Varicella

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%

Transmission

• Droplet or smear infection or direct contact (saliva, fluid contents, coughing, sneezing)

Infectivity

• 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.

• Impetiginisation
• 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

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