Three year seroepidemiological study of varicella-zoster virus in São Paulo, Brazil

Yu, Ana Lúcia Frugis; Costa, Jane Margarete; Amaku, Marcos; Pannuti, Cláudio Sérgio; Souza, Vanda Akico Ueda Fick de; Zanetta, Dirce Maria Trevisan; Burattini, Marcelo Nascimento; Massad, Eduardo; Azevedo, Raymundo Soares

doi:10.1590/s0036-46652000000300002

Cited by 23 publications

(30 citation statements)

References 13 publications

(18 reference statements)

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“…In remote areas laboratory facilities may not be accessed easily, and for research purposes uniform analysis techniques at a central location may be preferred over analyses in different laboratories. To address these problems in resource-limited settings, dried blood spot analysis has been used for the screening and diagnosis of various infectious diseases, including those caused by varicella-zoster virus, 9 as it greatly facilitates collection and transport of patient material and assures its stability. 10,11 The aims of this study were to determine the positive predictive value of clinical judgment in diagnosing herpes zoster and to assess the logistic appropriateness of dried blood spot analysis in primary care.…”

Section: Introductionmentioning

confidence: 99%

Clinical Diagnosis of Herpes Zoster in Family Practice

Opstelten

Loon²,

Schuller³

et al. 2007

The Annals of Family Medicine

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PURPOSE Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice.METHODS Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confi rmation of herpes zoster.RESULTS Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confi rmed serologically (positive predictive value of clinical judgment 90.8%; 95% confi dence interval, 87.3%-94.3%). Independent clinical variables for serologically confi rmed herpes zoster were severity and duration of rash at fi rst examination.CONCLUSION Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster. INTRODUCTIONH erpes zoster is a common disease, with a reported incidence varying from 2.2 to 4.8 per 1,000 persons per year. [1][2][3] It is due to a localized recrudescence of the varicella-zoster virus in sensory ganglia, where the virus has remained dormant since the primary infection (chickenpox). Age and immunity-attenuating diseases are well-known risk factors for herpes zoster. 4 The most frequent complications of herpes zoster include postherpetic neuralgia and, in cases of ophthalmic herpes zoster, sight-threatening eye problems.Because the typical unilateral rash helps family physicians diagnose herpes zoster clinically, suspected cases of herpes zoster are rarely investigated serologically or virologically. False-positive diagnosis of herpes zoster, however, is reported to occur in up to 13% of patients 5,6 and may result in unnecessary prescription of antiviral medications, erroneous referral, and unnecessary invasive interventions for the prevention of postherpetic neuralgia. 7 Serological analysis is one method to confi rm the diagnosis of herpes zoster, 8 but few studies have assessed its value in family practice. Moreover, such analysis in primary care can be fraught with logistic problems. In remote areas laboratory facilities may not be accessed easily, and for research purposes uniform analysis techniques at a central location may 306CLINIC A L DIAGNOSIS OF HER PES ZOS T ER be preferred over analy...

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Section: Introductionmentioning

confidence: 99%

Clinical Diagnosis of Herpes Zoster in Family Practice

Opstelten

Loon²,

Schuller³

et al. 2007

The Annals of Family Medicine

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“…A vacina contra varicela é recomendada pela Sociedade Brasileira de Pediatria (SBP) e pela Sociedade Brasileira de Imunizações (SBIm) para todas as pessoas não imunes com mais de 1 ano de idade. Do ponto de vista ético, os profissionais de saúde devem informar a população sobre a existência e possíveis benefícios da vacina contra varicela, mesmo quando a família dispõe de poucos recursos econômicos 6 .…”

Section: Considerações Finaisunclassified

“…Estudos de inquérito soroepidemiológico realizados no Brasil revelaram que, aos 5 anos, quase metade das crianças já foi infectada. Embora haja grandes variações regionais, crianças que vivem em condições promíscuas ou são cuidadas fora do próprio lar contraem mais cedo a infecção e apresentam maiores taxas de complicações [4][5][6][7][8] .…”

Section: Introductionunclassified

Varicella vaccines and measles, mumps, rubella, and varicella vaccine

Bricks¹,

Sato²,

Oselka³

2006

J Pediatr (Rio J)

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“…While there are major regional variations, children who live in crowded conditions or are looked after away from home contract the infection earlier and exhibit higher rates of complications. [4][5][6][7][8] Varicella cases occur all year round, but in temperate climates the majority of disease outbreaks are recorded during the end of winter and start of spring. [1][2][3][4] Varicella vaccines …”

Section: Pregnant Womenmentioning

confidence: 99%

“…has limited economic resources. 6 We hope that the measles, mumps, rubella, and varicella vaccine will soon be available in Brazil, since the use of combined vaccines facilitates compliance with recommendations for the use of new vaccines and makes wider vaccination coverage possible. …”

Section: Immunobiology Referral Centers (Crie Centros Dementioning

confidence: 99%

Vacinas contra varicela e vacina quádrupla viral

Bricks¹,

Sato²,

Oselka³

2006

J. Pediatr. (Rio J.)

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Objectives: To present an up-to-date review of studies investigating the efficacy, adverse events and vaccination regimens of the varicella vaccine and the new presentation combined with the vaccine for measles, mumps and rubella.Sources of data: Bibliographic review of the MEDLINE and LILACS databases covering the period 1999 to 2006. Summary of the findings:The varicella vaccine protects 70 to 90% of immunized children against any form of varicella zoster infection, but the efficacy against severe forms is higher (95 to 98%). This is a well-tolerated vaccine that causes few reactions. Since the vaccine was licensed, there have been three confirmed cases of transmission of the vaccine virus by domestic contacts to previously healthy people, who went on to develop mild disease. Despite evidence that the protection offered by this vaccine can wane over a number of years, it is not yet possible to state that a second dose is warranted, bearing in mind exposure to wild virus. After universal vaccination the chances of natural stimulation should drop and it is very probable that booster doses will become necessary. A measles, mumps, rubella, and varicella vaccine has recently been licensed that combines vaccines for measles, mumps, rubella and varicella in a single product with high rates of seroconversion. Conclusions:The Brazilian Society of Pediatrics recommends the varicella vaccine for children from 1 year on. We hope that the measles, mumps, rubella, and varicella vaccine will soon be available in Brazil, since combined vaccines facilitate wider vaccination coverage.J Pediatr (Rio J). 2006;82(3 Suppl):S101-8: Varicella, adverse events, efficacy, vaccination schedule, measles, mumps, rubella, and varicella vaccine.

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Three year seroepidemiological study of varicella-zoster virus in São Paulo, Brazil

Cited by 23 publications

References 13 publications

Clinical Diagnosis of Herpes Zoster in Family Practice

Clinical Diagnosis of Herpes Zoster in Family Practice

Varicella vaccines and measles, mumps, rubella, and varicella vaccine

Vacinas contra varicela e vacina quádrupla viral

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