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Purpose: The aim of this study was to analyze treatment outcomes and their predictors in children hospitalized due to varicella complicated by bacterial superinfections after pandemic of COVID-19. Methods: This retrospective study analyzed data collected in a multicenter, nationwide, observational database dedicated for children aged 0–17 years hospitalized due to bacterial complications of varicella in 9 Polish tertiary healthcare inpatient centers. The primary endpoint of this study was the treatment outcome established after the end of hospital management assessed at a 4-point scale. The secondary endpoint was defined as the necessity of surgical intervention. Results: There were 458 patients with a median age of 4 (IQR 2–6) years. After the completed treatment, 319 (69%) participants were found fully recovered; 132 (29%) had transient complications; 2 (0.5%) had persistent complications; and 1 child (0.5%) died. Multivariate analysis revealed that implementation of ibuprofen in pre-treatment management of a child with varicella was associated with a 4.07-fold (2.50–6.60) increase in risk of complications after the treatment and it was associated with 2.87 times (1.39–5.89) higher risk of surgical intervention necessity. For other pre-hospital interventions (implementation of acyclovir, antibiotics or antihistaminics) no significant impact was observed. GAS infection increased the necessity of surgical intervention by 7.51 (3.64–15.49) times. Conclusions: One-third of patients treated for bacterial complications of varicella have post-treatment complications, most of them transient. GAS infection increases the need for surgical intervention. The use of ibuprofen in the treatment of varicella significantly increases the risk of complications and the need for surgical intervention. [ABSTRACT FROM AUTHOR]

To estimate the economic burden of varicella among children in France from family and societal perspectives. We conducted an online cross-sectional survey of caregivers of 185 French children (≤ 17 years) diagnosed with varicella in the previous six weeks. Data collected included varicella-related healthcare resource use, out-of-pocket costs, missed school days, and workdays missed by either parents or other caregivers. Mean and median direct and indirect costs (2022 Euros) were calculated using survey data and published literature. The annual societal burden of pediatric varicella in France was estimated. Of the 185 children, 95.1% had ≥ 1 outpatient visit, 10.3% had ≥ 1 emergency room visit, and 2.2% were hospitalized. The median [interquartile range, IQR] number of outpatient visits/child was 1.0 [1.0 – 2.0]. The median length of hospital stay among those hospitalized (n = 4) was 5.0 [3.5 – 6.5] days. Caregivers of 185 children missed a median of 2.0 [0 – 5.0] workdays; 113 families (61.1%) had ≥ 1 parent miss work. A median of 5.0 [3.0 – 7.0] school days were missed by 170 children who attended preschool or school. The median direct out-of-pocket cost to the family was €30.0 [€17.0 – €60.0]. The median [IQR] societal costs per varicella case were €455.2 [€70.5 – €1013.5]; the median [IQR] direct and indirect costs per child were €60.8 [€39.0 – €102.7] and €364.7 [€0.0 – €911.7] respectively. The annual societal burden of varicella among children in France was estimated to be €450,427,578 (95% CI: €357,144,618 – €543,710,538), with indirect costs accounting for 85%. Conclusions: A substantial economic burden is associated with pediatric varicella in France, primarily due to the productivity loss among caregivers. What is Known: • Although varicella is considered a mild disease, it poses a significant burden on caregivers and society. Our study aimed to estimate the economic burden of varicella among children in France from family and societal perspectives to support policymakers in understanding the value of UVV in France. What is New: • We conducted an online survey of caregivers of 185 French children (≤17 years) diagnosed with varicella and collected data on varicella-related healthcare resource use, missed school days and workdays. Our study estimated annual societal burden of pediatric varicella in France. Out of 185 children with varicella, most (95.1%) had at least one outpatient visit, 10.3% had at least one emergency room visit, and 2.2% were hospitalized. 61.1% of parents with sick child, missed work and median productivity loss was 2.0 workdays. Additionally, 170 children who attended school or preschool missed a median of 5.0 school days. • The societal burden of pediatric varicella in France was estimated to be €450,427,578 (95% CI, €357,144,618 - €543,710,538), with indirect costs accounting for 85%. Pediatric varicella is associated with a substantial economic burden in France, primarily due to high productivity losses among parents and caregivers. [ABSTRACT FROM AUTHOR]

Background: Although acute hepatitis caused by varicella zoster virus mostly develops in immunocompromised patients, hyperacute liver failure is very rare. To our knowledge, there are no previous reports on liver transplant patients. Methods: We report the first case of fatal hyperacute liver failure due to varicella zoster virus immediately after living‐donor liver transplantation without cutaneous lesions and review the literature. Result: The present case exhibited rapid development and progression of acute liver failure from postoperative days 11–13, despite being seropositive for varicella zoster virus but unvaccinated and on immunosuppression before transplantation. Especially in solid organ transplantation, only six cases of severe acute liver failure that included hepatic encephalopathy and/or impaired consciousness and sudden extremely high (> 4000 U/L) serum aspartate aminotransferase levels have been reported in heart, lung, and kidney transplant patients. Conclusions: Early diagnosis of hyperacute liver failure due to varicella zoster virus is challenging because the disease progresses rapidly and skin lesions are absent. [ABSTRACT FROM AUTHOR]

