Epidemiological characteristics of varicella in Chongqing,China,2014-2021

Background:To analyze the epidemiological characteristics of varicella epidemics in Chongqing Municipality from 2014 to 2021,and to provide a scientific basis for the formulation of varicella prevention and control measures.Methods:Data on the incidence of varicella outbreaks and vaccination data in Chongqing from 2014 to 2021 were collected through the China Disease Control and Prevention Information System and statistically analyzed using descriptive epidemiological methods.Results:From 2014 to 2021,213,715 cases of varicella were reported in Chongqing Municipality,with an average annual incidence rate of 86.26/100,000,with a statistically significant difference(χ^(2)=24,972.069,P<0.001);varicella incidence is seasonal,with peaks in May/June and October/December each year,presenting a“double-peak distribution”.The average annual incidence rate of varicella in municipal districts was 90.74/100,000,which was higher than that of counties 69.62/100,000 and autonomous counties 84.04/100,000;the average annual incidence rate of varicella in males was 89.37/100,000,and in females,82.22/100,000,with the difference not being statistically significant;the age of onset of the disease was mainly in the group of people under 15 years of age,with a total of 190,021 cases reported(88.9%),with 5-9 years old(35.7%)as the high incidence age group.The incidence occupation was dominated by students in 133,733 cases(62.6%).Conclusion:The overall varicella epidemic in Chongqing is on the rise,and has obvious seasonal,regional and population distribution characteristics.The prevention and control of varicella epidemic should be strengthened,the publicity of varicella vaccine should be increased,and it is recommended that varicella vaccine should be included in the national immunization program.

Microbiology laboratory and the management of motherchild varicella-zoster virus infection

Varicella-zoster virus, which is responsible for varicella(chickenpox) and herpes zoster(shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella(particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times:(1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection;(2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear(atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation;(3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and(4) when the baby is born and it is necessary to confirm a diagnosis of varicella(and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.

Varicella zoster virus vaccines: potential complications and possible improvements

Varicella zoster virus(VZV) is the causative agent of varicella(chicken pox) and herpes zoster(shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine(v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons. The reactivation is sometimes associated with postherpetic neuralgia(PHN), a severe pain along the affected sensory nerves that can linger for years, even after the herpetic rash resolves. In addition to the older population that develops a secondary infection resulting in herpes zoster, childhood breakthrough herpes zoster affects a small population of vaccinated children. There is a great need for a neuro-attenuated vaccine that would prevent not only the varicella manifestation, but, more importantly, any establishment of latency, and therefore herpes zoster. The development of a genetically-defined live-attenuated VZV vaccine that prevents neuronal and latent infection, in addition to primary varicella, is imperative for eventual eradication of VZV, and, if fully understood, has vast implications for many related herpesviruses and other viruses with similar pathogenic mechanisms.

Varicella zoster meningitis complicating combined anti-tumor necrosis factor and corticosteroid therapy in Crohn's disease

Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.

Successful rescue of acute liver failure and hemophagocytic lymphohistiocytosis following varicella infection: A case report and review of literature

Herein we report a case of acute liver failure(ALF) and hemophagocytic lymphohistiocytosis(HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction(PCR) amplifications of varicella-zoster virus(VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient's symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.

Primary Research of Immunological Mechanism of Combined Hepatitis A-Measles-Varicella Vaccine

To explore the primary humoral and cellular immunological mechanism of the combined hepatitis A-measles-varicella vaccine, the mice were inoculated with hepatitis A-measles-varicella vaccine by intraperitoneally and two weeks later, blood was collected to observe the mice＇s immunological status. Antibody level was measured to appraise the humoral immunity. At the same time, T lymphocyte surface marker, NK cell activity, LAK cell activity, delayed type hypersensitivity of skin, Mφ phagocytic function, mRNA level of cytokine IL-2 and IFN-γ plus lymphocyte transformation test were used to analyze the cellular immunity. The humoral immunity results show that the combined hepatitis A-measles-varicella vaccine produce the same antibody level as their corresponding univalent vaccine, and maintained fine immunogenicity and security. The result of cellular immunity shows that the combined vaccine could activate physical immunocyte, increase the regulative ability of cytokine, enhance the physical immune function and immune defense ability. The present research proved the security and better humoral and cellular immunity of combined hepatitis A-measles-varicella vaccine from the immunological point of view, which laid good foundation for further study and development.

