

Dimova PS, Karparov AA.

Clinic of Child Neurology, University Hospital of Neurology and Psychiatry,
Sofia, Bulgaria. pdimova@omega.bg

We report a case of congenital varicella syndrome after maternal infection during
the 10th week of pregnancy. None of the typical abnormalities were manifested at 
birth; however, the child experienced neonatal tonic convulsions that evolved to 
refractory focal epilepsy with adversive, complex partial, and secondarily
generalized seizures. At the age of 5 years, after a prolonged generalized
seizure following cranial trauma, cranial computed tomography (CT) was performed.
It led to the misdiagnosis of post-traumatic intracerebral hemorrhage.
Afterwards, because of persistent seizures and developmental delay with mild or
slight intellectual deficit, the next CT and magnetic resonance imaging (MRI)
investigation at 8 years of age disclosed massive malformation of the left
cerebral hemisphere. The serologic evidence of varicella-zoster virus-specific
IgG antibodies without a history of varicella disease after birth and maternal
infection during early pregnancy were crucial to diagnosing the rare syndrome of 
congenital varicella consisting of isolated brain damage.

Publication Types: 
    Case Reports

PMID: 11510932 [PubMed - indexed for MEDLINE]

619: Curr Opin Microbiol. 2001 Aug;4(4):442-9.

Varicella-zoster virus: molecular virology and virus-host interactions.

Arvin AM.

G-312, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA
94305, USA. aarvin@stanford.edu

Cosmid-based mutagenesis and methods to examine varicella-zoster virus (VZV)
tropism for differentiated human cells in vivo provide new information about
molecular mechanisms of VZV infection. How specific VZV gene products contribute 
to viral replication has been further defined, and effects of VZV on expression
of cellular genes have been demonstrated.

Publication Types: 
    Review

PMID: 11495809 [PubMed - indexed for MEDLINE]

620: J Pediatr. 2001 Aug;139(2):305-10.

Immunization of HIV-infected children with varicella vaccine.

Levin MJ, Gershon AA, Weinberg A, Blanchard S, Nowak B, Palumbo P, Chan CY; AIDS 
Clinical Trials Group 265 Team.

University of Colorado School of Medicine, Denver, USA.

OBJECTIVE: To determine the safety and immunogenicity of varicella vaccine in
children with human immunodeficiency virus (HIV) infection. Children (n = 41) who
were mildly affected by HIV (Centers for Disease Control and Prevention stage N1 
or A1) and had no history or serum antibody indicative of prior varicella
infection were immunized with two doses of live attenuated varicella vaccine.
RESULTS: A minority of the vaccine recipients had mild local or systemic
reactions. Vaccination had no effect on the clinical stage of HIV or the HIV RNA 
plasma load. CD4 cell percentage and CD4 cell count were marginally decreased at 
week 4 after the first vaccination; this effect was no longer present at week 8
after vaccination. Two months after the second dose of vaccine, 60% of vaccine
recipients had anti-varicella antibody in their serum, and 83% had a positive
lymphocyte proliferation assay response to varicella antigen. CONCLUSION: On the 
basis of its safety and immunogenicity, varicella vaccine should be considered in
the childhood vaccines given to mildly affected HIV-infected children.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11487761 [PubMed - indexed for MEDLINE]

621: J Pediatr. 2001 Aug;139(2):297-304.

Childhood vaccination against varicella: persistence of antibody, duration of
protection, and vaccine efficacy.

Vessey SJ, Chan CY, Kuter BJ, Kaplan KM, Waters M, Kutzler DP, Carfagno PA,
Sadoff JC, Heyse JF, Matthews H, Li S, Chan IS.

Merck Research Laboratories, Merck & Co, Inc, West Point, Pennsylvania 19482,
USA.

OBJECTIVE: To document the duration of protection afforded by Oka/Merck varicella
vaccine over a 7-year period. STUDY DESIGN: The subjects were healthy children 1 
to 12 years of age originally enrolled in clinical studies to evaluate the
primary immune response to varicella vaccine 6 weeks after vaccination. Each was 
monitored for antibody persistence, breakthrough infection, and household
exposure to varicella to produce estimates of vaccine efficacy. RESULTS: The
6-year cumulative varicella antibody persistence rate was 99.5% (95% CI: 98.9%,
100.0%). The annual breakthrough rate through 7 years ranged from 0.2% to 2.3%
per year; the estimated cumulative event rate was 6.5%. Comparison of the
observed average annual breakthrough rate with the age-adjusted expected annual
incidence rate of varicella in unvaccinated children corresponded to an estimated
vaccine efficacy of 93.8% to 94.6%. Eighty vaccinated children were exposed to
varicella in the household, resulting in 8 (10%) cases of infection. When
compared with the historical attack rate of 86.8% in unvaccinated susceptible
persons exposed to varicella in the household, this yields an estimated vaccine
efficacy of 88.5% (95% CI: 80.9%, 96.1%). Varicella cases in vaccinated children 
generally were mild. CONCLUSION: The live attenuated varicella vaccine is highly 
effective in inducing persistent immunity and long-term protection against
breakthrough varicella infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11487760 [PubMed - indexed for MEDLINE]

622: Eur J Epidemiol. 2000;16(12):1177-81.

Impact on immunization of seasonal cycle of chickenpox.

Deguen S, Flahault A.

INSERM U444, Paris, France.

The objective of this work was to study the effect of incorporating a seasonal
term in a compartmental age-structured theoretical transmission model, on the
performance of vaccination strategies for chickenpox. The epidemiologic
parameters are taken from data or are based on a review of literature. We used a 
realistic age-structure model (RAS): It is a model that incorporate both age and 
seasonal structure. The seasonality was introduced in the model with the addition
of sinusoidal forcing term. This seasonal term varies between 0 and 1. From a
susceptible/exposed/infectious/removed (SEIR) model with or without
age-structure, the pattern of time series is dramatically modified after
introducing a seasonal term. This dynamic ends to the transition to chaos.
Regarding the evaluation of vaccination strategies, the results of the model
without seasonality may be disturbed when the seasonality is introduced,
especially during the first 30 years of simulations.

PMID: 11484809 [PubMed - indexed for MEDLINE]

623: Pediatrics. 2001 Aug;108(2):E39.

Disseminated vaccine strain varicella as the acquired immunodeficiency
syndrome-defining illness in a previously undiagnosed child.

Kramer JM, LaRussa P, Tsai WC, Carney P, Leber SM, Gahagan S, Steinberg S,
Blackwood RA.

Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.

The Food and Drug Administration licensed a live-virus varicella vaccine
(Varivax; Merck & Co Inc, West Point, PA) in March 1995. Prelicensure adverse
events were minimal; however, since licensure and increased vaccine use, rare
previously undetected risks have arisen. Presented here is the clinical course of
a previously undiagnosed, human immunodeficiency virus-infected boy who developed
dissemination of the vaccine strain of varicella zoster after immunization.
chickenpox, human immunodeficiency virus, pneumonia, encephalopathy, varicella
vaccine, adverse events, dissemination.

Publication Types: 
    Case Reports

PMID: 11483849 [PubMed - indexed for MEDLINE]

624: Epidemiol Infect. 2001 Jun;126(3):433-40.

The seroepidemiology of varicella in Italy.

Gabutti G, Penna C, Rossi M, Salmaso S, Rota MC, Bella A, Crovari P; Serological 
Study Group.

Department of Health Sciences, Hygiene and Preventive Medicine Section,
University of Genoa, Italy.

We conducted a seroepidemiological study to evaluate the potential impact of mass
varicella vaccination on the transmission of varicella-zoster virus (VZV) in
Italy, where vaccination is not mandatory. We tested 3179 serum samples,
collected from September 1996 to October 1997, for specific anti-VZV antibodies
using a commercially available ELISA. The results confirmed that varicella
typically involves children (82.1% seroprevalence among 10- to 14-year-olds) and 
that the mean age of acquiring the infection seems to be increasing. The results 
also revealed that southern Italy, compared to the rest of the country, has a
greater circulation of VZV and an earlier age of acquisition. The potential
impact of mass vaccination among 12- to 18-month-old children on the
epidemiological trend of the infection must be carefully considered, in that
failure to reach high levels of coverage could lead to an increase in the mean
age of acquisition, which is already occurring in Italy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11467800 [PubMed - indexed for MEDLINE]

625: Pediatr Infect Dis J. 2001 Jul;20(7):641-5.

Incidence and hospitalization rates of varicella and herpes zoster before
varicella vaccine introduction: a baseline assessment of the shifting
epidemiology of varicella disease.

Coplan P, Black S, Rojas C, Shinefield H, Ray P, Lewis E, Guess H.

Merck Research Laboratories, Blue Bell, PA 19422, USA. paul_coplan@merck.com

BACKGROUND: A 15-year postmarketing evaluation of the impact of varicella vaccine
on the age distribution of varicella disease is being conducted at Kaiser
Permanente Medical Care Program, Northern California (KPMCP). We report on a
baseline assessment of the age-specific incidence and hospitalization rates of
varicella and herpes zoster that was conducted before vaccine introduction.
METHODS: To assess the annual incidence of varicella, a telephone survey was
conducted in a random sample of approximately 8,000 youths 5 to 19 years of age. 
The annual incidence of hospitalizations for varicella and herpes zoster in 1994 
was assessed with the use of the computerized database at KPMCP. RESULTS:
Varicella annual incidence was 10.3% in 5- to 9-year-olds, 1.9% in 10- to
14-year-olds and 1.2% in the 15- to 19-year age groups, respectively.
Hospitalization rates among the entire KPMCP membership were 2.6 and 2.1 per
100,000 person years for varicella and zoster, respectively. Varicella incidence 
in the 15- to 19-year age group was higher among African-Americans than among
Caucasians. CONCLUSIONS: Varicella rates were similar in the 5- to 9- and 10- to 
14-year age groups to rates from other published studies conducted in 1972 to
1978, 1980 to 1988 and 1990 to 1992; however, the rate in 15- to 19-year-olds was
2 to 4 times higher than published rates in the same age category.

PMID: 11465834 [PubMed - indexed for MEDLINE]

626: Turk J Pediatr. 2001 Apr-Jun;43(2):139-42.

Lupus anticoagulant and protein S deficiency in a child who developed
disseminated intravascular coagulation in association with varicella.

Kurugöl Z, Vardar F, Ozkinay F, Kavakli K, Cetinkaya B, Ozkinay C.

Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey.

Varicella is not always a benign disease it may cause serious complications. We
report a two-year-old boy with disseminated intravascular coagulation in
association with varicella. The patient had the lupus anticoagulant, the
antiphospholipid antibody, acquired free protein S deficiency, and increased
concentrations of the prothrombin F 1+2 fragment. Intravenous immunoglobulin was 
administered due to its potential antibody-blocking activity, and the patient
responded well. We recommend that children with varicella and disseminated
intravascular coagulation should be examined for the lupus anticoagulant, the
free protein S antigen, the prothrombin fragment F 1+2 and the other coagulation 
parameters. Intravenous immunoglobulin administration could be useful in such
conditions because of its antibody-blocking activity.

Publication Types: 
    Case Reports

PMID: 11432493 [PubMed - indexed for MEDLINE]

627: Infect Control Hosp Epidemiol. 2001 May;22(5):279-83.

Persistence of immunity to varicella-zoster virus after vaccination of healthcare
workers.

Saiman L, LaRussa P, Steinberg SP, Zhou J, Baron K, Whittier S, Della-Latta P,
Gershon AA.

Department of Pediatrics, Columbia University, College of Phyicians & Surgeons,
New York City, New York 10032, USA.

OBJECTIVE: Varicella-zoster virus (VZV) vaccine is recommended to protect
susceptible healthcare workers (HCWs) from serious disease and to prevent
nosocomial spread of VZV. We evaluated clinical outcomes and serological
responses in HCWs after immunization with live attenuated VZV vaccine. DESIGN:
Vaccinees were immunized from 1979 to 1998 during VZV vaccine trials, as well as 
after licensure, and followed prospectively for 1 month to 20.6 (mean 4.6) years 
after vaccination. Sera were tested by fluorescent antibody to membrane antigen
(FAMA), latex agglutination (LA), and enzyme-linked immunoassay (EIA) to detect
VZV-specific antibodies. STUDY PARTICIPANTS: The median age of the 120 HCWs was
26 years; 51 (42%) were males. INTERVENTIONS: Ninety eight (82%) of these study
subjects received vaccine prepared by Merck and 22 (18%) by SmithKline Beecham;
25, 81, and 14 vaccinees received one dose, two doses, and three doses,
respectively. RESULTS: The crude attack rate was 10%; 12 of 120 HCWs developed
chickenpox 6 months to 8.4 years after vaccination. The attack rates following
household and hospital exposures were 18% (4/22) and 8% (6/72), respectively. All
resulting illness was mild to moderate (mean 40 vesicles). Seroconversion after
vaccination was documented by FAMA in 96% of HCWs, although 31% lost detectable
antibodies. Compared with FAMA, LA and EIA were 82% and 74% sensitive and 94% and
89% specific, respectively. CONCLUSIONS: The VZV vaccine effectively protected
HCWs from varicella, particularly from serious disease. Currently available
serological tests are not optimal, and improved assays are needed.

PMID: 11428437 [PubMed - indexed for MEDLINE]

628: Pediatr Transplant. 2001 Jun;5(3):153-9.

Varicella-zoster infection in pediatric solid-organ transplant recipients: a
hospital-based study in the prevaricella vaccine era.

Pandya A, Wasfy S, Hébert D, Allen UD.

The Department of Pediatrics, Divisions of Infectious Diseases,The Hospital for
Sick Children, University of Toronto, Toronto, Ontario, Canada.

We reviewed 58 cases of varicella-zoster infection that occurred between 1988 and
1998 in 47 pediatric solid-organ transplant recipients. The median age of
patients at the time of admission with varicella-zoster infection was 8.0 yr
(range 1-17 yr). The median interval between transplantation (Tx) and
varicella-zoster virus (VZV) infection was 1.6 yr (range 0.06-9.3 yr). Varicella 
infection occurred at a rate of one case for every seven transplant recipients.
Among the 58 cases of VZV infection, 53% were varicella while 47% were
herpes-zoster. Varicella infection occurred despite treatment with
varicella-zoster immune globulin (VZIG) in 17 of 31 cases of varicella infection.
However, the disease was generally mild with severe disease occurring in only two
patients. One patient (1.7%) died as a result of bacterial sepsis. There was no
significant relationship between VZV infection and specific immune suppressants. 
Episodes of rejection were more likely to be temporally associated with the
occurence of herpes zoster than with varicella infection (p = 0.02). The data
generated provide useful background information in our population in the
prevaricella vaccine era.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11422816 [PubMed - indexed for MEDLINE]

629: Southeast Asian J Trop Med Public Health. 2000 Dec;31(4):646-9.

Seroepidemiology of varicella-zoster in Pakistan.

Akram DS, Qureshi H, Mahmud A, Khan AA, Kundi Z, Shafi S, N-ur-Rehman, Olowokure 
B, Weil J, Bock H, Yazdani I.

Civil Hospital, Karachi, Pakistan.

The availability of safe and effective vaccines has renewed interest in the
epidemiology of varicella worldwide. To date published data on the epidemiology
of varicella in Pakistan is very scarce. Therefore, we conducted a study to
determine the age-specific seroprevalence rate of varicella-zoster virus (VZV)
antibodies in Pakistan. Between December 1997 and March 1998, 1,509 healthy
volunteers aged between 1 month and 30 years were recruited from the Islamabad,
Karachi, Lahore and Rawalpindi areas. Demographic information, socioeconomic
status and past medical history were obtained by questionnaire. Serum samples
were assayed for IgG antibodies against VZV by enzyme-linked immunosorbent assay.
Overall 41.8% (600/1,435) of those tested were found to be seropositive for VZV
antibodies. No difference was found in results obtained from the different
cities. A higher seroprevalence was observed among women (45.2%) compared to men 
(39.6%). Seroprevalence rates increased with age and were 28.4% in those aged 0-5
years, 41.5% in the 6-10 year age group, 42.5% in the 11-15 year age group, 46.7%
in the 16-20 year age group and 53.6% in those aged 21-30 years. Socioeconomic
status was not a significant risk factor for VZV seropositivity. This is the
first report of the seroepidemiology of VZV in Pakistan. The results indicate
that seroprevalence of VZV increases with age in the Pakistani population
studied. As in other tropical countries, there is greater susceptibility to
varicella among the adolescent and young adult population. The results of this
study suggest that these at-risk groups should be included in vaccination
programs aimed at reducing the public health impact of varicella.

Publication Types: 
    Multicenter Study

PMID: 11414405 [PubMed - indexed for MEDLINE]

630: Rheumatol Int. 2001 May;20(4):167-8.

Hughes syndrome associated with varicella infection.

Uthman I, Taher A, Khalil I.

American University of Beirut, Medical Center, Lebanon. iuthman@aub.edu.lb

We report a case of Hughes syndrome 1 week after the occurrence of chickenpox.
The patient presented with the clinical picture of acute right
iliofemoropopliteal deep vein thrombosis. IgM and IgG anticardiolipin (aCL) were 
both positive upon admission. The IgM aCL antibodies were still positive 6 weeks 
later, which suggests their role as a predisposing factor of deep vein
thrombosis.

Publication Types: 
    Case Reports

PMID: 11411963 [PubMed - indexed for MEDLINE]

631: MMWR Morb Mortal Wkly Rep. 2000 Aug 18;49(32):735-6.

Varicella outbreaks among Mexican adults--Alabama, 2000.

Centers for Disease Control and Prevention (CDC).

On May 19, 2000, a physician in southern Alabama reported seven cases of
varicella to the Alabama Department of Public Health (ADPH). All the cases were
in previously healthy young adults living in an apartment complex in town A and
working in a poultry processing plant in nearby town B. On May 24, ADPH invited
CDC to assist in outbreak investigation and control. This report summarizes the
investigation.

PMID: 11411828 [PubMed - indexed for MEDLINE]

632: Stroke. 2001 Jun;32(6):1257-62.

Chickenpox and stroke in childhood: a study of frequency and causation.

Askalan R, Laughlin S, Mayank S, Chan A, MacGregor D, Andrew M, Curtis R, Meaney 
B, deVeber G.

Hospital for Sick Children and the University of Toronto, Toronto, Canada.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether
infection with varicella is causal for arterial ischemic stroke (AIS) in
children. METHODS: First, a prospective cohort study was conducted in young
children (aged 6 months to 10 years) with AIS at 2 institutions (cohort study).
The presence of varicella infection <12 months before AIS was determined and
compared with the published frequency of varicella infection in the healthy
pediatric population. The clinical and radiographic features of AIS were compared
between the varicella and nonvaricella study cohorts. Second, a literature search
of varicella-associated AIS was conducted, and the clinical and radiographic
features were compared with the study nonvaricella cohort. RESULTS: In the cohort
study, 22 (31%) of 70 consecutive children with AIS had a varicella infection in 
the preceding year compared with 9% in the healthy population. Children in the
varicella cohort were more likely to have basal ganglia infarcts (P<0.001),
abnormal cerebral vascular imaging (P<0.05), and recurrent AIS or transient
ischemic attacks (P<0.05) than those in the nonvaricella cohort. The pooled
literature analysis of 51 cases of varicella-associated AIS showed similar
findings to the varicella cohort. CONCLUSION: In young children with AIS, there
is a 3-fold increase in preceding varicella infection compared with published
population rates, and varicella-associated AIS accounts for nearly one third of
childhood AIS. Varicella-associated AIS has characteristic features, including a 
2-fold increase in recurrent AIS and transient ischemic attacks. Varicella is an 
important risk factor for childhood AIS.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11387484 [PubMed - indexed for MEDLINE]

633: Cutis. 2001 May;67(5):423-6.