Copyright of Modern Preventive Medicine is the property of Modern Preventive Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To analyze the epidemiological characteristics of varicella and effectiveness of varicella vaccine in Jinan. Methods We collected data of varicella surveillance in Jinan from 2006 to 2022 from the Chinese Information System for Disease Control and Prevention and vaccination data for children born during 2010-2021 form the Jinan Immunization Planning Information System. All reported varicella cases from 2006 to 2022 in Jinan were analyzed with descriptive epidemiological methods; Coverage and effectiveness of varicella vaccine for children born during 2010 to 2021 were conducted with the screening method. Results 61 145 cases of varicella were reported in Jinan during 2006-2022, yielding an annual average incidence of 51.82 per 100 000 population; the incidence ranged from 74.48 per 100 000 in 2008 to 28.47 per 100 000 in 2022. Peak varicella incidences occurred between April and June and between November and the following January. The highest incidence rate was 5-9 years old group from 2006-2016 and was 15-19 years old group from 2017 to 2022. Coverage levels for one doses was 77.32% in the 2010-2021 births; the overall effectiveness of varicella vaccine was 91.83% (95%CI: 91.43%-92.30%). Coverage levels for two doses was 45.86% in the 2010-2018 births; the overall effectiveness of varicella vaccine was 95.14%(95%CI: 94.56%-95.66%). Conclusion The high incidence age group shifted from 5-9 years old to 15-19 years old. It was suggested that the vaccine administration should be used to targeted age groups. Levels of vaccine effectiveness for 2 doses of varicella vaccine were greater than levels of Vaccine effectiveness for one-doses. We suggest to introduce 2 dose of varicella vaccine into the national immunization program for children. [ABSTRACT FROM AUTHOR]

Objective To analyze the epidemiological distribution characteristics of chickenpox in Urumqi City from 2015 to 2023, to construct a prediction model by combining Baidu search keywords, and to explore the complementary application of Baidu index in chickenpox prevention and monitoring. Methods Descriptive epidemiological methods were used to analyze the characteristics of varicella case triple distribution in Urumqi City from 2015 to 2023. Chickenpox keywords were identified and a comprehensive Baidu search index was constructed. The models ARIMA and ARIMAX were constructed, the prediction effectiveness of the two models was evaluated by mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE). Results The average annual reported incidence rate of varicella in Urumqi was 80.85/100 000, with a higher incidence in men than in women (χ² = 1.136, P = 0.287), there were statistically significant differences in incidence rates by age group (χ² = 7 582.372, P < 0.001), seven districts and one county had different average annual incidence rates (χ² = 21.496, P < 0.001), with the highest in the Toutunhe district (100.54/100 000). ARIMAX(1,1,0)(1,0,0)52 was selected as the best prediction model (prediction set MAE 12.04%, RMSE 13.80%, MASE 1.18%) with a good fitting effect. Conclusion The ARIMAX prediction model established based on the search term Baidu index has a certain degree of predictability and sensitivity, and can predict the epidemic trend of chickenpox in Urumqi in time, which can be used as a technical support and further expansion of the traditional monitoring and early warning system. [ABSTRACT FROM AUTHOR]

Background: Varicella-Zoster Virus (VZV) is characterized by its ability to enter a dormant state within the body. When the wild or vaccine virus reactivates, it can lead to herpes zoster (HZ), which infrequently manifests as a neuroinfection. Objectives: The aim of the study was to analyze the clinical manifestations and outcomes associated with VZV reactivation in the CNS in immunocompetent children. Methods: We searched medical databases for case reports using the keywords "zoster", "meningitis", "encephalitis", and "immunocompetent". The inclusion criteria were age below 18 years, any gender, race, and ethnicity, no features or history of immunodeficiency, and confirmation of VZV reactivation through the detection of VZV DNA in the CSF. Patients were categorized into two groups: children experiencing the reactivation of the wild virus and children with the vaccine strain virus. Results: The cohort included six children hospitalized in our hospital and 49 children reported in the literature. In 37 (67%), a wild-type virus was detected, while in 18 (33%), an infection was caused by the vaccine strain. There were no differences in the clinical presentation between the two groups. A typical rash was observed in 32 (58%) children. Approximately 41 of the 55 children (75%) received antiviral treatment. Four patients experienced complications. Conclusions: Neither a history of VZV immunization nor the absence of a skin rash can definitively exclude VZV meningitis. It is important to note that any seemingly healthy child, regardless of recognized risk factors, could develop HZ meningitis. [ABSTRACT FROM AUTHOR]

