Varicella Vaccine Research Articles

AAP Issues Letter Regarding Vaccine Payment

The AAP has issued a letter to payers regarding payment for codes 90707 (measles, mumps, and rubella vaccine [MMR], live, for subcutaneous use) and 90716 (varicella virus vaccine, live, for subcutaneous use) when the 2 vaccines are administered separately rather than the combined vaccine listed under 90710 (measles, mumps, rubella, and varicella vaccine [MMRV], live, for subcutaneous use).

The Protective Effectiveness of 2-Dose Varicella Vaccination in Children in Korea: A Case-Control Study.

A 2-dose vaccination against varicella has been adopted in many places; however, it has not been widely introduced in Korea. This study aimed to assess 1-dose and 2-+dose vaccine effectiveness (VE) against laboratory-confirmed varicella in Korea to provide a scientific basis for developing an immunization strategy. We constructed a national cohort using national surveillance data and the national immunization registry. From the cohort, we conducted a 1:2 matched nested case-control study to estimate and compare the VE of the 1-dose and 2-dose of varicella vaccination using exact conditional logistic regression. VE was calculated as [1 - matched odds ratio (OR) × 100%]. From January 1, 2011 to December 31, 2020, a total of 205,173 varicella cases were reported to the notifiable diseases surveillance system. Of these, we included 4,387 laboratory-confirmed varicella cases and 8,774 controls for the analyses. The VE of 1-dose vaccination was 16.8% (95% CI: -9.0% to 36.5%), whereas the VE of 2-doses of the vaccination was 98.6% (95% CI: 96.0%-99.5%). These findings suggest that the 2-dose vaccination strategy can be an effective strategy to prevent varicella.

Chickenpox in pregnancy

Varicella, the number one contamination with varicella-zoster virus (VZV; human herpes virus) in pregnancy, might also cause maternal mortality or extreme morbidity. It may also be the cause of fetal varicella syndrome (FVS) and varicella contamination in new children, which incorporates congenital varicella syndrome (CVS) and neonatal varicella. This guiding principle addresses the role of varicella vaccination in women of reproductive ages. The rule also assesses evidence concerning the maternal and fetal risks of VZV contamination in pregnancy and whether these headaches may be prevented or changed beneficially with the aid of the management of varicella-zoster immunoglobulin (VZIG) or with the aid of a remedy for infected people with acyclovir. This fact should manual the prudent use of VZIG, which is made of the plasma of human blood donors and is consequently a restricted and costly aid. The control of neonates is outdoor the scope of this tenet. Guidance on neonatal publicity and disorder is to be had from other sources [1-2]

Using Baidu Index Data to Improve Chickenpox Surveillance in Yunnan, China: Infodemiology Study.

Chickenpox is an old but easily neglected infectious disease. Although chickenpox is preventable by vaccines, vaccine breakthroughs often occur, and the chickenpox epidemic is on the rise. Chickenpox is not included in the list of regulated communicable diseases that must be reported and controlled by public and health departments; therefore, it is crucial to rapidly identify and report varicella outbreaks during the early stages. The Baidu index (BDI) can supplement the traditional surveillance system for infectious diseases, such as brucellosis and dengue, in China. The number of reported chickenpox cases and internet search data also showed a similar trend. BDI can be a useful tool to display the outbreak of infectious diseases. This study aimed to develop an efficient disease surveillance method that uses BDI to assist in traditional surveillance. Chickenpox incidence data (weekly from January 2017 to June 2021) reported by the Yunnan Province Center for Disease Control and Prevention were obtained to evaluate the relationship between the incidence of chickenpox and BDI. We applied a support vector machine regression (SVR) model and a multiple regression prediction model with BDI to predict the incidence of chickenpox. In addition, we used the SVR model to predict the number of chickenpox cases from June 2021 to the first week of April 2022. The analysis showed that there was a close correlation between the weekly number of newly diagnosed cases and the BDI. In the search terms we collected, the highest Spearman correlation coefficient was 0.747. Most BDI search terms, such as "chickenpox," "chickenpox treatment," "treatment of chickenpox," "chickenpox symptoms," and "chickenpox virus," trend consistently. Some BDI search terms, such as "chickenpox pictures," "symptoms of chickenpox," "chickenpox vaccine," and "is chickenpox vaccine necessary," appeared earlier than the trend of "chickenpox virus." The 2 models were compared, the SVR model performed better in all the applied measurements: fitting effect, R2=0.9108, root mean square error (RMSE)=96.2995, and mean absolute error (MAE)=73.3988; and prediction effect, R2=0.548, RMSE=189.1807, and MAE=147.5412. In addition, we applied the SVR model to predict the number of reported cases weekly in Yunnan from June 2021 to April 2022 using the same period of the BDI. The results showed that the fluctuation of the time series from July 2021 to April 2022 was similar to that of the last year and a half with no change in the level of prevention and control. These findings indicated that the BDI in Yunnan Province can predict the incidence of chickenpox in the same period. Thus, the BDI is a useful tool for monitoring the chickenpox epidemic and for complementing traditional monitoring systems.