Linear IgA bullous dermatosis associated with vancomycin and disseminated
varicella-zoster infection.

Ahkami R, Thomas I.

UMDNJ-New Jersey Medical School, Newark.

Linear IgA bullous dermatosis (LABD) is characterized by linear deposits of IgA
at the basement membrane zone. Most cases are idiopathic, but medications,
infections, autoimmune disorders, and malignancies have been documented as
potential inducers. We report a case where both vancomycin and varicella-zoster
infection were present as triggers.

Publication Types: 
    Case Reports

PMID: 11381861 [PubMed - indexed for MEDLINE]

634: Arch Pathol Lab Med. 2001 Jun;125(6):770-80.

Varicella-Zoster virus infections of the nervous system: clinical and pathologic 
correlates.

Kleinschmidt-DeMasters BK, Gilden DH.

Department of Pathology, The University of Colorado Health Sciences Center,
Denver, CO 80262, USA. BK.DeMasters@UCHSC.edu

BACKGROUND: Diseases that present with protean manifestations are the diseases
most likely to pose diagnostic challenges for both clinicians and pathologists.
Among the most diverse disorders caused by a single known toxic, metabolic,
neoplastic, or infectious agent are the central and peripheral nervous system
complications of varicella-zoster virus (VZV). METHODS: The pathologic correlates
of the neurologic complications of VZV infection, as well as current methods for 
detecting viral infections, are discussed and presented in pictorial format for
the practicing pathologist. RESULTS: Varicella-zoster virus causes chickenpox
(varicella), usually in childhood; most children manifest only mild neurologic
sequelae. After chickenpox resolves, the virus becomes latent in neurons of
cranial and spinal ganglia of nearly all individuals. In elderly and
immunocompromised individuals, the virus may reactivate to produce shingles
(zoster). After zoster resolves, many elderly patients experience postherpetic
neuralgia. Uncommonly, VZV can spread to large cerebral arteries to cause a
spectrum of large-vessel vascular damage, ranging from vasculopathy to
vasculitis, with stroke. In immunocompromised individuals, especially those with 
cancer or acquired immunodeficiency syndrome, deeper tissue penetration of the
virus may occur (as compared with immunocompetent individuals), with resultant
myelitis, small-vessel vasculopathy, ventriculitis, and meningoencephalitis.
Detection of the virus in neurons, oligodendrocytes, meningeal cells, ependymal
cells, or the blood vessel wall often requires a combination of morphologic,
immunohistochemical, in situ hybridization, and polymerase chain reaction (PCR)
methods. The PCR analysis of cerebrospinal fluid remains the mainstay for
diagnosing the neurologic complications of VZV during life. CONCLUSIONS:
Varicella-zoster virus infects a wide variety of cell types in the central and
peripheral nervous system, explaining the diversity of clinical disorders
associated with the virus.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11371229 [PubMed - indexed for MEDLINE]

635: Pediatrics. 2001 May;107(5):1108-15.

Invasive group A streptococcal infection and nonsteroidal antiinflammatory drug
use among children with primary varicella.

Lesko SM, O'Brien KL, Schwartz B, Vezina R, Mitchell AA.

Slone Epidemiology Unit, School of Public Health, Boston University School of
Medicine, Brookline, Massachusetts, USA. leskos@bu.edu

OBJECTIONS: To test the hypothesis that nonsteroidal antiinflammatory drug use
increases the risk of necrotizing soft tissue infections and, secondarily, all
invasive group A streptococcal (GAS) infections in children with primary
varicella infection. METHODS: We conducted a prospective, multicenter
case-control study among children <19 years old. Cases were children hospitalized
with primary varicella complicated by invasive GAS infection or necrotizing soft 
tissue infection identified by a network of 45 pediatric infectious disease
specialists located throughout the United States. Controls were children with
uncomplicated primary varicella residing in the same communities as the cases.
Data on medical history, clinical features of the varicella infection, signs and 
symptoms of infectious complications, and medication use were collected by
structured telephone interviews. Univariate and multivariate matched odds ratios 
were calculated using conditional logistic regression. RESULTS: Between June 1996
and September 1998, 52 cases of invasive GAS infection, including 21 with
necrotizing soft tissue infection, and 172 controls with uncomplicated primary
varicella were enrolled. Risk of invasive GAS infection was increased among
children who were nonwhite (multivariate odds ratio [OR] 3.8, 95% confidence
interval [CI]: 1.4-11), living in low-income households (OR 5.1, 95% CI: 1.7-15),
exposed to varicella at home (OR 6.4, 95% CI: 2.6-16), or had a persistent high
fever (OR 9.6, 95% CI: 2.8-33). Antipyretic regimen was associated with several
measures of varicella illness severity among the controls. The risk of
necrotizing soft tissue infection was not associated with the use of ibuprofen
before the development of signs or symptoms of this complication (OR 1.3, 95% CI:
0.33-5.3). Risk of any invasive GAS infection was increased among children who
had received ibuprofen (OR 3.9, 95% CI: 1.3-12), but not acetaminophen (OR 1.2,
95% CI: 0.50-3.0). However, there was no evidence of increasing risk with
increasing duration of ibuprofen use. Subgroup analyses revealed that the risk of
invasive GAS infection was increased only among children who had received both
acetaminophen and ibuprofen. CONCLUSIONS: These data do not support the
hypothesis that nonsteroidal antiinflammatory drugs, or ibuprofen in particular, 
increase the risk of necrotizing GAS infections. A statistically significant
association was observed between nonnecrotizing invasive GAS infection and
ibuprofen use; however, because of potential confounding, the meaning of this
unexpected result is unclear. Nonetheless, these data suggest that parents use
ibuprofen or ibuprofen together with acetaminophen to treat high fever and severe
illness, which seems to identify children at high risk for invasive GAS
infection.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11331694 [PubMed - indexed for MEDLINE]

636: Fam Pract. 2001 Jun;18(3):249-52.

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

Shepherd J, Harris T, Harrison T, Hilton S.

Department of General Practice and Primary Care, St George's Hospital Medical
School, London, UK.

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

PMID: 11356729 [PubMed - indexed for MEDLINE]

637: Paediatr Drugs. 2001;3(4):285-92.

25 years' experience with the Biken Oka strain varicella vaccine: a clinical
overview.

Takahashi M.

Research Foundation for Microbial Diseases, Osaka University, Suita, Japan.
michiaki@biken.osaka-u.ac.jp

Although commonly considered a benign disease in childhood, varicella is a
potentially serious infection not only in high risk groups such as children with 
immune deficiencies, but also in otherwise healthy adults and children.
Complications include bacterial superinfections, pneumonia and encephalitis, and 
the infection can be fatal. In addition to the substantial burden of clinical
disease, varicella presents a large economic burden to society. In the absence of
a satisfactory treatment for varicella infection, vaccination has an important
role in preventing the disease and its sequelae. The original Oka strain live
attenuated varicella vaccine was developed in 1974 at the Biken Institute in
Japan. Since its development more than 25 years ago, the Biken varicella vaccine 
has been studied in a large number of clinical trials. The wealth of clinical
experience obtained with this vaccine serves to confirm its tolerability,
immunogenicity and efficacy in both healthy and high risk individuals.
Vaccination has been shown to prevent clinical infection and provide effective
protection against the severe complications of varicella. This historical review 
summarises the long clinical experience with the Biken varicella vaccine and
confirms that the vaccine is very well tolerated and provides long term immunity 
from varicella infection.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11354700 [PubMed - indexed for MEDLINE]

638: Epidemiol Infect. 2001 Apr;126(2):279-83.

Epidemiology of varicella in Slovenia over a 20-year period (1979-98).

Socan M, Kraigher A, Pahor L.

Centre of Communicable Diseases, Institute of Public Health of the Republic of
Slovenia, Ljubljana.

Varicella is one of the most common childhood diseases. The course of the disease
is usually mild and uncomplicated. In Slovenia, varicella is a notifiable
communicable disease which must be reported. Data collected from 1979-98 were
analysed. Over the 20-year period the number of varicella cases reported ranged
from a low of 11,086 (in 1994) to a maximum of 21,141 (in 1987). During the last 
10 years, the highest incidence of varicella was reported in children aged from
12 months to 2 years. In adults over 20, incidence has slightly but steadily
increased over the 20 year period. Overall, the number of males with varicella
exceeded that of females. The proportion of females was higher only in the
20-30-year age group, probably as a consequence of more frequent and closer
contact with infected children by mothers. The highest number of reported cases
was during winter and early spring.

PMID: 11349978 [PubMed - indexed for MEDLINE]

639: Epidemiol Infect. 2001 Apr;126(2):269-77.

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

Kokaze A, Yoshida M, Sekine Y, Ishikawa M, Kurokochi T, Uchida Y, Matsunaga N,
Takashima Y.

Department of Public Health, Kyorin University School of Medicine, Mitaka-shi,
Tokyo, Japan.

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

PMID: 11349977 [PubMed - indexed for MEDLINE]

640: Microbiol Immunol. 2001;45(3):267-9.

Investigation of varicella-zoster virus DNA in lymphocyte subpopulations by
quantitative PCR assay.

Ito Y, Kimura H, Hara S, Kido S, Ozaki T, Nishiyama Y, Morishima T.

Department of Pediatrics/Developmental Pediatrics, Nagoya University Graduate
School of Medicine, Aichi, Japan. yyito@med.nagoya-u.ac.jp

To investigate the nature of viremia during the acute phase of varicella, we
studied the viral load in nine otherwise healthy children with varicella. Plasma 
and peripheral blood mononuclear cells (PBMC) were obtained, then PBMC were
divided into CD4+T, CD8+T, and B lymphocytes and monocyte/macrophage fractions.
The viral DNA in each component was quantified using a real-time quantitative
polymerase chain reaction assay. Varicella-zoster virus (VZV) DNA was detected in
plasma, PBMC and all subpopulations. The amount of viral DNA was similar in each 
PBMC subpopulation, suggesting that each lymphocyte fraction and monocytes carry 
similar amounts of VZV DNA during viremia.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11345538 [PubMed - indexed for MEDLINE]

641: Arch Virol Suppl. 2001;(17):135-42.

Varicella zoster virus in human and rat tissue specimens.

Annunziato PW, Lungu O, Panagiotidis C.

Department of Pediatrics, College of Physicians and Surgeons, Columbia
University, New York, New York, USA.

The limited supple of appropriate tissues for study has been an impediment to
investigations of varicella zoster virus (VZV) latency. Human dorsal root ganglia
(DRG) harboring latent virus are not plentiful and are not amenable to
manipulation for studying the events surrounding the establishment, maintenance, 
and cessation of latency. An alternative to studies in human DRG is the rat model
of latency, which appears to provide a reliable method of investigating VZV
latency. Other alternatives include studies in other human tissues involved in
VZV pathogenesis. In order to improve our understanding of the establishment and 
cessation of latency, we performed comparative immunohistochemical analysis of
chickenpox and zoster skin lesions. This analysis revealed that during primary
infection and reactivation productive VZV infection occurs in a variety of cell
types and that the major VZV DNA binding protein, ORF29p, is present in
peripheral axons early during the course of chickenpox. VZV latency was studied
in the rat model by in situ hybridization and compared with similar studies
performed in human DRG containing latent virus, confirming that VZV DNA persists 
in the same sites in DRG of the two species.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11339542 [PubMed - indexed for MEDLINE]

642: Arch Virol Suppl. 2001;(17):1-6.

The current status of live attenuated varicella vaccine.

Gershon AA.

Department of Pediatrics, Columbia University College of Physicians & Surgeons,
New York, New York 10032, USA.

This manuscript reviews the means by which live attenuated varicella vaccine
offers protection against varicella and zoster. It is accepted that although
varicella is usually a mild illness, complications leading to morbidity and
mortality are significant and the disease is worth preventing. The vaccine offers
close to 100% protection from severe chickenpox and 90% protection from illness. 
Waning of immunity after vaccination, particularly in children, has not been a
significant problem. Ways in which vaccination may decrease the incidence and
severity of zoster include the following. Vaccine virus may be less likely to
establish latency and to be able to reactivate than wild type virus. In addition,
by selective immunization of certain hosts such as HIV-infected children whose,
immune systems are still relatively intact and individuals with latency due to
wild type virus to boost the cell-mediated immune response to the virus, zoster
may be decreased. Varicella vaccine is predicted to have a major impact on the
epidemiology of varicella and zoster in countries with high vaccine uptake.

Publication Types: 
    Review

PMID: 11339539 [PubMed - indexed for MEDLINE]

643: Pediatr Emerg Care. 2001 Apr;17(2):101-3.

Lack of reduction in hospitalizations and emergency department visits for
varicella in the first 2 years post-vaccine licensure.

Rhein L, Fleisher GR, Harper MB.

Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
Rhein_L@a1.tch.harvard.edu

OBJECTIVES: To describe and compare the incidence and spectrum of complications
of varicella pre-vaccine and post-vaccine licensure. METHODS: We performed a
retrospective chart review of children under age 21 years either treated in the
emergency department (ED) or admitted to the hospital with varicella at
Children's Hospital, Boston, from January to December 1994 (pre-licensure) and
from January 1996 to December 1997 (post-licensure). RESULTS: We identified 937
children who made a visit to the ED for varicella and 270 children hospitalized
for varicella during the 3-year study period. The ratio of varicella-related
visits to the ED to total visits (0.67%) did not vary significantly from the
post-vaccine ratio (0.60%). The most common reasons for a visit were cellulitis
in immunocompetent patients and treatment with varicella zoster immune globulin
(VZIG) in children with immunosuppression. Similarly, the ratio of
varicella-related hospitalizations to total hospitalizations did not vary in the 
pre-vaccine (0.53%) and post-vaccine (0.47%) eras. The most common complications 
in hospitalized patients were cellulitis in previously healthy children (37%) and
uncomplicated varicella in immunocompromised patients (36%). The distribution of 
diagnoses in the ED and complications among hospitalized children did not differ 
significantly in the pre-vaccine and post-vaccine eras. CONCLUSIONS: Despite
licensure of the varicella vaccine, varicella-related hospitalizations and ED
visits have not changed significantly. Further efforts are needed to increase
utilization of the varicella vaccine.

Publication Types: 
    Comparative Study

PMID: 11334087 [PubMed - indexed for MEDLINE]

644: Arch Pediatr Adolesc Med. 2001 Apr;155(4):455-61.

Comment in:
    Arch Pediatr Adolesc Med. 2001 Apr;155(4):440-1.

Partial uptake of varicella vaccine and the epidemiological effect on varicella
disease in 11 day-care centers in North Carolina.

Clements DA, Zaref JI, Bland CL, Walter EB, Coplan PM.

Campus Box 3810, Duke University Medical Center, Durham, NC 27710, USA.
cleme002@mc.duke.edu

BACKGROUND: The increasing use of varicella vaccine in children attending day
care has rapidly decreased the incidence of wild-type varicella disease. The herd
immunity noted is significant and will have an effect on the epidemiology of
natural varicella. OBJECTIVE: To monitor the change in varicella incidence in
day-care attendees after the licensure of varicella vaccine. DESIGN: A
prospective observational cohort study design. SETTING: Eleven private day-care
centers and preschools in North Carolina participated in the study from January
1, 1995, through December 31, 1999. PARTICIPANTS: All children in the 11 centers 
were eligible for participation. Some participated more actively, supplying
information on a regular basis. Others participated passively. Day-care personnel
provided information about all cases of varicella. INTERVENTIONS: None. MAIN
OUTCOME VARIABLES: The change in the incidence of varicella disease was
documented as the use of varicella vaccine increased. RESULTS: Varicella vaccine 
coverage increased substantially from 4.4% in 1995 to 63.1% in December 1999. The
vaccination rate accelerated dramatically in 1996 and 1997, leveled off in 1998, 
and rose again in 1999. Cumulative varicella incidence decreased from 16.74 cases
per 1000 person-months in July 1996 to 1.53 cases per 1000 person-months in
December 1999 in unvaccinated children. CONCLUSIONS: The varicella vaccination
rate continued to increase slowly in the day-care population after an initial
rapid uptake. The decrease in varicella disease is greater than the increase in
varicella vaccination. This herd effect is welcome and even apparent in the
unvaccinated children younger than 1 year.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11296072 [PubMed - indexed for MEDLINE]

645: Clin Infect Dis. 2001 May 15;32(10):1414-22. Epub 2001 Apr 18.

A predictive model of varicella-zoster virus infection after autologous
peripheral blood progenitor cell transplantation.

Offidani M, Corvatta L, Olivieri A, Mele A, Brunori M, Montanari M, Rupoli S,
Scalari P, Leoni P.

Department of Hematology, Ancona University School of Medicine, Ancona, Italy.
clinemat@popcsi.unian.it

Varicella-zoster virus (VZV) frequently causes severe infections in patients who 
have undergone bone marrow transplantation. The frequency of, characteristics of,
and risk factors for this infection were studied in 164 patients undergoing
autologous peripheral blood progenitor cell transplantation (PBPCT). Twenty-six
patients (15.8%) developed VZV infection, and the actuarial risk was 10% at 1
year. No patient had visceral dissemination or died because of VZV, although
one-third of the patients developed postherpetic neuralgia. By multivariate
analysis, a CD4(+) lymphocyte count of <200 cells/microL (P<.0001; odds ratio
[OR], 2.0) and a CD8(+) lymphocyte count of <800 cells/microL (P=.0073; OR, 2.0) 
at day 30 after transplantation were factors associated with VZV infection.
Patients with both these adverse factors had an actuarial risk of VZV of 48% at 1
year. Patients with deficiency in both CD4(+) and CD8(+) lymphocytes are at high 
risk of VZV infection. These patients should be considered as candidates for
preventive therapy, but whether for antiviral therapy or vaccination remains to
be investigated.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11317241 [PubMed - indexed for MEDLINE]

646: J Clin Pediatr Dent. 2001 Winter;25(2):107-12.

Oral manifestations of infections of infections due to varicella zoster virus in 
otherwise healthy children.

Kolokotronis A, Louloudiadis K, Fotiou G, Matiais A.

Department of Oral Medicine and Pathology, Dental School of Aristotle University 
of Thessaloniki, 54006 Thessaloniki, Greece.

Varicella zoster virus (VZV) causes varicella (or chickenpox) and establishes
latency in nerve ganglia after the primary infection. The reactivation of virus
later in life can cause mono- or polyneuropathy. The cranial nerves most commonly
involved are five (herpes zoster or shingles), six, seven eight, nine and ten. In
the present study we describe the oral lesions associated with VZV infections in 
normal children. In a 3 year period we examined 62 children, age 2 to 13 years
old with diagnosed varicella and a 4 year old boy with herpes zoster at the 3rd
branch of the trigeminal nerve. According to the clinical picture of varicella,
the disease was defined as: (1) group A mild cases; (2) group B moderate cases;
(3) group C severe. The manifestations of varicella were: mild varicella 19
children, moderate 26 children and severe 17 children. The results of the present
study indicate that the prevalence of oral manifestations of varicella is related
to the severity of the disease. In 17 severe cases, oral lesions were always
present and the number was between 5 to 30. From 26 moderate cases, oral lesions 
were observed in 23 and the number was between 2 to 10. From 19 mild cases, oral 
lesions were present only in 6 cases and their number was 1 or 2. Often
varicella's oral lesions resemble manifestations of other entities, and this may 
cause differential diagnostics problems.