Acipenserid herpesvirus 2 (AciHV-2) is a large double-stranded DNA virus in the family Alloherpesviridae that causes catastrophic outbreaks in young naive white sturgeon (Acipenser transmontanus) populations, with mortalities of up to 80%. Survivors of these infections are suspected to remain latently infected. The grampositive zoonotic bacterium Streptococcus iniae is another important sturgeon pathogen that causes severe myositis and up to 50% mortality during natural outbreaks. Throughout the last decade, co-infections of AciHV-2 and S. iniae have been reported in cultured white sturgeon in California resulting in severe presentations of piscine streptococcosis. This phenomenon of herpesvirus and streptococcus co-infection appears to span multiple taxa since in humans, it is recognized that a Human herpesvirus 3 infection (VZV) is a negative prognostic indicator for pediatric Invasive Group A Streptococcal infections (IGASI). While a decrease in humoral immunity caused by VZV has been hypothesized as a potentially important factor in IGASI cases, no natural animal model exists to study this process. Moreover, no studies have investigated these reported coinfections in white sturgeon. Therefore, the goal of this study was to investigate the effects of a recent AciHV-2 infection on the outcome of a subsequent S. iniae challenge in white sturgeon fingerlings. When fish were infected with 108 colony forming units (CFU) of S. iniae intramuscularly (IM), a statistically significant decrease in survival of 41% was detected in the co-infection group compared to the S. iniae group (p-value < 0.001). This difference was not observed when fish were infected with 106 CFU of S. iniae IM. At this lower infection dose, however, a statistically significant downregulation of tnfα was observed in the spleen of fish in the co-infection group compared to the S. iniae group (p-value = 0.0098). Analysis of serum from survivors revealed a statistically significant reduction in anti-S. iniae serum IgM and serum serotransferrin in fish from the co-infection group compared to the S. iniae group (p-value = 0.0134 and p-value = 0.0183, respectively). Further studies are indicated to determine what interactions lead to the decreased production of pathogen-specific IgM, serotransferrin, and TNFα in the host. [ABSTRACT FROM AUTHOR]

Background: Administration of live vaccines following liver transplant (LT) has historically not been recommended due to concerns regarding risk of vaccine‐attenuated disease. However, there is evidence suggesting that in select transplant recipients live vaccinations can be administered safely. Studies in other regions have indicated that despite this evidence many clinicians remain hesitant to administer live vaccinations. Method: A REDCap survey was distributed to gastroenterologists, pediatricians, and infectious diseases physicians at pediatric centers across Australia and New Zealand via email between September and November 2023. The survey included a series of questions regarding live vaccine and varicella postexposure prophylaxis (PEP) practices in pediatric LT recipients and barriers to live vaccine administration in this cohort. Results: There was a total of 16 responses to the survey, from 10 different pediatric centers, including 10/11 pediatric gastroenterology centers and all four pediatric LT centers in the region. Only 31% (5/16) of respondents (from 3/10 different centers) offer live vaccines. The main barrier to live vaccine administration was clinician reluctance and the main reason for not offering live vaccines was insufficient safety data. Sixty‐nine percent (11/16) of respondents take vaccination status and/or serology into account when deciding whether to offer varicella PEP to this cohort. Respondents universally offer varicella zoster immunoglobulin as PEP, though 31% (5/16) also offer antiviral medication. Conclusions: Many clinicians in our region remain hesitant to provide live vaccines to pediatric LT recipients, with concerns regarding insufficient safety data. Updated local guidelines may help to address this. [ABSTRACT FROM AUTHOR]

Background: Varicella‐zoster virus (VZV) pretransplant immunization rates, exposures, and posttransplant disease are poorly characterized among pediatric solid organ transplant (SOT) recipients in the two‐dose varicella vaccine era. Methods: A retrospective analysis of the electronic health records among children <18 years old who received SOT from January 1, 2011 through December 31, 2021, was performed at a single center to assess for missed pretransplant varicella vaccination opportunities, characterize VZV exposures, and describe posttransplant disease. Results: Among 525 children, 444 were ≥6 months old (m.o.) at SOT with a documented VZV vaccine status. Eighty‐five (19%) did not receive VZV Dose One; 30 out of 85 (35%) could have been immunized. Infants 6–11 m.o. accounted for 14 out of 30 (47%) missed opportunities. Among children ≥12 m.o. with documented Dose Two status (n = 383), 72 had missed vaccination opportunities; 57 out of 72 (79%) were children 1–4 years old. Most children had unclassifiable pre‐SOT serostatus as varicella serology was either not obtained/documented (n = 171) or the possibility of passive antibodies was not excluded (n = 137). Of those with classified serology (n = 188), 69 were seroimmune. Forty‐seven of 525 (9%) children had recorded VZV exposures; two developed varicella—neither had documented pre‐SOT seroimmunity nor had received post‐exposure prophylaxis. Nine additional children had medically attended disease: four primary varicella and five zoster. Of the 11 cases, 10 had cutaneous lesions without invasive disease; one had multi‐dermatomal zoster with transaminitis. Seven (64%) received treatment exclusively outpatient. Conclusions: VZV exposure and disease still occur. Optimizing immunization among eligible candidates and ensuring patients have a defined VZV serostatus pretransplantation remain goals of care. [ABSTRACT FROM AUTHOR]

