Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
Wind pox, water pox; sheep pox, chicken pox.
Non-notifiable, common disease caused by varicella (VZV)
- 98% of >15-year-olds have had initial infection, but primary infection is still possible in adulthood (Varicella adultorum)
- Occurrence mainly in winter and spring
- Incidence: approx. 50,000-75,000 / year in Switzerland
- Mortality: approx. approx. 0.03 / 100000 inhabitants / year
- Incubation period: approx. 2 weeks
- Diaplacentally transmissible. Congenital varicella syndrome in 1-3/1000 pregnancies, lethality: approx. 10%. Infection in the last trimester lead to maternal lethality of 20-45%
- Droplet or smear infection or direct contact (saliva, fluid contents, coughing, sneezing)
- The affected person is already contagious 1-2 days before the onset of the disease. As soon as all the blisters have dried up, there is no longer any danger of infection. Despite the formation of antibodies, the virus cannot be excreted from the organism and remains latent in the sensitive ganglia of the hind roots. In case of reactivation, mostly due to immunosuppression (exclusion of HIV in young people), herpes zoster occurs.
- In 95% of cases, the infection progresses with pronounced symptoms, but in children the course is often without complications. In adults, fever, lymphadenopathy, reduced AZ and pruritus are common
- Overall, the clinical picture is polymorphic (Heubner's starry sky, lesions occur sequentially and not simultaneously). Red macules, small erythematous papules on the entire integument become vesicles on an erythematous base as they progress. These then become opacified and become secondary pustules. After crusting, there is no longer a risk of infection
Clinical diagnosis, if applicable:
- PCR VZV
- Immunofluorescence (Syva MicroTrak®)
- Virus culture
- Affected throughout the integument, capillitium, palmar at times, plantar usually no involvement
- Rarely conjunctiva, larynx or genital mucosa are also affected
Thin vesicle cover, degeneration of basal cells, epidermal giant cells, focal colliquation of rete cells, inclusion bodies.
- Skin gangrene
- Purpura fulminans
- Meningitis or meningoencephalitis
- Ataxia in cerebellitis
- Reye syndromes (CAVE: no administration of ASS)
- Rare: Guillain-Barré type
- Varicella pneumonia (1-6 days after onset of exanthema, often difficult to diagnose clinically and auscultatorily → X-ray chest)
- Otherwise involvement of eyes, ears, joints, muscles, heart, and kidneys
- Ictus reaction
In Switzerland, chickenpox vaccination is recommended. Affected are:
- 11-39-year-olds, provided they have not had varicella
- IgG negative individuals
- Immunocompromised individuals
- Patients with severe neurodermatitis
- Persons with contact to above mentioned persons (family members, persons in medical professions)
- Post exposure prophylaxis with aciclovir in full dosage for one week, at the latest 9 days after exposure
Live varicella vaccine (Inj. Suspension)
- 2 vaccinations at least 1 month apart
- IND: Active immunisation against varicella
- KI: underlying haematological diseases, immunodeficiency (including tuberculosis), temperature > 38.5°C, pregnancy, lactation, after a severe allergic reaction (approx. 1/million) to the first vaccination or to neomycin, in case of mild illness (postponement of vaccination by 1-2 weeks)
- Generally well tolerated
- NW: local redness, mild fever, chickenpox-like rash
- Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP), in PsycEXTRA Dataset. American Psychological Association (APA).
- Varicella Syndrome, Congenital, in SpringerReference. Springer Science + Business Media.
- Andrei, G., et al., Comparative activity of selected antiviral compounds against clinical isolates of varicella-zoster virus. European Journal of Clinical Microbiology & Infectious Diseases, 1995. 14(4): p. 318-329.
- Arvin, A.M., Chickenpox (Varicella), in Varicella-Zoster Virus. 1999, S. Karger AG. p. 96-110.
- Banz, K., et al., The cost-effectiveness of routine childhood varicella vaccination in Germany. Vaccine, 2003. 21(11-12): p. 1256-1267.
- Blickenstaff, R.D., H.O. Perry, and M.S. Peters, Linear IgA deposition associated with cutaneous varicella-zoster infection: a case report. J Cutan Pathol, 1988. 15(1): p. 49-52.
- Broussard, R.C., Treatment with acyclovir of varicella pneumonia in pregnancy. CHEST Journal, 1991. 99(4): p. 1045.
- Brunell, P.A., Varicella in Pregnancy, the Fetus, and the Newborn: Problems in Management. Journal of Infectious Diseases, 1992. 166(Supplement 1): p. S42-S47.
- Chaves, S.S., et al., Loss of Vaccine-Induced Immunity to Varicella over Time. New England Journal of Medicine, 2007. 356(11): p. 1121-1129.
- Chaves, Sandra S., et al., Safety of Varicella Vaccine after Licensure in the United States: Experience from Reports to the Vaccine Adverse Event Reporting System, 1995–2005. The Journal of Infectious Diseases, 2008. 197(s2): p. S170-S177.
- Chaves, Sandra S., et al., Varicella Disease among Vaccinated Persons: Clinical and Epidemiological Characteristics, 1997–2005. The Journal of Infectious Diseases, 2008. 197(s2): p. S127-S131.
- Chopra, K.F., et al., Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of HIV infection. Journal of the American Academy of Dermatology, 1999. 41(1): p. 119-121.
- Delpiano M, L., Infección invasora por Streptococcus pyogenes post varicela y vacuna anti varicela. Reduction in pediatric hospitalizations for varicella-related invasive group A streptococcal infections in the varicella vaccine era. Patel R, Binns H, Shulman S. J Pediatr 2004; 144: 68-74. Rev. chil. infectol., 2004. 21(2).
