The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalized for chickenpox or an associated complication

Law, Barbara; MacDonald, Noni E.; Halperin, Scott A.; Scheifele, David W.; Déry, Pierre; Jadavji, Taj; LeBel, Marc; Mills, Elaine L.; Morris, Rob; Vaudry, Wendy; Gold, Ron; Marchessault, Victor; Duclos, Philippe

doi:10.1097/00006454-200011000-00005

Cited by 36 publications

(30 citation statements)

References 22 publications

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“…Also, such seroprevalence data critically instruct appropriate immunization strategies for VZV (25). The impact of diseases associated with VZV infections, hospitalizations, and complications should be evaluated with respect to vaccination goals and strategies.…”

Section: Discussionmentioning

confidence: 99%

Genotypic Analysis of Varicella-Zoster Virus and Its Seroprevalence in Finland

Koskiniemi

Lappalainen

Schmid

et al. 2007

Clin Vaccine Immunol

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We evaluated the seroprevalence of varicella-zoster virus (VZV) in the Finnish population among various age groups and genetically characterized VZV strains from documented cases of varicella and zoster. VZV-specific immunoglobulin G was measured in 2,842 serum samples that had been submitted for virological studies to the Department of Virology, University of Helsinki, from 1995 to 1996. Specimens for VZV genotyping were obtained from vesicular lesions from two pediatric patients and 26 adult patients. Seroprevalence to VZV varied markedly by age: 45% in children aged <2 months, 12.5% in children aged 6 to 8 months, and >90% in children near 10 years of age, plateauing thereafter into advanced age. The seroprevalence rates indicate that in Finland, as in other countries with temperate climates, primary VZV infection usually occurs during the first decade of life. Twenty-eight VZV DNA-positive specimens were analyzed to identify VZV vaccine and wild-type genotypes. All analyzed specimens were wild type and the European (E) genotype.Varicella zoster virus (VZV) is a common, globally distributed virus that causes chickenpox upon primary infection; it is normally associated with a generalized vesicular rash but may rarely occur without obvious dermal lesions. VZV establishes lifelong latency upon first infection and can reactivate, usually in the elderly, to cause shingles (herpes zoster) (2,12,13,15,34). Patient age is often related to disease severity, with the greatest risk occurring among the very young and very old; immunocompromised persons are also at elevated risk for severe disease (7,11,14). Varicella vaccine use in Finland is currently limited to children with recognized immunosuppression due to leukemia, bone marrow transplant, et cetera. The seroprevalence rate for VZV varies among different populations, and lower prevalence rates have generally been observed in tropical versus temperate climates (9,21,26,27). Over the past 25 years, there has been an evident increase in VZV seroprevalence among children 1 to 4 years of age in the United Kingdom (21). In Finland, VZV has become the agent most frequently associated with central nervous system infections, particularly encephalitis, for all age groups (18,22). Currently, several methods are being used to identify and genotype VZV strains. A variety of methods have been explored for genotyping VZV both to discern strain variation and to discriminate vaccine strains from wild-type isolates (3,4,6,8,10,16,18,23,24,31,36).We developed a novel strategy for VZV genotyping based on the complete sequencing of a short region in open reading frame 22 (ORF22) using material obtained directly from clinical samples (29). By sequencing a collection of 321 contemporary VZV isolates representing multiple countries and six continents, we sorted strains into three discrete geographically associated genotypes: E (European), J (Japanese), and M (mosaic). M strains were dominant in tropical latitudes, and J and E VZV isolates prevail in temperate climate latitudes (29). Genot...

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Section: Discussionmentioning

confidence: 99%

Genotypic Analysis of Varicella-Zoster Virus and Its Seroprevalence in Finland

Koskiniemi

Lappalainen

Schmid

et al. 2007

Clin Vaccine Immunol

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“…Law et al 12 reviewed chickenpox admissions to 11 pediatric Canadian hospitals from 1991 to 1996 and found that 49% of the serious bacterial infections were caused by GAS, but no cases of SEA were found.…”