Background Varicella is a highly infectious disease, particularly affecting children, that can lead to complications requiring antibiotics or hospitalization. Antibiotic use for varicella management is poorly documented. This study assessed antibiotic use for varicella and its complications in a pediatric population in England. Methods Data were drawn from medical records in the Clinical Practice Research Datalink and Hospital Episode Statistics data sets. The study included patients <18 years old with varicella diagnosed during 2014–2018 and 3-month follow-up available. We determined varicella-related complications, medication use, healthcare resource utilization, and costs from diagnosis until 3 months after diagnosis. Results We identified 114 578 children with a primary varicella diagnosis. Of these, 7.7% (n = 8814) had a varicella-related complication, the most common being ear, nose, and throat related (37.1% [n = 3271]). In all, 25.9% (n = 29 706 of 114 578) were prescribed antibiotics. A higher proportion of patients with complications than without complications were prescribed antibiotics (64.3% [n = 5668 of 8814] vs 22.7% [n = 24 038 of 105 764]). Mean annualized varicella-related costs were £2 231 481 for the study cohort. Overall, antibiotic prescriptions cost approximately £262 007. Conclusions This study highlights high antibiotic use and healthcare resource utilization associated with varicella management, particularly in patients with complications. A national varicella vaccination program in England may reduce varicella burden and related complications, medication use, and costs. [ABSTRACT FROM AUTHOR]

Aim of the study: This research aimed to investigate the incidence and course of varicella-zoster virus hepatitis in immunocompetent children. Material and methods: Medical charts of children hospitalised between 2019 and 2022 (excluding the period of the COVID-19 pandemic) due to varicella were retrospectively analysed and compared. Results: In total, 216 children were included in the analysis. In 24 children (11.1%) alanine aminotransferase (ALT) levels were elevated, whereas in 192 (88.9%) children, ALT levels were within the normal range. In 19 patients, ALT levels exceeded the upper limit of normal (ULN) less than twofold, in 4 patients ALT levels were elevated 2-3-fold, and in only one infant, a value 9.4× ULN was observed. None of the patients developed liver failure. The median age at the time of the diagnosis was significantly higher in the group of patients with elevated ALT – 5.5 years vs. 3 years in the group with normal ALT values (p = 0.02). The median duration of fever and hospitalization was longer by 1 day in the group with elevated ALT. Additionally, varicella lesions lasted longer in this group, 7.5 days vs. 6 days in the group with normal ALT levels (p = 0.01). Although median C-reactive protein (CRP) and procalcitonin (PCT) values did not differ, median leukocyte values were lower (p = 0.01) in the group with elevated ALT (7.3 × 103/ml vs. 8.8 × 103/ml). Conclusions: Elevation of ALT during varicella is observed in 1 out of 10 immunocompetent patients. The course of this hepatitis is predominantly mild. [ABSTRACT FROM AUTHOR]

Objectives: Analyse alternative methods of intrathecal antibody detection by comparing chemiluminescent immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) techniques to determine if CLIA can replace ELISA in the diagnosis of CNS infections. Methods: A panel of 280 paired samples—cerebrospinal fluid (CSF) and serum—with known antibody reactivities (Varicella, n = 60; Measles, n = 120) and negative samples (n = 100) were used to evaluate the performance of six serological test kits (Enzygnost, VirClia®, and Serion ELISA (Measles and Variella). Results: For Measles virus IgG, the VirClia® IgG monotest revealed 97% and 94% positive and negative agreement to the Enzygnost as reference test, respectively. In contrast, Serion ELISA kits yielded values of 18% and 90%. For the Varicella Zoster virus (VZV) IgG, the VirClia® IgG monotest showed 97% and 90% positive and negative agreement compared to Enzygnost. The Serion ELISA kits showed values of 55% and 86%, respectively. ROC analysis revealed that the areas under the curve for Measles and VZV IgGs were 0.7 and 0.852, respectively, using the Serion kit, and 0.963 and 0.955, for Vircell S.L CLIA technique. VirClia® monotest values were calculated using an antibody index cut-off of 1.3. Conclusion: The findings indicate that CLIA testing can improve antibody detection in CSF samples, aiding the diagnosis of infectious neurological impairments. [ABSTRACT FROM AUTHOR]

