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Chickenpox
Chickenpox, also spelled chicken pox, is the common name for varicella simplex, classically one of the childhood infectious diseases caught and survived by most children. Chickenpox is caused by the varicella-zoster virus(VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes virusesknown to affect humans. it starts with conjunctival and catarrhal symptoms, moderate feverand then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw pox(pocks), small open sores which heal mostly without scarring.
EffectsImage:Child with chickenpox.jpg Chickenpox has a two-week incubation period and is highly contagious by air transmission two days before symptoms appear. Therefore, chickenpox spreads quickly through schools and other places of close contact. Once someone has been infected with the disease, they usually develop protective immunity for life. It is fairly rare to get the chickenpox multiple times, but it is possible for people with irregular immune systems. As the disease is more severe if contracted by an adult, parents have been known to ensure their children become infected before adulthood. The disease is rarely fatal: if it is involved in a fatality, the actual death is usually from opportunisticvaricella pneumonia, and occurs more frequently in pregnant women. In the US, 55 percent of chickenpox deaths were in the over-20 age group, which is indeed at risk from the virus. Doctors advise pregnant women who come into contact with chickenpox should contact their doctor immediately, as the virus can cause serious problems for the foetus. Later in life, virusesremaining in the nerves can develop into the painful disease shingles, particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Some of these will develop zoster-associated pain or post-herpetic neuralgia, described usually as "horrible" or "excruciating". A chickenpox vaccinehas been available since 1995, and is now required in some countries for children to be admitted into elementary school. In addition, effective medications (e.g., acyclovir) are available to treat chickenpox in healthy and immunocompromisedpersons. Symptomatic treatment—calamine lotionto ease itching and paracetamolto reduce fever—is widely used. Aspirin is contraindicated in children with chickenpox, as it can lead to Reye's syndrome. HistoryOne history of medicine book claims Giovanni Filippo(1510–1580) of Palermogave the first description of varicella (chickenpox). Subsequently in the 1600s, an Englishphysician named Richard Morton described what he thought was a mild form of smallpoxas "chicken pox." Later, in 1767, a physician named William Heberden, also from England, was the first physician to clearly demonstrate that chickenpox was different from smallpox. However, it is believed the name chickenpox was commonly used in earlier centuries before doctors identified the disease. There are many explanations offered for the origin of the name chickenpox:
As "pox" also means curse, in medieval times some believed it was a plague brought on to curse children by the use of black magic. During the medieval era, oatmeal was discovered to soothe the sores, and oatmeal baths are today still commonly given to relieve itching. VaccinationRoutine vaccination against varicella zoster virus is performed mainly in the United States, and the incidence of chickenpox has been dramatically reduced there (from 4 million cases per year in the pre-vaccine era to approximately 400,000 cases per year as of 2005). In Europemost countries do not currently vaccinate against varicella, though the vaccine is gaining wider acceptance. Australia, Canada, and other countries have now adopted recommendations for routine immunization of children and susceptible adults against chickenpox. Other countries, such as Germany and The United Kingdom have targeted recommendations for the vaccine, e.g. for susceptible health care workers at risk of varicella exposure. Chickenpox is most often a mild disease -- especially for children. Prior to the introduction of vaccine, there were around 4,000,000 cases per year in the US, mostly children, yet typically 100 or fewer people died. Though mostly children caught it, the majority of deaths (by as much as 80%) were among adults. Additionally, chickenpox involved the hospitalization of about 10,000 people each year. During 2003 and the first half of 2004, the CDC reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospitalizations have substantially declined in the US due to vaccination, though the rate of shingles infection has increased for the same reason. The vaccine has more recently been determined to be effective at preventing shingles (zoster) in persons 60 years of age and older, if administered regularly. The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated more than thirty years ago with no evidence of waning immunity, while others have become vulnerable in as few as 6 years. Assessments of duration of immunity are complicated in an environment where natural disease is still common, which typically leads to an overestimation of effectiveness, and we are only now entering an era in the US where the long-term efficacy of varicella vaccine can be accurately gauged (Goldman, 2005). Controversy
It is common ground that the perverse effect of an increase in the more dangerous shingles may increase after introduction of varicella vaccine (Yih, et al., 2005). [1]. There is no evidence this has occurred yet, and it might occur due to falls produced by other causes of decreased childhood infection. Observation continues. Vaccination is common in the US, 41 of the 50 states require parents to immunize their children, it is not routine in the UK. Debate continues in the UK on the time when it will be desirable to adopt routine chickenpox vaccination, and in the US opinions that it should be dropped, individually, or along with all immunistions, are also voiced. Duration of Immunity: Some vaccinated children have been found to lose their protective antibody in as little as five to eight years. The officially expected span is only 20 years. As time goes on, boosters may be determined to be necessary, and introduced. It is common ground that if immunity declines rapidly, in the absence of re-challenge with wild virus then failure to boost immunity is likely to leave those immunised as children vulnerable to Varicella either as Chickenpox or SHingles and that in that case the disease is more dangerous than it is in childhood. Catching wild chickenpox as a child has been thought to commonly result in lifelong immunity, indeed parents have deliberately ensured this in the past with "pox parties" (and similarly for some other diseases such as Rubella. Doctors generally don't advise it.). Historically exposure of adults to spotty children has boosted their immunity, reducing the risk of shingles[2]. Second episodes of chickenpox have been rare, but occur and probably more frequently in the UK latterly[citation needed] and definitely more frequently in the vaccine group. In one study, 30% of children had lost the antibody after five years, and 8% had already caught "wild" chickenpox in that five year period[3].
Immunocompromise The mortality rate in immunocompromised patients with disseminated herpes zoster is 5-15%, with most deaths from pneumonia. Vaccines, unfortunately are less effective among these high-risk patients, as well as being more dangerous because it is an attenuated live virus (see last footnote), but clearly immunisation before immunocompromise would be desirable. References
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|then=: 205-213 PMID 16126614
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See also
External links
de:Windpocken es:Varicela eo:Varioleto fr:Varicelle id:Cacar air it:Varicella he:אבעבועות רוח ja:?? nl:Waterpokken pl:Ospa wietrzna pt:Varicela sk:Ovčie kiahne fi:Vesirokko sv:Vattkoppor th:???????????? zh:水痘 Categories: Articles lacking sources| Infectious diseases| Pediatrics
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