- Furuta, Y., et al., Varicella-Zoster Virus Reactivation Is an Important Cause of Acute Peripheral Facial Paralysis in Children. The Pediatric Infectious Disease Journal, 2005. 24(2): p. 97-101.
- Galil, K., et al., Outbreak of Varicella at a Day-Care Center despite Vaccination. New England Journal of Medicine, 2002. 347(24): p. 1909-1915.
- Gilden, D.H., et al., Neurologic Complications of the Reactivation of Varicella–Zoster Virus. New England Journal of Medicine, 2000. 342(9): p. 635-645.
- Gnann, J.John W., Varicella‐Zoster Virus: Atypical Presentations and Unusual Complications. The Journal of Infectious Diseases, 2002. 186(s1): p. S91-S98.
- Hambleton, S. and A.A. Gershon, The impact of varicella vaccination in the United States. Seminars in Pediatric Infectious Diseases, 2005. 16(1): p. 38-43.
- Josephson, C., et al., The Varicella-Autoantibody Syndrome. Pediatr Res, 2001. 50(3): p. 345-352.
- LaRussa, P., Clinical manifestations of varicella, in Varicella-Zoster Virus. Cambridge University Press (CUP). p. 206-219.
- Lipton, S.V., Management of varicella exposure in a neonatal intensive care unit. JAMA: The Journal of the American Medical Association, 1989. 261(12): p. 1782-1784.
- Maranich, A.M. and M. Rajnik, Varicella-Specific Immunoglobulin G Titers in Commercial Intravenous Immunoglobulin Preparations. PEDIATRICS, 2009. 124(3): p. e484-e488.
- Marin, M., H.C. Meissner, and J.F. Seward, Varicella Prevention in the United States: A Review of Successes and Challenges. PEDIATRICS, 2008. 122(3): p. e744-e751.
- Mattson, S.N., et al., Neurodevelopmental follow-up of children of women infected with varicella during pregnancy: a prospective study. The Pediatric Infectious Disease Journal, 2003. 22(9): p. 819-823.
- McCrary, M.L., J. Severson, and S.K. Tyring, Varicella zoster virus. Journal of the American Academy of Dermatology, 1999. 41(1): p. 1-16.
- Mehta, Satish K., et al., Varicella‐Zoster Virus in the Saliva of Patients with Herpes Zoster. The Journal of Infectious Diseases, 2008. 197(5): p. 654-657.
- Mohsen, A.H. and M. McKendrick, Varicella pneumonia in adults. Eur Respir J, 2003. 21(5): p. 886-891.
- Pastuszak, A.L., et al., Outcome after Maternal Varicella Infection in the First 20 Weeks of Pregnancy. New England Journal of Medicine, 1994. 330(13): p. 901-905.
- Rappersberger, K., Infections with herpes simplex and varicella-zoster virus in pregnancy: clinical manifestations in the mother, fetus and newborn – therapeutic options. Hautarzt, 1999. 50(10): p. 706.
- Rockley, P.F. and S.K. Tyring, PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS OF VARICELLA ZOSTER VIRUS INFECTIONS. International Journal of Dermatology, 1994. 33(4): p. 227-232.
- Sauerbrei, A., et al., Intracerebral varicella-zoster virus reactivation in congenital varicella syndrome. Developmental Medicine & Child Neurology, 2007. 45(12): p. 837-840.
- Sauerbrei, A. and P. Wutzler, Neonatal Varicella. J Perinatol, 2001. 21(8): p. 545-549.
- Sauerbrei, A. and P. Wutzler, Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections. Med Microbiol Immunol, 2006. 196(2): p. 95-102.
- Snoeck, R., G. Andrei, and E. De Clercq, Chemotherapy of varicella zoster virus infections. International Journal of Antimicrobial Agents, 1994. 4(3): p. 211-226.
- Thomson, J.J., A. Retter, and B.J. Hunt, Novel management of post varicella purpura fulminans owing to severe acquired protein S deficiency. Blood Coagulation & Fibrinolysis, 2010. 21(6): p. 598-600.
- Thune, P., Acute Linear IgA Dermatosis in a Child Following Varicella. Arch Dermatol, 1984. 120(9): p. 1237.
- Vázquez, M. and E.D. Shapiro, Varicella Vaccine and Infection with Varicella–Zoster Virus. New England Journal of Medicine, 2005. 352(5): p. 439-440.
- Verstraelen, H., et al., Prenatal ultrasound and magnetic resonance imaging in fetal varicella syndrome: correlation with pathology findings. Prenatal Diagnosis, 2003. 23(9): p. 705-709.
- Wauters, O., E. Lebas, and A.F. Nikkels, Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections. Journal of the American Academy of Dermatology, 2012. 66(6): p. e217-e227.
- Weber, D.M., Varicella Pneumonia. JAMA, 1965. 192(6): p. 572.
- Wutzler, P., Antiviral Therapy of Herpes simplex and Varicella-zoster Virus Infections. Intervirology, 1997. 40(5-6): p. 343-356.
- Wutzler, P., et al., Seroprevalence of varicella-zoster virus in the German population. Vaccine, 2001. 20(1-2): p. 121-124.
- Zerr, D.M., et al., A Case-Control Study of Necrotizing Fasciitis During Primary Varicella. PEDIATRICS, 1999. 103(4): p. 783-790.
- Oxman, M.N., et al., A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med, 2005. 352(22): p. 2271-84.
- Schmader, K.E., et al., Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis, 2012. 54(7): p. 922-8.
- Bundesamt für Gesundheit - Windpocken / Varizellen / „wilde oder spitze Blattern“. (2016). Bag.admin.ch. Retrieved 13 September 2015, from http://www.bag.admin.ch/themen/medizin/00682/00684/00730/index.html?lang=de