Noticing the trend in decreased vaccination, let’s review varicella.
Varicella-zoster virus (VZV): one of eight herpesviruses known to cause human infection
full-body rash that starts on the trunk and is characterized by lesions in various stages of development.
Buzz words: asynchronous vesicular lesions
· Requires airborne precautions
· Chickenpox used to be very common in the United States.
o Each year, chickenpox caused about 4 million cases, about 10,600 hospitalizations and 100 to 150 deaths.
· Two doses of the vaccine are about 90% effective at preventing chickenpox.
· Although varicella is usually a self-limited disease and usually management is supportive
o Exception to this is if you are at risk for complication or develop complications.
· Who is most at risk for complications from varicella?
o Older patients, pregnant patients, and anyone who is immunocompromised (think on chronic steroids or immunosuppressants who are not vaccinated).
· Complications: hepatitis, pneumonia, superimposed cellulitis, meningitis and encephalitis
· Pneumonia is more frequent complication in these at risk populations (especially pregnant patients) who develop varicella.
· Severe complications of varicella pneumonia in pregnant patients: development of congenital varicella syndrome in the baby and, if the mother develops varicella rash right before or after delivery, risk for neonatal varicella.
· When associated with pregnancy, varicella pneumonia is the leading cause of varicella-related illness and death in adults, with a reported maternal mortality rate of up to 44%.
· Patients with severe varicella disease should be admitted and treated with intravenous acyclovir.
o Special attention to airway monitoring
· When do we give Varicella-zoster immune globulin (VZIG)?
o VZIG is indicated for prophylaxis in susceptible pregnant women who have been exposed to the varicella-zoster virus.
o The primary purpose of VZIG prophylaxis is to prevent or attenuate maternal disease.
· PO acyclovir for those cases that are not severe and can be managed with close outpatient follow up
Sources:
https://www.cdc.gov/vaccines/vpd/varicella/index.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155623/
Peer IX
Uptodate: varicella: https://www.uptodate.com/contents/treatment-of-varicella-chickenpox-infection