History Of Varicella-zoster Virus Infection Research Articles

Varicella Seroprevalence among Healthcare Workers: A Pilot Study from a Tertiary Care Centre in Northern India

Introduction: Susceptible Healthcare Workers (HCWs) lacking immunity to Varicella Zoster Virus (VZV) can get infected and spread the infection to their patients. Effective screening can help in early vaccination to limit nosocomial transmission of VZV. Aim: To assess the seroprevalence of VZV among HCWs. Materials and Methods: This was a hospital-based pilot study where serum samples were collected from 201 HCWs working in different departments of the Government Medical College, Srinagar, Jammu and Kashmir, India and its eight associated hospitals over a period from January 2021 to February 2021, after obtaining their consent to participate in the study. Samples were tested for VZV Immunoglobulin G (IgG) antibodies using the Enzyme Linked Immuno Sorbent Assay (ELISA) method (NovaLisaVZVIgG, ELISA Kit). Variables including age, sex, professional category, history of varicella infection, and VZV vaccination were collected in a proforma. Statistical analysis was done using Open Epi version 3.01. Results: The overall prevalence of antibodies to varicella was 150/196 (76.53%). HCWs had equivocal results in 4 (2.04%) cases. An age-related increase in seroprevalence was observed. Only 6/196 (3.06%) participants were vaccinated against VZV, and 38/196 (19.39%) participants had a history of VZV infection in the past. Conclusion: The present study found a significant proportion of HCWs susceptible to VZV, making them potentially at risk of acquiring and transmitting the infection. This reinforces the need for screening HCWs against VZV and vaccinating them whenever necessary to protect the patients.

Acute Transverse Myelitis after Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case Report

Herpes zoster is caused by reactivated varicella-zoster virus (VZV) and characterized by a painful skin rash with vesicles that affects the adjacent dermatomes. Transverse myelitis is a rare complication of VZV infection that may even occur in immunocompetent patients. Here, we report a 60-year-old male patient admitted with right lower-extremity weakness and hypesthesia. Spine magnetic resonance imaging (MRI) revealed transverse myelitis at the C3–C4 and T6 levels. A month prior to admission, the patient was diagnosed with herpes zoster involving the right T2-T4 dermatome. Considering his history of VZV infection, he was treated with intravenous steroids and acyclovir. Eleven days after hospitalization, paraplegia developed to Medical Research Council grade 0/5 despite performing plasmapheresis. MRI confirmed the aggravation of the cord lesion between T4 and T7. Acute transverse myelitis after VZV infection is a rare disease that can cause serious sequelae in immunocompetent patients. Therefore, clinicians should be cautious of this situation.

Idiopathic purpura fulminans associated with anti-protein S antibodies in children: a multicenter case series and systematic review

AbstractIdiopathic purpura fulminans (IPF) is a rare but severe prothrombotic coagulation disorder that can occur after chickenpox or human herpesvirus 6 (HHV-6) infection. IPF leads to an autoantibody-mediated decrease in the plasma concentration of protein S. We conducted a retrospective multicenter study involving patients with IPF from 13 French pediatric centers and a systematic review of cases in published literature. Eighteen patients were included in our case series, and 34 patients were included as literature review cases. The median age was 4.9 years, and the diagnostic delay after the first signs of viral infection was 7 days. The lower limbs were involved in 49 patients (94%) with typical lesions. In all, 41 patients (78%) had a recent history of varicella-zoster virus infection, and 7 patients (14%) had been infected by HHV-6. Most of the patients received heparin (n = 51; 98%) and fresh frozen plasma transfusions (n = 41; 79%); other treatment options were immunoglobulin infusion, platelet transfusion, corticosteroid therapy, plasmapheresis, and coagulation regulator concentrate infusion. The antithrombin level and platelet count at diagnosis seemed to be associated with severe complications. Given the rarity of this disease, the creation of a prospective international registry is required to consolidate these findings.

Acute ataxia in paediatric emergency departments: a multicentre Italian study

ObjectivesTo evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP).Study designThis...

Impact of Vaccination History on Serological Testing in Pregnant Women.

