Herpes Zoster In Children Research Articles

A clinico-epidemiological multicenter study of herpes zoster in immunocompetent and immunocompromised hospitalized children.

PurposeThere are limited population-based data regarding herpes zoster in children. Thus we conducted a multi-institutional epidemiological analysis of herpes zoster in children and comparative analysis according to their immune status.Materials and MethodsThe study included 126 children under the age of 18 years who were hospitalized for herpes zoster at 8 hospitals in South Korea, between July 2009 and June 2015. The subjects were divided into 2 groups according to their immune status, and medical records were reviewed.ResultsThere were 61 cases (48.4%) in the immunocompetent group and 65 cases (51.6%) in the immunocompromised group. Median age was older in immunocompromised group (11.4 vs. 8.6) (p<0.001). The mean duration of hospitalization was longer in immunocompromised group (11.0 vs. 6.6) (p<0.001). Patients were treated with oral or intravenous antiviral agents. A total of 12 in immunocompetent group were cured only by oral acyclovir. No treatment failure was found in both groups. Six immunocompromised patients had postherpetic neuralgia and 1 case was in immunocompetent group. In immunocompetent children, herpes zoster was likely caused by early varicella infection. There was no increase in progression of severity in both groups due to appropriate treatment.ConclusionEarly initiation of therapy is necessary for those in immunocompromised conditions. And inactivated herpes zoster vaccination may be considered in immunocompromised adolescents in the future.

Clinical Features of Herpes Zoster in Children according to Immune Status

Clinical Features of Herpes Zoster in Children according to Immune Status

Case Series of Herpes Zoster in Children; Ultraviolet as a Trigger?

Case Series of Herpes Zoster in Children; Ultraviolet as a Trigger?

Herpes Zoster Reacting with Short-Term Corticosteroid Therapy in a Healthy 8-Year-Old Girl

Herpes zoster (HZ) is an infectious disease characterized by acute vesicles, located in the dermatomes formed by the reactivation of varicella zoster virus with dorsal ganglia. Although the disease is common in advanced age and in immunosuppressed people, it can also be seen rarely in healthy children and young people who have had in the early period. Herpes zoster in children have a mild course of the disease and the disease mainly affects the thoracic dermatomes. The clinical manifestations of the disease in children differ from adults. Pain and postherpetic neuralgia are rarely seen in pediatric patients before the onset of herpes zoster rashes and during rash. Unlike the findings in adults, herpes zoster in children is painless but itchy. In this study, we presented a herpes zoster case -8 years old girl- who had suffered chickenpox at the age of one and had received short time corticosteroid therapy for acute urticaria two weeks before herpes zoster.

Asthma status is an independent risk factor for herpes zoster in children: a population-based cohort study

Backgrounds: Literatures regarding the effects of childhood asthma on the risk of herpes zoster (HZ) is very limited. The aim of this study is to investigate the risks of children developing HZ with asthma.Methods: From the National Health Insurance Research Database, we identified 300,649 patients who had asthma between 2000 and 2007 as an asthma cohort. We identified another matched non-asthma cohort. All subjects were followed until the end of 2008. A Cox model was used to estimate the association of asthma on the risk of HZ.Results: Asthma cohort had significantly higher risk of developing HZ than the comparison cohort (HR=1.15; 95 % CI =1.06-1.26). However, compared to those without regular controller, asthma cohort with regular inhaled corticosteroid (ICS) treatment had slightly increased risk for HZ (HR=1.14; 95% CI=1.01-1.27) but decreased risk for HZ in those with regular combined ICS and Montelukast (HR=0.83; 95% CI=0.69-0.98). Uncontrolled asthma with more than 3-4 times ED visits and admissions per year had 3.72 (CI =1.86-7.47) and 20.5 (CI =10.2-41.2) greater risks for HZ than those without asthma, respectively.Conclusions: Asthma poses an increased risk of zoster, therefore control of asthma is important to minimize risk of HZ.

The alpha-herpesviridae in dermatology : Varicella zoster virus.

The second part of this publication deals with varicella zoster virus (VZV) and presents an overview of new, rare, and atypical clinical manifestations, including photolocalized varicella, hemorrhagic bullae during varicella, the implication of VZV in immunoglobulinAvasculitis, VZV-related alopecia, ulcerative varicella skin lesions, childhood herpes zoster (HZ), prolonged prodromal pains, recurrent HZ, VZV implication in burning mouth syndrome, verruciform VZV lesions, the significance of satellite lesions during HZ, and late HZ complications, either neurological or internal. Furthermore, certain associations between the occurrence of HZ and subsequent internal pathologies, as well as risk factors for HZ and new developments in vaccination against HZ will be addressed.

