A strikingly
similar case occurred in a 25-year-old previously healthy woman in whom
a classic varicella rash, fever and headache developed about 2 weeks
after her young unvaccinated child had chickenpox. A cough developed on
day 2, followed by shortness of breath on day 3 and progressive
respiratory difficulty and confusion on day 4. A chest x-ray showed
bilateral infiltrates and the patient was found to be hypoxemic.
Treatment with oxygen and intravenous acyclovir was started; intubation
was also required. On day 6 computerized tomography of the brain showed
severe, diffuse, cerebral edema. Renal failure and coma developed, and
the patient died on day 7.
In the third
case, a 32-year-old woman with Crohn disease presented to an emergency
department with abdominal and back pain. She had recently had an
exacerbation of Crohn disease that was being treated with prednisone (40
mg/d, tapered to 20 mg/d). A mild macular, nonpruritic rash on her back
was ignored, and a benign abdominal syndrome was presumptively
diagnosed. The abdominal pain persisted, and the patient was admitted to
hospital on day 3; her white blood cell count was elevated, and a
maculopapular vesicular rash with crusted lesions was observed on her
trunk, head and neck. Varicella was presumptively diagnosed. The patient
reported that 2 weeks earlier she had been exposed to her 4-year-old
unvaccinated niece who had chickenpox. On day 4 the vesicles became
hemorrhagic and the patient began to bleed from intravenous sites.
Hypotension and disseminated intravascular coagulation rapidly
developed, and the patient died from shock on the same day. Autopsy
showed viral inclusion bodies, consistent with varicella, in multiple
organs.
These cases
illustrate that varicella is potentially fatal. Although fewer than 5%
of cases occur in people over age 20, 55% of varicella-related deaths
occur in this age group. The CDC recommends that all children be
routinely vaccinated at age 1218 months. The vaccine is not yet
available in Canada. People at increased risk of serious complications
from varicella who have been exposed to a case should be given varicella
zoster immune globulin within 96 hours of exposure. The earlier the
immune globulin is given, the more likely it is that the disease will be
attenuated. If varicella develops in an immunocompromised patient,
acyclovir should be given, preferably within 24 hours of onset of rash.
Prevention is important: varicella is highly contagious, especially
during the 2 days before the rash appears. In the US it is recommended
that all children and susceptible adults receive the vaccine. The 3
deaths reported here could have been prevented if the children to whom
the young women were exposed had been vaccinated. It is important for
Canadians to have access to the vaccine, which has been used in the US
since 1995, in Japan since 1984 and is used in various European
countries. Health Canada should consider taking steps to encourage
manufacturers to license their varicella vaccines in this country. -- JH,
AMT Reference 1.Varicella-related deaths among adults -- United States,
1997. MMWR 1997;46:412-5. | CMAJ September 1, 1997 (vol 157, no 5) /
JAMC le 1er septembre 1997 (vol 157, no 5) |
Study:
Chickenpox vaccine reduces adults’ odds of illness, complications
September 8, 2000 From staff reports ATLANTA (CNN) -- A vaccine that
prevents most cases of chickenpox is effective in protecting adults from
brain inflammation, pneumonia and other serious complications that may
occur with chickenpox, researchers announced Thursday. Immunization is
recommended for adults who have not had chickenpox, the researchers said
in a report for members of the Infectious Diseases Society of America,
meeting this week in New Orleans. Chickenpox, usually a childhood
disease, also strikes adults. They are more likely than children to
experience complications and death, according to the U.S. Centers for
Disease Control and Prevention (CDC). About 85 percent of adults who
have not had chickenpox and haven’t been vaccinated will get the
sickness when exposed to the disease, said Dr. Krow Ampofo, who led the
research. The infection rate drops to about 20 percent among vaccinated
adults who are later exposed to the chickenpox virus. "They have fewer
complications," Ampofo said. "It’s a milder form. Recovery time is
quicker." One of the most serious complications of chickenpox,
especially for adults, is encephalitis. It is an inflammation of the
brain that can cause loss of consciousness, seizures, muscle weakness,
sudden severe dementia, memory loss, withdrawal from social interaction
and impaired judgment, according to the CDC. Milder symptoms include
confusion, sudden fever, headache, vomiting, photophobia (abnormal
visual sensitivity to light), stiff neck, stiff back, drowsiness,
clumsiness, unsteady walk and irritability.
Ampofo, a
pediatric infectious-disease specialist at Columbia Presbyterian
Hospital, New York City, said rates of infections did not decrease
significantly during the first three years the chickenpox vaccine was
available for U.S. children, beginning in 1995. Since 1998, as more and
more children were vaccinated, the incidence of chickenpox has declined,
he said. As additional transmission routes are broken by the expanding
use of the vaccine, the chickenpox virus finds fewer hospitable hosts.
"It may become eradicated," said Ampofo. The vaccine is for healthy
children 12 months of age or older and for adolescents and adults who
have not had chickenpox. A simple test can determine whether a person
has had the illness, Ampofo said. Usually, having the disease prevents a
person from a second infection. For adults who may be susceptible to
chickenpox, he recommended visiting a physician. "Despite the fact that
adults account for only 5 percent of varicella (chickenpox) cases per
year," a CDC report said, "they account for a disproportionate number of
deaths (55 percent) and hospitalizations (33 percent) compared with
children." Ampofo and his colleagues studied the cases of 557 vaccinated
adults. "Among those who did contract chickenpox, the disease was
generally mild with an average of 54 skin lesions or blisters," he said.
A severe case may produce more than 500 lesions, and the average is
about 350, according to the CDC. Chickenpox is contagious one to two
days before the rash appears and until all blisters have formed scabs.
Chickenpox develops within 10 to 21 days after contact with an infected
person. An itchy rash develops into skin blisters that dry and become
scabs in four to five days, CDC officials said. The rash, often the
first sign of chickenpox, is sometimes accompanied by fever and malaise,
which is usually more severe in adults. Ampofo said one complication of
chickenpox is a secondary skin infection caused by bacteria. Vesicles on
the face and body can result in deep scars. Before vaccinating began
nationwide in 1995, there were approximately 11,000 hospitalizations and
100 deaths from chickenpox annually in the United States, CDC officials
said. The cost of caring for U.S. children of normal health who contract
chickenpox was estimated at $918 million in 1993, two years before
introduction of the vaccine. By 1999, CDC officials detected a dramatic
decline in cases and the typical springtime increase in chickenpox cases
did not occur. Since chickenpox is highly contagious, more than 95
percent of Americans have gotten the disease by adulthood in
pre-vaccination years. The virus spreads from person to person by direct
contact or through the air, according to a CDC report. Approximately 90
percent of persons in a household who have not had chickenpox will get
it if exposed to an infected family member.
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ALL INFORMATION, DATA, AND
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