Occult Varicella

in Pediatric Infectious Disease Journal (2009), 28(12), 1073-1075

Background: Localized varicella has been associated with UV-exposure and skin trauma. Varicella restricted to a pre-existent dermatitis is exceptional. Objectives: The clinical features, cytohistologic ... [more ▼]

Background: Localized varicella has been associated with UV-exposure and skin trauma. Varicella restricted to a pre-existent dermatitis is exceptional. Objectives: The clinical features, cytohistologic and immunohistochemical results, as well as serologic data of 6 patients with a sudden eruption of vesicular and eroded lesions restricted to a pre-existent dermatitis are presented. Results: All patients (mean age: 8,3 years, range: 3–22) showed crops of a few to numerous vesicular lesions clustered on the restricted sites of posttraumatic wound, perianal streptococcal dermatitis, dermatomycosis, allergic contact dermatitis, lichen sclerosus, and atopic foot dermatitis. All the Tzanck smears and 1 biopsy revealed multinucleated giant cells, consistent with herpes simplex virus (HSV) or varicella zoster virus (VZV) infection. Immunohistochemistry using specific anti-VZV antibodies (IE63 and gE) was positive on all the smears and the biopsy, whereas HSV-I and HSV-II immunolabeling was negative. VZV specific IgM , IgG EIAbased serology, and positive VZV-specific IgM complement fixation test suggested primary VZV infection. None had received varicella vaccine. None of the patients presented a history of varicella nor experienced breakthrough varicella. It was decided not to administer antiviral treatment, as the varicella lesions remained localized without any further skin extension and systemic signs. About 2 months later, EIA-serology revealed positive VZV-IgG and negative IgM levels in 5/5 patients. Conclusion: Some patients have varicella infection that remains hidden in a pre-existent infectious and/or inflammatory dermatitis without ever presenting full-blown chickenpox. The sudden occurrence of vesicular and/or ulcerated lesions on a pre-existent dermatitis should prompt searching for a viral infection. [less ▲]

Consensus : Varicella vaccination of healthy children - A challenge for Europe

in Pediatric Infectious Disease Journal (2004), 23(5), 379-389

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 ... [more ▼]

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-rabella-varicella combined vaccine. [less ▲]