Review of varicella-zoster virus infections in pregnant women and neonates

Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not associated with special problems during pregnancy and peri- natal period. Pregnant women, who contract varicella, are at risk of varicella pneumonia which must be regarded as medical emergency. At any stage during pregnancy, chickenpox may cause intrauterine infection. The consequences for the fetus depend on the time of maternal disease. During the first two trimesters, maternal varicella may result in congenital varicella syndrome which may occur in nearly 2%. Typical symptoms are skin lesions in dermatomal distribution, neurological defects, eye diseases, and skeletal anomalies. Maternal infection near term is associated with a substantial risk of intrauterine acquired neonatal chickenpox in the neonate. If the mother develops varicella rash between day 4 (5) ante partum and day 2 post partum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. The present paper reviews the clinical consequences and the currently available concepts of prevention, diagnosis, and therapy of varicella-zoster virus infections during pregnancy.

Seroprevalence of varicella zoster virus in Colombo district, Sri Lanka

Objective: To determine the seroprevalence of varicella zoster virus(VZV) antibodies among the population residing in the Colombo district of Sri Lanka. Methods: A cross-sectional population-based study was conducted which included 1 258 participants. Blood samples were collected and questionnaires administered to obtain sociodemographic information and history of varicella and/or herpes zoster. Serum samples were assayed for VZV IgG antibodies using a commercial enzyme-linked immunosorbent assay kit. Results: Overall, the seroprevalence was 54.2%(95% CI= 51.5% 57.0%). Children below 1 year of age were seronegative, and only about 20.0% of children between 1 and 10 years of age were seropositive. Seropositivitiy increased with age and by the age of 40 years 74.3% were seropositive. Among women of childbearing age, the overall seroprevalence was about 62.0%(95% CI = 57.7%-66.1%) but was low 37.0% in the 15-19 age group. Conclusion: In this population, 45.8% lacked natural immunity against varicella. Of women of childbearing age, 39.9% lacked immunity and in the subgroup of women 15-19 years of age, 63.0% women lacked immunity. In light of the country's success with the control and high coverage of other vaccine preventable diseases and that the vaccine is available in the private sector, the inclusion of varicella vaccine in the national immunization program may be considered.

An economic analysis of varicella immunization in the Singapore military

Background:Varicella outbreaks occur frequently in closed environments such as those of militaries.This paper compares the economic outcomes of varicella vaccination in enlisted servicemen without prior reported varicella infection or vaccination.Methods:We analyzed the economic outcomes of a varicella vaccination program on all enlisted servicemen without prior reported varicella infection or vaccination in the Singapore Armed Forces(SAF) between December 11,2010–December 20,2013,compared with the previous program of varicella vaccination only for selected personnel between December 1,2007–December 10,2010.Results:In the at-risk population of all active SAF servicemen,the program of varicella vaccination for all servicemen without prior reported varicella infection or vaccination upon enlistment would save 72.0 work days per 1000(95% CI:61.2-82.9),valued at SG$6,544 per 1000(95% CI:6,524-6,564),i.e.,costing SG$91.5 per work day saved(95% CI:78.7-107.3).This also results in a reduction of 2.7 varicella cases per 1000 and 5.43 outbreaks per 10000,or a total savings of SG$1,695 per 1000(95% CI:–2,730-6,834),taking into account the cost of work days lost over a three-year period,compared with the previous regime of vaccinations only for selected individuals.Conclusion:The varicella vaccination strategy targeting all enlisted servicemen without prior reported varicella infection or vaccination is able to prevent varicella infections and outbreaks,thus reducing absenteeism and days lost.

Effect of the Routine Varicella Immunization on Herpes Zoster in Japan in the First Half of the Year

In Japan, herpes zoster is not monitored officially or nationwide. Recently, the databases of all electronic medical claims nationwide (NDBEMC) have been available for research. We use NDBEMC from April 2011 to March 2015. To evaluate the effects of initiation of routine immunization for varicella in children, we regressed the number of herpes zoster patients on the dummy variable for the routine immunization for varicella in children with and without a linear time trend. The estimated coefficient for the routine immunization for varicella was 0.5157 and its p-value was 0.001. However, if the time trend was added as an explanatory variable, the estimated coefficient for the routine immunization for varicella changed to be -0.039 and its p-value was 0.384. It means that the routine immunization for varicella was 7.8% higher after introduction than before. However, it was presumed to reflect such an upward trend.