The alpha-herpesviridae in dermatology : Varicella zoster virus. German version

The second part of this publication deals with varicella zoster virus (VZV) and presents an overview of new, rare, and atypical clinical manifestations, including photolocalized varicella, hemorrhagic bullae during varicella, the implication of VZV in immunoglobulinAvasculitis, VZV-related alopecia, ulcerative varicella skin lesions, childhood herpes zoster (HZ), prolonged prodromal pains, recurrent HZ, VZV implication in burning mouth syndrome, verruciform VZV lesions, the significance of satellite lesions during HZ, and late HZ complications, either neurological or internal. Furthermore, certain associations between the occurrence of HZ and subsequent internal pathologies, as well as risk factors for HZ and new developments in vaccination against HZ will be addressed.

Herpes Zoster in Children and Adolescents: Is It a Problem?

Herpes Zoster in Children and Adolescents: Is It a Problem?

Increased risk of herpes zoster in children with cancer: A nationwide population-based cohort study.

Herpes zoster is rare in healthy children, but immunocompromised persons have an increased risk of herpes zoster and severe diseases. Considering the very limited information on herpes zoster in children with cancer, we performed a nationwide population-based cohort study to estimate the incidence of herpes zoster in children with cancer and to explore the association between the 2 diseases.Data were obtained from the National Health Research Institutes Database in Taiwan. A total of 4432 children with newly diagnosed cancer between 2000 and 2007 were identified as the cancer cohort, and 17,653 children without cancer frequency-matched by sex and age at entry were considered the noncancer cohort. The association between herpes zoster and childhood cancer was determined.Children with cancer had a higher risk of herpes zoster. The incidence rate of herpes zoster was higher in the cancer cohort than in the noncancer cohort (20.7 vs 2.4 per 10,000 person-years; IRR = 8.6; 95% CI = 4.8–15.6). The cumulative incidence was significantly higher in the cancer cohort (P < 0.0001). Leukemia, lymphoma, and solid tumor were all associated with the increased risk, and leukemia had the highest magnitude of strength of association.This nationwide population-based cohort study demonstrated that children with cancer were associated with an increased risk of herpes zoster. In addition to early antiviral treatment, vaccination with heat-treated zoster vaccine or adjuvanted subunit vaccine could be an appropriate policy to decrease the incidence in children with cancer.

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression.

BackgroundTo analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment.MethodsRetrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included.ResultsTwenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir.ConclusionThe clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment.

Herpes Zoster in Children and Adolescents: Is It a Problem?

Herpes Zoster in Children and Adolescents: Is It a Problem?

A clinicomorphological study of childhood herpes zoster at a rural based tertiary center, Gujarat, India

Aims and Objectives: To study the clinical features of herpes zoster (HZ) in childhood along with prevalence of human immunodeficiency virus (HIV) seropositivity. Materials and Methods: The study was carried out in the Department of Dermatology at a Tertiary Care Centre of Gujarat, India, for 6 years. Children aged ≤12 years with a diagnosis of HZ seen in the Departments of Dermatology were enrolled in a predesigned pro forma. Diagnosis of HZ was made on clinical grounds, confirmed by tzanck smear as and when required. Sera of all cases were tested for HIV. Results: Total of 34 children aged ≤12 years were enrolled in the study. Nineteen (55.88%) were boys and 15 (44.12%) were girls. The mean age was 9.26 years. In 97.06% patient have localized dermatomal involvement. Most common symptom was burning pain seen in 30 (88.24%) patients. Previous history of chickenpox was present in 19 (55.88%) patients. Evidence of immunosuppression on history, clinical examination, and investigations was present only in one patient, who had HIV infection. Conclusion: Although there is increased incidence of HZ in childhood, atypical presentations are rare, multidermatomal involvement is not commonly seen. Majority of these children do not show immunosuppression. Hence, we conclude HZ in childhood occurs as a relatively mild and self-limiting disease.

A Prospective Study of Herpes Zoster in Children.