PMID: 11314207 [PubMed - indexed for MEDLINE]

647: Vaccine. 2001 Apr 30;19(23-24):3097-103.

Age-specific seroprevalence to varicella-zoster virus: study in Swiss children
and analysis of European data.

Aebi C, Fischer K, Gorgievski M, Matter L, Mühlemann K.

Department of Pediatrics, University of Bern, CH-3010 Inselspital, 3010, Bern,
Switzerland. christoph.aebi@insel.ch

Up to date epidemiological data provide the rationale for potential varicella
immunization strategies in Europe. The scope of this study was: (1) to generate
new seroprevalence data by evaluating sera of 970 individuals aged 0-16 years for
the presence of IgG against Varicella-zoster virus (VZV); and (2) to review
existing seroprevalence data. Of 256 individuals >12 years of age, 96.1% (95%
confidence interval [CI], 93.7-98.5) were seropositive. Swiss citizens > 12 years
of age were less likely to be seronegative than foreign citizens (2.3 vs. 15.4%; 
odds ratio, 0.17; CI, 0.05-0.58). The age-specific seroprevalence curve
demonstrated a peak at 7 years of age (84.9%; CI, 75.2-94.5) followed by lower
rates at 8 and 9 years. A peak at 7-10 years of age was found in all previously
reported seroprevalence curves (chi(2)-test for trend of pooled data, P = 0.09;
Poisson analysis, P < 0.001). It is concluded that: (1) > 90% of individuals in
Europe acquire immunity against VZV before adolescence; (2) there is no evidence 
for a recent upward shift of the age at primary varicella; and (3) there may be a
north-to-south gradient of seroprevalence. The peak at 7-10 years may represent a
transient loss of detectable antibody by some individuals.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11312004 [PubMed - indexed for MEDLINE]

648: Infect Dis Clin North Am. 2001 Mar;15(1):65-81, viii.

Live-attenuated varicella vaccine.

Gershon AA.

Department of Pediatrics, Columbia University College of Physicians & Surgeons,
New York, New York, USA. aag1@columbia.edu

This article reviews the history and development of live attenuated varicella
vaccine from its early days in Japan to its widespread use throughout the world. 
The vaccine has proven extremely safe after immunization of as many as 10 million
healthy children and adults in the United States alone. The vaccine is also
highly immunogenic and offers close to 100% protection from severe chickenpox and
90% protection from illness. It is expected to have a major impact on the
epidemiology of varicella and zoster in countries with high vaccine uptake.

Publication Types: 
    Review

PMID: 11301823 [PubMed - indexed for MEDLINE]

649: Med J Aust. 2001 Mar 19;174(6):288-92.

The management of varicella-zoster virus exposure and infection in pregnancy and 
the newborn period. Australasian Subgroup in Paediatric Infectious Diseases of
the Australasian Society for Infectious Diseases.

Heuchan AM, Isaacs D.

King George V Hospital, Sydney, NSW.

Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative
women with significant exposure to varicella-zoster virus (VZV) (chickenpox)
infection. Oral aciclovir prophylaxis should be considered for susceptible
pregnant women exposed to VZV who did not receive ZIG or have risk factors for
severe disease. Intravenous aciclovir should be given to pregnant women who
develop complicated varicella at any stage of pregnancy. Counselling on the risk 
of congenital varicella syndrome is recommended for pregnant women who develop
chickenpox. ZIG should be given to a baby whose mother develops chickenpox up to 
7 days before delivery or up to 28 days after delivery. Intravenous aciclovir
should be given to babies presenting unwell with chickenpox, whether or not they 
received ZIG. Breastfeeding of babies infected with or exposed to VZV is
encouraged. A mother with chickenpox or zoster does not need to be isolated from 
her own baby. If siblings at home have chickenpox, a newborn baby should be given
ZIG if its mother is seronegative. The newborn baby does not need to be isolated 
from its siblings with chickenpox, whether or not the baby was given ZIG. After
significant nursery exposure to VZV, ZIG should be given to seronegative babies
and to all babies born before 28 weeks' gestation.

PMID: 11297117 [PubMed - indexed for MEDLINE]

650: Singapore Med J. 2000 Dec;41(12):602-3.

Acute retinal necrosis syndrome complicating chickenpox.

Smith JR, Chee SP.

Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751.
jrsmith@cyberway.com.sg

Chickenpox may be complicated by ocular involvement. In these patents, acute
retinal necrosis usually forms a relatively mild course. Systemic antiviral
treatment during the acute phase of the disease is recommended. Rarely, retinal
detachment may develop, resulting in blindness. It is strongly recommended that
patients with chickenpox who develop visual symptoms should be referred for an
ophthalmological opinion early.

Publication Types: 
    Case Reports

PMID: 11296787 [PubMed - indexed for MEDLINE]

651: Aust N Z J Obstet Gynaecol. 2001 Feb;41(1):23-8.

Seroprevalence of varicella zoster virus, parvovirus B19 and Toxoplasma gondii in
a Melbourne obstetric population: implications for management.

Karunajeewa H, Siebert D, Hammond R, Garland S, Kelly H.

Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia.

At an antenatal clinic at a Melbourne obstetric hospital, 308 women were
questioned about a known past history of infection with varicella zoster virus
(VZV), human parvovirus B19 and Toxoplasma gondii. Immunoglobulin G (IgG)
concentrations were determined for the 3 infectious agents and a recalled history
of infection was compared with the presence of specific antibody. Exactly 66% of 
women recalled being infected with chickenpox (VZV) and 94% showed serological
evidence of past exposure. Although 64% of women had parvovirus specific IgG,
only one gave a definite history of past parvovirus infection. None of the 23% of
women with evidence of previous exposure to Toxoplasma gondii recalled a past
infection. The proportion of antenatal women at risk in this study was used to
estimate the potential burden of disease from congenital infections in Australia 
and to examine implications for management of pregnancies complicated by these 3 
infections.

PMID: 11284642 [PubMed - indexed for MEDLINE]

652: Commun Dis Public Health. 2000 Dec;3(4):282-7.

Epidemiology of chickenpox in Scotland: 1981 to 1998.

Bramley JC, Jones IG.

Scottish Centre for Infection and Environmental Health, Clifton House, Clifton
Place, Glasgow G3 7LN. claire.bramley@scieh.csa.scot.nhs.uk

Scotland requires cases of chickenpox to be notified formally and maintains
comprehensive data on general practice consultations, hospital admissions,
abortions, laboratory reports, and mortality associated with the disease. These
were used to investigate the age specific incidence of chickenpox for the years
1981 to 1998. The general trend was towards decreased age at infection: most
infections now occur in the 1 to 4 year age group, rather than among
schoolchildren. Hospital admissions for which a diagnosis of chickenpox was
recorded increased, mainly in the under 5 and 25 to 34 year age groups. These
data, which we believe to be among the most comprehensive available on current
chickenpox epidemiology, may be used to inform preventative policy, particularly 
now that a live vaccine for the prevention of primary varicella infection is
available. If vaccination against varicella is introduced in the United Kingdom, 
these data will provide a baseline against which to assess its impact on primary 
varicella infection.

PMID: 11280260 [PubMed - indexed for MEDLINE]

653: Commun Dis Intell. 2001 Jan;25(1):13-5.

Varicella vaccine in post-exposure prophylaxis.

Ferson MJ.

South Eastem Sydney Public Health Unit, Locked Bag 88, Randwick, NSW, Australia
2031. fersonm@sesahs.nsw.gov.au

Evidence concerning the effectiveness of Oka-based varicella vaccines when
administered following exposure to varicella zoster virus in domestic and
hospital settings is reviewed. The evidence appears to support post-exposure use 
of Oka-derived varicella vaccines in children within 3 days of rash onset in the 
index case. Despite vaccination, a small proportion will develop mild, but
infectious, chickenpox, especially if they have been exposed in the household
setting. Controlled studies of post-exposure prophylaxis in adults using both
Varilrix and Varivax II are still needed. The applicability of this approach to
disease control in health care facilities and in community settings warrants
wider discussion.

Publication Types: 
    Review

PMID: 11280194 [PubMed - indexed for MEDLINE]

654: N Engl J Med. 2001 Mar 29;344(13):955-60.

Comment in:
    N Engl J Med. 2001 Aug 9;345(6):464-5.    N Engl J Med. 2001 Mar 29;344(13):1007-9.

The effectiveness of the varicella vaccine in clinical practice.

Vázquez M, LaRussa PS, Gershon AA, Steinberg SP, Freudigman K, Shapiro ED.

Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
06520-8064, USA.

BACKGROUND: A live attenuated varicella vaccine was approved for use in the
United States in March 1995 and is recommended for all susceptible persons 12
months of age or older. METHODS: To assess the effectiveness of the varicella
vaccine, we conducted a case-control study with two controls per child with
chickenpox, matched according to both age and pediatric practice. Children with
potential cases of chickenpox were identified by active surveillance of pediatric
practices in the New Haven, Connecticut, area. Research assistants visited the
children on day 3, 4, or 5 of the illness, assessed the severity of the illness, 
and collected samples from lesions to test for varicella-zoster virus by
polymerase chain reaction (PCR). RESULTS: From March 1997 through November 2000, 
data collection was completed for 330 potential cases, of which 243 (74 percent) 
were in children who had positive PCR tests for varicella-zoster virus. Of the 56
vaccinated children with chickenpox, 86 percent had mild disease, whereas only 48
percent of the 187 unvaccinated children with chickenpox had mild disease
(P<0.001). Among the 202 children with PCR-confirmed varicella-zoster virus and
their 389 matched controls, 23 percent of the children with chickenpox and 61
percent of the matched controls had received the vaccine (vaccine effectiveness, 
85 percent; 95 percent confidence interval, 78 to 90 percent; P<0.001). Against
moderately severe and severe disease the vaccine was 97 percent effective (95
percent confidence interval, 93 to 99 percent). The effectiveness of the vaccine 
was virtually unchanged (87 percent) after adjustment for potential confounders
by means of conditional logistic regression. CONCLUSIONS: Varicella vaccine is
highly effective as used in clinical practice.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11274621 [PubMed - indexed for MEDLINE]

655: Eur J Pediatr. 2001 Feb;160(2):91-4.

Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella.

Huang YC, Lin TY, Lin YJ, Lien RI, Chou YH.

Division of Paediatric Infectious Diseases, Chang Gung Children's Hospital 5 and 
Chang Gung University, Kweishan, Taoyuan, Taiwan. kere@adm.cgmh.com.tw

Maternal chickenpox around the time of delivery can cause severe and even fatal
illness in the newborn but an effectively preventive method has not yet been
established. We proposed that a combination of intravenous immunoglobulin (IVIG) 
and acyclovir (ACV) intravenously could effectively prevent perinatal varicella. 
A group of 24 newborn infants whose mother had developed a varicella rash within 
14 days before and after delivery were studied. Some 15 infants whose mothers'
rash appeared within 7 days before and 5 days after delivery were categorised as 
an at-risk group and received IVIG prophylaxis (500 mg/kg) administered soon
after birth or post-natal contact either alone or with intravenous acyclovir (5
mg/kg every 8 h) for a total of 5 days starting from 7 days after the onset of
maternal rash. Of four infants receiving IVIG alone, two developed clinical
varicella. None of ten infants receiving both IVIG and ACV contracted varicella. 
One infant receiving ACV alone had no varicella vesicles either. Of nine infants 
in the not at-risk group four had undetectable varicella-zoster virus antibody on
admission and developed clinical varicella subsequently. CONCLUSION: The
combination of intravenous immunoglobulin given soon after birth and prophylactic
acyclovir intravenously administered 7 days after the onset of maternal rash can 
effectively prevent perinatal varicella.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 11271397 [PubMed - indexed for MEDLINE]

656: J Microbiol Immunol Infect. 2000 Dec;33(4):248-52.

Complications of varicella in children: emphasis on skin and central nervous
system disorders.

Tseng HW, Liu CC, Wang SM, Yang YJ, Huang YS.

Department of Pediatrics, National Cheng Kung University Hospital, Tainan,
Taiwan, ROC.

A review of medical records at a tertiary hospital in southern Taiwan from June
1988 through May 1998 identified 136 children who had been hospitalized for
varicella-related complications. Of the children, 83% (113/136) were healthy
before the onset of varicella and 17% (23/136) had underlying illnesses. The mean
age was 4.7 years (ranged from 1 day to 18 years) with a male predominance
(1.7:1). The mean hospital stay was 5.5 days (ranged from 1 to 22 days).
Secondary bacterial skin or soft tissue infections were the most common
complications (44%), followed by central nervous system (CNS) involvement (23%), 
pneumonia (18%), thrombocytopenia (12%), and liver function impairment (10%).
Among the 60 patients with secondary bacterial cutaneous infection, 16 (27%) had 
positive isolates, including 12 isolates of Staphylococcus aureus and four
Streptococcus pyogenes. Age above 8 years was significantly associated with the
development of varicella-associated CNS complications (p = 0.019). Of the 23
immunocompromised hosts, the most common underlying conditions were hematological
diseases (11 patients, 48%), followed by neonatal varicella (7 patients, 30%) and
chronic illness with steroid treatment (5 patients, 22%). All of the subjects in 
this study had a favorable outcome except for three lethal cases, resulting in a 
case-fatality rate of 2.2%. The cause of death was S. aureus septicemia in one
patient, streptococcal toxic shock syndrome in one patient, and encephalitis with
brain herniation in one patient. Our results demonstrate that varicella continues
to be a serious disease that occasionally results in life-threatening
complications in healthy and immunocompromised children. Routine immunization of 
all healthy children against varicella is recommended.

PMID: 11269370 [PubMed - indexed for MEDLINE]

657: Pediatr Transplant. 2001 Feb;5(1):44-50.

Pretransplant varicella vaccination is cost-effective in pediatric renal
transplantation.

Olson AD, Shope TC, Flynn JT.

Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, University
of Michigan, Ann Arbor, USA. olsona@centocor.com

Because of the severe complications that may result from varicella zoster virus
(VZV) infection following renal transplantation (Tx), transplanted
varicella-susceptible children exposed to varicella are typically given varicella
zoster immunoglobulin (VZIG) as prophylaxis or are admitted and treated with
parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hospitalization 
are costly, prevention of varicella infection by vaccination could potentially
result in significant cost savings in addition to decreasing morbidity and
mortality. To test this hypothesis, we developed a decision-analysis model to
evaluate the cost-effectiveness of vaccinating patients with chronic renal
failure (CRF) against varicella prior to renal transplant. Under baseline
assumptions, vaccination for varicella pretransplant was a cost-effective
strategy, with a cost of $211 per patient vaccinated compared with $1,828 per
patient not vaccinated. The magnitude of cost savings from vaccination was
sensitive to variations in the cost of varicella vaccine, the percentage of
patients hospitalized for treatment with acyclovir, and the percentage of
patients exposed to varicella infection. One- and two-way sensitivity analyses
confirmed that vaccination was the dominant cost-effective strategy under all
conditions examined. We conclude that vaccination for varicella pretransplant is 
cost-effective for patients with CRF, and that the magnitude of cost savings is
sensitive to the cost of hospitalization, the percentage of patients exposed to
varicella, and the cost of varicella vaccination. Pending results of ongoing
studies of the safety and efficacy of VZV vaccine in children with CRF, we
recommend that VZV vaccine be given to all children with CRF.

Publication Types: 
    Comparative Study

PMID: 11260488 [PubMed - indexed for MEDLINE]

658: J Hosp Infect. 2001 Mar;47(3):243-5.

Should health care workers in the tropics be immunized against varicella?

Richard VS, John TJ, Kenneth J, Ramaprabha P, Kuruvilla PJ, Chandy GM.

Hospital Infection Control Committee, Christian Medical College and Hospital,
Vellore, India.

In tropical regions, chickenpox affects both adults and children. Therefore,
healthcare workers in the tropics are vulnerable to hospital-acquired varicella
infection and they may transmit infection to susceptible hospitalized
individuals. Although the varicella vaccine is safe and effective, its cost is a 
deterrent to its use in routine immunization programmes. In order to assess
whether vaccination of susceptible healthcare workers to prevent
hospital-acquired transmission may be justified, we have documented the frequency
of varicella among healthcare workers in our hospital. There were 96 admissions
for varicella during the 1993-1997 period; staff and student nurses accounted for
76%. The peak season of admission was from February to April. The attack rate in 
staff and student nurses was 0.78 and 1.54 per 100 person-years, respectively.
While community outbreaks of varicella occur in this region once in 4-5 years,
hospital outbreaks of varicella occurred every year. This poses the risk of
transmission to hospitalized patients, with serious consequences among
immunocompromized individuals. Therefore, we recommend systematic selective
vaccination of susceptible healthcare workers to break this cycle of annual
varicella outbreaks among hospital personnel. Copyright 2001 The Hospital
Infection Society.

Publication Types: 
    Validation Studies

PMID: 11247687 [PubMed - indexed for MEDLINE]

659: Prenat Diagn. 2001 Feb;21(2):121-4.

Fetal varicella-herpes zoster syndrome in early pregnancy: ultrasonographic and
morphological correlation.

Petignat P, Vial Y, Laurini R, Hohlfeld P.

Department of Gynecology and Obstetrics, CHUV, Lausanne, Switzerland.
ppetignat@hotmail.com

We report a case of an intrauterine fetal infection by the varicella-herpes
zoster virus following maternal varicella at 17 weeks' amenorrhea. Prenatal
diagnosis of fetal infection was confirmed by serology and fetal damage by
ultrasonography. Autopsy of the fetus showed multiorgan manifestation with
disseminated foci of necrosis and microcalcifications, encephalitis and
unilateral segmental skin scarring with an underlying hypoplastic fixed lower
limb. The placenta showed a multifocal chronic villitis with multinucleated giant
cells. The lesions included segmental anomalies and multiorgan damage. Copyright 
2001 John Wiley & Sons, Ltd.

Publication Types: 
    Case Reports

PMID: 11241539 [PubMed - indexed for MEDLINE]

660: Brain Dev. 2001 Mar;23(1):54-7.

Varicella-associated acute necrotizing encephalopathy with a good prognosis.

Tran TD, Kubota M, Takeshita K, Yanagisawa M, Sakakihara Y.

Department of Pediatrics, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku,
113-8655, Tokyo, Japan.

A patient with acute necrotizing encephalophathy (ANE) following varicella
infection with a good prognosis is reported. A somatosensory evoked magnetic
field (SEF) study using a 37-channel-magnetoencephalography system demonstrated
normal latency and strength of the first component (N20m) elicited by median
nerve stimulation, despite bilateral symmetrical thalamic lesions on MRI. The
normal SEF findings and the good prognosis suggested a reversible breakdown of
the blood-brain barrier, and an edematous process as the brain pathology.
Furthermore, our results support the idea of distinct generators for the three
earliest cortical SEF components (N20m, P30m, N45m).

Publication Types: 
    Case Reports

PMID: 11226732 [PubMed - indexed for MEDLINE]

661: Microbiol Immunol. 2000;44(12):1027-31.

IL-12, IFN-gamma, and TNF-alpha released from mononuclear cells inhibit the
spread of varicella-zoster virus at an early stage of varicella.

Torigo S, Ihara T, Kamiya H.