Detection of Varicella Zoster Virus DNA within Lesions and Healed Skin Lesions of Herpes Zoster by PCR

Varicella zoster virus(VZV) DNA in blister lesions and skin biopsies obtained from healed skin lesions in 16 patients with herpes zoster was detected using polymerase chain reaction. A 385 bp VZV DNA fragment was found in all the blister lesions and in two of six biopsies from the skin lesions healed within two months by PCR. No VZV DNA was found in the skin lesions more than two months after healing in 10 cases of herpes zoster. VZV DNA may be detected at the sites of resolved herpes zoster lesions within short duration.

Systemic lupus erythematosus with visceral varicella:A case report

BACKGROUND As an autoimmune disease,systemic lupus erythaematosus(SLE)can affect multiple systems of the body and is mainly treated by steroids and immunosuppressive agents.SLE results in a long-term immunocompromised state with the potential of infection complications(e.g.,bacterial,fungal and viral infections).Abdominal pain or acute abdomen are frequently the only manifestations of SLE at disease onset or during the early stage of the disease course.Thus,multidisciplinary collaboration is required to identify these patients because timely diagnosis and treatment are crucial for improving their prognosis.CASE SUMMARY Herein,we reported a case of an SLE patient with visceral varicella that was identified after the onset of abdominal pain.The 16-year-old female patient with SLE was admitted to our hospital due to initial attacks of abdominal pain and intermittent fever.The patient’s condition rapidly became aggravated within a short time after admission,with large areas of vesicular rash,severe pneumonia,respiratory failure,shock,and haematologic system and hepatic function impairment.Based on multidisciplinary collaboration,the patient was diagnosed with visceral disseminated varicella and was administered life support,antiviral(acyclovir),immunomodulatory(intravenous injection of human immunoglobulin),anti-infection(vancomycin)and anti-inflammatory(steroid)therapies.After treatment,her clinical symptoms and laboratory indicators gradually improved,and the patient was discharged.CONCLUSION SLE patients long treated with steroids and immunosuppressive agents are susceptible to various infections.Considering that visceral varicella with abdominal pain as the initial presentation is characterized by rapid progression and often coexists with serious complications,prompt diagnosis and early antiviral therapy are critical to prevent severe life-threatening complications.

Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report

BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.

Varicella-zoster virus meningitis after spinal anesthesia:A case report

BACKGROUND Headache is a common complication of regional anesthesia.The treatment of post spinal anesthesia headache varies depending on the cause.Although meningitis is rare,it can cause significant harm to the patient.Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache;however,other causes should also be considered.CASE SUMMARY A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia.The procedure was performed aseptically,and surgery was completed without any complications.After 4 d,the patient visited the emergency room with complaints of headache,nausea,and anorexia.Clinical examination revealed that the patient was afebrile.Considering the history of spinal anesthesia,post dural puncture headache and septic meningitis was initially suspected,and the patient was treated with empirical antibiotics.Subsequently,varicella-zoster virus PCR test result was positive,and all other test results were negative.The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d.The headache improved,and the patient was discharged without any problems.CONCLUSION Viral meningitis due to virus reactivation may cause headache after regional anesthesia.Therefore,clinicians should consider multiple etiologies of headache.

Post-Varicella Disciform Keratitis: Case Report

The purpose of this study is to report a rare condition of post-varicella disciform keratitis in a 4-year-old child. It is a prospective study of the follow-up of a 4 year-old girl who was diagnosed as post-varicella stromal disciform keratitis related to high serum antibody titers five months after the skin lesions. Rapid response to topical steroids, topical and oral antivirals have been observed in 6 weeks of treatment. There was no recurrence in the 6 months of follow-up. Total resolution of the disciform stromal keratitis in a short period of time was disclosed with an effective treatment of both topical and oral antivirals and topical steroids.