Background:Herpes zoster (HZ) is a dermatomal viral infection, caused by reactivation of varicella zoster virus (VZV) that persists in the posterior root ganglion. HZ is uncommonly reported in immunocompetent children. It may be due to intrauterine VZV infection or secondary to postnatal exposure to VZV at an early age.Aims:Our study was to review clinico-epidemiological data for HZ in children for early diagnosis and treatment to prevent complications.Materials and Methods:A prospective observational study was conducted from January 2013 to December 2014. Consecutive cases clinically diagnosed as HZ in the pediatric age group were taken up.Results:We report the clinico-epidemiological study of 26 cases of HZ, their benign course and recovery among children.Conclusions:HZ is a rare disease in childhood. Varicella in early childhood is a risk factor of HZ in immunocompromised and immunocompetent children. Childhood zoster occurs in either healthy or underlying immunodeficient children. The appearance of HZ in a young child does not always imply an underlying immunodeficiency or malignancy. But the identification of HZ with or without immunodeficiency is of prime importance from the treatment and prognostic point of view and should be considered in the differential diagnosis of vesicular eruptions. The prognosis is generally good in healthy children.

Risk of herpes zoster in children with asthma.

There is literature that indicates the association of asthma with an increased risk of common and serious microbial infections. We recently reported an increased risk of vaccine-preventable diseases, e.g., herpes zoster (HZ) among children with asthma, defined by predetermined asthma criteria. Little is known about whether this association is persistent if the asthma status is defined by different asthma criteria, e.g., the Asthma Predictive Index, given the heterogeneity of asthma. To assess the consistency of the association between asthma and the risk of HZ in children. This is a population-based case-control study based on all pediatric patients with HZ between 1996 and 2001 in Olmsted County, Minnesota, and 1:1 age- and sex-matched controls without a history of HZ who were enrolled in our previous study. The original Asthma Predictive Index criteria was operationalized by two or more wheezing episodes in a year for the first 3 years of life plus one of the major (physician-diagnosed asthma for a parent or physician-diagnosed eczema for a patient) or two of the minor criteria (physician-diagnosed allergic rhinitis for a patient, wheezing apart from cold, or eosinophilia [≥4%]). Data were fit to traditional logistic regression models to calculate odds ratios and 95% confident intervals. Of the original cohort (n = 554), 95 (17%) did not meet the enrollment criteria for this study, which left 459. Of the 221 patients, 53% were female, with a mean (standard deviation) age of 9.7 ± 4.2 years. The risk of HZ was increased in children with asthma defined by the API controlling for a varicella vaccine history and atopic status (adjusted odds ratio 2.56 [95% confidence interval, 1.08-6.56]). The association between asthma and increased risk of HZ in children and adolescents is consistent, independent of asthma definitions. Asthma might be an important clinical condition to be considered in HZ vaccine studies.

Herpes Zoster in Childhood

Herpes zoster is caused by reactivation of latent varicella-zoster virus that resides in a dorsal root ganglion. Herpes zoster can develop at any time after a primary infection or varicella vac- cination. The incidence among children is approximately 110 per 100,000 person-years. Clini- cally, herpes zoster is characterized by a painful, unilateral vesicular eruption in a restricted dermatomal distribution. In young children, herpes zoster has a predilection for areas supplied by the cervical and sacral dermatomes. Herpes zoster tends to be milder in children than that in adults. Also, vaccine-associated herpes zoster is milder than herpes zoster after wild-type vari- cella. The diagnosis of herpes zoster is mainly made clinically, based on a distinct clinical ap- pearance. The most common complications are secondary bacterial infection, depigmentation, and scarring. Chickenpox may develop in susceptible individuals exposed to herpes zoster. Oral acyclovir should be considered for uncomplicated herpes zoster in immunocompetent children. Intravenous acyclovir is the treatment of choice for immunocompromised children who are at risk for disseminated disease. The medication should be administered ideally within 72 hours of rash onset.

Herpes zoster in the pediatric age group: study from a tertiary care hospital

Background: Herpes zoster (HZ) caused by Varicella zoster virus (VZV) is uncommon in childhood. Methods: During a period of one year all the children with HZ coming to the Departments of Pediatrics and Dermatology from a tertiary hospital were enrolled in the study. Various parameters like demographic details, history of vaccination against VZV, site of involvement and associated complications were noted down. Results: HZ in children is very rare. Only 19 cases were reported from a tertiary care institute. It is more common in older children (one case <5 yrs). Most common site is thoracic (55%) segmental involvement. Complications (26.3%) are rare in children as compared to elderly. Conclusions: Paediatric herpes zoster although uncommon can develop in immunocompetent children and should be considered in the differential diagnosis of vesicular eruptions in children. Proper treatment reduces the course as well as complications in the children.

