Varicella Patients Research Articles

Economic burden of varicella in Bangkok, Thailand: A multicenter medical chart review study.

Our multicenter, medical chart review, cost-of-illness study used a micro-costing approach to evaluate the economic burden associated with varicella in Bangkok, Thailand, from a societal perspective. We reviewed medical charts of adults and children with a primary diagnosis of varicella (2014-2018) from 4 hospitals in Bangkok. Reported healthcare resource utilization and missed school or workdays were extracted from medical charts. Mean direct, indirect, and total costs per patient were estimated for overall, adult, and pediatric patients (2020 USD). Of the 200 children and 60 adults, 99.6%, 5.4%, and 5.4% had a varicella-related outpatient visit, emergency department visit, and hospitalization, respectively. The mean direct medical cost was 33 USD for pediatric and adult patients. The mean cost of outpatient visits (8 vs 13 USD, P<0.001) and medications (7 vs 9 USD, P<0.001) was significantly lower among pediatric patients. Forty-eight children reported a mean of 5.8 school days lost, and 32 adult patients reported a mean of 7.4 workdays lost. The mean total cost per varicella patient was 89 USD, with the mean total cost higher for adult than pediatric patients (145 vs 72 USD, P<0.001). Indirect cost accounted for 63% of the total cost per patient (54% for pediatric patients and 77% for adult patients). There is a substantial economic burden associated with patients seeking varicella-related healthcare in Thailand, including considerable indirect costs.

ASSESSMENT OF CLINICAL FEATURES AND TREATMENT OPTIMIZATION OF ACUTE VARICELLA-ZOSTER VIRUS MYOCARDITIS: AN OBSERVATIONAL STUDY

The purpose of the study: to explore the frequency of development, features of the clinical course and treatment of acute myocarditis in adults with chickenpox. Materials and methods. This study included 240 patients with chickenpox between the ages of 18 and 40 years. Clinical, biochemical, molecular genetics and instrumental examination methods were used for assessment. Examination of selected patients was carried out in the acute period, after normalization of body temperature and before being discharged from the hospital. Student’s t test was used for statistical evaluation. Results and discussion. Acute myocarditis was diagnosed in 16.6% of patients with chickenpox caused by Varicella-zoster virus. A high correlation has been revealed between the severity of chickenpox and the frequency of development, as well as the severity of acute myocarditis in adults. Conclusions. An increase in CRP, sialic acid and fibrinogen in the blood serum of chickenpox patients reflects the severity of the disease, but is not specific for myocarditis. Treatment of acute myocarditis in patients with chickenpox should be early and comprehensive.

A cross-sectional study to assess the epidemiologic profile and complications among chickenpox patients in an infectious disease hospital in a Metropolitan city

Background: Chickenpox is a highly contagious and acute disease caused by the varicella-zoster virus. According to a WHO position paper, varicella has a global disease burden of 140 million infections, 42 million severe sequelae, and 4200 fatalities every year. Chickenpox affects 16 persons per 1,000 people annually in wealthy countries. With a case fatality rate of 3 per 1,000 instances annually, 3% of these cases have problems, and 5% require hospitalization. This cross-sectional study assesses the epidemiological determinants &amp; complications among the patients admitted to infectious disease hospitals. Methods: It was a descriptive, cross sectional and hospital based study. Total duration of study was 18 months (Jan 2020 -August 2021), conducted in infectious hospital of a metropolitan city. A total of 453 patients with confirmed diagnosis of chickenpox and getting admitted in the infectious disease hospital .were selected as study subjects and interviewed by a validated questionnaire. Results: A total of 453 chickenpox patients were included in the study and because of covid pandemic situation only 118 samples are interviewed of which 91 (77.1%) were males, remaining 27 (22.9%) were females and all 118 (100%) patients presented with rash which is the diagnostic feature of chickenpox, out of that 106 had fever, 84 had cough, 74 had malaise and 32, 17 patients had shivering and backache respectively. Conclusions: It was found that about one-quarter of cases recorded were in the age group of 19–40 years. This group most probably comprised those who missed the vaccination when they were children. Health education among the general population is suggested to reduce the secondary cases by early diagnosis and vaccination and isolation to reduce the burden of diseases.