Developmental milestones as ACNS turns one year old

Developmental milestones as ACNS turns one year old

The Impact of a Revised National Childhood Immunization Schedule on Vaccination Defaulters.

Immunization schedules affect community vaccine uptake rates, especially in children who have defaulted on their regular immunization timelines. In 2020, Singapore revised its National Childhood Immunization Schedule (NCIS) to incorporate two new combination vaccines: the hexavalent hepatitis, diphtheria, acellular pertussis, tetanus (DTaP), hemophilus influenzae b (Hib), inactivated poliovirus (IPV) (6-in-1), and the quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccines, thus reducing the mean number of clinic visits and vaccine doses by two. Our database study aims to evaluate the impact of the 2020 NCIS on catch-up vaccination uptake rates in children at 18 and 24 months of age and the catch-up immunization rates of individual vaccines at two years. Vaccination data from two cohorts, in 2018 (n = 11,371) and in 2019 (n = 11,719), were extracted from the Electronic Medical Records. Catch-up vaccination rates increased by 5.2% and 2.6% in children on the new NCIS at 18 and 24 months, respectively. The uptake of individual 5-in-1 (DTaP, IPV, Hib), MMR, and pneumococcal vaccines increased by 3.7%, 4.1%, and 1.9% at 18 months. Reduced vaccination doses and visits in the new NCIS bring direct and indirect benefits to parents and promote vaccination adherence for their children. These findings highlight the importance of timelines in improving catch-up vaccination rates in any NCIS.

Meningitis caused by the varicella vaccine virus in 17 immunized children and adolescents from the United States, Europe, and Japan

AbstractThe varicella vaccination program has an excellent safety record. The vaccine virus, like its wild‐type counterpart, can enter latency and later reactivate as herpes zoster. A lesser known but serious adverse event following reactivation is varicella vaccine meningitis. We investigate that adverse event. We performed a literature search using the PubMed and Google Scholar search engines to locate all published cases of varicella vaccine meningitis. We continued the search through January 2023. We found 17 cases of varicella vaccine meningitis. The first case was published in 2003, and the last case was published in 2023. The children lived in the United States, Greece, Germany, Switzerland, and Japan. Among the 17 cases, 14 were immunocompetent; nine of the 17 were adolescents. One potential risk factor was the administration of corticosteroids three to four weeks before the onset of meningitis. Varicella vaccine meningitis is a rare but one of the more serious adverse events that occurs several years following varicella vaccination. In immunocompetent children, this complication is treatable with a single course of intravenous acyclovir after hospitalization.

Acil Tıp Uzmanlarının Aşılanma Durumu ve Aşılara İlişkin Görüşleri: Kesitsel Bir Çalışma

Objective: Health workers may be exposed to some occupational risks due to the nature of their work and one of them is infectious diseases. One of the ways to prevent infectious diseases is vaccination and this study was carried out to evaluate the vaccination status and perspectives of emergency medicine physicians. Materials and Methods: This descriptive and cross-sectional study was conducted on 311 emergency medicine physicians working in emergency departments. Results: Of the participants, 22.5% had seasonal flu vaccine, 83.0% had at least one dose of tetanus-diphtheria vaccine, 90.7% had at least one dose of hepatitis b vaccine, and 63.0% had at least one dose of the measles-rubella-mumps vaccine and 43.1% had at least one dose of chickenpox vaccine. 16.5% of those working as research assistants, 22.6% of specialists, and 40.0% of faculty members had the seasonal flu vaccine (p<0.05). Among those who had full dose tetanus-diphtheria, hepatitis b, measles-rubella-mumps, and chickenpox vaccines, those who preferred to gain personal immunity against diseases were between 2.90 and 2.96 times higher than those who preferred to gain immunity by passing the disease (p<0.05). Conclusion: Emergency medicine physicians have low rates of vaccinations recommended for healthcare workers. Knowing the vaccination rates of emergency medicine physicians can contribute to the planning of vaccination services for all healthcare professionals, especially physicians.