Department of Pediatrics, Yokkaichi Social Insurance Hospital, Mie, Japan.
yokkab32@pmet.or.jp

The activity of mononuclear cells to inhibit plaque formation of varicella-zoster
virus (VZV) was investigated by an in vitro infectious center assay. Peripheral
blood mononuclear cells (PBMC) inhibited VZV plaque formation by co-cultivation
with VZV-infected fibroblasts. As compared to mononuclear cells from normal
individuals, mononuclear cells from umbilical cord blood and from patients
receiving corticosteroids showed a significant decrease in the ability to inhibit
viral replication. This ability was significantly increased for mononuclear cells
collected during the acute phase of varicella. PBMC obtained from patients in the
acute phase of varicella produced significantly higher amounts of interferon
(IFN)-gamma, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-12 in the
supernatant compared with those of healthy individuals. These data suggest that
the cytokines have an important role in the inhibition of the spread of VZV at an
early stage of varicella. Th1 type adaptive immunity might play a major role in
VZV infection.

PMID: 11220676 [PubMed - indexed for MEDLINE]

662: Epidemiol Infect. 2000 Dec;125(3):651-69.

Modelling the impact of immunization on the epidemiology of varicella zoster
virus.

Brisson M, Edmunds WJ, Gay NJ, Law B, De Serres G.

PHLS Communicable Disease Surveillance Centre, London.

The objective of this study was to develop and apply a dynamic mathematical model
of VZV transmission to predict the effect of different vaccination strategies on 
the age-specific incidence and outcome of infection. To do so a deterministic
realistic age-structured model (RAS) was used which takes account of the
increased potential for transmission within school aged groups. Various vaccine
efficacy scenarios, vaccine coverages and vaccination strategies were
investigated and a sensitivity analysis of varicella incidence predictions to
important parameters was performed. The model predicts that the overall (natural 
and breakthrough) incidence and morbidity of varicella would likely be reduced by
mass vaccination of 12-month-old children. Furthermore, adding a catch-up
campaign in the first year for 1-11 year olds seems to be the most effective
strategy to reduce both varicella incidence and morbidity (in the short and long 
term), though with the possible detrimental effect of increasing the incidence of
zoster.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11218215 [PubMed - indexed for MEDLINE]

663: Lancet. 2001 Feb 3;357(9253):360-1.

Genetic resistance factor for HIV-1 and immune response to varicella zoster
virus.

Wiencke JK, Kelsey KT, Zuo ZF, Weinberg A, Wrensch MR.

A 32 bp deletion in the chemokine receptor CCR5 gene modulates HIV-1 infection.
However, whether this CCR5 gene variation modifies immunity to common herpesvirus
infections is unknown. We investigated whole blood IgG concentrations of 157
normal adult blood donors. Also we assessed whether the 32 bp deletion of CCR5
(delta32CCR5) was associated with circulating IgG to four herpesviruses:
varicella zoster virus, Epstein-Barr virus, cytomegalovirus, and herpes simplex
virus type 1 and type 2. Individuals who carried delta32CCR5 were 9.2 times more 
likely to be seronegative for varicella zoster virus than non-carriers (95% CI
2.9-29.1), but no differences were seen for the other herpesviruses studied.
Variation in CCR5 may modulate humoral immunity to varicella zoster virus.

Publication Types: 
    Letter
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11211001 [PubMed - indexed for MEDLINE]

664: Mil Med. 2001 Jan;166(1):11-3.

Comment in:
    Mil Med. 2001 Jul;166(7):ii.

The cost-saving potential of prevaccination antibody tests when implementing a
mass immunization program.

Memish ZA, Oni GA, Bannatyne RM, Qasem L.

Department of Infection Prevention and Control, King Fahad National Guard
Hospital, Riyadh 11426, Saudi Arabia.

A seroprevalence study of hepatitis A virus (HAV), hepatitis B virus (HBV), and
varicella-zoster virus (VZV) was carried out among Saudi Arabian National Guard
soldiers with the objective of determining the cost-saving potential of
prevaccination antibody tests when implementing an immunization program for the
soldiers. A systematic sampling of 450 blood samples from 1,350 soldiers who
donated blood at our hospital was carried out. Antibody tests were performed
using the enzyme-linked immunosorbent assay method. The seropositivity rates for 
antibodies to HAV, HBV, and VZV were 97.5, 17.8, and 88.5%, respectively.
Comparing the cost of prevaccine screening with that of universal vaccination, it
was estimated that savings of 76 and 32% could be effected for HAV and VZV.
Conversely, screening for HBV before immunization could increase the cost of
vaccinating against the disease by 49%. A seroprevalence study could be a useful 
cost-saving approach to a mass immunization program against endemic, natural
immunity-conferring diseases.

PMID: 11197089 [PubMed - indexed for MEDLINE]

665: Acta Paediatr. 2000 Dec;89(12):1497-9.

Acyclovir-resistant varicella infection with atypical lesions in a non-HIV
leukemic infant.

Crassard N, Souillet AL, Morfin F, Thouvenot D, Claudy A, Bertrand Y.

Department of Pediatric Hematology and Immunology, H pital Debrousse, Lyon,
France.

An HIV-negative infant presented with VZV primary infection during the
maintenance therapy for megakaryoblastic leukaemia. The lesions were initially
vesicular and necrotic but became verrucous and hyperkeratotic. A clinical
resistance to acyclovir was suspected and confirmed by histologic and virologic
studies. The patient was successfully treated by foscarnet. CONCLUSION:
resistance of VZV to acyclovir may occur after a short treatment in a non-AIDS
patient.

Publication Types: 
    Case Reports

PMID: 11195245 [PubMed - indexed for MEDLINE]

666: Pediatr Int. 2000 Dec;42(6):674-7.

Safety and immunogenicity of live attenuated varicella vaccine in 9-month-old
children.

Kanra G, Ceyhan M, Ozmert E.

Hacettepe University Faculty of Medicine, Pediatric Infectious Disease Unit,
Ankara, Turkey. gkanra@gen.hun.edu.tr

BACKGROUND: The present study was conducted to evaluate the safety and
immunogenicity of live attenuated varicella vaccine (Oka-strain) in 9-month-old
infants. METHODS: One hundred and fourteen infants were vaccinated once with live
attenuated varicella vaccine (Valrix; SmithKline Beecham Biologicals, Rixensart, 
Belgium) containing a mean virus titer of 10(4.0) plaque-forming units (p.f.u.)
per dose. Signs and/or symptoms after vaccination were followed for 42 days. Home
visits were made to detect solicited local reactions (0-3 days) and solicited
general reactions (0-21 days), as well as unsolicited reactions. Specific
varicella antibodies were determined by an indirect immunofluorescence method.
The geometric mean titer and seroconversion rate were calculated. RESULTS: Signs 
and/or symptoms were reported in 47.4% (54/114) of cases following vaccination.
The only local symptom reported was pain on digital pressure at the injection
site and this was reported in 28.1% (32/114) of infants. General symptoms were
reported in 38.6% (44/114) of cases. The most frequently reported findings were
fever (27.2%), which was mostly mild, restlessness (20.2%) and cough (11.4%).
Only four unsolicited symptoms were reported and they were all unrelated to
vaccination. No serious adverse event was reported. Of the 109 infants included
in the immunogenicity analysis, 105 were seronegative and four were seropositive 
for antibodies against varicella before vaccination. The vaccine elicited
seroconversion in 97.1% of initially seronegative cases. The post-vaccination
geometric mean titer for these infants was 30.9 geometric mean titer (GMT).
CONCLUSIONS: The vaccine was found to be safe and immunogenic when given to
infants as young as 9 months of age. This may be of clinical significance during 
outbreaks of varicella and especially for developing countries.

Publication Types: 
    Clinical Trial

PMID: 11192526 [PubMed - indexed for MEDLINE]

667: J Perinatol. 2000 Dec;20(8 Pt 1):548-54.

The congenital varicella syndrome.

Sauerbrei A, Wutzler P.

Institute for Antiviral Chemotherapy, Friedrich-Schiller University Jena, H.
Winzeulaer Strasse 10, D-07745 Jena, Germany.

Maternal varicella during the first two trimesters of pregnancy may cause the
congenital varicella syndrome (CVS). After infection in the first 20 weeks'
gestation, the incidence is estimated to be about 2%. To date, nearly 100 infants
born with signs of CVS have been reported in the literature, more than three
quarters of them during the last two decades. The characteristic symptoms consist
of skin lesions in dermatomal distribution (76%), neurologic defects (60%), eye
diseases (51%), and skeletal anomalies (49%). About 30% of infants born with
these lesions died in the first months of life. The diagnosis of CVS should be
established by the appearance of maternal varicella, the presence of typical
clinical symptoms as well as the laboratory evidence of in utero varicella-zoster
virus (VZV) infection. In the reviewed infants, intrauterine VZV-infection has
been proved in about 60%. Passive immunization may reduce the risk of fetal
infection but there is no evidence to prevent fetal viremia. Up to now, there are
no controlled studies concerning antiviral chemotherapy in preventing CVS.

Publication Types: 
    Review

PMID: 11190597 [PubMed - indexed for MEDLINE]

668: J Dermatol. 2000 Nov;27(11):750-2.

A case of varicella complicated by cellulitis and scarlet fever due to
Streptococcus pyogenes.

Oyake S, Ohi T, Koga M.

Department of Dermatology, Tokyo Medical University, 6-7-1 Nishishinjuku,
Shinjuku-ku, Tokyo 160-0023, Japan.

We report a 4-year-old boy with cellulitis and scarlet fever due to streptococcal
infection following the onset of varicella. He developed a painful ulcer and
subcutaneous induration on the left shoulder and a small, light-red-colored rash 
on the trunk at approximately the same time as the development of vesicles over
the entire body. Streptococcus pyrogenes was isolated from samples from the
posterior intranasal space and the ulcer on the shoulder. The clinical symptoms
improved with the administration of antibiotics and intravenous drip infusion,
but it took approximately one month from the first visit for the subcutaneous
induration to disappear and the ulcer to heal with epithelialization. The
complication of secondary streptococcal infection in varicella is relatively rare
in Japan, but in Western countries there have been many reported cases of
life-threatening necrotizing fasciitis and necrotizing pyomyositis due to
secondary streptococcal infection following varicella. Close attention should be 
paid to streptococcal infection as a complication of varicella.

Publication Types: 
    Case Reports

PMID: 11138545 [PubMed - indexed for MEDLINE]

669: J Adolesc Health. 2001 Jan;28(1):26-9.

Serotesting versus presumptive varicella vaccination of adolescents with a
negative or uncertain history of chickenpox.

Harel Z, Ipp L, Riggs S, Vaz R, Flanagan P.

Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode
Island 02903, USA.

OBJECTIVE: To review the current practice of adolescent health care providers
when an adolescent reports a negative or uncertain history of chickenpox in order
to provide information for future practice. METHODS: Retrospective chart review
of a sample of patients seen in a hospital-based adolescent primary care clinic
between 1996 and 1999. RESULTS: Among adolescents who reported a positive history
of chickenpox (190 patients, aged 15 +/- 1 years), varicella occurred before age 
5 years in 30%, between 5 and 10 years in 56%, and at older than age 10 years in 
14% of the patients. When adolescents reported a negative or uncertain history of
varicella (55 patients, aged 15 +/- 1 years), serotesting was ordered for the
majority (73%) of cases, while only 16% were presumptively vaccinated with
varicella vaccine. In six patients no intervention was noted in the charts, and
these patients were contacted. In 80% of the patients who were serotested,
varicella IgG titers of > or = 1:32 indicated a previous unnoticed infection and 
lifelong immunity to varicella. In only 20% of the patients sera were negative
for varicella IgG titer, requiring varicella vaccination. There was no
statistical difference between the number of siblings of patients with a positive
serologic test (3 +/- 1) and the number of siblings of seronegative patients (2
+/- 1, p = 0.41). Seven of the eight seronegative patients consented to varicella
vaccination and were vaccinated within 10 months of serotesting. CONCLUSIONS:
These data support the practice of serotesting for a previously unnoticed
varicella infection rather than presumptive vaccination in the adolescent age
group. A follow-up vaccination of seronegative adolescents should be scheduled as
close to serotesting as possible.

Publication Types: 
    Comparative Study

PMID: 11137902 [PubMed - indexed for MEDLINE]

670: Pediatrics. 2001 Jan;107(1):E9.

Central nervous system and renal vasculitis associated with primary varicella
infection in a child.

Caruso JM, Tung GA, Brown WD.

Department of Neurology, Childrens National Medical Center, Washington, DC, USA.

A 7-year-old girl with primary varicella presented with encephalopathy and focal 
neurologic deficits 10 days after her first skin lesions appeared. She was
discovered to have bilateral wedge-shaped renal infarctions, and ischemic lesions
in the conus medullaris, cerebral cortex, and deep gray matter consistent with a 
medium and large vessel arteritis on magnetic resonance imaging. This
complication has never before been reported in an immunocompetent child with
primary varicella infection, and it represents a rare but serious complication of
childhood chickenpox.

Publication Types: 
    Case Reports

PMID: 11134473 [PubMed - indexed for MEDLINE]

671: Pediatrics. 2001 Jan;107(1):67-72.

Varicella outbreak at a summer camp for human immunodeficiency virus-infected
children.

Winquist AG, Roome A, Hadler J.

Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease
Control and Prevention, Atlanta, Georgia, USA. aiw1@cdc.gov

OBJECTIVES: Varicella can result in severe, persistent, or recurrent disease in
human immunodeficiency virus (HIV)-infected children. In the summer of 1997, we
were notified of a suspected varicella outbreak among attendees of a summer camp 
for HIV-infected children. We investigated this outbreak to determine the extent 
and sequelae of the outbreak, and to identify factors that contributed to the
outbreak to identify measures for preventing such outbreaks at the camp in the
future. DESIGN: To identify varicella-susceptible persons and those developing
varicella after camp and to evaluate the camp's varicella prevention measures, we
reviewed camp records for the 110 campers and 96 staff at the implicated camp
session, mailed questionnaires to the campers' parents/guardians and physicians, 
and interviewed susceptible staff. We defined a case as varicella in a person who
attended the session with onset </=21 days after the session ended. RESULTS:
Eleven of 31 susceptible children (36%) and 2 of 4 susceptible adults developed
varicella. Two children were hospitalized. One developed cellulitis. Cases
occurred among children in 5 of 15 cabins. The most likely index case was a child
with active zoster at camp, reported to the camp after the session ended. The
camp had varicella-prevention measures in place, but the varicella-susceptibility
and exposure information provided to the camp was often incomplete or inaccurate.
Staff with no varicella history underwent serologic testing, but susceptible
staff members were not vaccinated. CONCLUSIONS: Widespread varicella transmission
occurred at the camp. A case of zoster was the most likely source. The risk for
such outbreaks can be minimized through vaccinating susceptible staff members,
considering vaccination for asymptomatic or mildly symptomatic HIV-infected
children according to Advisory Committee on Immunization Practices and American
Academy of Pediatrics guidelines, rigorously collecting recent varicella and
zoster exposure information, excluding anyone with active varicella or zoster or 
with recent varicella or zoster exposure, and considering varicella and zoster
exposures at camp to be potentially camp-wide.varicella, human immunodeficiency
virus infections, disease outbreaks, intravenous immunoglobulin.

PMID: 11134436 [PubMed - indexed for MEDLINE]

672: Cent Eur J Public Health. 2000 Nov;8(4):227-8.

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

Hudecková H, Straka S, Rusnáková S.

Department of Epidemiology, State Health Institute, Kuzmányho 27, 036 80 Martin, 
Slovak Republic.

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

PMID: 11125976 [PubMed - indexed for MEDLINE]

673: Heart. 2001 Jan;85(1):E2.

Varicella myocarditis in an adult.

Alter P, Grimm W, Maisch B.

Department of Internal Medicine-Cardiology, Philipps-University of Marburg,
Baldingerstrabetae, D-35033 Marburg/Lahn, Germany. alter@mailer.uni-marburg.de

A 24 year old male with varicella myocarditis was admitted with chest pain and
fever up to 39 degrees C. The ECG showed J point and ST elevation in leads V2-V4,
and inverted T waves in leads V5 and V6. Creatine kinase (CK) was raised to 435
U/l (CK-MB 36 U/l), troponin I was 63.4 microgram/l, and lactate dehydrogenase
was 359 U/l, suggesting cardiac involvement of varicella infection. The left
ventricle was dilated (58 mm) and left ventricular ejection fraction was globally
reduced (ejection fraction 45%). Myocarditis was confirmed by endomyocardial
biopsy. The patient was treated with specific varicella hyperimmunoglobulins,
aciclovir, and a non-steroidal anti-inflammatory drug. During two months follow
up the patient recovered completely. This case report is a reminder that a
varicella infection can cause myocarditis in adults. Early diagnosis and
appropriate treatment of this rare form of myocarditis may lead to complete
recovery.

Publication Types: 
    Case Reports

PMID: 11119480 [PubMed - indexed for MEDLINE]

674: J Pediatr. 2000 Dec;137(6):871-4.

The natural history of varicella embryopathy: a 25-year follow-up.

Schulze A, Dietzsch HJ.

Ludwig Maximilian University of Munich, Department of Obstetrics & Gynecology,
Division of Neonatology, Munich, Germany.

A patient with clinically and immunologically proven varicella embryopathy
achieved substantial recovery after initial severe developmental delay and
manages well with her residual physical disabilities in adulthood.

Publication Types: 
    Case Reports

PMID: 11113846 [PubMed - indexed for MEDLINE]

675: Am J Perinatol. 2000;17(5):253-6.

Congenital varicella syndrome: a rare case of central nervous system involvement 
without dermatological features.

Kent A, Paes B.

Neonatal Division, The Children's Hospital at the Hamilton Health Sciences
Corporation, Ontario, Canada.

An unusual case of congenital varicella syndrome with significant central nervous
system involvement, but without dermatological features at birth is described.
The mother contracted chicken pox at 15 weeks' gestation. Congenital varicella
syndrome involves multiple systems, but rarely without skin lesions identifiable 
at birth. Although varicella infection in pregnant women is an uncommon
complication, the fetal embryopathy that may result can be devastating. Antenatal
diagnosis of fetal embryopathy during the first 20 weeks of pregnancy should be
established by amniocentesis or cordocentesis when a mother presents in the first
trimester with chicken pox, and appropriate risk counselling provided.

Publication Types: 
    Case Reports

PMID: 11110343 [PubMed - indexed for MEDLINE]

676: Minerva Pediatr. 2000 Jul-Aug;52(7-8):375-9.

Childhood glomerulonephritis associated with varicella and streptococcal
infection.

[Article in English, Italian]

Miceli Sopo S, Valentini P, Ranno O.

Department of Pediatrics, Catholic University of Rome.
stefano.micelisopo@mailcity.com

Varicella is a usually benign disease of childhood and its complications are
uncommon in immunocompetent children. In recent years we have witnessed the
increasing virulence of group A beta-haemolytic streptococci (GABHS). In
particular, in 1993, 50% of new cases of invasive GABHS disease were associated
with varicella infection and all were suppurative complications. Because also a
non suppurative complication of varicella as glomerulonephritis associated with
GABHS infection, has been published in only one case, we feel that it could be of
interest to describe this condition in two other cases we have observed.

Publication Types: 
    Case Reports

PMID: 11103594 [PubMed - indexed for MEDLINE]

677: Pediatr Radiol. 2000 Nov;30(11):801-3.