Antimicrobial use for the management of varicella in Thailand: a retrospective observational study

Objective To describe the clinical characteristics of varicella patients seeking medical consultation and the use of antimicrobials for their management in Thailand in the absence of universal varicella vaccination (UVV). Methods A multicenter, retrospective chart review of 260 children and adults with a primary diagnosis of varicella was conducted at one private and three public hospitals in Bangkok, Thailand. Charts of varicella patients (inpatient or outpatient) were randomly selected over a 5-year period. Key outcomes included clinical complications and the use of antibiotics, antivirals, and other medications. Results Charts of 200 children (mean age 5.7 years, range 0.3–16 years) and 60 adults (mean age 27.9 years, range 18–50 years) were reviewed. Fourteen patients (including 8 children) were hospitalized. Five percent of the children and none of the adults were immunocompromised. At least 1 varicella-related complication was reported by 7.3% (7% of children, 8.3% of adults, p = .778) of all patients, including 57.1% (62.5% of children, 50% of adults) of inpatients (p < .001, compared with outpatients). Skin/soft tissue infection (47.7%) and dehydration (47.4%) were the most common complications. Antivirals (mainly oral acyclovir) were prescribed to 46.5% of patients (31.5% of children, 96.7% of adults, p < .001). Antibiotics were prescribed to 20.8% of patients (19% of children, 26.7% of adults, p = .199). Topical, oral, and intravenous antibiotics were prescribed to 12.3%, 8.5%, and 1.2% of patients, respectively. Antimicrobial prescriptions were higher among adults (p < .001) and immunocompromised patients (p = .025). Apart from antimicrobials, acetaminophen (62.3%) and oral antihistamines (51.5%) were the most prescribed. Conclusion A considerable number of varicella patients, both children and adults, seeking medical consultation in Thai hospitals are prescribed antibiotics and antivirals, with one-fifth of patients being prescribed an antibiotic and almost half prescribed an antiviral. The study may be of interest to policymakers in Thailand and other Asia-Pacific countries considering UVV implementation.

372. Analysis of the reliability of rapid diagnostic tests for varicella patients, including breakthrough cases

Abstract Background In the era of universal varicella vaccination, diagnosis of varicella is challenging, especially for breakthrough cases. We sought to clarify the reliability of direct varicella-zoster virus (VZV) loop-mediated isothermal amplification (LAMP) and DermaQuick® VZV using the immunochromatography technique as rapid diagnostic tests for varicella. In addition, the usefulness of saliva as a sample type for direct LAMP was also investigated. Methods Between April 2019 and January 2021, 46 patients suspected VZV infection were enrolled in this study. Written informed consent was obtained from the parents of all participants. This study was approved by the institutional review board of Fujita Health University (No. 15–247). Samples were collected from skin eruptions using two different swabs. one swab which was soaked in 1 mL of isotonic saline was used for direct VZV LAMP and the other swab which was immersed in 500 µL of DermaQuick® VZV reaction buffer was used for DermaQuick® VZV. The isotonic saline solution used to wash the oral swab sample was used for direct VZV LAMP. The DNA extracted from the solutions were used for real-time PCR analysis. Results Thirty one patients (67.3%) were diagnosed with varicella based on real-time PCR of skin swabs. Direct LAMP of skin swabs was positive in 29 (63.0%) of 46 patients. DermaQuick® VZV was positive in 25 (54.3%) of 46 patients. The sensitivity for direct LAMP of skin swabs, DermaQuick® VZV, direct LAMP of oral swabs, and real-time PCR of oral swabs was 93.6% (95% confidence interval [CI], 79.3–98.9%), 80.7% (95% CI, 63.7–90.8%), 48.3% (95% CI, 32.0–65.1%), and 74.2% (95% CI, 56.8–86.3%), respectively. The sensitivity and specificity of real-time PCR for DNA extracted from oral swabs was 74.2% (95% CI, 56.8–86.3%) and 93.3% (95% CI, 79.8–99.7%), respectively. Conclusion Although DermaQuick® VZV is the most convenient point-of-care test for varicella, the sensitivity and specificity of this method were slightly lower than those of direct VZV LAMP. Disclosures All Authors: No reported disclosures.