Serological testing guidelines for vaccine-preventable infectious diseases in pregnant women are heterogeneous. It is unclear how vaccination history influences health care workers' (HCWs) attitudes about testing. The aim of this study was to describe current practices in screening for rubella, hepatitis B, and varicella-zoster virus (VZV) in pregnant women in the province of Québec. In 2015, an electronic survey was distributed to HCWs who followed the case of at least one pregnant woman in the previous year and who could be contacted by email by their professional association. A total of 363 of 1084 (33%) participants were included in the analysis: general practitioners (57%), obstetrician-gynaecologists (20%), midwives (41%), and nurse practitioners (31%). For rubella, 48% of participants inquired about vaccination status, and of these, 98% offered serological testing for unvaccinated women versus 44% for vaccinated women. Similarly, of the 48% of participants who asked about hepatitis B vaccination status before offering testing, 96% ordered testing for hepatitis B surface antigen, 28% ordered testing for hepatitis B surface antibody, and 1% ordered no serological testing to unvaccinated women versus 72%, 46%, and 8%, respectively, for vaccinated women. Among the 81% of respondents who discussed VZV during prenatal care, 13% ordered serological testing if patients had a history of VZV infection, 87% if the VZV history was uncertain, and 19% if patients had a positive history of vaccination. Asking about vaccination status influences HCWs' attitudes about serological testing for rubella, hepatitis B, and VZV. In the context of increasing vaccination coverage in women of child-bearing age, it is important to clarify the impact of vaccination status in serological screening guidelines in pregnant women.

Chickenpox-related Pulmonary Granulomas in Immunocompetent Adults

Pulmonary granulomas represent a common inflammatory reaction to several lung infective or noninfective diseases. However, little is known about the histology and clinical presentation of chickenpox-related granulomas in immunocompetent subjects. We collected a series of 8 adult patients (mean age, 40 y; range, 33 to 53 y) with several bilateral pulmonary granulomas incidentally discovered after imaging studies. All patients were asymptomatic and had experienced a varicella-zoster virus (VZV) infection as adults but were clinically suspected to have a metastatic neoplasm of unknown origin. Chest computed tomography scan revealed numerous, tiny (few millimeters to 1 cm in size) nodules randomly dispersed through the lungs. Positron emission tomography scan performed in 4 patients was negative. All patients underwent video-assisted thoracoscopic surgical resection and were still alive and well. At histology, granulomas consisted of well-defined, rounded, small nodules centered by a deeply eosinophilic, acellular necrosis rimmed by lamellar dense collagen and a chronic inflammatory infiltrate with or without multinucleated giant cells. Chickenpox-related granulomas were included in the differential diagnosis along with several other granulomatous diseases. Polymerase chain reaction-based molecular analysis for VZV performed on paraffin sections detected VZV DNA in all 8 cases. By contrast, 85 cases of pulmonary granulomas of different etiologies were simultaneously studied by molecular analysis with negative results. Pathologists should be familiar with the peculiar morphologic appearance of chickenpox-related granulomas. A careful search for a history of VZV infection in adulthood and molecular studies may be very helpful in confirming the diagnosis.

Pneumonia Due to Varicella-Zoster Virus Reinfection in a Renal Transplant Recipient

Varicella pneumonia is one of the serious complications of primary varicella zoster virus (VZV) infection in adults. A 36-year-old woman with end-stage renal disease underwent renal transplantation from a living donor in 1998, receiving immunosuppressive treatment with cyclosporine, mycophenolate mofetil, and methylprednisolone. She had a history of VZV infection during childhood. The patient developed an intractable cough on December 10, 2006, but there were no abnormalities in the laboratory data or chest radiograph for several weeks. On January 1, 2007, she was admitted to our hospital with cutaneous vesicles covering the entire body. We learnt that when her symptoms developed, her son was diagnosed with varicella. The chest radiograph at this stage showed a diffuse miliary pattern in the entire lung field. We started intravenous administration of acyclovir. VZV antigen was detected in the cutaneous lesions and VZV antibody in the serum after the start of these treatments, so we continued to administer acyclovir for 18 days. The cutaneous lesions healed and the pneumonia improved based on the chest radiograph. She was discharged from the hospital on January 19, 2007. In conclusion, this report documents VZV reinfection in a transplant patient.

Association of a history of varicella virus infection with multiple sclerosis

Objective To analyze the association of a previous history of varicella virus infection with multiple sclerosis (MS) and its subtypes. Material and methods We performed a case–control study including 126 cases and 157 controls. Subjects were divided into subgroups according to MS subtype and the history of varicella virus infection along with other variables was assessed. Results History of varicella zoster virus (VZV) infection was positive in 42% of controls and 66% of MS cases ( p ≤ 0.001). Patients with a history of VZV infection had a threefold risk increase of having MS. Regarding MS subtypes, relapsing-remitting (RR) MS had four times the risk and secondary progressive had a threefold increase in risk when compared with control patients. Conclusions An association between varicella infection history and MS was found, particularly in the RR subtype.