Inflammatory pseudotumour of the pancreas in a child.

Slavotinek JP, Bourne AJ, Sage MR, Freeman JK.

Department of Medical Imaging, Flinders Medical Centre, Adelaide, South
Australia. rajps@flinders.edu.au

We describe a 4-year-old girl with an inflammatory pseudotumour of the pancreas, 
which was preceded by varicella-zoster infection. Inflammatory pseudotumour may
involve a variety of tissues, the lungs and liver being typical sites of
predilection. Imaging and laboratory tests are nonspecific, and for this reason
the diagnosis of inflammatory pseudotumour is rarely made prior to surgery. These
benign but locally aggressive masses simulate malignancy in the majority of
cases. Inflammatory pseudotumour should, therefore, be considered when a mass
arises in an unusual location in the paediatric age group.

Publication Types: 
    Case Reports

PMID: 11100500 [PubMed - indexed for MEDLINE]

678: Pediatr Infect Dis J. 2000 Nov;19(11):1053-9.

The Immunization Monitoring Program Active (IMPACT) prospective five year study
of Canadian children hospitalized for chickenpox or an associated complication.

Law B, MacDonald N, Halperin S, Scheifele D, Déry P, Jadavji T, Lebel MH, Mills
E, Morris R, Vaudry W, Gold R, Marchessault V, Duclos P.

Department of Medical Microbiology, Winnipeg, Manitoba, Canada.
blaw@ms.umanitoba.ca

BACKGROUND: Varicella vaccine was approved for use in Canada in 1998. A major
goal of universal varicella vaccine programs is to reduce severe infection and
associated complications. Baseline data are essential against which to judge the 
effectiveness of routine childhood immunization. OBJECTIVE: To describe morbidity
and mortality among children hospitalized for chickenpox. Methods. From January
1, 1991, to March 31, 1996, chickenpox admissions to 11 pediatric referral
centers were actively identified. Patient and illness characteristics were
compared for 3 subgroups defined by prior health: healthy; unhealthy but
immunocompetent; immunocompromised. RESULTS: Of 861 cases 488 (56.7%) were
healthy, 75(8.7%) were unhealthy and 298 (34.6%) were immunocompromised. The
immunocompromised children differed from healthy/unhealthy cases in mean age (6.4
vs. 4.0/4.6 years, respectively, P < 0.0001); median interval from rash onset to 
admission (2 vs. 5/5 days, P < 0.0001); complication rate (20% vs. 90%/79%; P =
0.001); and rate of acyclovir therapy (98% vs. 24%/39%; P = 0.001). Unhealthy vs.
healthy cases had a higher frequency (P < 0.01) of intensive care (13.3% vs.
4.7%), ventilation (9.3% vs. 2.0%) and death (4% vs. 0.2%). CONCLUSION: These
data provide a baseline for morbidity/mortality resulting from chickenpox before 
varicella vaccine use in Canada.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11099085 [PubMed - indexed for MEDLINE]

679: Can J Neurol Sci. 2000 Nov;27(4):316-20.

Autoantibodies in childhood post-varicella acute cerebellar ataxia.

Adams C, Diadori P, Schoenroth L, Fritzler M.

Alberta Children's Hospital and Faculty of Medicine, University of Calgary,
Canada.

BACKGROUND: Anti-Purkinje cell antibodies have been reported in cerebellar ataxia
following Epstein-Barr virus (EBV) infection. We investigated autoantibody
responses, including anti-Purkinje cell antibodies, and the clinical course in
eight children who developed post-varicella ataxia, five of their siblings with
uncomplicated varicella, one child with post-EBV ataxia, two children with acute 
disseminated encephalomyelitis (ADEM) and one with neuroblastoma associated
ataxia, and in age and gender matched controls. METHODS: Autoantibodies were
tested by indirect immunofluorescence (IIF) on cryopreserved cerebrum and
cerebellum sections. Other autoantibodies were measured by conventional IIF
protocols using HEp-2 cells as a substrate. Antibodies to myelin associated
glycoprotein (MAG), asialo-GM1, beta2 glycoprotein 1, cardiolipin and myelin
basic protein (MBP) were measured by ELISA. RESULTS: Three of eight children with
acute post-varicella ataxia, one child with post-EBV ataxia, one child with ADEM 
and one child with uncomplicated varicella, had high titer autoantibodies
(>1/160) that reacted with cerebrum and cerebellar tissue. This reactivity was
not seen in one child with ADEM, in one with neuroblastoma and ataxia, in the
remainder of the children with uncomplicated varicella or age and gender matched 
controls. Autoantibodies were not seen in CSF from two children with
post-varicella ataxia. The punctate staining seen on cerebrum and cerebellum
sections co-localized with rabbit antibodies to the centrosome protein
pericentrin. All patients with strong reactivity with cerebrum and cerebellar
tissue by IIF had elevated levels of anti-MAG that was not confirmed by
absorption assay. No reactivity was seen with asialo-GM1, MBP, beta2 glycoprotein
1 or cardiolipin. None of the sera had autoantibodies directed against endosomes,
the Golgi complex, or the paraneoplastic autoantigens Hu and Yo. CONCLUSION: Some
children with post-viral ataxia develop antibodies that have strong reactivity
with cerebral and cerebellar tissue. Some of the antigenic reactivity
co-localized with the centrosome protein pericentrin.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 11097523 [PubMed - indexed for MEDLINE]

680: Virchows Arch. 2000 Oct;437(4):440-4.

Fetal varicella syndrome: disruption of neural development and persistent
inflammation of non-neural tissues.

Bruder E, Ersch J, Hebisch G, Ehrbar T, Klimkait T, Stallmach T.

Department of Pathology, University Hospital Zürich, Switzerland.
thomas.stallmach@pty.usz.ch

Primary varicella zoster virus (VZV) infection during pregnancy is rare. If it
occurs between the 8th and 20th week of gestation, fetal varicella syndrome
results in 1-2% of the fetuses. We report about a varicella infection that
affected a pregnant mother in the 12th week of gestation. At 33 weeks, a
premature girl was born with destruction of neurons in spinal cord, spinal
ganglia and plexus myentericus, and secondary developmental disturbance including
mummification of one arm and segmental intestinal atresia. The brain did not show
any abnormalities. However, VZV DNA could be detected by PCR in tissues from the 
brain and spinal ganglia. Chronic necrotizing inflammation was found in the
placenta, fetal membranes, and one ovary. These locations showed nuclear
inclusions which by in-situ-hybridization were proven to be VZV derived. This
case demonstrates that in the fetal age, 'neurotropism' of VZV signifies severe
destruction but not necessarily persistent inflammation of neural tissue.
However, due to the inefficient fetal immune system, inflammation can go on for
weeks, preferentially in non-neural tissues.

Publication Types: 
    Case Reports

PMID: 11097371 [PubMed - indexed for MEDLINE]

681: Acta Paediatr. 2000 Oct;89(10):1186-9.

Lupus anticoagulant and protein S deficiency in otherwise healthy children with
acute varicella infection.

Kurugöl Z, Vardar F, Ozkinay F, Kavakli K, Ozkinay C.

Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey.

Acquired protein S deficiency and lupus anticoagulant have been described in
children with varicella who had purpura fulminans, disseminated intravascular
coagulation or thrombosis. The aim of this study was to investigate the natural
anticoagulants, hypercoagulability markers, other parameters of coagulation and
fibrinolytic systems, and the presence of the lupus anticoagulant in otherwise
healthy children with acute varicella infection. Blood samples were obtained from
17 children with varicella without thrombosis during acute varicella infection
and 1 mo after onset. Coagulation tests included determinations of the
prothrombin time, the activated partial thromboplastin time, the thrombin time,
the thrombin antithrombin complex, the prothrombin fragment F 1 + 2, the tissue
plasminogen activator, the plasminogen activator inhibitor-1, protein C activity 
and free protein S antigen. Antiphospholipid antibodies were determined in
enzyme-linked immunosorbent assays. The mean free protein S concentration in the 
acute phase (0.63 +/- 0.16 U/ml) was significantly lower than that of the
concentration determined 1 mo later (0.82 +/- 0.17 U/ml). The children with
acquired free protein S deficiency also had a lupus anticoagulant. Elevated
concentrations of the prothrombin fragment F 1 + 2, the thrombin antithrombin
complex, D-Dimer, tissue plasminogen activator and plasminogen activator
inhibitor-1 were detected in most of the children. CONCLUSION: There is a
significantly increased prevalence of lupus anticoagulant, a significantly
reduced plasma concentration of free protein S and elevations in coagulation and 
fibrinolytic parameters in otherwise healthy children with acute varicella
infection.

PMID: 11083373 [PubMed - indexed for MEDLINE]

682: Expert Opin Investig Drugs. 2000 Aug;9(8):1743-51.

Novel agents for the therapy of varicella-zoster virus infections.

Snoeck R, Andrei G, De Clercq E.

Rega Institute for Medical Research, K.U.Leuven, Minderbroedersstraat 10, B-3000 
Leuven, Belgium. robert.snoeck@rega.kuleuven.ac.be

Varicella-zoster virus (VZV), a member of the herpesvirus family, is responsible 
for both primary (varicella or chickenpox) as well as recurrent (zoster or
shingles) infections. Acyclovir has been the mainstay for treating VZV infections
in both immunocompetent and immunocompromised patients. Recently, newer anti-VZV 
drugs, i.e., valaciclovir (the oral prodrug form of acyclovir) and famciclovir
(the oral prodrug form of penciclovir) have been developed and have enlarged the 
therapeutic options to treat VZV infections. Both acyclovir and penciclovir are
dependent on the virus-encoded thymidine kinase (TK) for their intracellular
activation. Although emergence of drug-resistant strains does not occur in
immunocompetent patients, several reports have documented the isolation of
drug-resistant VZV strains following long-term acyclovir therapy in
immunocompromised patients. Mutations at the level of the TK are responsible for 
development of resistance to drugs that depend on the viral TK for their
phosphorylation (i.e., acyclovir and penciclovir). Foscarnet, a direct inhibitor 
of the viral DNA polymerase, which does not require activation by the viral TK,
is the drug of choice for the treatment of TK-deficient VZV mutants emerging
under acyclovir therapy. Recently, emergence of foscarnet-resistant strains has
also been reported. Both TK-deficient strains and foscarnet-resistant mutants are
sensitive to the acyclic nucleoside phosphonate cidofovir, CDV, HPMPC,
(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine. This agent does not depend
on the virus-encoded TK, but on cellular enzymes for its conversion to the
diphosphoryl derivative, which then inhibits the viral DNA polymerase.

Publication Types: 
    Review

PMID: 11060773 [PubMed - indexed for MEDLINE]

683: Mil Med. 2000 Oct;165(10):791-5.

The epidemiology of varicella hospitalizations in the U.S. Army.

Lee T, Nang RN.

U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving
Grounds, MD 21010-5403, USA. terrence.lee@apg.amedd.army.mil

Varicella infections affect the U.S. Army, but the extent has not been quantified
recently. We obtained 1990 to 1997 hospitalization data from the U.S. Army
Medical Command and calculated rates using data from the Army Medical
Surveillance Activity and the U.S. Army Training Command. There was a decline in 
the number and incidence of varicella hospitalizations for U.S. Army active duty 
soldiers from 1990 to 1997. Varicella incidence rates for active duty soldiers
are significantly higher for females, blacks, those younger than 20 years, and
those whose home of record were tropical island regions. Army initial entry
training hospitalizations constitute 11.8% of active duty Army hospitalizations
and have also declined. Varicella continues to affect the training and health of 
the U.S. Army; however, the impact has diminished over the years. A feasible
approach to limit varicella in the U.S. Army is to target trainees for screening 
or vaccination. Refinement of this strategy should be determined from a follow-up
cost-effectiveness analysis.

PMID: 11050878 [PubMed - indexed for MEDLINE]

684: J Am Acad Dermatol. 2000 Nov;43(5 Pt 1):864-6.

Ipsilateral renal dysplasia with hypertensive heart disease in an infant with
cutaneous varicella lesions: an unusual presentation of congenital varicella
syndrome.

Liang CD, Yu TJ, Ko SF.

Department of Pediatrics, Chang Gung Children' Hospital, Kaohsiung, Taiwan.

A child with congenital varicella syndrome including cutaneous lesions and
ipsilateral renal dysplasia with hypertensive heart disease is described.
Varicella was contracted during the tenth week of gestation. Typical congenital
varicella bullae, high titer of anti-varicella-zoster virus IgM, and a small
right kidney were noted after birth. Hypertensive heart disease resulting from
renal dysplasia occurred at 1 year of age. The cutaneous lesions and the
dysplastic kidney involved the same dermatomes. Nephrectomy proved to be the
treatment of choice for hypertension and congestive heart failure.

Publication Types: 
    Case Reports

PMID: 11050597 [PubMed - indexed for MEDLINE]

685: Trop Med Int Health. 2000 Oct;5(10):732-6.

High seroprevalence of antibodies to varicella zoster virus in adult women in a
tropical climate.

O'Grady KA, Merianos A, Patel M, Gilbert L.

National Centre for Epidemiology and Population Health, Canberra, Australia.
kogrady@menzies.edu.au

OBJECTIVES: To determine whether the seroprevalence of antibodies to varicella
zoster virus (VZV) in adults is similar to that reported in tropical populations 
elsewhere. METHODS: We measured the seroprevalence of VZV IgG antibodies, using
an enzyme immunoassay (EIA) in women attending an antenatal clinic in an urban
centre in tropical Australia. RESULTS: The overall seroprevalence of VZV
antibodies in 298 women was 92% (95% CI 88-95), with no difference between women 
who spent their childhoods in the tropics and colleagues. None of the
overseas-born women was seronegative. CONCLUSION: The seroprevalence of VZV
antibodies in this tropical population in Australia is as high as that reported
from temperate regions, suggesting that social and cultural factors and
population mobility are more important determinants of age distribution of VZV
immunity than tropical climate.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11044268 [PubMed - indexed for MEDLINE]

686: Lupus. 2000;9(7):558-60.

Pulmonary embolism and transitory anti-beta2-GPI antibodies in an adult with
chicken pox.

Viseux V, Darnige L, Carmi E, Chaby G, Poulain JF, Cevallos R, Lok C, Denoeux JP.

Department of Dermatology and Venereology, Hôpital Sud, Amiens, France.

Anti-beta2-glycoprotein I antibodies are considered as a specific marker for the 
antiphospholipid syndrome. In contrast to lupus circulating anticoagulant and
anticardiolipin (aCL) antibodies, they are usually not found at significant
levels in infections. We report a case of pulmonary embolism in an adult with
varicella. Transient significant levels of aCL antibodies and of IgM
anti-beta2-GPI antibodies were observed. No other prothrombotic factor, including
free protein S antigen deficiency, was found. The direct pathogenic role of these
transient antibodies on the thrombotic event may then be suspected. They are
probably associated with VZV acute infection and are absent two months after
varicella.

Publication Types: 
    Case Reports

PMID: 11035426 [PubMed - indexed for MEDLINE]

687: Southeast Asian J Trop Med Public Health. 2000 Mar;31(1):21-4.

Seroprevalence of hepatitis A virus and varicella zoster antibodies in a Javanese
community (Yogyakarta, Indonesia).

Juffrie M, Graham RR, Tan RI, Widjaja S, Mulyadi S, Weil J, Bock HL.

Department of Pediatrics, Faculty of Medicine, Dr Sardjito Hospital, Gadjah Mada 
University, Yogyakarta, Indonesia.

Hepatitis A virus (HAV) cause an acute inflammation of the liver.
Varicella-zoster virus (VZV) cause chickenpox (varicella) and herpes zoster.
Effective vaccines against hepatitis A and varicella are available for children, 
adolescents and adults. In order to implement an appropriate vaccination policy, 
a baseline to assess the potential benefits and sections of the population who
would benefit most are required. We investigated seroprevalence of hepatitis A
virus and varicella zoster antibodies in a Javanese community. A total of 1,103
subjects were studied. The 600 subjects aged 4 to 9 years were sampled between 23
October and 2 November, 1995. The other subjects were sampled between 12 October 
and 1 November, 1996. The overall prevalence of anti-HAV in cohort was 28.7%.
Anti-HAV seroprevalence rates were below 30% until the age of 15 and below 40%
until the age of 25. The anti-varicella seroprevalence showed only in two thirds 
of seropositive population at the age of 15. The results of the study have
implications for vaccination strategies for both hepatitis A and varicella
zoster.

PMID: 11023059 [PubMed - indexed for MEDLINE]

688: Commun Dis Public Health. 2000 Sep;3(3):213-5.

Chickenpox increasingly affects preschool children.

Ross AM, Fleming DM.

DFleming@rcgp-bru.demon.co.uk

Between 1983 and 1998, age specific incidences of chickenpox derived from
consultations with general practitioners taking part in the Royal College of
General Practitioners Weekly Returns Service doubled in children aged 0 to 4
years, halved in children aged 5 to 14 years, and fell by almost a third in
adults aged 15 to 44 years. This downward shift in age of contracting chickenpox 
may be a result of increased social contact between preschool children.

PMID: 11014039 [PubMed - indexed for MEDLINE]

689: J Postgrad Med. 2000 Apr-Jun;46(2):91-3.

Scleredema adultorum.

Parmar RC, Bavdekar SB, Bansal S, Doraiswamy A, Khambadkone S.

Department of Paediatrics, Seth G. S. Medical College and K. E. M. Hospital,
Parel, Mumbai - 400 012, India. rameshparmar@yahoo.com.

Scleredema adultorum is a rare connective tissue disorder reported usually
following streptococcal infection, influenza, measles, and mumps. It has been
reported occasionally following trauma and tuberculous lymphadenitis. This is a
report of scleredema adultorum developing after chicken pox in an eight-year-old 
male child. The diagnosis was established by characteristic picture on skin
biopsy using special stain. The patient had a benign course and a spontaneous
recovery in two weeks. The case has been reported as the first case of scleredema
adultorum developing after chicken pox.

Publication Types: 
    Case Reports

PMID: 11013472 [PubMed - indexed for MEDLINE]

690: J Clin Microbiol. 2000 Sep;38(9):3187-9.

Diagnosis of varicella-zoster virus infections in the clinical laboratory by
LightCycler PCR.

Espy MJ, Teo R, Ross TK, Svien KA, Wold AD, Uhl JR, Smith TF.

Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.

Varicella-zoster virus (VZV) causes vesicular dermal lesions which are clinically
evident as varicella (primary infection) or zoster (reactivated) diseases. The
LightCycler system (Roche Molecular Biochemicals) is a newly developed
commercially available system designed to rapidly perform PCR with real-time
detection of PCR products using a fluorescence resonance energy transfer. We
compared the detection of VZV from dermal specimens by shell vial cell culture
(MRC-5) and by LightCycler PCR. Of 253 specimens, VZV was detected in 23 (9.1%)
by shell vial cell cultures and 44 (17.4%) by LightCycler PCR directed to a
nucleic acid target sequence in gene 28. Twenty-one of 44 (47.7%) specimens were 
exclusively positive by LightCycler PCR; the shell vial cell culture assay was
never positive when DNA amplification was negative (specificity, 100%). VZV DNA
was detected in 39 of 44 (88.6%) specimens positive during cycles 10 through 30
of the LightCycler PCR. These VZV DNA-positive specimens (cycles 10 to 30) and 5 
of 11 other PCR positive specimens (cycles 31 to 36) were confirmed by another
LightCycler PCR directed to another (gene 29) target of the viral genome. For
routine laboratory practice, all specimens yielding amplified DNA to the VZV gene
28 target can be considered positive results. The increased sensitivity (91%) of 
the LightCycler PCR for detection of VZV, rapid turnaround time for reporting
results, virtual elimination of amplicon carryover contamination, and equivalent 
costs compared to shell vial cell culture for detection of VZV indicate the need 
for implementation of this technology for routine laboratory diagnosis of this
viral infection.