Varicella Outbreak at a Boarding School, Chikomba District, Mashonaland East Province, Zimbabwe, 2019

Background: Varicella is a contagious illness, caused by varicella zoster virus (VZV). It is transmitted via the respiratory route and through contact with the infected person. Fourteen cases of varicella from a boarding school in Chikomba District, Zimbabwe were reported on 14 February 2019. We investigated the outbreak to determine its scope, identify risk factors for transmission and recommend evidence-based control measures. Methods: A 1:2 unmatched case-control study was conducted. A case was a form one student at a boarding school in Chikomba District who developed acute onset of diffuse maculopapulovesicular rash without other apparent cause from 22 January 2019 to 24 February 2019. A control was a form one student at the same boarding school who did not develop the signs and symptoms of varicella during the same period. The diagnosis was based on clinical signs and symptoms. An interviewer-administered questionnaire was used to collect data. Epi info 7TM was used to calculate frequencies, odds ratios and perform logistic regression to control for confounding variables. Results: We recruited 31 cases and 62 controls. Independent risk factors for contracting varicella were classmate contact [AOR 24;(95% CI 4.4 - 83), p Conclusion: A perfect setting for the spread of infection was available in the form of students in a naive community living in close proximity both at class and at dormitories, which lead to the rapid transmission of the virus. Screening and isolation of the infected students controlled the outbreak.

A Case Report: PCR-Assisted Diagnosis of Varicella in an Adult

A 41-year-old woman developed skin lesions on her upper back and arm. Initially, a definitive diagnosis could not be made. Subsequently, PCR detected VZV DNA in skin lesions and saliva. Immediate antiviral treatment led to a quick recovery without complicating prolonged fatigue and weakness typically seen in adults with varicella.

Clinic Characteristics of Varicella Zoster Myocarditis

Objective To analyze the clinic characteristics of varicella zoster myocarditis and to determine the diagnostic value of serum cardiac troponin I (cTnI ) on the disease. Methods Information of 58 hospitalized patients with varicella zoster was collected, and the incidence of varicella zoster myocarditis and clinic characteristics (ECG, cTnI, age and sex distribution, etc. ) were analyzed respectively. Results It was found that 36.2% of the patients developed myocarditis. The old and female persons were much more susceptible to varicella zoster myocarditis. All patients had responsive ECG manifestations, and the abnormal ST T changes were more common than other ECG abnormalities. CTnI remained higher than normal and had significant diagnostic value. Most of the patients had good prognosis, only a few patients lasted a long time and even progressed into cardiomyopathy. Nearly all the patients came to see dermatologists when they felt ill initially. That would lead to more misdiagnosis. Conclusion Infection of varicella zoster can complicate myocarditis, we must pay more attention to the patients who suffer from varicella zoster especially in the aged and female; cTnI is an important and effective index for diagnosis of varicella zoster myocarditis.

Severe autoimmune hepatitis triggered by varicella zoster infection

Autoimmune hepatitis (AIH) is a chronic disease of unknown etiology that is characterized by the presence of circulatory autoantibodies and inflammatory histological changes in the liver. Although the pathogenesis of AIH is not known, it is thought that, in a genetically predisposed individual, environmental factors such as viruses can trigger the autoimmune process. Herpes simplex virus, Epstein-Barr virus, measles virus, and hepatitis viruses are thought to play a role in the etiology of AIH. Proteins belonging to these viruses may be similar to the amino acid chains of different autoantigens in the liver, this causes immune cross reactions and liver tissue damage. We report a case of severe AIH following varicella zoster infection in a 23-year-old man, and speculate that, based on the molecular mimicry hypothesis, the liver damage was caused by an immune cross reaction to the viral proteins. Varicella-zoster-induced AIH has not been reported previously.

Weeks-Ahead Epidemiological Predictions of Varicella Cases From Univariate Time Series Data Applying Artificial Intelligence

Background:"Chickenpox"is a highly infectious disease caused by the varicella-zoster virus,influenced by seasonal and spatial factors.Dealing with varicella-zoster epidemics can be a substantial drain on health-authority resources.Methods that improve the ability to locally predict case numbers from time-series data sets every week are therefore worth developing.Methods:Simple-to-extract trend attributes from published univariate weekly case-number univariate data sets were used to generate multivariate data for Hungary covering 10 years.That attribute-enhanced data set was assessed by machine learning(ML)and deep learning(DL)models to generate weekly case forecasts from next week(t0)to 12 weeks forward(t+12).The ML and DL predictions were compared with those generated by multilinear regression and univariate prediction methods.Results:Support vector regression generates the best predictions for weeks t0 and t+1,whereas extreme gradient boosting generates the best predictions for weeks t+3 to t+12.Long-short-term memory only provides comparable prediction accuracy to the ML models for week t+12.Multi-K-fold cross validation reveals that overall the lowest prediction uncertainty is associated with the tree-ensemble ML models.Conclusion:The novel trend-attribute method offers the potential to reduce prediction errors and improve transparency for chickenpox timeseries.