Herpes zoster em crianças saudáveis: o rosto inocente da controvérsia

Introduction: Herpes zoster (HZ) emerges sporadically by reactivation of the varicella zoster virus (VZV). It lies latent within the dorsal root of sensory ganglia or cranial nerves after primary infection, which manifests clinically as varicella. Its incidence increases with age and is rare in childhood. Case report: We describe the case of a 9-year-old previously healthy male, brought to medical consultation for pain and vesicular exanthema in the T1 dermatome, compatible with HZ. He was treated with acyclovir and improved clinically after three weeks. Discussion: In healthy children, HZ is rare. The main risk factor for childhood onset of HZ is primary VZV infection during gestation or the first year of life. It is not necessary to exclude underlying immunodeficiency, except in cases of recurrence. Due to its characteristics, childhood HZ is a disease that raises questions at diagnosis and regarding appropriate treatment.

Association of asthma and herpes zoster in children

The incidence of asthma and herpes zoster (HZ) rose concurrently at the end of the 20th century. Investigators took advantage of the setting of Olmstead County, Minnesota, where medical care is “virtually self-contained,” to perform a population-based epidemiologic study to explore whether HZ was associated with asthma. The study was performed before substantial use of varicella vaccine, and no case had received systemic corticosteroid in the three months prior to HZ. Twenty-three percent of cases of HZ had asthma compared with 12.6% of matched controls (aOR: 2.09, 95% CI 1.24-3.52; P = .006). The authors provide arguments about why detection bias is likely not responsible for their finding. They conclude that asthma may be an unrecognized risk factor for reactivation of non—airway-related latent VZV infection and speculate that altered cell-mediated innate immune response could be the biologic link.Article page 816▶ The incidence of asthma and herpes zoster (HZ) rose concurrently at the end of the 20th century. Investigators took advantage of the setting of Olmstead County, Minnesota, where medical care is “virtually self-contained,” to perform a population-based epidemiologic study to explore whether HZ was associated with asthma. The study was performed before substantial use of varicella vaccine, and no case had received systemic corticosteroid in the three months prior to HZ. Twenty-three percent of cases of HZ had asthma compared with 12.6% of matched controls (aOR: 2.09, 95% CI 1.24-3.52; P = .006). The authors provide arguments about why detection bias is likely not responsible for their finding. They conclude that asthma may be an unrecognized risk factor for reactivation of non—airway-related latent VZV infection and speculate that altered cell-mediated innate immune response could be the biologic link. Article page 816▶ Increased Risk of Herpes Zoster in Children with Asthma: A Population-Based Case-Control StudyThe Journal of PediatricsVol. 163Issue 3PreviewTo determine the risk of herpes zoster (HZ) in children with and without asthma. Full-Text PDF

Increased Risk of Herpes Zoster in Children with Asthma: A Population-Based Case-Control Study

To determine the risk of herpes zoster (HZ) in children with and without asthma. This study was designed as a population-based case-control study. We examined all children (aged <18 years) with possible HZ in Olmsted County, Minnesota, between 1996 and 2001 (n = 306; identified by International Classification of Diseases, Eighth Revision codes and predetermined criteria for HZ) to identify true cases. To determine the association between asthma and HZ, we compared the frequency of asthma among children with HZ with that among age- and sex-matched corresponding controls (1:1 matching) who resided in Olmsted County, Minnesota, during the study period. Asthma was ascertained based on predetermined criteria. A conditional logistic regression model was used to calculate ORs and 95% CIs. We identified 277 eligible patients with HZ, 63 (23%) of whom had a history of asthma before the index date of HZ, compared with 35 of 277 (12.6%) matched controls (aOR, 2.09; 95% CI, 1.24-3.52; P = .006), adjusting for varicella vaccination and atopy status. The population-attributable risk percentage was 12%. Controlling for asthma and atopy status, varicella vaccination was associated with reduced risk of HZ (aOR, 0.44; 95% CI, 0.21-0.92; P = .028). Asthma may be an unrecognized risk factor for reactivation of a non-airway-related latent infection such as HZ in children.

Multisegmental Herpes Zoster in a Healthy Girl

Children infrequently are afflicted with herpes zoster (HZ). Activation of latent varicella-zoster virus (VZV) in a partially immune host results in HZ. Herpes zoster in children can be benign or with varied severity, especially in cases associated with malignancy. Because of its rarity, we report widespread multisegmental HZ primarily presenting on the right side of the body and right flank in a 11 years old immunocompetent girl. The Authors have previously described a similar observation in a 6 years old female immunocompetent girl Children infrequently are afflicted with herpes zoster (HZ). Activation of latent varicella-zoster virus (VZV) in a partially immune host results in HZ. Herpes zoster in children can be benign or with varied severity, especially in cases associated with malignancy. Defects in normal immunity and cellular immunity have been postulated as important factors in the pathogenesis of HZ. Disseminated HZ is typical HZ associated with widespread cutaneous lesions simulating chicken pox and it may be associated with immunosuppression [1].