Impact assessment of immunization and the COVID-19 pandemic on varicella across Europe using digital epidemiology methods: A descriptive study.

Varicella is usually a mild disease in children but may be life-threatening, especially in adolescents and adults. Infection control measures implemented during the Coronavirus Disease 2019 (COVID-19) pandemic may have suppressed varicella transmission, potentially creating an 'immunity debt', particularly in countries without universal varicella vaccination. To assess trends in Google search engine queries for varicella keywords as a proxy for varicella infection rates and to evaluate the effect of universal varicella vaccination on these trends. A further objective was to assess the impact of the COVID-19 pandemic on varicella keyword search query trends in countries with and without universal varicella vaccination. This study used the keyword research tool, Google Trends, to evaluate trends in time series of the relative search query popularity of language-specific varicella keywords in 28 European countries from January 2015 through December 2021. The Google Ads Keyword Planner tool was used to evaluate absolute search volumes from March 2018 through December 2021. The relative search query popularity of varicella keywords displayed marked seasonal variation. In all 28 countries, the relative search query popularity of varicella keywords declined after the start of the COVID-19 pandemic (March 2020), compared with pre-pandemic levels (range, -18% to -70%). From April 2020 to July 2021, a period of intense COVID-19 transmission and infection control, absolute search volumes for varicella keywords were lower than pre-pandemic levels but rebounded after July 2021, when infection control measures were relaxed. This evaluation of search query trends demonstrated that search query data could be used as a proxy for trends in varicella infection rates and revealed that transmission of varicella may have been suppressed during the COVID-19 pandemic. Consideration should be given to using search query data to better understand the burden of varicella, particularly in countries where surveillance systems are inadequate.

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.

Acceptability of mandatory vaccination against influenza, measles, pertussis and varicella by workers in healthcare facilities: a national cross-sectional study, France, 2019

BackgroundVaccination of healthcare workers (HCW) aims to protect them and to reduce transmission to susceptible patients. Influenza, measles, pertussis, and varicella vaccinations are recommended but not mandatory for HCW in France. Insufficient vaccine coverage for these diseases in HCW has raised the question of introducing mandatory vaccination. We conducted a survey to estimate acceptability of mandatory vaccination for these four vaccines by HCW working in healthcare facilities (HCF) in France, and to identify associated determinants.MethodsIn 2019, we performed a cross-sectional survey of physicians, nurses, midwives and nursing assistants working in HCF in France using a randomised stratified three-stage sampling design (HCF type, ward category, HCW category). Data were collected in face-to-face interviews using a tablet computer. We investigated the possible determinants of acceptability of mandatory vaccination using univariate and multivariate Poisson regressions, and estimated prevalence ratios (PR).ResultsA total of 8594 HCW in 167 HCF were included. For measles, pertussis, and varicella, self-reported acceptability of mandatory vaccination (very or quite favourable) was 73.1% [CI95%: 70.9–75.1], 72.1% [69.8–74.3], and 57.5% [54.5–57.7], respectively. Acceptability varied according to i) HCW and ward category for these three vaccinations, ii) age group for measles and pertussis, and iii) sex for varicella. For mandatory influenza vaccination, acceptability was lower (42.7% [40.6–44.9]), and varied greatly between HCW categories (from 77.2% for physicians to 32.0% for nursing assistants).ConclusionHCW acceptability of mandatory vaccination was high for measles, pertussis and varicella but not as high for influenza. Vaccination for COVID-19 is mandatory for HCW in France. Replication of this study after the end of the COVID-19 crisis would help assess whether the pandemic had an impact on their acceptability of mandatory vaccination, in particular for influenza.

Universal varicella vaccination in Denmark: Modeling public health impact, age-shift, and cost-effectiveness.