Publication Types: 
    Evaluation Studies

PMID: 10970354 [PubMed - indexed for MEDLINE]

691: J Clin Microbiol. 2000 Sep;38(9):3156-60.

Improved identification and differentiation of varicella-zoster virus (VZV)
wild-type strains and an attenuated varicella vaccine strain using a VZV open
reading frame 62-based PCR.

Loparev VN, Argaw T, Krause PR, Takayama M, Schmid DS.

Division of Viral and Rickettsial Diseases, National Center for Infectious
Diseases, Centers for Disease Control and Prevention, U.S. Department of Health
and Human Services, Atlanta, Georgia 30333, USA.

A new method was developed to identify and differentiate varicella-zoster virus
(VZV) wild-type strains from the attenuated varicella Oka vaccine strain. The PCR
technique was used to amplify a VZV open reading frame (ORF) 62 region. A single 
specific amplicon of 268 bp was obtained from 71 VZV clinical isolates and
several laboratory strains. Subsequent digestion of the VZV ORF 62 amplicons with
SmaI enabled accurate strain differentiation (three SmaI sites were present in
amplicons of vaccine strain VZV, compared with two enzyme cleavage sites for all 
other VZV strains tested). This method accurately differentiated the Oka vaccine 
strain from wild-type VZV strains circulating in countries representing all six
populated continents. Moreover, the assay more reliably distinguished wild-type
Japanese strains from the vaccine strain than did previously described methods.

Publication Types: 
    Evaluation Studies

PMID: 10970349 [PubMed - indexed for MEDLINE]

692: Pediatrics. 2000 Sep;106(3):E40.

Endocarditis attributable to group A beta-hemolytic streptococcus after
uncomplicated varicella in a vaccinated child.

Laskey AL, Johnson TR, Dagartzikas MI, Tobias JD.

Department of Child Health, University of Missouri, Columbia, Missouri 65212,
USA.

Varicella is generally a benign, self-limited childhood illness; however, severe,
life-threatening complications do occur. A live, attenuated vaccine exists to
prevent this illness, but controversy remains concerning the need to vaccinate
children for what is generally a benign, self-limited disease, although more
states are currently recommending this vaccine. We report a previously healthy
3-year-old who developed varicella 6 months after vaccination with no apparent
skin superinfections, who subsequently developed group A beta-hemolytic
streptococcus (GABHS) bacteremia resulting in endocarditis of a normal heart
valve. We are unaware of previous reports of endocarditis related to GABHS after 
varicella. After developing a harsh, diastolic murmur that led to an
echocardiogram, aortic valve endocarditis was diagnosed. A 6-week course of
intravenous penicillin G was administered. Two weeks after the initiation of
therapy, the diastolic murmur was harsher, and echocardiography revealed a large 
vegetation on the posterior leaflet of the aortic valve, with severe aortic
insufficiency and a dilated left ventricle. The patient subsequently developed
congestive heart failure requiring readmission and aggressive management. One
month after the initial echocardiogram, a repeat examination revealed worsening
aortic regurgitation and mitral regurgitation. The patient received an additional
4 weeks of intravenous penicillin and gentamicin followed by aortic valve
replacement using the Ross procedure. Our patient, the first reported case of
bacteremia and endocarditis from GABHS after varicella, illustrates the need for 
the health care practitioner to consider both common and life-threatening
complications in patients with varicella. While cellulitis, encephalitis, and
septic arthritis may be readily apparent on physical examination and commonly
recognized complications of varicella, the possibility of bacteremia without an
obvious skin superinfection should also be entertained. The case we report is
unique in that the patient had normal immune function, had been previously
vaccinated, and developed a rare complication of varicella-endocarditis-in a
structurally normal heart with a previously unreported pathogen. Although a child
may have been vaccinated against varicella, the chance of contracting the virus
still exists and parents should be informed of this risk. group A beta-hemolytic 
streptococcus, endocarditis, varicella, Varivax, complications of varicella.

Publication Types: 
    Case Reports

PMID: 10969124 [PubMed - indexed for MEDLINE]

693: Infection. 2000 Jul-Aug;28(4):200-4.

Hospitalization for primary varicella-zoster virus infection and its
complications in patients from Southern Israel.

Somekh E, Maharashak N, Shapira Y, Greenberg D, Dagan R.

Pediatric Infectious Disease Unit, Wolfson Medical Center, Holon, Israel.

BACKGROUND: We conducted this study to determine the impact of chickenpox on two 
different ethnic populations in southern Israel: Jews and Bedouins. METHODS:
Hospital records of 113 patients discharged from the Soroka Medical Center with
the diagnosis of varicella during a 4.5-year period were reviewed. RESULTS: Mean 
age was 9.2 years and the average hospital stay was 5.4 days. Bacterial skin or
soft tissue infections were the most common complications (30%), followed by
pneumonia (17%) and central nervous system complications (11.5%). There were no
fatal cases throughout the study period.The calculated hospitalization rate for
varicella was one in every 319 cases. Major differences between Jews and Bedouins
included an older mean age of Bedouin patients (13.9 years versus 4.5 years);
higher hospitalization rate (relative risk [R.R.]: 2.8, 95% confidence interval: 
1.9-4.2), and higher risk for complicated varicella (R.R.: 2.1, 95% confidence
interval: 1.3-3.4). CONCLUSION: Hospitalization of patients with varicella in
southern Israel is common and varicella infection in Bedouins is associated with 
greater morbidity compared with that in Jews in southern Israel.

PMID: 10961523 [PubMed - indexed for MEDLINE]

694: J Med Virol. 2000 Sep;62(1):46-51.

Low induction of varicella-zoster virus-specific secretory IgA antibody after
vaccination.

Terada K, Niizuma T, Yagi Y, Miyashima H, Kataoka N, Sadahiro T.

Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama, Japan.
kihei@med.kawasaki-m.ac.jp

Breakthrough after varicella vaccination occurs in approximately 2. 6%
approximately 18.6% of immunocompetent children, but the reason has not been
demonstrated clearly. As a first defense, specific secretory IgA antibody on the 
mucosa plays an important role in preventing invasion of microorganisms. To
examine induction of varicella-zoster virus (VZV) specific secretory IgA after
natural infection and vaccination and its booster mechanisms, 143 salivary
samples were tested by ELISA. The VZV-secretory IgA values were significantly
higher in the matched children after natural chickenpox than in those after
vaccination, although the total secretory IgA did not differ between them. Two
(7%) of the vaccinees lacked the sIgA antibody. In the elderly and in
immunocompromised children, the VZV-secretory IgA values were no lower than those
in healthy children, and they did not lack VZV-secretory IgA. The doctors and
nurses taking care of patients with chickenpox had higher values than the other
groups as did individuals who had had herpes zoster recently. VZV-secretory IgA
was thought to be stimulated by exogenous and reactivated endogenous VZV to
neutralize VZV with weak activity. These results suggest that low or no induction
of VZV-secretory IgA antibody after vaccination may be one of the possible
explanations for a breakthrough. Copyright 2000 Wiley-Liss, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10935988 [PubMed - indexed for MEDLINE]

695: Occup Environ Med. 2000 Sep;57(9):621-6.

Occupational risk of infection by varicella zoster virus in Belgian healthcare
workers: a seroprevalence study.

Vandersmissen G, Moens G, Vranckx R, de Schryver A, Jacques P.

IDEWE Occupational Health Services, Leuven, Belgium.

OBJECTIVES: To assess the prevalence of varicella zoster virus (VZV) antibodies
in Flemish (Belgian) healthcare workers, to investigate the association between
seronegativity and selected variables, and to assess the reliability of recall
about disease as a predictor of immunity. METHODS: A seroprevalence study of VZV 
antibodies (IgG) was conducted among a systematic sample of 4923 employees in
various professional groups, employed in 22 hospitals in Flanders and Brussels
(Belgium). Information about sex, age, department, job, and years of employment, 
the country of origin, and history of varicella was obtained. The presence of VZV
antibodies was investigated with the enzyme linked immunosorbent assay (ELISA),
Enzygnost anti VZV / IgG (Dade Behring, Marburg, Germany). Statistical analysis
was performed by calculating prevalences and prevalence ratios (PRs) and their
95% confidence intervals (95% CIs). Sensitivity, specificity, and positive and
negative predictive values (PPV and NPV) of the recalled history were determined.
RESULTS: The prevalence of VZV seropositivity in Flemish healthcare workers was
98.5% (95% CI 98.1 to 98.8). Seronegativity was significantly associated with age
and job, increasing with both older and younger age. The prevalence of
seronegative workers was significantly less in nursing staff than non-nursing
staff. There was no significant difference for sex and years of employment. The
PPV and NPV of recalled history were 98.9% and 3.4%. Sensitivity and specificity 
were 83% and 38.9%. CONCLUSION: The prevalence of VZV seropositivity was very
high in this sample of Flemish healthcare workers. Because of this low overall
susceptibility, VZV infection seems not to be an important occupational risk
among healthcare workers in Flanders. The increasing seronegativity above the age
of 45 is possibly due to a loss of detectable antibodies. A positive history of
varicella was a good predictor of immunity, but a negative history had no value
as a predictor of susceptibility in adults.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10935943 [PubMed - indexed for MEDLINE]

696: Am J Med. 2000 Jun 15;108(9):723-9.

Comment in:
    Am J Med. 2000 Jun 15;108(9):746-7.

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

Smith KJ, Roberts MS.

Mercy Hospital of Pittsburgh, University of Pittsburgh School of Medicine,
Pennsylvania, USA.

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

PMID: 10924649 [PubMed - indexed for MEDLINE]

697: Transplantation. 2000 Jul 15;70(1):211-3.

Donor organ transmission of varicella zoster due to cardiac transplantation.

Fall AJ, Aitchison JD, Krause A, Hasan A, Hamilton JR, Gould FK.

Department of Paediatric Cardiology, Freeman Hospital, Newcastle-upon-Tyne,
United Kingdom.

BACKGROUND: We report a case of donor-transmitted varicella zoster viral (VZV)
infection in a cardiac transplant recipient. A 15-month-old girl developed
primary VZV infection 12 days after cardiac transplantation. The donor suffered
from varicella 2 weeks before death from pneumococcal meningitis. METHODS:
Despite treatment of the seronegative recipient with intravenous acyclovir from
the time of surgery, she developed symptoms of fever, a nonspecific macular rash,
and small palatal vesicles. RESULTS: After rapid diagnostic confirmation by
direct immunofluorescence on vesicular fluid, high-dose intravenous acyclovir was
commenced. In addition, the cyclosporine dose was reduced by 25%. The child made 
a quick and uncomplicated recovery. CONCLUSIONS: Donor organ transmission of VZV 
has not, to our knowledge, been previously reported. It occurred despite
treatment with acyclovir and resulted in an atypical cutaneous eruption. It
responded to an increased dose of acyclovir and a reduced level of
immunosuppression.

Publication Types: 
    Case Reports

PMID: 10919605 [PubMed - indexed for MEDLINE]

698: Pediatrics. 2000 Aug;106(2):E28.

Chickenpox attributable to a vaccine virus contracted from a vaccinee with
zoster.

Brunell PA, Argaw T.

Ahmanson Pediatrics Department, Cedars Sinai Medical Center, Los Angeles,
California, USA. pbrunell@niaid.nih.gov

Five months after 2 siblings were immunized with varicella vaccine, 1 developed
zoster. Two weeks later the second sibling got a mild case of chicken pox. Virus 
isolated from the latter was found to be vaccine type. Thus, the vaccine strain
was transmitted from the vaccinee with zoster to his sibling. Vaccinees who later
develop zoster must be considered contagious. varicella-zoster, zoster, vaccine, 
transmission, rash, PstI.

Publication Types: 
    Case Reports

PMID: 10920184 [PubMed - indexed for MEDLINE]

699: J Infect Dis. 2000 Aug;182(2):383-90. Epub 2000 Jul 12.

Varicella mortality: trends before vaccine licensure in the United States,
1970-1994.

Meyer PA, Seward JF, Jumaan AO, Wharton M.

Council of State and Territorial Epidemiologists and Centers for Disease Control 
and Prevention, Atlanta, Georgia, USA.

We examined varicella deaths in the United States during the 25 years before
vaccine licensure and identified 2262 people who died with varicella as the
underlying cause of death. From 1970 to 1994, varicella mortality declined,
followed by an increase. Mortality rates were highest among children; however,
adult varicella deaths more than doubled in number, proportion, and rate per
million population. Despite declining fatality rates, in 1990-1994, adults had a 
risk 25 times greater and infants had a risk 4 times greater of dying from
varicella than did children 1-4 years old, and most people who died of varicella 
were previously healthy. Varicella deaths are now preventable by vaccine.
Investigation and reporting of all varicella deaths in the United States is
needed to accurately document deaths due to varicella, to improve prevention
efforts, and to evaluate the vaccine's impact on mortality.

PMID: 10915066 [PubMed - indexed for MEDLINE]

700: Aust Fam Physician. 2000 Jul;29(7):631-3, 636-7.

A rash of exanthems. How they affect children and pregnant women.

Starr M.

Department of Microbiology and Infectious Diseases, Royal Children's Hospital,
Victoria. starrm@cryptic.rch.unimelb.edu.au

BACKGROUND: Viral exanthems are a common problem for children, particularly
during preschool years. Many of these infections have a dramatic impact on
siblings, parents and other contacts. There may also be particular ramifications 
for pregnant contacts. OBJECTIVE: To discuss some of the most common viral
exanthems affecting children, in terms of the epidemiology, clinical features,
diagnosis, and the management of both the patient and the contacts. DISCUSSION:
Recommendations are made for measles, rubella, parvovirus and varicella regarding
immunisations, use of immunoglobulin, serological diagnosis and management of
pregnant contacts.

Publication Types: 
    Review

PMID: 10914446 [PubMed - indexed for MEDLINE]

701: Indian Pediatr. 2000 Jul;37(7):714-9.

Age related seroprevalence of antibodies to varicella in India.

Lokeshwar MR, Agrawal A, Subbarao SD, Chakraborty MS, Ram Prasad AV, Weil J, Bock
HL, Kanwal S, Shah RC, Shah N.

Hinduja Hospital, Mumbai, India.

OBJECTIVE: To determine the age related prevalence of Varicella Zoster Virus
(VZV) antibodies in India. SETTING: This was a cross sectional multicentric study
performed in 4 major cities of India: Calcutta (outpatients), Mumbai
(outpatients), Lucknow (walk-in patients to a diagnostic laboratory, orphanage
and factory workers) and Bangalore (outpatients and walk-in patients to a
diagnostic laboratory). METHODS: A total of 1609 volunteers from birth to 40
years of age were included into the study. IgG antibodies against VZV were
determined using commercial kits (ELISA-Enzygnost). RESULTS: Overall
seroprevalence of anti VZV antibodies was 68. 22percnt. The age related
seroprevalence rate of anti VZV antibodies was 29percnt in the age group of 1-5
years, 51.1percnt in 5-10 years, 71.7percnt in 11-15 years, 79.8percnt in 16-20
years, 88.1percnt in 21-30 years and 91.1percnt in 31-40 years. CONCLUSION: A
significant proportion of adolescents and adults are susceptible to varicella in 
India, as in other tropical countries

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10906803 [PubMed - indexed for MEDLINE]

702: Arch Dis Child. 2000 Aug;83(2):172-3.

Immune response to gangliosides in a case of Guillain-Barré syndrome after
varicella.

Yoshikawa T, Suzuki K, Suga S, Miyata E, Yamamoto H, Hosokawa T, Kumagai T, Asano
Y.

Department of Pediatrics, Fujita Health University School of Medicine, Aichi,
Japan. tetsushi@med.nagoya-u.ac.jp

An 8 year old girl was admitted to hospital with the typical clinical features of
Guillain-Barré syndrome (GBS) after recovering from varicella. Onset of the
disease was just two weeks after the onset of varicella in her young sister.
Examination of cerebrospinal fluid and nerve conduction studies showed typical
findings of GBS. Although serum from both the patient and sister were analysed
for autoantibodies to gangliosides and myelin P0 protein, IgM anti-GM1 antibody
and anti-GD1b antibody were only detected in the patient. HLA DR haplotypes were 
quite different between the two subjects. This suggests that these autoantibodies
may play an important role in the pathogenesis of GBS after varicella zoster
virus infection.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 10906031 [PubMed - indexed for MEDLINE]

703: Rev Inst Med Trop Sao Paulo. 2000 May-Jun;42(3):125-8.

Three year seroepidemiological study of varicella-zoster virus in São Paulo,
Brazil.

Yu AL, Costa JM, Amaku M, Pannuti CS, Souza VA, Zanetta DM, Burattini MN, Massad 
E, Azevedo RS.

Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São 
Paulo, SP, Brazil.

A serosurvey of varicella has been carried out in children attending the public
school network of São Paulo city, Brazil, from 1992 to 1994. This study was
performed in order to establish the age related prevalence of antibodies against 
varicella-zoster virus (VZV) and its age specific transmission dynamics pattern
in these children. Among 2500 schools in the city of São Paulo public network,
304 were randomly selected; 7 children of a given age (ranging from 1 to 15
years) were randomly selected in each school, and blood samples were obtained by 
fingerprick into filter paper. Blood eluates were analyzed for the presence of
antibodies to VZV by ELISA. Proportion of seropositivity were calculated for each
age group. Samples consisted of 1768 individuals in 1992, 1758 in 1993, and 1817 
in 1994, resulting in 5343 eluates. A high proportion of seropositive children
from 1 to 3 years of age was observed, ascending until 10 years of age and
reaching a plateau around 90% afterwards. VZV transmission in this community was 
similar along the three years of the study. In children attending public schools 
in the city of São Paulo, contact with VZV occurs in early childhood. If
immunization against VZV is considered it should be introduced as soon as
possible.

PMID: 10887369 [PubMed - indexed for MEDLINE]

704: J Clin Microbiol. 2000 Jul;38(7):2568-73.

Quantitation of varicella-zoster virus DNA in whole blood, plasma, and serum by
PCR and electrochemiluminescence.

de Jong MD, Weel JF, Schuurman T, Wertheim-van Dillen PM, Boom R.

Section of Clinical Virology, Department of Medical Microbiology, Academic
Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
M.D.deJong@AMC.UVA.NL

We describe a highly sensitive assay for quantitation of varicella-zoster virus
(VZV) DNA in blood, involving PCR amplification, solution hybridization with
Tris-(2, 2'-bipyridine)-ruthenium(II) chelate-labeled probes, and measurement by 
electrochemiluminescence (ECL). Extraction and amplification efficiencies were
monitored by the inclusion of internal control (IC) DNA, mimicking the VZV
target, in the DNA extraction. Viral DNA load was calculated from the ratio of
VZV and IC ECL signals. The lower limit of sensitivity was 20 VZV DNA copies/ml
of plasma or serum and 80 copies/ml of whole blood. In reconstruction
experiments, expected and calculated VZV DNA loads were in excellent accordance. 
Blood specimens from 42 VZV-infected patients were tested for the presence of VZV
DNA and showed detection rates of 86% in patients with varicella and 81% in
patients with herpes zoster. In specimens obtained during the first week after
onset of the rash, detection rates were 100 and 89%, respectively. Viral DNA was 
detected in all immunocompromised patients with herpes zoster, emphasizing the
risk of disseminated disease in this patient group. VZV DNA load was similar in
patients with varicella and multidermatomal herpes zoster and lower in patients
with unidermatomal zoster. Despite the cell-associated nature of the virus, VZV
DNA was detected in serum and plasma at high copy numbers, and at similar
frequencies compared to whole-blood specimens. Quantitation of VZV DNA in blood
is of potential importance for diagnosis and clinical management of VZV-infected 
patients. Plasma and serum provide convenient matrices for this purpose.

