Clinical Manifestations of Herpes Zoster Associated with Complications in Children.

Dong Ha Kang,Han Wool Kim,A Young Park,Byung Ok Kwak

doi:10.3390/children8100845

Abstract

Herpes zoster (HZ) is caused by latent varicella-zoster virus (VZV) reactivation when VZV-specific cell-mediated immunity declines. Information on HZ in children is limited. Therefore, we retrospectively investigated HZ’s clinical course and complications in children. We extracted the outpatient and hospitalization medical records of pediatric patients (<19 years) primarily diagnosed with HZ (ICD-10 B02 code) between January 2010 and November 2020. HZ was defined as a typical unilateral dermatomal vesicular rash where HZ was the treating physician’s primary diagnosis. Recognized HZ complications included combined bacterial skin infection, ophthalmic zoster, zoster oticus without facial paralysis, meningitis, and PHN. We identified 602 HZ cases, among which 54 developed HZ complications and were included in our analysis. The median age was 14.7 years, most patients were aged ≥13 years (42, 79%), and none were aged <4 years. Fifty-three were immunocompetent, and only one had systemic lupus erythematosus. The most frequent complication was zoster ophthalmicus (n = 26, 48%). HZ complications were also observed in immunocompetent or vaccinated children exhibiting a head or neck rash before and after VZV immunization. Current VZV vaccination programs may be insufficient in preventing HZ complications. Therefore, close varicella and HZ burden monitoring and the establishment of effective VZV vaccination programs are imperative.

Highlights

Herpes zoster (HZ) is caused by the reactivation of the latent varicella-zoster virus (VZV) when VZV-specific cell-mediated immunity declines, and it is characterized by small blisters and pain in the corresponding unilateral skin segment [1]
In South Korea, a single-dose varicella vaccine was included in the National Immunization Program (NIP) for 12–15-month-old children in 2005, and the varicella vaccine coverage was estimated at over 95% in children born after 2007 [11]
An HZ case was defined as a patient with a typical unilateral dermatomal vesicular rash in which HZ was the treating physician’s primary diagnosis, when the patient was managed in a manner consistent with HZ, and when no alternative diagnoses emerged from diagnostic testing or subsequent events

Summary

Introduction

Herpes zoster (HZ) is caused by the reactivation of the latent varicella-zoster virus (VZV) when VZV-specific cell-mediated immunity declines, and it is characterized by small blisters and pain in the corresponding unilateral skin segment [1]. The vaccination strategy could affect HZ epidemiology, as childhood varicella vaccination potentially increases HZ incidence in the adult population by decreasing exogenous boosting [4]. Another possible reason underlying the increasing incidence, similar to that for wild-type VZV, is the reactivation of the latent infection established by vaccination, resulting in HZ. HZ is potentially caused by vaccine-strain or wild-type VZV acquired either from unrecognized infection before or after vaccination or breakthrough varicella [5,6,7,8,9,10]. In South Korea, a single-dose varicella vaccine was included in the National Immunization Program (NIP) for 12–15-month-old children in 2005, and the varicella vaccine coverage was estimated at over 95% in children born after 2007 [11]

Methods

Discussion

Conclusion