In this study, we aimed to characterize a cohort of children hospitalized due to varicella before and after the outbreak of the COVID-19 pandemic. Medical charts of all children hospitalized in the Regional Hospital of Infectious Diseases in Warsaw due to varicella in the years 2019 and 2022 were retrospectively analyzed and compared. In total, 221 children were included in the analysis; 59 of them were hospitalized in 2019, whereas 162 were hospitalized in 2022. Children hospitalized in 2022 were older than those reported in 2019 (median 4.0 vs. 3.0 years, p = 0.02). None of the hospitalized children received complete varicella vaccination. The most common complication in both years was bacterial superinfection of skin lesions, found in 156/221 (70.6%) of patients. This complication rate was higher in 2022 (50.8% in 2019 vs. 77.8% in 2022, p = 0.0001), OR = 3.38, 95% CI: 1.80–6.35. Moreover, skin infections in 2022 more often manifested with cellulitis (in 2022 13.6% vs. 3.4% in 2019, p = 0.03), OR = 4.40, 95% CI: 1.00–19.33. Sepsis as a complication of varicella was almost five-fold more prevalent in 2022 than in 2019 (p = 0.009), OR = 5.70, 95% CI: 1.31–24.77. Antibiotic use increased between 2019 and 2022 (71.2% vs. 85.2%, p = 0.01). Furthermore, patients were treated more frequently with the combination of two different antibiotics simultaneously (only 3.4% of patients in 2019 compared to 15.4% in 2022, p = 0.01). Primary infections with varicella zoster virus in 2022 led to a more severe course of the disease. [ABSTRACT FROM AUTHOR]

Background: Varicella infection, commonly known as chickenpox, can lead to various neurological complications. The study aimed to investigate the clinical characteristics, imaging findings, and outcomes of neurological complications following varicella infection. Methods: An observational study was conducted involving sixty patients presenting with neurological abnormalities subsequent to acute varicella infection were included. Data collection involved comprehensive neurological examinations and investigations, including imaging studies and cerebrospinal fluid analysis. Treatment outcomes were assessed through a multi-disciplinary approach and follow-up evaluations over a 3-month period. Statistical analysis was performed using SPSS version 21.0, emphasizing descriptive and inferential statistics. Results: The participants had a mean age of 38 years and 60% males. Encephalitis (41.7%), meningitis (25.0%), and Guillain-Barré Syndrome (16.7%) were the most prevalent complications. Complications peaked 30 days after varicella infection. Intravenous Immunoglobulin (IVIG) improved Guillain-Barré Syndrome more than plasmapheresis. Complication severity increased neurological symptom duration. In 60 patients, demographic characteristics were significantly associated with post-varicella neurological sequelae. Older patients had increased encephalitis and meningitis risks (p < 0.05), but gender did not significantly affect risk (p > 0.05). Post-infection complications peaked within 30 days and then decreased (p < 0.01). IVIG was more effective than plasmapheresis in treating Guillain Barré Syndrome (p < 0.05). Corticosteroids improved cerebellitis symptoms faster (p < 0.01). Prolonged symptoms were linked to severe consequences (p < 0.001), increasing our understanding of post-varicella neurological sequelae. Conclusion: The study underscores the diverse spectrum of neurological complications following varicella infection. Early recognition and appropriate management are essential for favorable outcomes. The findings contribute to better understanding and management strategies for these complications. Recommendations: Further research with larger sample sizes is warranted to validate these findings and explore additional prognostic factors. Multicenter studies could provide broader insights into the epidemiology and outcomes of varicella-associated neurological complications. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Disease / Türkiye Çocuk Hastalıkları Dergisi is the property of Turkish Journal of Pediatric Disease and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article presents a systematic review and meta-analysis of studies on the effectiveness of a two-dose varicella vaccination strategy in preventing varicella (chickenpox) infection. The analysis included 25 studies with a total of 49,265 participants. The results showed that the two-dose strategy was highly effective in reducing the risk of varicella infection compared to no vaccination or a one-dose strategy. The study suggests that a two-dose varicella vaccination is recommended for public health, but acknowledges limitations in the study design. [Extracted from the article]

Measles, mumps, rubella (MMR), and varicella incidence rates have increased due to the delayed vaccination schedules of children secondary to the COVID-19 pandemic. Decreased herd immunity creates a risk for immunocompetent children and immunocompromised individuals in the community. Historically, live-attenuated vaccines (MMR and varicella) were recommended before solid organ transplants. The amount of time before transplant when this is appropriate is often debated, as is the utility of vaccine titers. MMR and varicella vaccines previously were not recommended in immunocompromised patients post-solid organ transplant due to the undue risk of transmission and posed infection risk. The new literature on live-attenuated vaccines in post-transplant pediatric patients provides more insight into the vaccines' safety and efficacy. The present article aims to provide guidance on live-attenuated vaccines (MMR and varicella) in the pre-transplant and post-operative solid organ transplant phases of care in pediatric patients. [ABSTRACT FROM AUTHOR]