Genetic analysis of varicella-zoster virus in patients with viral anterior uveitis

Objective: To analyze the intraocular varicella-zoster virus (VZV) infection and genetic characteristics in patients clinically diagnosed with viral anterior uveitis. Methods: A total of 83 aqueous humor samples were collected from patients clinically diagnosed with viral anterior uveitis infection in China from June 2018 to July 2019. The positive samples infected with VZV were screened by real time polymerase chain reaction, and the single nucleotide polymorphisms on the open reading frames 22, 38 and 62 of the positive samples were amplified and analyzed. According to the gene characteristics of the amplified target fragment, the vaccine strain and wild strain (8 vaccine strains and the rest were wild strains) were identified to determine the genotype. Results: There were 83 patients (31 females and 52 males) with viral uveitis infection, whose mean age was 51.0 (45.5, 61.0) (range: 15-83) years,, and, of which 57.8% (48 cases) were infected with viral uveitis over 50 years of age. None of the patients had a history of varicella or herpes zoster vaccination. Of the samples of 83 patients infected with viral uveitis, 57 (68.6%) were positive for VZV. Among them, 14 were successfully amplified to obtain the target fragment gene sequences, all of which were wild strains by analysis, and belonged to Clade2 of genotype, which was the same as the VZV vaccine strain types infected by varicella and herpes zoster patients in China. Conclusion: From 2018 to 2019, VZV infection in Chinese patients with viral anterior uveitis was a wild strain, and the genotype belonged to Clade2 as the vaccine strain, which was the same as the main epidemic genotype of VZV infection in Chinese patients with varicella and herpes zoster.

Gene Polymorphism of Toll-Like Receptors in Chickenpox Patients: Observational Cohort Study