Case 2: Rash, fever and headache….first, do no harm

A 16-year-old healthy boy presented with a two-day history of pruritic painful rash involving his left abdomen and back in a T9 to T10 distribution. In addition, he had a fever, blurry vision, painful eye movements and a headache. The patient had a history of varicella-zoster virus infection without complications when he was eight years of age, and his past medical history was unremarkable. There were no sick contacts, and his vaccinations were current. He had not received the varicella vaccine.

Cost-Effectiveness of a Vaccine To Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults

The Shingles Prevention Study showed that a varicella-zoster virus (VZV) vaccine administered to adults 60 years of age or older reduced the incidence of herpes zoster from 11.12 to 5.42 cases per 1000 person-years. Median follow-up was 3.1 years, and relative risk reduction was 51.3% (95% CI, 44.2% to 57.6%). To assess the extent to which clinical and cost variables influence the cost-effectiveness of VZV vaccination for preventing herpes zoster in immunocompetent older adults. Decision theoretical model. English-language data published to March 2006 identified from MEDLINE on herpes zoster rates, vaccine effectiveness, quality of life, medical resource use, and unit costs. Immunocompetent adults 60 years of age or older with a history of VZV infection. Lifetime. U.S. societal. Varicella-zoster virus vaccination versus no vaccination. Incremental quality-adjusted survival and cost per quality-adjusted life-year (QALY) gained. By reducing incidence and severity of herpes zoster, vaccination can increase quality-adjusted survival by 0.6 day compared with no vaccination. One scenario in which vaccination costs less than 100,000 dollars per QALY gained is when 1) the unit cost of vaccination is less than 200 dollars, 2) the age at vaccination is less than 70 years, and 3) the duration of vaccine efficacy is more than 30 years. Vaccination would be more cost-effective in "younger" older adults (age 60 to 64 years) than in "older" older adults (age > or =80 years). Longer life expectancy and a higher level of vaccine efficacy offset a lower risk for herpes zoster in the younger group. Other factors influencing cost-effectiveness include quality-of-life adjustments for acute zoster, unit cost of the vaccine, risk for herpes zoster, and duration of vaccine efficacy. The effectiveness of VZV vaccination remains uncertain beyond the median 3.1-year duration of follow-up in the Shingles Prevention Study. Varicella-zoster virus vaccination to prevent herpes zoster in older adults would increase QALYs compared with no vaccination. Resolution of uncertainties about the average quality-of-life effects of acute zoster and the duration of vaccine efficacy is needed to better determine the cost-effectiveness of zoster vaccination in older adults.

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P = .006). In the post-intervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZV-specific T-helper cell responses, HSV infections, CMV disease, chronic graft-versus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression.

Varicella-Zoster Virus Susceptibility in Day-Care Workers

Abstract The susceptibility of day-care workers to varicella-zoster virus (VZV) was evaluated by determining antibody to VZV in 545 day-care workers using a commercial enzyme-linked immunosorbent assay (ELISA). Historical information about primary infection with VZV and demographic data were obtained from questionnaires completed by 494 workers. The proportion of daycare workers susceptible to VZV was 4.8 percent, and the seronegativity among workers with a negative history of VZV infection was 13.6 percent. These data indicate that a small proportion of the day-care workers are susceptible to varicella infection. The following recommendations are made to enhance the well-being of day-care workers. All day-care workers susceptible to VZV should be made aware of the adverse health affects associated with VZV if contracted. Susceptible workers identified by the serological screen should be sent home for 8-21 days after exposure if VZV infection occurs in the day-care setting. All day-care workers who are of...

Impact and costs of varicella prevention in a university hospital.

Information regarding all patient and staff exposures to varicella-zoster virus (VZV) was prospectively accumulated from 1/1/86 to 12/31/86 at North Carolina Memorial Hospital. During this period of time 37 sources of exposure to VZV were reported: 10 outside and 27 within the hospital. Index cases for nosocomial exposure included: 12 patients with zoster, 9 patients with varicella, two staff with varicella, three visitors with varicella, and one staff with zoster. One hundred and twenty patients received nosocomial exposures; 28 had no history of VZV infection (23 per cent), of whom 11 were serosusceptible (39 per cent). Sources of nosocomial patient exposure included: other patients (85 per cent), staff (14 per cent), and a single visitor (1 per cent). More than 300 employees received nosocomial exposure; 158 had no history of VZV infection, of whom 49 were serosusceptible (31 per cent). Only a single employee and no patients developed clinical varicella as a result of nosocomial exposure. Costs associated with VZV control during 1986 totaled $55,934: $39,658 for work furloughs, $9,800 for serologies, $4,293 for patient isolation, $155 for varicella-zoster immune globulin, and $2,028 for infection control personnel time. These costs should be considered as part of any benefit-cost analysis of varicella immunization of health care personnel.