Abstract
Objectives: To describe the current panorama of severe chickenpox disease and seroprevalence in Sweden, as a basis for the approaching decision on universal vaccination.Methods: Patients discharged with an International Classificationof Diseases 10th revision-code for chickenpox (B01-B01.9) in eight pediatric and infectious diseases departments in Stockholm and Gothenburg in 2012-2014 were included in the study and their medical charts were reviewed. Further, residual serum samples collected from 11 laboratories across Sweden were analyzed for varicella zoster IgG-antibodies to investigate age-specific seroprevalence.Results: A total of 218 children and 46 adults were included in this hospital-based study; 87.2% of children and 63.0% of adults had complications. An underlying condition was not associated with an increased risk of complication. Dehydration (31.7%), bacterial skin infections (29.8%) and neurological involvement (20.6%) were the most frequent complications in children. Among adult cases, 63% were born abroad. The seroepidemiological analysis included 957 patient samples. Seroprevalence was 66.7% at 5 years and 91.5% at 12 years. Infants and adolescents/adults were overrepresented among admitted patients compared to seroprevalence data.Conclusions: Half of all complications in hospitalized chickenpox cases were seen in previously healthy children, which supports universal childhood vaccination. Adult migrants was a risk group for chickenpox hospitalization. Age-specific seroprevalence was similar to neighboring countries.
Highlights
Chickenpox is the clinical manifestation of primary infection with varicella zoster virus (VZV) and a mild disease in the vast majority of cases
This study described complications and underlying conditions of children and adults hospitalized with chickenpox in 2012-2014 in Stockholm and Gothenburg, Sweden, a country without routine chickenpox vaccination
The majority of complications from chickenpox in children were seen in those who were previously healthy, showing that vaccination of at-risk groups or cocoon vaccination around vulnerable children will not prevent the majority of severe chickenpox cases
Summary
Chickenpox is the clinical manifestation of primary infection with varicella zoster virus (VZV) and a mild disease in the vast majority of cases. Complications do occur, primarily bacterial infections of vesicles, sometimes with deeper infection and sepsis, as well as neurological complications (e.g. encephalitis, meningitis, or classically acute cerebellitis with ataxia). ✩ Running title: Severe chickenpox disease in Sweden ∗ Corresponding author: Department of Medicine, Huddinge, C2:94, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden such as pneumonitis, hepatitis and haemorrhagic complications may occur (Gershon et al, 2018). The virus establishes latency in nerve ganglia and can reactivate as shingles and/or neurological engagement (Gershon et al, 2018). Chickenpox hospitalization rates have previously been investigated using register data and were found to be relatively low in Sweden at 3.6/100,000 person-years (Widgren et al, 2016)
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