Background. Toll-like receptors (TLR) play a key role in the innate immune system, as they are the fi rst to recognize a foreign agent and initiate the human body defense mechanism. At present, the role of toll-like receptors in predicting infectious diseases requires further investigation.Objectives. To study TLR3 (Phe412Leu), TLR9 (A2848G) and TLR9 (T1237C) polymorphisms in healthy individuals and chickenpox patientsMethods. An observational cohort study involved 201 conscripted soldiers of Caucasian race, aged between 18 and 24, who was born in) and served in Zabaykalsky Krai. All of them agreed to participate voluntarily. The main group was represented by 105 males who received treatment at a military hospital with a diagnosis of chickenpox in 2019. The control group consisted of 96 healthy conscripts. The study was carried out on the basis of Chita State Academy of Medicine, Russia, and included a physical examination, anthropometry, determination of SNP genes by PCR. Amplifi cation of TLR3 and TLR9 gene fragments was carried out by means of thermocycler BIS-М111. IBM SPSS Statistics 25.0 (International Business Machines Corporation, License No. Z125-3301-14, USA) was used for statistical processing of the results.Results. A total of 354 people were screened, 87 of them did not meet the inclusion criteria and 19 refused to participate in the study. 134 males were excluded in the process, 47 of which appeared to have an exacerbation of chronic diseases, 21 were not of Caucasian race, 64 were not born in Zabaykalsky Krai, and 2 did not meet the age criteria. Totally, the study included 201 conscripted soldiers. The study groups were established as follows: chickenpox patients (n = 105) and healthy individuals (controls, n = 96). The -412Leu allele was 1.8 times less frequent in the chickenpox group, with a frequency of 0.138, compared with 0.250 in healthy controls (Ȥ 2 = 8.11; p = 0.004). In the main group, allele -412Phe prevailed with a frequency of 0.862, whereas in the control group its frequency was 0.750 (χ2 = 8.11; p = 0.004). In patients group, the genoype Phe412Phe prevailed (75.2%), the genotype Leu412Leu was less common — 2.9% (Ȥ 2 = 7.09; p = 0.03). In the group of healthy individuals, the distribution of genotypes was as follows: Phe412Phe — 60.4%, Phe412Leu — 30.2%, Leu412Leu — 9.4% (Ȥ 2 = 7.09; ɪ = 0.03). Carriers of allele -412Phe (OR = 2.08 [CI95%: 1.25–3.47]) and genotype Phe412Phe (OR = 2.08 [CI95%: 1.14–3.80]) are more likely to develop chickenpox. The probability of developing the disease for persons having the major allele A of the genotype TLR9 (Ⱥ2848G) is 0.29 [CI95%: 0.19– 0.43], for individuals with the mutant allele G of the genotype TLR9 (Ⱥ2848G) — 3.50 [CI95%: 2.32–5.29]. The prevalence of TLR9 (T1237C) in the main group was not signifi cantly different from that in the control group (p &gt; 0.05). The probability of developing the disease for persons having the major allele A is 0.29 [95% CI 0.19–0.43], for carriers of the mutant allele G — 3.50 [95% CI 2.32-5.29]. When analyzing SNP TLR9 (A2848G), it was found that allele G prevailed with a frequency of 0.614, and allele A — with a frequency of 0.386, which is 1.9 times less than in the control group (Ȥ 2 = 36.67; p &lt; 0.001). In patients group, homozygotes AA were found in 9.5% of cases, heterozygotes AG — in 58.1%, the rest cases were homozygous variants GG (Ȥ 2 = 40.11; p &lt; 0.001). In the control group, all possible genotypes with a predominance of the heterozygous genotype AG were identifi ed and comprised 47.9%. When assessing the relative risk of gene variation associations connected with the development of chickenpox, we found that the polymorphism of genes TLR9 (A2848G) AG/GG increases the risk of the development of disease caused by varicella virus in the studied category by 3.4 times, and the polymorphism TLR3 (Phe412Leu) Phe/ Phe — by 1.42 times. The ROC analysis was carried out, the area under curve was 0.77 (95% CI0.70–0.83); p &lt; 0.001; specifi city — 0.62; sensitivity — 0.8. The developed model, being a relatively good identifi er, has satisfactory properties as a discriminator.Conclusion. Our study suggests that allele -412Phe and homozygous variant Phe412Phe of gene TLR3 (Phe412Leu), as well as allele G and homozygous variant GG of gene TLR9 (A2848G) predispose to chickenpox development. Meanwhile, the allele -412Leu of gene TLR3 (Phe412Leu), allele A, and homozygous variant AA of gene TLR9 (A2848G) reduce the probability of chickenpox development.

Genetic characteristics of varicella zoster virus in Shandong province from 2020 to 2021

Objective: To investigate the genetic characteristics of varicella zoster virus (VZV) in Shandong province from 2020 to 2021. Methods: From April 2020 to December 2021, 85 herpes fluid samples from suspected varicella patients in Shandong province were collected. The qPCR was used to detect viral DNA and screen suspected samples. Six single nucleotide polymorphisms (SNPs) of ORF22 fragment and ORF38 fragment in positive samples were examined via PCR and Sanger sequencing to identify the viral genotypes. Four SNPs of ORF38 and ORF62 were examined to identify the vaccine and wild-type strains. The sequences were analyzed with Sequencher and MEGA7 software, using the VZV reference strain sequences from GenBank. Results: In the 85 samples suspected of varicella, 80 were VZV positive and wild-type strains belonging to Clade 2. Compared with clade 2 representative strains, the nucleotide and amino acid similarities of ORF22 fragment were 99.5%-100% and 98.5%-100%, respectively. SD20-1, SD20-5, SD20-6, SD20-8, SD20-9, SD20-10, SD20-11, SD20-12, SD20-13, SD20-30 and SD20-31 had a A➝G nucleotide mutation at 37990, causing amino acid change from glutamine to arginine. SD21-1 had a C➝A nucleotide mutation at 38059, causing threonine to asparagine during coding. Conclusions: From 2020 to 2021, all VZV strains in Shandong province are the wild-type strains belonging to Clade 2.