PMID: 10878045 [PubMed - indexed for MEDLINE]

705: Hybridoma. 2000 Apr;19(2):143-9.

Expression of neutralizing recombinant human antibodies against Varicella Zoster 
virus for use as a potential prophylactic.

Lloyd-Evans P, Gilmour JE.

International Blood Group Reference Laboratory, Bristol, United Kingdom.

Chickenpox is a highly infectious disease that can be life-threatening to certain
groups such as the newborn of nonimmune mothers and immunocompromised patients.
At present, prophylactic treatment of individuals at risk involves the use of a
polyclonal antibody preparation derived from the pooled sera of hyperimmune
donors. While this product is effective, there are problems associated with
maintaining supply, which depends on the availability of donors, and the
variation of potency between batches. An effective human monoclonal preparation
would be of value by providing a well-characterized and standardized preparation 
available on demand. In this study recombinant human anti-varicella zoster virus 
(VZV) monoclonals were generated from the mRNA of unstable anti-VZV secreting
heterohybridoma cell lines, and characterized according to their molecular
weight, isoelectric point, glycosylation, binding to C1q, and efficacy at
neutralizing VZV in vitro. In one antibody (AEVZ 5.3) the VH region was grafted
from the IgG1 parent antibody onto an IgG3 backbone to determine the effect of
isotype on neutralization in vitro. Antibodies were expressed from NSO cells at
concentrations of 3-24 microg/mL and contained the expected heavy and light chain
fragments and N-linked glycan structures. Both AEVZ 5.1 and AVEZ 4 antibodies
were IgG1 and recognized the viral coat protein glycoprotein E; both showed
complement-independent and complement-enhanced neutralization. Changing the
isotype of AEVZ 5.1 from IgG1 to IgG3 (AEVZ 5.3) further enhanced VZV
neutralization in the presence of complement, but reduced its neutralization
capacity in the absence of complement. Complement enhancement was consistent with
our findings that the IgG3 form could bind more molecules of C1q. The results
demonstrate the successful use of recombinant methods to generate stable,
functional monoclonal antibodies. Modifications of the original antibodies were
made with the aim of improving functionality. The resulting cell lines could be
used for large-scale production of well-characterized antibodies for therapeutic 
use.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10868794 [PubMed - indexed for MEDLINE]

706: Eur J Anaesthesiol. 2000 Apr;17(4):269-72.

Nitric oxide in the treatment of fulminant pulmonary failure in a young pregnant 
woman with varicella pneumonia.

Bugge JF, Tanbo T.

Extracorporeal membrane oxygenation is the recommended treatment for fulminant
pulmonary failure due to varicella pneumonia. However, in pregnancy fetal
viability during extracorporeal membrane oxygenation is generally poor resulting 
in either therapeutic or spontaneous abortion. The present case is to our
knowledge the first report on the treatment with nitric oxide to improve
oxygenation in a pregnant woman with fulminant pulmonary failure due to varicella
pneumonia. Adding 20 parts per million nitric oxide to the inspiratory gas
increased arterial oxygen saturation from 75 to 88%, and it could be kept at this
level. Due to a vaginal bleeding, an emergency Caesarean section was performed
with successful outcome for the fetus. The mother started to improve after
delivery and could be weaned from nitric oxide after 5 days. We conclude that
inhalation of nitric oxide may be a good alternative to extracorporeal membrane
oxygenation in the treatment of fulminant pulmonary failure due to varicella
pneumonia in pregnancy.

Publication Types: 
    Case Reports
    Letter

PMID: 10866012 [PubMed - indexed for MEDLINE]

707: Br J Haematol. 2000 May;109(2):328-9.

Paroxysmal cold haemoglobinuria in an adult with chicken pox.

Papalia MA, Schwarer AP.

Clinical Haematology and Bone Marrow Transplant Unit, Alfred Hospital, Melbourne,
Victoria, Australia.

Paroxysmal cold haemoglobinuria (PCH) is an autoimmune disorder characterized by 
intravascular haemolysis causing haemoglobinuria. It is due to a biphasic
haemolysin known as the Donath-Landsteiner antibody, which binds specifically to 
the P antigen of red blood cells at low temperatures, leading to complement
activation and red cell lysis at 37 degrees C. PCH is a rare disease which
predominantly affects the paediatric population, occurring mostly during viral
infections. We report on what is possibly the first case of PCH in an adult to be
precipitated by chicken pox infection.

Publication Types: 
    Case Reports
    Review

PMID: 10848819 [PubMed - indexed for MEDLINE]

708: J Infect Dis. 2000 Jun;181(6):1897-905. Epub 2000 Jun 5.

Epidemiology of primary varicella and herpes zoster hospitalizations: the
pre-varicella vaccine era.

Lin F, Hadler JL.

Department of Epidemiology and Public Health, Yale University School of Medicine,
New Haven, Connecticut, USA.

To determine the epidemiology and costs of hospitalization with primary varicella
and herpes zoster in the prevaccine era and the usefulness of hospital discharge 
data to determine the population impact of vaccination on these conditions,
statewide hospital discharge data in Connecticut from 1986 to 1995 were analyzed.
Annual hospitalizations for herpes zoster were 4-fold higher than for primary
varicella (16.1 vs. 4.1/100,000). Overall, 69% and 83%, respectively, had no
underlying immunosuppressive conditions. Regarding primary varicella, 53% of
patients were aged <15 years, there was a marked winter-spring seasonality, and
Hispanics and blacks were 4.1 and 2.6 times more likely than whites to be
hospitalized. Regarding herpes zoster, 66.9% of patients were aged >64 years, and
there was no seasonality. The mean patient charges in 1995 were $12,819 for
primary varicella and $15,583 for herpes zoster. Analysis of population-based
hospital discharge data is a feasible means of monitoring the impact of varicella
immunization on severe morbidity due to primary varicella and herpes zoster.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10837168 [PubMed - indexed for MEDLINE]

709: S D J Med. 2000 May;53(5):193-7.

Facts and fallacies about varicella and the varicella vaccine.

Chatterjee A, Fiechtner HB, Patrick S.

Department of Pediatrics, University of South Dakota School of Medicine, Sioux
Falls, USA.

Varicella is a nearly ubiquitous infection that results in significant morbidity 
and occasional mortality. The varicella vaccine has been licensed in the United
States for the past five years. While varicella vaccination rates are slowly
growing nationally, the immunization rate for South Dakota remains abysmally low.
The legislature has recently mandated this vaccine for school entry in South
Dakota, to promote its increased use. There are many fallacies about varicella
and the varicella vaccine and questions about how new requirements of varicella
vaccination before school entry will be met. This article identifies these common
misconceptions and can serve as a resource for answers to questions commonly
asked of vaccine providers.

Publication Types: 
    Review

PMID: 10835949 [PubMed - indexed for MEDLINE]

710: J Clin Microbiol. 2000 Jun;38(6):2447-9.

Comparison of quantitations of viral load in varicella and zoster.

Kimura H, Kido S, Ozaki T, Tanaka N, Ito Y, Williams RK, Morishima T.

Department of Pediatrics, Nagoya University School of Medicine, Nagoya, Japan.
hkimura@med.nagoya-u.ac.jp

The pathogenesis of varicella and zoster and the effects of antiviral treatment
were investigated using real-time PCR for varicella-zoster virus (VZV) DNA in
skin lesions and peripheral blood. A higher occurrence of viremic VZV DNA was
observed in varicella than in zoster. Acyclovir treatment resulted in marked
suppression of viremia in varicella.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10835029 [PubMed - indexed for MEDLINE]

711: Mil Med. 2000 Apr;165(4):309-15.

The cost-effectiveness of varicella screening and vaccination in U.S. Army
recruits.

Howell MR, Lee T, Gaydos CA, Nang RN.

Johns Hopkins University, Baltimore, MD 21205, USA. mrh@welchlink.welch.jhu.edu

Varicella outbreaks in the U.S. Army disrupt training, reduce readiness, and
represent substantial costs. Vaccination of susceptible individuals may be
cost-effective. We conducted a cost-effectiveness analysis comparing screening of
all incoming recruits and vaccination of susceptible individuals at either
initial entry training (IET) or medical entrance processing station (MEPS),
universal vaccination at IET, and no intervention. Primary health outcomes
included the number of varicella cases prevented during the 8-week initial
training period. The varicella hospitalization rate was 21.6 per 10,000 per year.
In 100,000 recruits, 36 cases of varicella are expected at a cost of $181,000 in 
the absence of an intervention. Screening at IET would prevent 4 cases but would 
cost an additional $3,255,000 more than no intervention. Screening at MEPS would 
prevent 3 cases and save $521,000 per case prevented during the IET but would
cost $2,734,000 more than no intervention. Universal vaccination would prevent 2 
cases but would cost $15,858,000 more than MEPS screening and $18,592,000 more
than no intervention. These results are robust. Cost per case of varicella
prevented ranged from $390,000 to $7.9 million. Scarce prevention resources could
be more cost-effectively allocated to other prevention programs.

Publication Types: 
    Comparative Study

PMID: 10803008 [PubMed - indexed for MEDLINE]

712: Pediatrics. 2000 May;105(5):E60.

Invasive group A streptococcal disease in children and association with
varicella-zoster virus infection. Ontario Group A Streptococcal Study Group.

Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A.

Department of Microbiology and Infectious Diseases, University of Calgary,
Calgary, Alberta, Canada.

OBJECTIVES: To describe the incidence and clinical features of invasive group A
streptococcal (GAS) disease in children in Ontario and determine the risk of
invasive GAS infection following chickenpox. METHODS: During 1992-1996, we
conducted prospective, active, population-based surveillance for pediatric
invasive GAS disease in Ontario, Canada (population: 11 million; 2.5 million
children) and reviewed clinical and laboratory records. RESULTS: There were 1.9
cases of invasive GAS disease per 100,000 children per year. Streptococcal toxic 
shock syndrome (STSS) occurred in 7% of cases and necrotizing fasciitis (NF) in
4% for incidences of.08 and.13 per 100,000 per year, respectively. Case-fatality 
rates were 56% for STSS, 10% for NF, and 4% overall. The presence of chronic
underlying illness other than asthma was associated with death (relative risk
[RR]: 11; 95% confidence interval [CI]: 2.4-45). Fifteen percent of children
identified had preceding chickenpox infection, which significantly increased the 
risk for acquisition of invasive GAS disease (RR: 58; 95% CI: 40-85). Children
with invasive GAS and recent chickenpox were more likely to have NF (RR: 6.3; 95%
CI: 1.8-22.3). CONCLUSIONS: Childhood invasive GAS disease occurs at an incidence
similar to the adult population but has a lower rate of STSS and case-fatality.
Chickenpox dramatically increases the risk for acquiring invasive GAS disease,
and universal chickenpox vaccination could potentially prevent up to 15% of all
pediatric invasive GAS disease.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10799624 [PubMed - indexed for MEDLINE]

713: Stat Med. 2000 May 15;19(9):1207-16.

Estimation of the contact rate in a seasonal SEIR model: application to
chickenpox incidence in France.

Deguen S, Thomas G, Chau NP.

Epidémiologie et Sciences de l'Information, INSERM U444, Faculté de Médecine
Saint-Antoine, 27 rue Chaligny, 75571 Paris cedex 12, France.

This work was an attempt at analysing the seasonal pattern of varicella epidemics
in France by fitting a susceptibles-exposed-infectives-recovered (SEIR) model
with a periodic contact rate function to weekly chickenpox incidence data
collected over the period 1991 to 1996.The contact rate was assumed to be either 
a continuous, or a piecewise constant, periodic function. Both assumptions gave a
reasonable fit to the data and yielded estimates of the incubation and infectious
periods that were consistent with values derived on clinical or serological
grounds. Seasonal fluctuation of the estimated contact rate function was likely
to reflect the impact of school holidays on chickenpox diffusion among
schoolchildren. Copyright 2000 John Wiley & Sons, Ltd.

PMID: 10797517 [PubMed - indexed for MEDLINE]

714: Virology. 2000 May 10;270(2):278-85.

Varicella-zoster virus infection of a human CD4-positive T-cell line.

Zerboni L, Sommer M, Ware CF, Arvin AM.

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
94305-5208, USA. zerboni@leland.stanford.edu

Varicella-zoster virus (VZV) is a human alpha-herpesvirus that causes varicella
(chickenpox) at primary infection and may reactivate as herpes zoster. VZV is a
T-lymphotropic virus in vivo. To investigate the T-cell tropism of VZV, we
constructed a recombinant virus expressing green fluorescent protein (VZV-GFP)
under the CMV IE promoter. Coculture of VZV-GFP-infected fibroblasts with II-23
cells, a CD4-positive human T-cell hybridoma, resulted in transfer of virus to
II-23 cells. II-23 cells are susceptible to VZV-GFP infection as demonstrated by 
expression of immediate/early (IE62), early (ORF4), and late (gE) genes. Recovery
of infectious virus was limited, with only 1 to 3 in 10(6) cells releasing
infectious virus by plaque assay, indicating that transfer of virus results in a 
limited productive infection. In vitro infection of II-23 cells will be useful
for further analysis of VZV tropism for T-lymphocytes. Copyright 2000 Academic
Press.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10792986 [PubMed - indexed for MEDLINE]

715: Pediatr Nephrol. 2000 Apr;14(4):305-8.

Comment in:
    Pediatr Nephrol. 2000 Dec;15(3-4):326-7.

Acyclovir prophylaxis of varicella in children with renal disease receiving
steroids.

Goldstein SL, Somers MJ, Lande MB, Brewer ED, Jabs KL.

Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA.
slgoldst@msmail.po2.is5.tmc.tch.edu

Varicella, or chickenpox, is very communicable and has been shown to be
transmitted to nearly 90% of household contacts. Severe varicella infections with
fatal complications have been noted in children receiving corticosteroids despite
the administration of varicella-zoster immune globulin (VZIG). The use of
post-exposure acyclovir prophylaxis in immunocompetent children exposed to a
household contact with varicella has been shown to decrease the transmission rate
of varicella significantly. We studied the safety and efficacy of acyclovir
prophylaxis as an adjunctive preventive measure in 8 children (10 separate
exposures) receiving corticosteroids for renal disease. Four children (6 separate
exposures) served as controls. No adverse reactions were reported with the
acyclovir prophylaxis. The maximum change between pre- and study serum creatinine
levels was 0.1 mg/dl. None of the 8 patients who received acyclovir prophylaxis
developed chickenpox. One of these 8 patients developed humoral immunity to
varicella despite the absence of clinical infection. One of 4 patients who
received VZIG prophylaxis alone developed chickenpox. These data support the use 
of acyclovir prophylaxis as an adjunctive measure to VZIG for the prevention of
potentially serious varicella infection in children receiving steroids.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10775074 [PubMed - indexed for MEDLINE]

716: J Paediatr Child Health. 2000 Apr;36(2):186-8.

Congenital varicella syndrome diagnosed by polymerase chain reaction--scarring of
the spinal cord, not the skin.

Cooper C, Wojtulewicz J, Ratnamohan VM, Arbuckle S.

Departments of Neonatology and Pathology, Royal Alexandra Hospital for Children
and Virology Unit ICPMR, Westmead Hospital, Westmead, New South Wales, Australia.

A term infant with congenital varicella syndrome (CVS) is reported. Monoplegia of
the left arm and paraplegia were present with no evidence of dermatomal skin
scarring. Following death at 12 days of age, autopsy documented severe atrophy
and gliosis of the spinal cord. Testing for varicella-zoster virus by the
polymerase chain reaction method on brain tissue was positive. This case extends 
the current understanding of the clinical and pathological features of CVS.

Publication Types: 
    Case Reports

PMID: 10760023 [PubMed - indexed for MEDLINE]

717: J Paediatr Child Health. 2000 Apr;36(2):184-5.

Congenital varicella syndrome in the absence of cutaneous lesions.

Choong CS, Patole S, Whitehall J.

Department of Neonatology, Kirwan Hospital for Women, Thuringowa, Queensland,
Australia.

A case of congenital varicella syndrome characterized by intrauterine growth
retardation, ocular and neurologic abnormalities, but no cutaneous lesions is
reported. This case highlights the risk of embryopathy from varicella infection
during pregnancy in non-immune women.

Publication Types: 
    Case Reports

PMID: 10760022 [PubMed - indexed for MEDLINE]

718: J Paediatr Child Health. 2000 Apr;36(2):108-13.

Congenital and neonatal varicella in Australia.

Forrest J, Mego S, Burgess M.

National Centre for Immunisation Research and Surveillance of Vaccine Preventable
Diseases (NCIRS), Royal Alexandra Hospital for Children, Westmead, New South
Wales, Australia. jillf@nch.edu.au

OBJECTIVE: To establish the incidence and severity of congenital and neonatal
varicella in Australia. METHODOLOGY: Demographic and clinical details were
obtained by postal questionnaire regarding cases notified to the Australian
Paediatric Surveillance Unit by over 930 participating clinicians in 1995-97
inclusive. RESULTS: Seven cases of congenital varicella (1: 107 000
pregnancies/year) followed maternal infection at 8-26 weeks: five had defects,
two did not. Four of the seven infants with congenital varicella developed herpes
zoster in the first 15 months of life. Forty-four infants had neonatal varicella 
(1: 17 000 pregnancies/year). CONCLUSION:: There is an ongoing, albeit low,
incidence of congenital and neonatal varicella in Australia.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 10760005 [PubMed - indexed for MEDLINE]

719: Nat Med. 2000 Apr;6(4):451-4.

Comment in:
    Nat Med. 2000 Apr;6(4):381-2.    Nat Med. 2000 Dec;6(12):1298-300.    Nat Med. 2000 Dec;6(12):1299-300.

Varicella vaccination: evidence for frequent reactivation of the vaccine strain
in healthy children.

Krause PR, Klinman DM.

Laboratory of DNA Viruses, Bethesda, Maryland, USA.

Wild-type varicella zoster virus (VZV) causes chickenpox, a common childhood
illness characterized by fever and a vesicular rash and rare serious
complications. Wild-type VZV persists in a latent form in the sensory ganglia,
and can re-activate to cause herpes zoster. More than 10 million American
children have received the live attenuated Oka strain VZV vaccine (OkaVZV) since 
its licensure in 1995. Pre-licensure clinical studies showed that mean serum
anti-VZV levels among vaccinees continued to increase with time after
vaccination. This was attributed to immunologic boosting caused by exposure to
wild-type VZV in the community. Here, we examine the alternative, that
large-scale asymptomatic reactivation of OkaVZV might occur in vaccinees. We
analyzed serum antibody levels and infection rates for 4 years of follow-up in
4,631 children immunized with OkaVZV. Anti-VZV titers decreased over time in
high-responder subjects, but rose in vaccinees with low titers. Among subjects
with low anti-VZV titers, the frequency of clinical infection and immunological
boosting substantially exceeded the 13%-per-year rate of exposure to wild-type
varicella. These findings indicate that OkaVZV persisted in vivo and reactivated 
as serum antibody titers decreased after vaccination. This has salient
consequences for individuals immunized with OkaVZV.