Section: Discussionmentioning

confidence: 99%

Group A Streptococcus Spinal Epidural Abscess During Varicella

2002

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ABSTRACT. Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. V aricella is a common childhood viral illness, with a projection of 380 000 cases annually in Canada, approaching the annual birth rate. 1 The estimated risk of hospitalization is approximately 1 in 550 cases. 2 Multiple complications from varicella have been described. The majority of these consist of secondary skin and soft tissue bacterial infections ranging from 45% to 73% of the reported complications caused mainly by group A ␤-hemolytic streptococcus (GAS) and Staphylococcus aureus. 2,3 Neurologic complications (18%-21%), such as encephalitis, postinfectious cerebellar ataxia, Reye syndrome, aseptic meningitis, and transverse myelitis, have also been reported. 2,4,5 Musculoskeletal complications mostly attributable to GAS (osteomyelitis, necrotizing fasciitis, myositis, and septic arthritis) are well-described, 6 but no previous case of spinal epidural abscess (SEA) has been found in the literature. We describe 2 cases of children with a diagnosis of SEA as a complication of varicella. CASE 1A previously healthy 1 1 ⁄2-year-old boy presented with fever up to 40°C for 4 days and refusal to sit or walk for 3 days. He had developed varicella 6 days before the onset of fever and had a mild case until then. His mother had received a diagnosis of streptococcal pharyngitis the week before admission. On examination, he was irritable. There was no evidence of secondary bacterial superinfection of the skin and soft tissues. He had a stiff neck and bilateral brisk patellar deep tendon reflexes, clonus, and positive Babinski sign. The muscular strength was normal. His peripheral white blood cell (WBC) count was 14.8 ϫ 10 9 /mm 3 . A lumbar puncture yielded clear cerebrospinal fluid (CSF) containing 50 WBC/mm 3 , 4.3 mmol/L glucose, and 13.4 g/L proteins. Gram stain and culture of the CSF were negative. Intravenous therapy with cefotaxime and vancomycin was started. A throat culture done b...

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“…18,19 The risk is increased if household contacts are not immune to VZV, and varicella tends to be more severe in secondary family cases. 20 The age of occurrence of chickenpox for this infant might have coincided with a decrease in the levels of transplacentally acquired VZV-specific immunoglobulin G antibodies.…”

Section: Discussionmentioning

confidence: 99%

Group A Streptococcal Subdural Empyema as a Complication of Varicella

2005

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ABSTRACT. Group A ␤-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox. T he clinical course of varicella in childhood is usually benign and self-limited. However, secondary bacterial complications can occur in skin, soft tissues, and other sites, caused predominantly by group A streptococcus (GAS) and Staphylococcus aureus. 1 For varicella-associated, invasive, suppurative complications, the former is associated with increased morbidity and mortality rates among both immunocompetent and immunosuppressed children, and episodes can occur even without an obvious skin source of infection. Among children, GAS infections of the central nervous system (CNS) and peripheral nervous system after chickenpox are extremely rare. [2][3][4] We describe an infant who developed a GAS subdural empyema during varicella, which is, to our knowledge, an association not described previously. CASE REPORTA 3-month-old boy was admitted to a community hospital, on day 5 of a varicella skin rash, with fever and focal seizures. On day 1 of the rash, the patient developed decreased appetite and vomited twice; the following day, he began to exhibit a fever of 39°C. On day 4, he was examined at a primary care clinic, a diagnosis of acute otitis media (AOM) was made, and treatment with orally administered trimethoprim-sulfamethoxazole was initiated (the patient received a total of 2 doses). On day 5, the patient was described by his parents as being irritable and lethargic, and that night he developed right-sided focal seizures of the face, arm and leg, with subsequent ocular deviation. The seizures persisted, became generalized, and led to status epilepticus, which necessitated repeat doses of intravenously administered diazepam and phenytoin after admission to the local hospital. The body temperature was 37.8°C, a diffuse varicella skin rash with no evidence of secondary bacterial infection was described, and no AOM was observed. The patient underwent head computed tomography, which showed bilateral subdural fluid collections with left-sided predominance, with a compressed ventricular system and mild midline deviation. A clinical diagnosis of varicella encephalitis and subdural effusions was made, blood cultures were obtained, 1 dose of acyclovir was administered intravenously, and the patient was transferred...

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The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalized for chickenpox or an associated complication

Abstract: These data provide a baseline for morbidity/mortality resulting from chickenpox before varicella vaccine use in Canada.

Cited by 36 publications

References 22 publications

Genotypic Analysis of Varicella-Zoster Virus and Its Seroprevalence in Finland

Genotypic Analysis of Varicella-Zoster Virus and Its Seroprevalence in Finland

Group A Streptococcus Spinal Epidural Abscess During Varicella

Group A Streptococcal Subdural Empyema as a Complication of Varicella

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