EPIDEMIOLOGICAL CHARACTERISTICS OF VARICELLA IN KON TUM PROVINCE IN 2018

Abstract: Background: In Vietnam, the number of people suffered from Varicella was high, accounting for 25.000 – 40.000 cases and children were dominant. In Kon Tum, the annual number of Varricella cases remains high, the average 5-year period from 2013-2017 was 779 cases per year. Objective: The study aimed to describe the epidemiological characteristics of Varicella in Kon Tum province in 2018. Methodology: The retrospective description was conducted among 368 Varicella patients in Kon Tum Province from January to December 2018. Data collection was based on the Varicella monthly reporting form of the Kon Tum Center for Disease Control. Results: The cumulative prevalance of Varicella/100.000 people was 68.8. The distribution of Varicella in region III was highest, accounting for 52.7%. The Varicella experienced all months of the year, and in March had the highest number of infectious cases, accounting for 51%. The cumulative prevalence of Varicella/100.000 people among women was 78.6, the figure for was 60,0. The incidence of Varicella/100.000 people in the group under 5 years old was the highest (286.6). The cumulative prevalemce of Varicella/100.000 people in ethnic minorities was nearly 3 times higher than that of the Kinh people. The distribution of Varicella in young children accounted for the highest proportion (45.6%). Conclusion: There was a need in further strengthening health communication and education for people on preventing and controlling Varicella, especially for ethnic minorites. Key words: epidemiological characteristics, varicella, Kon Tum, Vietnam

Predictive role of blood eosinophils in adult varicella patients.

The study aimed to explore the relationship between eosinophils and the prognosis of varicella in adults. We retrospectively reviewed the medical records of patients who were hospitalised in The Fifth People's Hospital of Suzhou with a diagnosis of adult varicella during the period between 1 January 2012 and 31 December 2020. Of the 359 patients, 228 (63.51%) had eosinopenia. The proportion of patients with mild type disease was significantly lower in the eosinopenia group than that in the non-eosinopenia group (50.44% vs. 65.65%, P = 0.006). The proportion of the patients with common type disease was significantly higher in the eosinopenia group than that in the non-eosinopenia group (39.47% vs. 28.24%, P = 0.039). The proportion of the patients with severe type disease was higher in the eosinopenia group, although the difference did not reach statistical significance (10.09% vs. 6.11%, P = 0.243). The rates of high fever (47.81% vs. 32.82%, P = 0.008; relative risk (RR) 1.296, 95% confidence interval (CI) 1.091-1.540), headache (43.42% vs. 22.14%, P < 0.001; RR 1.415, 95% CI 1.233-1.623), anorexia (53.51% vs. 35.88%, P = 0.001; RR 1.367, 95% CI 1.129-1.655) and complications (82.89% vs. 64.12%, P < 0.001; RR 2.106, 95% CI 1.460-3.038) were also significantly higher in the eosinopenia group. Among the complications, the liver injury and skin infection were more serious in the eosinopenia group. The disease course was significantly longer in the eosinopenia group than that in the non-eosinopenia group (9.43 ± 1.89 days vs. 8.73 ± 1.25 days, P < 0.001). The improvement rate of liver injury in the recovery period was lower in the eosinopenia group than that in the non-eosinopenia group (35.38% vs. 50%, P = 0.012). The study found that adult varicella patients with eosinopenia had a more serious condition, a higher morbidity of complications and a slower recovery. Blood eosinophils can be used as a new predictor of the severity of adult varicella.

Varicella-Zoster Scar Treatments: A Tertiary Review.

Chickenpox is a highly communicable disease caused by Varicella Zoster Virus. Varicella rash commonly evolves into permanent depressed scars, documented in up to 18% of post varicella patients, leaving life-long cosmetic issues for patients. Although there is a lot of reviews on depressed scars, the viral etiology and the unique scar morphology of post varicella scar discriminate it from other depressed scars. Therefore it is required to assess the efficacy of scar removal modalities on these scars, specifically. Yet, despite the prevalence, there is no comprehensive review on chickenpox scars’ treatment, particularly. This review provides an overview and categorization of efficacy and adverse events of various methods used in the treatment of post varicella skin scars. A comprehensive literature search was performed on major databases, including all papers related to post varicella scar treatment until 2020. The results were categorized into topical treatment with tretinoin, systemic medical treatments with topiramate and isotretinoin, non-invasive procedures including chemical peelings, micro-needling and laser, invasive procedures including dermal grafting and subcision-suction method, and combination therapies. According to literature, chemical peeling with trichloroacetic acid was the most frequently used method in the treatment of chickenpox scar, revealing moderate to excellent response in patients. However, there is insufficient evidence to accurately compare the efficacy of other modalities on these scars specifically.