We modeled the long-term clinical and economic impact of two-dose universal varicella vaccination (UVV) strategies in Denmark using a dynamic transmission model. The cost-effectiveness of UVV was evaluated along with the impact on varicella (including age-shift) and herpes zoster burden. Six two-dose UVV strategies were compared to no vaccination, at either short (12/15 months) or medium (15/48 months) intervals. Monovalent vaccines (V-MSD or V-GSK) for the 1st dose, and either monovalent or quadrivalent vaccines (MMRV-MSD or MMRV-GSK) for the 2nd dose were considered. Compared to no vaccination, all two-dose UVV strategies reduced varicella cases by 94%-96%, hospitalizations by 93%-94%, and deaths by 91%-92% over 50 years; herpes zoster cases were also reduced by 9%. There was a decline in the total number of annual varicella cases in all age groups including adolescents and adults. All UVV strategies were cost-effective compared to no vaccination, with ICER values ranging from €18,228-€20,263/QALY (payer perspective) and €3,746-€5,937/QALY (societal perspective). The frontier analysis showed that a two-dose strategy with V-MSD (15 months) and MMRV-MSD (48 months) dominated all other strategies and was the most cost-effective. In conclusion, all modeled two-dose UVV strategies were projected to substantially reduce the clinical and economic burden of varicella disease in Denmark compared to the current no vaccination strategy, with declines in both varicella and zoster incidence for all age groups over a 50-year time horizon.

Seroprevalence of varicella-zoster virus antibody and immunogenicity of live attenuated varicella vaccine in healthcare workers in Taiwan.

Healthcare workers (HCWs) without evidence of immunity to varicella-zoster virus (VZV) are recommended to undergo varicella vaccination. Immunogenicity of live attenuated varicella vaccine has rarely been investigated among HCWs in Taiwan. Anti-VZV immunoglobulin G (IgG) titer was checked for all HCWs at Changhua Christian Hospital from 2011 to 2017. One-dose and two-dose (separated by 4-8 weeks) vaccines were administered to HCWs with equivocal and negative anti-varicella IgG results, respectively. Follow-up anti-VZV IgG was determined at least 4 weeks after completion of vaccination. Factors associated with seroconversion to varicella vaccination were analyzed. Among 2406 included HCWs, the anti-VZV IgG serostatus was tested positive, equivocal and negative in 1924 (79.9%), 117 (4.9%) and 365 (15.2%), respectively. The seroprevalence had decreased from 88.0% (235/267) in 2011 to 72.2% (270/374) in 2017 (p for trend <0.05). A total of 67.8% (327/482) HCWs completed scheduled vaccination and serological follow-up. The seroconversion rates for HCWs with baseline equivocal and negative anti-VZV IgG results were 100% (80/80) and 79.4% (196/247) after one- and two-dose vaccination, respectively. In multivariate analysis, obesity (adjusted odds ratio, 0.308; 95% confidence interval [CI], 0.11-0.94, p=0.039) was the only factor statistically significantly associated with seroconversion to vaccination. Decreasing trends of seroprevalence of VZV were observed among HCWs from 2011 to 2017. HCWs who were obese were less likely to respond to varicella vaccination.

Chickenpox in Poland in 2020.

Chickenpox is an infectious disease caused by the varicella zoster virus. The characteristic feature of this virus is very high visibility of 90-95%. The most common connection is direct contact with the disease or via droplets. The United States was the first country to introduce a universal, population-based childhood varicella vaccination program in 1995. In its 25 years of implementation, this program has significantly reduced the burden of chickenpox. There was a more than 97% reduction in varicella incidence and a 90% reduction in varicella-related hospitalizations and deaths, the highest (99%) in those under the age of 20 (born after starting the vaccination programme). Chickenpox is very common in Poland. In recent years, starting from 2002, there has been an upward trend in the incidence of chickenpox, except for 2020. In 2020, a decrease in the number of cases was recorded. The aim of the study was to assess the epidemiological situation of chickenpox in Poland in 2020 and to compare it with the situation in previous years. Evaluation of the epidemiological situation of chickenpox in Poland in 2020 was based on the results of the analysis of aggregate data published in the annual bulletins: "Infectious diseases and poisonings in Poland in 2020." and "Vaccinations in Poland in 2020". In addition, recommendations from the Protective Vaccination Program for 2020 were used. In 2020, 71,567 cases of chickenpox were registered in Poland, i.e. 39.6% less than in the previous year. The incidence of chickenpox in 2020 was 186.6 per 100,000 and was lower than in 2019. The lowest incidence was recorded in the Świętokrzyskie Voivodship - 118.5/100,000, while the highest in the Kujawsko-Pomorskie Voivodeship - 263.5/100,000. Most cases concerned children aged 0-4 years (36,661). The incidence of chickenpox in men was higher than in women, and in rural areas higher than in urban dwellers. Hospitalization due to chickenpox in 2020 covered 1,368 people, which accounted for 0.51% of the total number of registered cases. In 2020, there was a decrease in the number of cases of chickenpox compared to the previous year. The lower incidence may have been the result of reduced transmission of the varicella virus due to changes in the health behavior of the population during the COVID-19 pandemic (isolation measures and the introduction of a lock down throughout Poland limiting the activity of the population).