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 (χ2 = 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. [ABSTRACT FROM AUTHOR]

Acipenserid herpesvirus 2 (AciHV-2) is a large double-stranded DNA virus in the family Alloherpesviridae that causes catastrophic outbreaks in young naive white sturgeon (Acipenser transmontanus) populations, with mortalities of up to 80%. Survivors of these infections are suspected to remain latently infected. The grampositive zoonotic bacterium Streptococcus iniae is another important sturgeon pathogen that causes severe myositis and up to 50% mortality during natural outbreaks. Throughout the last decade, co-infections of AciHV-2 and S. iniae have been reported in cultured white sturgeon in California resulting in severe presentations of piscine streptococcosis. This phenomenon of herpesvirus and streptococcus co-infection appears to span multiple taxa since in humans, it is recognized that a Human herpesvirus 3 infection (VZV) is a negative prognostic indicator for pediatric Invasive Group A Streptococcal infections (IGASI). While a decrease in humoral immunity caused by VZV has been hypothesized as a potentially important factor in IGASI cases, no natural animal model exists to study this process. Moreover, no studies have investigated these reported coinfections in white sturgeon. Therefore, the goal of this study was to investigate the effects of a recent AciHV-2 infection on the outcome of a subsequent S. iniae challenge in white sturgeon fingerlings. When fish were infected with 108 colony forming units (CFU) of S. iniae intramuscularly (IM), a statistically significant decrease in survival of 41% was detected in the co-infection group compared to the S. iniae group (p-value < 0.001). This difference was not observed when fish were infected with 106 CFU of S. iniae IM. At this lower infection dose, however, a statistically significant downregulation of tnfa was observed in the spleen of fish in the co-infection group compared to the S. iniae group (p-value = 0.0098). Analysis of serum from survivors revealed a statistically significant reduction in anti-S. iniae serum IgM and serum serotransferrin in fish from the co-infection group compared to the S. iniae group (p-value = 0.0134 and p-value = 0.0183, respectively). Further studies are indicated to determine what interactions lead to the decreased production of pathogen-specific IgM, serotransferrin, and TNFa in the host. [ABSTRACT FROM AUTHOR]

Acipenserid herpesvirus 2 (AciHV-2) is a large double-stranded DNA virus in the family Alloherpesviridae that causes catastrophic outbreaks in young naive white sturgeon (Acipenser transmontanus) populations, with mortalities of up to 80%. Survivors of these infections are suspected to remain latently infected. The grampositive zoonotic bacterium Streptococcus iniae is another important sturgeon pathogen that causes severe myositis and up to 50% mortality during natural outbreaks. Throughout the last decade, co-infections of AciHV-2 and S. iniae have been reported in cultured white sturgeon in California resulting in severe presentations of piscine streptococcosis. This phenomenon of herpesvirus and streptococcus co-infection appears to span multiple taxa since in humans, it is recognized that a Human herpesvirus 3 infection (VZV) is a negative prognostic indicator for pediatric Invasive Group A Streptococcal infections (IGASI). While a decrease in humoral immunity caused by VZV has been hypothesized as a potentially important factor in IGASI cases, no natural animal model exists to study this process. Moreover, no studies have investigated these reported coinfections in white sturgeon. Therefore, the goal of this study was to investigate the effects of a recent AciHV-2 infection on the outcome of a subsequent S. iniae challenge in white sturgeon fingerlings. When fish were infected with 108 colony forming units (CFU) of S. iniae intramuscularly (IM), a statistically significant decrease in survival of 41% was detected in the co-infection group compared to the S. iniae group (p-value < 0.001). This difference was not observed when fish were infected with 106 CFU of S. iniae IM. At this lower infection dose, however, a statistically significant downregulation of tnfa was observed in the spleen of fish in the co-infection group compared to the S. iniae group (p-value = 0.0098). Analysis of serum from survivors revealed a statistically significant reduction in anti-S. iniae serum IgM and serum serotransferrin in fish from the Frontiers in co-infection group compared to the S. iniae group (p-value = 0.0134 and p-value = 0.0183, respectively). Further studies are indicated to determine what interactions lead to the decreased production of pathogen-specific IgM, serotransferrin, and TNFa in the host. [ABSTRACT FROM AUTHOR]