Impact of six years of routine varicella vaccination on the disease-related hospitalizations at Minas Gerais, Brazil

IntroductionThe varicella vaccine was first introduced into the Brazilian immunization schedule in September 2013 as a single dose for children aged 15 months. In 2018, a second dose was recommended for individuals between 4 and 6 years old. This study aims to assess the impact of routine varicella vaccination on the number and profile of hospitalized varicella patients during the single dose period, as well as in the first two years after the adoption of the second dose. MethodsAn observational retrospective study was conducted in an infectious disease pediatric hospital, in Minas Gerais, Brazil. Clinical as well as epidemiological data from patients hospitalized due to varicella between 2010 and 2019 were collected. Patients were split into groups based on the vaccine introduction: pre-vaccine period, single dose and two-dose period. They were compared by age, sex, reason for admission, illness-related complications and clinical outcome. ResultsThere were 1193 admissions due to varicella during the studied period. When compared with the pre-vaccine period, the number of hospitalizations decreased in 61.5% during the single-dose regime, reaching 95.2% in the two-dose period. Hospitalization rates decreased in all age groups, including non-vaccinated individuals such as those younger than 12 months (92.1%). As for reasons of admission, secondary bacterial skin infections were perceived to be the most common cause (>70%). A reduction was also seen in admission of immunocompromised or HIV positive patients (84.8%). ConclusionThe collected data shows a significant impact in the number of hospital admissions due to varicella after six years of the implementation of the vaccine, positively affecting both vaccinated and non-vaccinated individuals. Further reduction was seen after the second dose was initiated, but its true impact will only be understood fully after a longer period of continuous vaccination.

Free radical damage: role in varicella zoster virus infection

Study of the role of lipid peroxidation and antioxidant system in patients with infectious diseases is of great interest to researchers. Numerous studies have led to a common understanding of their contribution to the pathogenesis of infectious diseases, as well as to the complications development. However, the state of lipid peroxidation and antioxidant protection in patients with chickenpox (varicella) has not been sufficiently studied which is important for the development of new targeted treatments.&#x0D; The aim of the research - to assess the state of lipid peroxidation (LPO) and the antioxidant system (AOS) in the dynamics in patients with chickenpox, depending on the severity of the disease.&#x0D; Materials and methods. We selected for participating in the study 240 chickenpox patients (142 women and 98 men) aged 18-40 years. Chickenpox was diagnosed using clinical, serological, and molecular genetic methods. The state assessment of LPO in chickenpox patients was based on the determination of serum diene conjugates (DC), malondialdehyde (MDA) levels and the total oxidative activity (TOA) of blood plasma.&#x0D; Results. Study showed that the process of lipid peroxidation increases and the activity of the antioxidant system decreases in patients with chickenpox during the acute period of the disease. The extent of these processes becomes greater as the severity of chickenpox increases. A decrease in the activity of antioxidant enzymes and a disruption in the functioning of the glutathione system in patients with moderate to severe hypertension leads to disruption of protective mechanisms and, as a result, to an increase in the free radical chain reactions, the uncontrolled growth of which causes irreversible damage to the membranes of various cells, which underlies visceropathy in chickenpox patients.&#x0D; Conclusions. Antioxidant system is activated in the acute period in patients with mild chickenpox. It is evidenced by an increase in the overall antioxidant activity of blood plasma (p=0.045) and red blood cells (p=0.00087), in the activity of catalase (p=0.001), superoxide dismutase (p=0.0093), glutathione peroxidase (p=0.036), glutathione reductase of plasma and red blood cells, and an increase in the concentration of oxidized and reduced glutathione in blood. Lipid peroxidation is hyperactivated in the acute period in patients with a moderate and severe course of the disease and an excess amount of primary and secondary hydroperoxides of fatty acids accumulates in the blood. This is accompanied by indicates a developing imbalance between the oxidative and antioxidant systems in group of patients with moderate and severe chickenpox. Our findings confirm the usefulness of antioxidants in the treatment of chickenpox.

