Last Updated: 2021-10-15
chickenpox, waterpox; sheep flakes, chicken pox
Non-reportable, common disease caused by varicella (VZV).
- 98% of the >15 year-olds have undergone initial infection, but primoinfection is still possible in adulthood (varicella adultorum).
- Appears mainly in winter and spring.
Incidence: approx. 50,000-75,000 / year in Switzerland
Mortality: approx. 0.03 / 100'000 inhabitants / year.
- Incubation period: approx. 2 weeks.
Diaplacentary transferable. Congenital varicella syndrome in 1-3/1000 pregnancies, mortality: approx. 10%. Infection in the last trimester leads to a mother's mortality of 20-45%.
Droplet or smear infection or direct contact (saliva, fluid content, cough, sneezing).
The affected person is already in contact 1-2 days before the onset of the disease. Once all the bubbles have dried up, there is no longer any risk of infection. Despite the formation of antibodies, the virus cannot be excreted from the organism and remains latent in the sensitive ganglia of the posterior roots. Reactivation, usually due to immunosuppression (exclusion of HIV in young people) leads to herpes zoster.
- In 95% of cases, the infection progresses with pronounced symptoms, but in children there are often no complications. Fever, lymphadenopathy, reduced AZ and pruritus are more common in adults.
Overall, the clinical picture is polymorphic (Heubner's starry sky, lesions appear one after the other and not at the same time). Red maculae, small erythematous papules along the entire integument become vesicles on erythematous ground. These then cloudy and become secondary pustules. After crust formation there is no longer any danger of infection.
Clinical diagnosis, if necessary:
- PCR VZV
Immunofluorescence (Syva MikroTrak®)
- Viral culture
- On the entire integument, capillitium, palmar temporarily affected, plantar usually no infestation.
Conjunctives, larynx or genital mucosa are also rarely affected.
Thin blister cover, degeneration of basal cells, giant epidermal cells, herd-shaped colliquation of rete cells, inclusion bodies.
- Skin gangrene
- Purpura fulminans
- Meningitis or meningoencephalitis
- Ataxia in cerebellitis
Reye syndrome (CAVE: no administration of ASS)
Rarely: Guillain-Barré type.
Varicella pneumonia (1-6 days after exanthema, often clinically and auscultatorically difficult to diagnose → X-ray chest).
Otherwise, involvement of eyes, ears, joints, muscles, heart, and kidneys.
- Primary: Symptomatic, possibly acyclovir. Find complications!
Secondary: Foscarnet, valacyclovir.
If necessary paracetamol or calf compress.
Children: primarily only topical treatment.
Tanning agents (e.g. Tannosynt®-Lsg.), KI: Application in the eye area or hypersensitivity e.g. to propylene glycol.
- Drying zinc shake mixtures
Antihistamines against pruritus (e.g. Aerius®), application: 1-3x daily; Side effects: fatigue. Contra indication: Pregnancy, lactation, hypersensitivity to ingredients.
Systemic therapy (only for severe progressions, newborns, immunosuppressed, pregnant women)
Aciclovir (Zovirax®) administration: 3x 15!mg/kg bw/d intravenously or 800mg 4-5x/day per oral; Contra indication: hypersensitivity, lactation; Side effects (very frequent): headache. CAVE: In older patients there is an increased risk of reversible neurological disorders. Adjustment of dosage for reduced kidney function. Sufficient liquid supply.
Valaciclovir (e.g. Valtrex®), administration: 3 times daily 1 g p.o.for 10 days (initial infection), 5 days (recurrence). Contra indications: Hypersensitivity, lactation. Side effects (frequent): headache, nausea. CAVE: Adjustment of dosage for reduced kidney function. Check hydration condition.
Famciclovir (e.g. Famvir®) Application: 500 mg 2x/d. In patients >50, 500mg 3x/d should be given to prevent zosterneuralgia. Independent of meals. Drug interaction: Probenecid. Contra indication: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir. CAVE: Patients at risk of dehydration, especially older patients, should pay attention to adequate hydration. Efficacy in black patients may be reduced.
Foscarnet (Foscavir®) Application: 3 x 40 mg/kg bw/d intravenously; Contra indication: hypersensitivity, pregnancy, lactation. Side effects (very common): granulocytopenia, anorexia, hypokalemia, hypomagnesemia, hypocalcaemia, paresthesia, headache, dizziness, nausea, vomiting, diarrhea, rash, increased serum creatinine, fever, fatigue, chills, asthenia. CAVE: Adjustment of dosage for reduced kidney function. Sufficient liquid supply.
Brivudine (Brivex® - Tbl.) application: 125 mg 1x/d for 7 days. Drug interaction: 5-fluorouracil preparations (at least 4 weeks apart). Side effects (frequent): Nausea. AI: 5-fluorouracil therapy, pregnancy, lactation, hypersensitivity to ingredients, not tested on children and adolescents. No kidney function checks necessary.
In Switzerland, the use of chickenpox vaccination is recommended: Are affected:
- 11-39-year-olds, unless the varicella's gone through.
- IgG negative persons.
- Patients with severe neurodermatitis.
Persons with contact to the above mentioned persons (family members, persons in medical professions).
Post-exposure prophylaxis with acyclovir in full dosage for one week, at the latest 9 days after exposure
Live varicella vaccine (Varivax® Inj. Suspension) 2 vaccinations at intervals of at least 1 month. Indication: Active immunization against varicella. Contra indication: Basic haematological diseases, immunodeficiency (e.g. tuberculosis), temperature > 38.5°C, pregnancy, lactation. Cost: A ready-to-fill syringe (0.5 ml) amounts to CHF 67.65 as of 09/2015. The costs for this are covered by the basic insurance. Contraindications: During pregnancy. With a weakened immune system. After a severe allergic reaction (about 1/Million) to the first vaccine or to Neomycin. In case of mild illness (postponement of vaccination by 1-2 weeks). Basically good compatibility. Side effects: 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