Varicella(Chickenpox) / Zoster (Shingles)

Varicella/Zoster

  • A herpes virus that has its primary infection resulting in varicella (chickenpox) and its recurrent infection resulting in herpes zoster (shingles)
  • Incubation stage is 14-16 days; prodrome for 1-2 days of fever and malaise prior to rash onset
  • Rash appears first on head & is most concentrated on the trunk
    • In health kids- symptoms: malaise, itching, temp up to 102 for 2-3 days
  • In immunocompromised patients the zoster virus can disseminate causing generalized skin lesions, CNS, pulmonary and hepatic involvement
  • Complications associated with varicella:
    • Secondary bacterial infections of the skin lesions with staph or strept.
    • Pneumonia following varicella is usually viral but also may be bacterial (bacterial is more common in kids less than 1 year old)
    • Rarely encephalitis
    • Rarely Reye’s syndrome can occur kids who take aspirin during the illness
    • Number of other rare complications:  aseptic meningitis, transverse myelitis, Guillain-Barre syndrome, thrombocytopenia, hemorrhagic varicella, purpura fulminans, glomerulonephritis, myocarditis, arthritis, orchitis, uveitis, iritis, and hepatitis
  • People at increased risk for these complications:  ppl older than 15, younger than 1, immunocompromised, newborns of mothers who show a chickenpox rash 5 days before to up to 2 days after delivery
  • Varicella vaccine (varivax) is a live attenuated SC viral vaccine for people 1 year old or older
    • 1st dose = 12-15 months old
    • 2nd dose = 4-6 years old                 (need a minimum of 3 months between doses for kids under 13;  need 4-8 weeks for ppl 13 or older)
  • Sometimes combined with MMR for the ProQuad vaccine which is also a live vaccine and is used for kids 1 year to 12 years old
  • Herpes Zoster vaccine (Zostavax) is used for people 60 years of age or older
    • Contains a much higher titer of the varicella strain than do the other vaccines
    • Efficacy is lower the older the recipients


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