Is chickenpox so bad, what do we know about immunity to varicella zoster virus, and what does it tell us about the future?

Abstract

Summary Varicella and zoster continue to cause significant morbidity and even mortality in children and adults. Complications include bacterial superinfection, central nervous system manifestations such as meningitis, encephalitis, and cerebellar ataxia, and pain syndromes especially post herpetic neuralgia. Many developed countries but not all, are now administering live attenuated varicella vaccine routinely, with a decrease in the incidence of disease, providing personal and herd immunity. There is some controversy, however, in some countries concerning whether a decrease in the circulation of wild type virus will result in loss of immunity to VZV in persons who have already had varicella. This manuscript reviews the complications of varicella and zoster in detail, the reasons for development of vaccines against these diseases, complications of vaccinations, and mechanisms by which immunity to this virus develops and is maintained. There are strong indications that the best way to control disease and spread of this virus is by vaccination against both.

Postherpetic abdominal pseudohernia. Presentation of a clinical case and literature review

“…This virus, like the other Herpesviridae family viruses, has lifetime latency, although it has a variable period (usually lasting several years after the primary VZV infection) before it reactivates like HZ . HZ occurs approximately in an estimated 30% of individuals whom have had varicella before …”

“…It prevents HZ and the postherpetic neuralgia, which is the most common complication in elderly patients, in approximately 60% of the cases. In contrast, there is a recently developed recombinant vaccine which showed a protective efficacy in phase 3 trials higher than 90% being as well, safe for immunocompromised patients according to phase 2 trials, in whom it shows great promise …”

“…It should be kept in mind that it is an entity with good prognosis, that usually restores ad integrum with no sequelae; therefore, physicians should reassure the patient, limiting complementary studies and treatments.…”

Clinical Features of Varicella-Zoster Virus Infection

“…Today, varicella vaccine is used all over the world, although many countries are not yet using a two-dose schedule. One dose offers about 85% protection, while two doses protect about 98% of vaccinees [ 44 , 45 ]. Widespread immunization of healthy infants and children has led to herd immunity in the United States, where varicella vaccine is no longer offered to immunocompromised patients.…”

Bullous varicella in an immunocompetent infant

“…However, varicella continue to cause significant morbidity and even mortality. Complications include bacterial surinfection, pneumonia, meningitis, encephalitis, cerebellar ataxia and pain syndromes 1 2. Chickenpox in infants may lead to complications when it occurs in-between the loss of the maternal antibodies and the recommended age for vaccination.…”