Does Varicella Zoster Virus in Children Affect Temporal Artery Structure or Blood Flow?

Introduction: Varicella-Zoster Virus (VZV) is a member of the Herpesviridae family of viruses and causes two different clinical conditions. The main objective of our study is not to diagnose GCA but instead, we wanted to assess whether there is a structural or flow change following VZV during childhood using US in temporal artery, which is the most commonly affected artery by GCA in advanced age and to review whether the patients show any clinical symptoms related with GCA. Materials and Methods: The study was designed as a prospective single-blind study and included 30 patients diagnosed with varicella under 16 by the same pediatrician and shows infection characteristics. Results: None of the patients included in the study showed halo signs. Moreover, none of the patients showed compression signs, occlusion, or stenosis results. The mean value for intima-media complex thickness was measured as 0.25mm (0.18 - 0.27mm) in a common superficial temporal artery. Conclusion: Chickenpox patients did not show any ultra sonographic changes in their temporal artery and no clinical symptoms related to GCA, yet we think that the relationship between VZV infection and GCA development warrants further studies with larger series and longer follow-up periods.

Trend in varicella patients 4 years after implementation of universal two-dose varicella vaccination in Japan

ObjectiveTo elucidate the trend and clinical spectrum of virologically diagnosed varicella patients after implementation of universal vaccination as a national immunization program in Japan. Patients and methodsStudy subjects were patients suspected of varicella, less than 15 years of age, who visited 14 pediatric clinics in the Nagoya VZV Study Group from September 2015 to August 2019. Practitioners collected patient samples and information such as backgrounds, clinical symptoms, and previous immunization status. All patients were confirmed as having varicella based on molecular diagnostic assays. ResultsVaricella zoster virus (VZV) DNA was detected in swab samples from 506 (83.1%) of the 609 suspected patients. The 455 varicella patients for whom vaccination status was available were divided into two groups: 180 universal vaccination targets and 275 non-targets. Numbers of monthly varicella patients decreased gradually during the observation period. In the 2016/17 season, the seasonal epidemic of varicella became undetectable in the universal vaccination target group, and starting in the 2017/18 season, it was obscured even in the non-target group. The median age of patients was significantly lower in the universal vaccination target group (3 years) than the non-target group (7 years) (P < 0.001). Vaccination status differed significantly between the two groups (P < 0.001). Most varicella patients were in the non-target group, especially those who had been vaccinated once (60.4%). Frequency of fever (P < 0.001) and number of skin rashes at the time of the first hospital visit (P = 0.001) were significantly higher in the non-target group. ConclusionsAlthough the number of childhood varicella patients declined after implementation of national immunization with two doses of varicella vaccination, sporadic outbreaks still occurred, mainly in the non–universal vaccination target group. Insufficient vaccination of members of this group is likely to be a major reason for small local outbreaks.

Effectiveness and failure rate of the varicella vaccine in an outbreak in Jiangsu, China: a 1:2 matched case-control study

ABSTRACT Background: The varicella vaccine is not included in the national childhood immunization schedules in China, although one-dose varicella vaccine has been suggested for susceptible children aged 1–12 years in Jiangsu Province. However, varicella epidemics and outbreaks are frequently reported. We investigated a varicella outbreak in an elementary school to explore the risk factors for varicella transmission and vaccine failure. Methods: A 1:2 matched case-control study was carried out. Participant data were collected with standardized questionnaires. For each case, we enrolled two controls: a subject with high exposure in the same classroom as the case and a subject with low exposure in a different classroom. Data regarding vaccination status and medical and exposure histories were analyzed. Results: Fifty-one cases were reported during the outbreak; 26 cases (51%) were breakthrough varicella. Varicella vaccine immunization history (P < .001, OR = 0.19, 95% CI = 0.08–0.45) and the presence of siblings (P = .037, OR = 0.45, 95% CI = 0.21–0.95) were protective factors in preventing varicella infection. Contact with varicella patients increased the risk of varicella infection (P = .028, OR = 3.39, 95% CI = 1.14–10.09). Breakthrough varicella cases tended to present a milder rash (P = .049), fewer complications (P = .02), fewer rash sites (P = .02) and a shorter duration of active lesions (P = .001). One pneumonia case and one encephalitis case were reported in breakthrough cases. Age <15 months at the time of vaccination increased the risk of breakthrough varicella (P = .012). The adjusted vaccine effectiveness was 81%. Conclusions: One-dose varicella vaccine is effective at alleviating clinical manifestations. The moderate coverage provided by one dose cannot prevent varicella outbreaks, and vaccination after 15 months of age should be considered in the immunization schedule; a two-dose strategy is highly recommended.