PMID: 10742154 [PubMed - indexed for MEDLINE]

720: Bone Marrow Transplant. 2000 Mar;25(6):657-64.

Varicella-zoster infection after allogeneic bone marrow transplantation:
incidence, risk factors and prevention with low-dose aciclovir and ganciclovir.

Steer CB, Szer J, Sasadeusz J, Matthews JP, Beresford JA, Grigg A.

Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Australia.

We examined the incidence of herpes varicella-zoster virus (VZV) infection in 151
patients undergoing allogeneic BMT between August 1990 and September 1997 and who
survived at least 3 months. Median follow-up was 17 (range 3.3-80.7) months.
Herpes simplex virus antibody positive (HSV+) patients received aciclovir 1200 mg
p.o. daily or 750 mg i.v. daily, in divided doses from day 0 to engraftment.
Ganciclovir (5 mg/kg i.v. three times per week) was given in CMV+ patients (or if
the donor was CMV+) from engraftment to day 84. Ganciclovir was continued or
recommenced if a dose of greater than 20 mg of prednisone was used for the
treatment of GVHD otherwise aciclovir was recommenced. In HSV+ patients not
receiving ganciclovir, aciclovir 600 mg p.o. daily in divided doses was given
until at least 6 months after BMT. Thirty-two patients developed VZV infection
from 4.1 to 28 months after transplant. The estimated cumulative incidence of VZV
was 13% (95% confidence interval 6-19%) at 12 months, 32% (22-42%) at 24 months
and 38% (27-50%) at 28 months, with no further cases beyond that time. No patient
developed VZV whilst receiving aciclovir or ganciclovir (P < 0.0001). However,
there was a rapid onset of VZV following cessation of antiviral therapy (33%
(20-46%) at 1 year post cessation). The presence of GVHD and the prior duration
of antiviral prophylaxis were significant and independent risk factors for the
development of VZV. Age, underlying disease, conditioning therapy or donor type
were not. We conclude that 3-6 months of low-dose aciclovir and ganciclovir are
effective at delaying the onset of VZV after allogeneic BMT, but may not affect
the overall incidence of infection. Prolonged prophylaxis may be warranted in
patients at high risk of infection, for example those patients with GVHD.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 10734301 [PubMed - indexed for MEDLINE]

721: Arch Pediatr Adolesc Med. 2000 Mar;154(3):302-6.

Parental attitudes toward varicella vaccination. The Puget Sound Pediatric
Research Network.

Taylor JA, Newman RD.

Department of Pediatrics, University of Washington School of Medicine, Seattle
98103-8652, USA. uncjat@u.washington.edu

OBJECTIVES: To evaluate parental health beliefs regarding the varicella vaccine
and to identify potential areas for interventions designed to increase
immunization against varicella. SETTING: Data were collected in the offices of
pediatricians who are members of the Puget Sound Pediatric Research Network, a
regional practice-based research group in the Seattle, Wash, area. METHODS: At
the time of an office visit, parents were asked to complete a survey on the
varicella vaccine. Respondents indicated level of agreement with 10 health belief
statements regarding the immunization using a 6-point Likert scale from
"completely agree" to "completely disagree"; responses were subsequently
transformed to an ordinal scale from 1 to 6, with 6 corresponding to highly
positive beliefs. A composite health belief score for each respondent was
computed by averaging responses to all statements. Parents also were asked to
indicate the level of influence of their child's pediatrician on their decision
to use the varicella vaccine. RESULTS: A total of 598 surveys were completed.
Generally, parents agreed that the vaccine was worthwhile even if the only
benefit was preventing a rare complication. Conversely, the majority of parents
disagreed that varicella vaccine was worthwhile if the only benefit was
preventing lost time from work, and that the immunization was worthwhile even if 
immunity was not lifelong. Parents who indicated that their child's
pediatrician's opinion significantly influenced their decision to use the vaccine
had higher composite health belief scores than those who indicated less influence
(median scores, 4.3 and 4.0, respectively; P<.001). CONCLUSIONS: In this sample, 
parents had more positive health beliefs about the ability of varicella vaccine
to prevent rare complications than to save time lost from work. These data also
suggest that pediatricians can have an important role in increasing positive
health beliefs about the vaccine. These findings may help future interventions to
increase the immunization rate against varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10710032 [PubMed - indexed for MEDLINE]

722: Biol Blood Marrow Transplant. 2000;6(1):44-9.

Varicella zoster virus infections following allogeneic bone marrow
transplantation: frequency, risk factors, and clinical outcome.

Koc Y, Miller KB, Schenkein DP, Griffith J, Akhtar M, DesJardin J, Snydman DR.

Department of Medicine, New England Medical Center, Boston, Massachusetts, USA.

Reactivation of varicella zoster virus (VZV) is a common event in patients
undergoing allogeneic bone marrow transplantation (BMT) and may lead to
life-threatening complications. We retrospectively analyzed the incidence,
clinical outcome, and risk factors for VZV infections occurring within the first 
5 years of transplantation in 100 consecutive adults undergoing allogeneic BMT
between 1992 and 1997. Forty-one patients (41%) developed VZV reactivation a
median of 227 days (range 45-346 days) post-transplantation. Twelve percent of
VZV reactivation occurred in the first 100 days and 88% within the first 24
months. Among those who survived for 2 or more years after transplantation (n =
47), 59% developed VZV infection. Forty percent of patients with VZV reactivation
required admission with a mean hospital stay of 7.2 days. Two patients developed 
encephalitis, and 1 died despite antiviral therapy. The most frequent
complications were post-herpetic neuralgia and peripheral neuropathy (68%).
Thoracic dermatomal zoster represented 41% of the infections; disseminated
cutaneous involvement was observed in 17% of patients. No clinical or
epidemiologic risk factors were associated with recurrence. Administration of
ganciclovir for prevention of cytomegalovirus infection delayed the onset of VZV 
infection beyond 4 months (P = .06). In a further subset analysis, patients with 
a limited chronic graft-versus-host disease (GVHD) had a lower estimated
incidence of VZV reactivation compared with those with extensive chronic GVHD (P 
= .11). We conclude that complications from reactivation of VZV infection are
common and associated with considerable morbidity and mortality in patients
undergoing allogeneic BMT.

Publication Types: 
    Clinical Trial

PMID: 10707998 [PubMed - indexed for MEDLINE]

723: J Hosp Infect. 2000 Mar;44(3):224-6.

Variation in risk for nosocomial chickenpox after inadvertent exposure.

Langley JM, Hanakowski M.

Izaak Walton Killam Grace Health Centre for Children, Women and Families,
Dalhousie University, Halifax, Nova Scotia. joanne.langley@dal.ca

Inadvertent exposure to chickenpox in the healthcare setting results in
time-consuming and expensive infection control management strategies. In
households, secondary cases occur in up to 96% of susceptibles, but transmission 
risk after exposure in an occupational setting is less well defined. In this
prospective cohort study of inadvertent exposures in a 180-bed paediatric
hospital, the secondary transmission rate was 4.5% (4/89; 95% confidence interval
1.2, 11.1%). Fourteen index cases exposed 158 patients and 93 healthcare workers 
over a 36-month study period. Exposures occurred in inpatient and ambulatory
settings, with patients, staff and siblings serving as index cases. Transmission 
only occurred when the index case and contacts were in the same room and not in a
multi-room setting (12% v. 0%, Fisher exact test, P = 0.02). Occupational
exposures present a lesser transmission risk than those in households. Definition
of those exposure variables that increase risk of transmission in the
occupational setting should be explored in future studies. Copyright 2000 The
Hospital Infection Society.

PMID: 10706806 [PubMed - indexed for MEDLINE]

724: J Dermatol Sci. 2000 May;23(1):63-72.

Characterization of acyclovir susceptibility and genetic stability of
varicella-zoster viruses isolated during acyclovir therapy.

Ida M, Kageyama S, Sato H, Kamiyama T, Toyomoto T, Ozaki T, Kajita Y, Morohashi
M, Shiraki K.

Department of Virology, Toyama Medical and Pharmaceutical University, 2630
Sugitani, Toyama, Japan.

We have characterized the susceptibility and genetic stability of
varicella-zoster viruses (VZV) isolated from skin lesions of three patients with 
herpes zoster and six patients with varicella treated with conventional
short-term acyclovir (ACV) administration. The susceptibilities to ACV of the
serial isolates from the patients were examined, and there was no significant
difference in the susceptibility to ACV among the isolates before and during the 
ACV treatment, indicating that conventional short-term ACV treatment did not
generate ACV-resistant VZV infections. Polymerase chain reaction (PCR) analyses
of these as well as seven thymidine kinase-deficient VZV strains derived from in 
vitro ACV treatment were carried out to examine their genomic stability. Five
regions containing tandem direct reiterations (R1-R5) were amplified by PCR and
compared, and the region containing the Pst I-site was also examined. PCR
analyses demonstrated that the R1, R5 and the Pst I-sites were stable and useful 
in epidemiological studies even after ACV treatment. The R2, R3 and R4 sites were
far less stable in these experimental conditions. In this paper we discuss the
results of the PCR analyses with regard to the dynamics of VZV population in
patients with VZV infection treated with conventional short-term ACV
administration.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10699766 [PubMed - indexed for MEDLINE]

725: Am J Dermatopathol. 2000 Feb;22(1):70-4.

Benign cephalic histiocytosis progressing into juvenile xanthogranuloma: a
non-Langerhans cell histiocytosis transforming under the influence of a virus?

Rodriguez-Jurado R, Duran-McKinster C, Ruiz-Maldonado R.

Department of Pathology, National Institute of Pediatrics of Mexico, Mexico City.

Benign cephalic histiocytosis (BCH) is best understood as a form of
non-Langerhans cell histiocytosis, specifically as an early mononuclear variant
of juvenile xanthogranuloma (JXG). However, the progression of BCH into JXG in
the same patient has only been reported once before. We describe the case of a
2-year-old girl with asymptomatic, large, ill-defined infiltrated flat plaques
over both cheeks, in addition to isolated papules. A punch biopsy of a plaque
revealed dermal infiltration by vacuolated and scalloped histiocytes positive for
CD68 KP-1, and that lacked expression of CD1a and S-100 protein, favoring
macrophages over Langerhans cells. Electron microscopy study showed comma-shaped 
intracytoplasmic bodies in the histiocytic cells leading to the diagnosis of BCH.
One year later, after an episode of varicella-zoster infection, the flat plaques 
over the cheeks became large reddish-yellow nodules, and in a second biopsy
appeared to progress to JXG. Virus-related mechanisms of progression are
discussed.

Publication Types: 
    Case Reports

PMID: 10698221 [PubMed - indexed for MEDLINE]

726: J Virol Methods. 2000 Feb;84(2):169-73.

Serological diagnosis of varicella-zoster virus in sera with antibody-capture
enzyme-linked immunosorbent assay of IgM.

Oladepo DK, Klapper PE, Percival D, Vallely PJ.

Cortecs Diagnostics, Deeside, UK.

Evaluation was made of three enzyme-linked immunosorbent assay (ELISA) formats;
varicella-zoster virus (VZV) indirect ELISA; VZV IgM capture using biotin and VZV
IgM capture using peroxidase, for the detection of VZV-specific IgM antibodies in
human sera. It was observed that there was no significant difference in
sensitivity of detection using the three formats but there were important
practical differences in the number of steps and hence time for assay completion 
between the three assay formats. All assays showed some cross-reactivity with
sera containing anti-HSV1 antibodies.

PMID: 10680966 [PubMed - indexed for MEDLINE]

727: Ann Pharmacother. 2000 Feb;34(2):228-34.

Immunology of Varicella Immunization in the elderly.

Raeder CK, Hayney MS.

School of Pharmacy, University of Wisconsin-Madison, 53706, USA.

OBJECTIVE: To review the varicella-zoster virus (VZV) and herpes zoster disease
and to summarize published reports on the use of the live-attenuated varicella
zoster vaccine to enhance cell-mediated immunity in elderly individuals. DATA
SOURCE: A MEDLINE search (1966-August 1999) for English-language clinical studies
and review articles pertaining to VZV and the live-attenuated varicella vaccine
was conducted; references obtained from these publications were subsequently
reviewed for additional relevant articles. STUDY SELECTION AND DATA EXTRACTION:
Representative clinical trials were summarized and relevant information was
selected to assist in the understanding of VZV, the subsequent immune response,
and the live-attenuated varicella vaccine. DATA SYNTHESIS: The physiologic,
age-related decline in VZV cell-mediated immunity has been shown to be restored
on administration of live-attenuated varicella vaccine. Various studies report
serum anti-VZV antibody concentrations, and production of interferon-gamma were
increased following vaccination. Concentrations subsequently returned to baseline
one year after vaccination. Increase in responder cell frequency, a measure of
cell-mediated immunity, has been reported to last up to four years after
vaccination, at concentrations similar or superior to those observed following
herpes zoster. CONCLUSIONS: Enhancement of cell-mediated immune response in
elderly individuals through vaccination with live-attenuated varicella vaccine is
a possible measure to protect this population from herpes zoster and to attenuate
its complications. A summary of immunogenicity studies to identify the immune
response to live-attenuated varicella vaccine in the elderly is presented. The
absolute clinical significance, as well as appropriate administration guidelines 
of this prophylactic intervention, will become evident following forthcoming
large, masked, placebo-controlled trials.

Publication Types: 
    Review

PMID: 10676831 [PubMed - indexed for MEDLINE]

728: Bone Marrow Transplant. 2000 Jan;25(2):167-72.

Incidence, risk factors and outcome of varicella-zoster virus infection in
children after haematopoietic stem cell transplantation.

Leung TF, Chik KW, Li CK, Lai H, Shing MM, Chan PK, Lee V, Yuen PM.

Division of Haematology and Oncology, Department of Paediatrics, The Chinese
University of Hong Kong, Hong Kong.

We report a retrospective analysis of VZV infection after haematopoietic stem
cell transplantation (HSCT) in children. Thirty-three (30%) of the total 109
children who were transplanted during a 7 year period developed post-transplant
VZV infection. Twenty-four of these 33 (73%) children had VZV infection within 1 
year following HSCT. The cumulative incidences of post-transplant VZV infection
at 1 and 5 years were 26% and 45%, respectively. The positive and negative
predictive values of pretransplant VZV serology in recipients on the development 
of HZ following HSCT were 39% and 88%, respectively. Pretransplant VZV
seropositivity in recipients was the only risk factor for post-transplant herpes 
zoster (HZ) infection on multivariate analysis. All patients responded to
acyclovir. The median duration of VZV infection was 5 days. Three (11%) and one
(3%) children with HZ developed visceral dissemination and post-herpetic
neuralgia, respectively. No mortality was directly attributed to VZV infection.
VZV infection remains a major cause of morbidity in children after HSCT. Further 
studies are warranted to evaluate the potential use of VZV vaccine in these
children. Bone Marrow Transplantation (2000) 25, 167-172.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10673675 [PubMed - indexed for MEDLINE]

729: Pediatrics. 2000 Jan;105(1):e17.

The use of school-based vaccination clinics to control varicella outbreaks in two
schools.

Hall S, Galil K, Watson B, Seward J.

National Immunization Program, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA.

School-based vaccination clinics were offered in 2 schools experiencing varicella
outbreaks. The clinics raised coverage of susceptible children from 52.9% to
92.2% and from 68.8% to 85.3% in the 2 schools, respectively. Although routine
immunization and school-entry requirements are the best strategies for preventing
outbreaks, school-based vaccination clinics may greatly increase coverage and
shorten outbreaks.

PMID: 10617754 [PubMed - indexed for MEDLINE]

730: Pediatrics. 2000 Jan;105(1):e13.

Post-varicella epiglottitis and necrotizing fasciitis.

Slack CL, Allen GC, Morrison JE, Garren KC, Roback MG.

Department of Otolaryngology, University of Colorado School of Medicine,
Children's Hospital, Denver, Colorado, USA. cnvslack@concentric.net

Varicella is a nearly ubiquitous acquired childhood disease. Infectious
complications of varicella can be life- or limb-threatening. These complications 
appear 3 to 4 days after the appearance of varicella exanthem and are heralded by
fever, pain, and erythema of the overlying skin. Airway complications of
varicella are rare, rapidly evolving, and, unfortunately, difficult to visualize.
We report a child who presented with a unique combination of varicella-induced
airway complications-acute epiglottitis and subsequent necrotizing fasciitis of
the head and neck. varicella, epiglottitis, necrotizing fasciitis, group A
beta-hemolytic streptococcus, nasopharyngoscopy.

Publication Types: 
    Case Reports

PMID: 10617750 [PubMed - indexed for MEDLINE]

731: Pediatrics. 2000 Jan;105(1 Pt 1):136-41.

Comment in:
    Pediatrics. 2001 Mar;107(3):612.

American Academy of Pediatrics. Committee on Infectious Diseases. Varicella
vaccine update.

[No authors listed]

Recommendations for routine varicella vaccination were published by the American 
Academy of Pediatrics in May 1995, but many eligible children remain unimmunized.
This update provides additional information on the varicella disease burden
before the availability of varicella vaccine, potential barriers to immunization,
efforts to increase the level of coverage, new safety data, and new
recommendations for use of the varicella vaccine after exposure and in children
with human immunodeficiency virus infections. Pediatricians are strongly
encouraged to support public health officials in the development and
implementation of varicella immunization requirements for child care and school
entry.

Publication Types: 
    Guideline
    Practice Guideline
    Review

PMID: 10617719 [PubMed - indexed for MEDLINE]

732: Pediatrics. 2000 Jan;105(1 Pt 1):84-8.

Postexposure effectiveness of varicella vaccine.

Watson B, Seward J, Yang A, Witte P, Lutz J, Chan C, Orlin S, Levenson R.

Department of Public Health Philadelphia, Philadelphia, Pennsylvania 19146, USA. 
barbara.watson@phila.gov

OBJECTIVE: 1) To describe the postexposure effectiveness of varicella vaccine in 
a homeless shelter; and 2) to demonstrate an effective public health intervention
and its implications. DESIGN: A prospective observational study. SETTING: A women
and children's shelter in Philadelphia with 2 cases of varicella before
intervention. OUTCOME MEASURES: Varicella in vaccinated and unvaccinated shelter 
residents; vaccine effectiveness for prevention of varicella when administered
after exposure among children <13 years of age. RESULTS: Sixty-seven shelter
residents received varicella vaccine after exposure, including 42 children <13
years of age. One child who was unvaccinated developed varicella, but no
vaccinated child developed typical disease. Vaccine effectiveness was 95.2% (95% 
CI, 81.6%-98.8%) for prevention of any disease and 100% for prevention of
moderate or severe disease among the children <13 years of age. CONCLUSION: When 
used within 36 hours after exposure to varicella in a setting where close contact
occurred, varicella vaccine was highly effective in preventing further disease.
This study provides support for the recent recommendation by the Advisory
Committee on Immunization Practices to administer varicella vaccine after
exposure: this practice should minimize the number of moderate or severe cases of
disease and prevent prolonged outbreaks.

PMID: 10617709 [PubMed - indexed for MEDLINE]