Background: Despite the efforts of the World Health Organization, some childhood viral diseases, for which there is already an effective vaccine, have not yet been eradicated. Among these, we find varicella, mumps, measles, and rubella, which although in most cases have a benign course, can in some cases be responsible for infectious outbreaks, especially in nosocomial settings. The aim of this study was to verify the immunological situation of a cohort of trainee obstetricians in Campania regarding varicella, mumps, measles, and rubella to be used as an example for the evaluation of possible preventive strategies to avoid infectious outbreaks. Methods: All the samples collected and sent to the laboratory were eligible for analysis and have been included in the study. Specific IgG for varicella, measles, mumps, and rubella were assayed on serum samples taken from 517 trainee obstetricians using the enzyme-linked immunosorbent assay (ELISA) technique. The seropositivity results were statistically analyzed by correlating them to age group and gender. Results: The results obtained show that a percentage of trainee obstetricians tested do not have an effective immunological coverage against at least one of the vaccine-preventable diseases considered, especially for mumps. Conclusions: Therefore, it is proposed to extend surveillance to other professionals in contact with frail patients and increase awareness of vaccination campaigns. [ABSTRACT FROM AUTHOR]

We aim to understand the varicella-zoster virus (VZV) antibody levels in children after vaccination and to construct VZV-IgG centile curves and reference values for children aged 1–7 years. From September to October 2023, a total of 806 children were recruited according to the time intervals of 1 month, 6 months, 1 year, 2 years, and 3 years after vaccination, as well as age groups. A generalized additive model for location, shape, and scale (GAMLSS) was applied to estimate P3, P10, P25, P50, P75, P90, and P97 centile reference values of VZV-IgG, and 95% reference intervals were calculated. A total of 785 children were included in the analysis, with an overall positivity rate of 70.3%, a median antibody concentration of 192.05 (82.89–571.14) mIU/mL, and a positivity rate of 57.7% for one dose of vaccine and 84.2% for two doses. Antibody positivity rates at 1 month, 6 months, 1 year, 2 years, and 3 years after vaccination were 65.1%, 74.4%, 80.4%, 67.7%, and 63.0%, respectively. The GAMLSS results showed that VZV-IgG had a tendency to increase and then decrease after vaccination, and the second dose of vaccination could significantly increase VZV-IgG. Two doses of varicella vaccine should be administered to children in a timely manner and included in the routine vaccination programs. [ABSTRACT FROM AUTHOR]

We present a case of serious and progressive neuropathy shortly following the administration of the herpes zoster subunit (HZ/su) vaccine, otherwise known as Shingrix. The progressive neuropathy occurred a week following the vaccination and progressed until discharge 16 days post-admittance. The patient's mild symptoms persist. The development of neuropathy following HZ/su administration is exceedingly rare, with an attributable risk of three cases per million vaccines administered. A black box warning was issued for this indication, although diagnosis and treatment were not confirmed for this patient. Reporting cases like this is crucial for a comprehensive understanding of vaccine risks and to characterize the underlying etiology of these serious adverse events. [ABSTRACT FROM AUTHOR]

We report a chickenpox outbreak among international students in Ontario, Canada. This paper highlights the complex challenges of clinical and public health response to outbreak situations. While the incidence of varicella infection has decreased due to widespread vaccination programs in Canada, specific groups, such as international students from areas with lower vaccination rates, remain at risk. The outbreak involved primarily unvaccinated international students residing in a college residence building. Coordinated and prompt contact tracing and administration of post-exposure vaccination were core strategies to control the outbreak. The incident highlighted several challenges that can arise in varicella outbreak management, from determining when and how to order and interpret serological tests, to adjusting isolation measures based on the community's low vaccination rate. Ethical considerations surrounding vaccination policies, particularly for international students came to the forefront. The disparity in access to preventive care highlights broader public health implications and prompts a discussion on equitable vaccination strategies. [ABSTRACT FROM AUTHOR]

Pneumonia is the most common complication of varicella infections. Although previous studies have tended to focus mainly on immunocompromised patients, varicella pneumonia can also occur in healthy adults. Therefore, in this study, we aimed to assess the progression of varicella pneumonia in immunocompetent hosts. This retrospective study involved immunocompetent adult outpatients with varicella who attended the adult Fever Emergency facility of Peking University Third Hospital from April 1, 2020, to October 31, 2022. Varicella pneumonia was defined as a classic chickenpox-type rash in patients with infiltrates on chest computed tomography. The study included 186 patients, 57 of whom had a contact history of chickenpox exposure. Antiviral pneumonia therapy was administered to 175 patients by treating physicians. Computed tomography identified pneumonia in 132 patients, although no deaths from respiratory failure occurred. Seventy of the discharged patients were subsequently contacted, all of whom reported being well. Follow-up information, including computed tomography findings, was available for 37 patients with pneumonia, among whom 24 reported complete resolution whereas the remaining 13 developed persistent calcifications. Notably, we established that the true incidence of varicella pneumonia is higher than that previously reported, although the prognosis for immunocompetent hosts is generally good. [ABSTRACT FROM AUTHOR]