Varicella in the neonatal ICU due to the Varicella vaccine Oka strain.

Varicella vaccination of non-immune post-partum women is recommended to reduce the risk of chickenpox in mothers and their infants. Though rare, transmission of the varicella vaccine strain vOka can occur from recent vaccinees to non-immune contacts who usually develop mild chickenpox. Here we describe an infant hospitalized in the neonatal ICU with vaccine-strain varicella due to transmission from their mother who received the varicella vaccine post-partum. We describe the infection prevention and control strategies implemented to prevent further transmission. Vaccine-strain varicella transmission from mother to infant is a rare event and its occurrence in the neonatal ICU setting can be challenging. Anticipatory guidance for mothers vaccinated in the postpartum period and support of parents of an infected infant are recommended.

Pediatric herpes zoster ophthalmicus: a systematic review.

While typically affecting older adults and immunocompromised individuals, herpes zoster ophthalmicus (HZO) has been reported with varying manifestations and complications in children. In this review, we evaluate reported cases of pediatric HZO in the literature and discuss the epidemiology, risk factors, clinical presentation, treatment and outcomes. A literature search on PubMed, Scopus, and Web of Science databases was performed using the terms "pediatric herpes zoster ophthalmicus" and "herpes zoster ophthalmicus children." Publications that were not specific to HZO or pediatric populations were excluded, as were publications that were not available to review or not published in the English language. Fifty-seven reports describing 130 cases of HZO or HZO-related complications were reviewed. Major risk factors for pediatric HZO included intrauterine exposure to varicella or primary varicella infection at a young age; HZO also occurred in patients who had received varicella vaccination. Both healthy and immunocompromised children were affected, with the majority of affected children being immunocompetent. The diagnosis of HZO is primarily clinical. Children appear to have good vision recovery and resolution of symptoms if they are treated promptly and if they adhere to treatment regimens, except for irreversible vision loss related to uncommon complications such as optic neuritis. HZO occurs in both healthy and immunocompromised children. Recognizing this treatable condition is essential for reducing ocular and systemic morbidity. Long-term follow-up and assessments of the impact on health in adulthood are lacking. More systematic study is needed to determine the incidence of HZO in children and appropriate diagnostic and treatment protocols for the care of pediatric patients with HZO.

Trend in the Numbers of Hospitalized Patients With Varicella, Herpes Zoster, and Ischemic Stroke in Japanese Individuals

Several studies have shown an association between varicella-zoster virus infection and ischemic stroke. We analyzed the trends in the numbers of patients with varicella, herpes zoster and ischemic stroke before and after the universal vaccination program using a Japanese database of hospitalized patients. The number of patients with varicella decreased but those of herpes zoster and ischemic stroke did not change.

Acceptability of Herpes Zoster Vaccination among Patients with Diabetes: A Cross-Sectional Study in Saudi Arabia

Background: Vaccines have recently been made available free of charge by the Saudi Ministry of Health for people 50 years or older. Diabetes mellitus (DM) increases herpes zoster (HZ) susceptibility, severity, serious complications, and negative impacts on underlying DM conditions, which are highly prevalent in Saudi Arabia. This study aimed to assess the acceptability of the HZ vaccination and its predictors among patients with diabetes in the Qassim region of Saudi Arabia. Methods: A cross-sectional study of patients with diabetes from a primary healthcare center in the Qassim region was conducted. Information was obtained on sociodemographic characteristics, history of herpes zoster infection, knowing someone who had had herpes zoster, past vaccinations, and factors influencing their intention to receive the HZ vaccination through a self-administered online questionnaire. Results: The median age (IQR) was 56 years (53-62). Overall, 25% (n = 104/410) of the participants reported their acceptability of the HZ vaccination, and the predictors were being male (AOR 2.01, 95% CI 1.01-4.00, p = 0.047), believing the HZ vaccine was effective (AOR 3.94, 95% CI 2.25-6.90, p < 0.001), and awareness that immunocompromised individuals are at a higher risk of contracting HZ (AOR 2.32, 95% CI 1.37-3.93, p = 0.002). A total of 74.2% (n = 227/306) of the participants reported their acceptability of the HZ vaccination if advised by their physician, and the predictors were being male (AOR 2.37, 95% CI 1.18-4.79, p = 0.016) and having a history of varicella vaccine uptake (AOR 4.50, 95% CI 1.02-19.86, p = 0.047). Conclusions: One-quarter of the participants were ready to accept the HZ vaccine, but this proportion significantly increased when the patients were advised by their physicians. The uptake rate can be improved with the involvement of healthcare providers and focused awareness campaigns about the effectiveness of the vaccine.