The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe

BackgroundVaricella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation.MethodsPooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1–14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country.ResultsFour hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%.ConclusionsHigh rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications.

Prescription surveillance for early detection system of emerging and reemerging infectious disease outbreaks

Based on prescriptions filled at external pharmacies, prescription surveillance (PS) in Japan has been reporting the estimated numbers of influenza and varicella patients and people prescribed certain drugs since 2009. Every morning, this system estimates the numbers of patients from the numbers of prescriptions filled nationwide for neuraminidase inhibitors, anti-herpes virus drugs, antibiotic drugs, antipyretic analgesics, and multi-ingredient cold medications. Moreover, it can detect "unexplained" infectious diseases that are not explained as infectious diseases monitored by other surveillance systems. Such "unexplained" infectious diseases might be emerging and re-emerging infectious diseases including bioterrorism attacks, which are reportedly difficult to diagnose, at least in early outbreak stages. To ascertain the system's potential benefits, this study examined schemes to detect "unexplained" infectious diseases using PS information. The numbers of patients prescribed the respective drugs are first regressed on the known infectious diseases, time trends, and dummies for day-of-the-week, holidays, and days following a holiday. Known infectious diseases are defined as covered by the National Official Sentinel Surveillance for Infectious Diseases under the Infection Control Law. After the numbers of patients from PS are compared with the predicted numbers of patients, their probabilities of occurrence are calculated. We examined the system's prospective operation from January 2017 through July 2018. The criterion we used to define aberrations varied, from 0.01 to 10-7. For criteria of 0.01 and 10-7 we found 254 and 15 aberrations, respectively. We confirmed its feasibility and effectiveness.

Modeling of Infectious Disease Through the Contact, Treatment and Recovery 0f Chicken Pox Patients (A Case Study of Offa Local Government Area of Kwara State)

Modeling of Infectious Disease Through the Contact, Treatment and Recovery 0f Chicken Pox Patients (A Case Study of Offa Local Government Area of Kwara State)

Descriptive epidemiology of varicella based on national surveillance data before and after the introduction of routine varicella vaccination with two doses in Japan, 2000–2017

Routine childhood immunization using two doses of the varicella vaccine was introduced in Japan in October 2014. In this study, we analyzed the data extracted from national varicella surveillance, including pediatric sentinel surveillance from 2000 to 2017 and hospitalized varicella surveillance from the 38th week of 2014 to the 37th week of 2017. Compared with the 2000–2011 baseline data, the number of varicella cases per sentinel decreased substantially by 76.6% overall and by 88.2% among children aged 1–4 years in 2017. Of 997 hospitalized patients, we found a decreasing trend in the number of cases among children aged <5 years. We also found a decreasing trend in the number of cases with complications among children aged 1–4 years. Data on the self-reported transmission sites in 35.5% (354/997) of the hospitalized varicella patients showed that transmission of varicella zoster virus (VZV) occurred frequently in household, at school for young children, in the workplace for adults, and at hospital for all age groups. Data from 29.0% (289/997) of the hospitalized patients with a self-reported source of infection showed that transmission of VZV occurred from a patient with herpes zoster (HZ) in 30.4% (88/289) of cases. Our data demonstrate a substantial decrease in the number of varicella cases in young children following introduction of routine childhood vaccination program with two-dose varicella vaccination in Japan. These data highlight the unique aspects of transmission sites across age groups and the important role of HZ cases in disease circulation.