Incidence and clinical and microbiological features of invasive and probable invasive streptococcal group A infections in children and adults in the Brussels-Capital Region, 2005–2020

Assess the incidence, risk factors, clinical and microbiological features, and outcome of both probable invasive and invasive group A Streptococcus (GAS) infections in children and adults in the BrusselsCapital Region between 2005 and 2020. A retrospective, multicentric study was performed in three university hospitals in Brussels. Patients were identified through the centralized laboratory information system. Epidemiological and clinical data were collected from patients' hospital records. A total of 467 cases were identified. Incidence has increased from 2.1 to 10.9/100,000 inhabitants between 2009 and 2019 in non-homeless adults while it was above 100/100,000 on homeless in years with available denominators. Most of GAS were isolated from blood (43.6%), and the most common clinical presentation was skin and soft tissue infections (42.8%). A third of all the patients needed surgery, a quarter was admitted to the intensive care unit, and 10% of the adult patients died. Wounds and chickenpox disease were the main risk factors for children. Tobacco, alcohol abuse, wounds or chronic skin lesion, being homeless, and diabetes were identified as major predisposing factors for adults. The most common emm clusters were D4, E4, and AC3; 64% of the isolates were theoretically covered by the 30-valent M-protein vaccine. The burden of invasive and probable invasive GAS infections is on the rise in the studied adult population. We identified potential interventions that could contribute to decrease this burden: appropriate care of wounds, specifically among homeless and patients with risk factors such as diabetes and systematic chickenpox vaccination for children.

Vaccine Induced Herpes Zoster in An Immunocompetent Child After 3 months of 1st Dose of Vaccination

Varicella zoster virus (VZV) is an enveloped double stranded linear virus, which belongs to the herpesvirus’s family. It can cause two clinically different forms of diseases, primary infection known as chicken pox and latent infection know as herpes zoster (Shingles). Primary infection presents with diffuse vesicular rash accompanied by fever, malaise, and pharyngitis. However, latent infection results from reactivation of dormant virus in an immunocompromised patient and presents with painful localized skin rashes called as shingles. Currently, in the US, 2 doses of live attenuated varicella vaccine are available to prevent VZV infection. One of the major side effects of vaccination are the rashes. We report a unique case of vaccine induced VZV infection in a previously healthy child that presents with vesicular rashes 3 months after 1st dose of vaccination. A 16-month-old child with past medical history of premature birth at 32 weeks, presented to the pediatric outpatient clinic with complains of well-demarcated, erythematous, dry rash on both labia. Parents denied fever, cough, or any other signs and symptoms associated with rashes. patient activity level was normal and oral intake was usual. PCR testing was performed was found to be negative for Herpes Simplex Virus-1 (HSV-1) and Herpes Simplex Virus-2 (HSV-2) and positive for VZV. Due to patient recent vaccination status, further classification of infection was needed to determine if the source of infection was wild type chicken pox or vaccine induced. A swab of one of the vesicular lesions was sent to the Ohio Department of Health, for vaccine vs wild-type strain PCR testing. The results were positive for Vaccine induced VZV infection. The patient was started on acyclovir therapy. On follow-up, the patient condition improved clinically. In pediatric populations, it is important to do extensive evaluation of rashes post vaccination as it can be occurred due to wild type, break through or it can be vaccine induced virus. Proper evaluation can significantly impact the management patients as they are maybe infectious and need to be isolated in wild type and breakthrough infection versus non-infectious in case of vaccine induced. After detailed clinical history and physical examination, it is important to investigate further through PCR testing to differentiate one category from another!