Simian varicella virus (SVV) produces peripheral inflammatory responses during varicella (primary infection) and zoster (reactivation) in rhesus macaques (RM). However, it is unclear if peripheral measures are accurate proxies for central nervous system (CNS) responses. Thus, we analyzed cytokine and Aβ42/Aβ40 changes in paired serum and cerebrospinal fluid (CSF) during the course of infection. During varicella and zoster, every RM had variable changes in serum and CSF cytokine and Aβ42/Aβ40 levels compared to pre-inoculation levels. Overall, peripheral infection appears to affect CNS cytokine and Aβ42/Aβ40 levels independent of serum responses, suggesting that peripheral disease may contribute to CNS disease. [ABSTRACT FROM AUTHOR]

The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient's previous situation as well as the current infectious disease, in addition to experience. What is Known: • Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. • Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults. What is New: • In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists. [ABSTRACT FROM AUTHOR]

Introduction: Displaced populations face disproportionately high risk of communicable disease outbreaks given the strains of travel, health care circumstances in their country of origin, and limited access to health care in receiving countries. Study Objective: Understanding the role of demographic characteristics in outbreaks is important for timely and efficient control measures. Accordingly, this study assesses chickenpox outbreaks in three large refugee camps on mainland Greece from 2016 – 2017, using clinical line-list data from Médecins du Monde (MdM) clinics. Methods: Clinical line-list data from MdM clinics operating in Elliniko, Malakasa, and Raidestos camps in mainland Greece were used to characterize chickenpox outbreaks in these camps. Logistic regression was used to compare the odds of chickenpox by sex, camp, and yearly increase in age. Incidences were calculated for age categories and for sex for each camp outbreak. Results: Across camps, the median age was 19 years (IQR: 7.00 - 30.00 years) for all individuals and five years (IQR: 2.00 - 8.00 years) for cases. Males were 55.94% of the total population and 51.32% of all cases. There were four outbreaks of chickenpox across Elliniko (n = 1), Malakasa (n = 2), and Raidestos (n = 1) camps. The odds of chickenpox when controlling for age and sex was lower for Malakasa (OR = 0.46; 95% CI, 0.38 - 0.78) and Raidestos (OR = 0.36; 95% CI, 0.24 - 0.56) when compared Elliniko. Odds of chickenpox were comparable between Malakasa and Raidestos (OR = 1.49; 95% CI, 0.92 - 2.42). Across all camps, the highest incidence was among children zero-to-five years of age. The sex-specific incidence chickenpox was higher for males than females in Elliniko and Malakasa, while the incidence was higher among females in Raidestos. Conclusion: As expected, individuals five years of age and under made up the majority of chickenpox cases. However, 12% of cases were teenagers or older, highlighting the need to consider atypical age groups in vaccination strategies and control measures. To support both host and displaced populations, it is important to consider risk-reduction needs for both groups. Including host communities in vaccination campaigns and activities can help reduce the population burden of disease for both communities. [ABSTRACT FROM AUTHOR]

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Chickenpox (varicella) is a rare occurrence in healthcare settings in the USA, but can be transmitted to healthcare workers (HCWs) from patients with herpes zoster who, in turn, can potentially transmit it further to unimmunized, immunosuppressed, at-risk, vulnerable patients. It is uncommon due to the inclusion of varicella vaccination in the recommended immunization schedule for children and screening for varicella immunity in HCWs during employment. We present a case report of hospital-acquired chickenpox in a patient who developed the infection during his prolonged hospital stay through a HCW who had contracted chickenpox after exposure to our patient's roommate with herpes zoster. There was no physical contact between the roommates, but both patients had a common HCW as caregiver. The herpes zoster patient was placed in airborne precautions immediately, but the HCW continued to work and have physical contact with our patient. The HCW initially developed chickenpox 18 days after exposure to the patient with herpes zoster, and our patient developed chickenpox 17 days after the HCW. The timeline and two incubation periods, prior to our patient developing chickenpox, indicate transmission of chickenpox in the HCW from exposure to the herpes zoster patient and subsequently to our patient. The case highlights the potential for nosocomial transmission of chickenpox (varicella) to unimmunized HCWs from exposure to patients with herpes zoster and further transmission to unimmunized patients. Verification of the immunization status of HCWs at the time of employment, mandating immunity, furloughing unimmunized staff after exposure to herpes zoster, and postexposure prophylaxis with vaccination or varicella zoster immunoglobulin (Varizig) will minimize the risk of transmission of communicable diseases like chickenpox in healthcare settings. Additionally, establishing patients' immunity, heightened vigilance and early identification of herpes zoster in hospitalized patients, and initiation of appropriate infection control immediately will further prevent such occurrences and improve patient safety. Summary: This is a case report of a varicella-unimmunized 31-year-old patient who developed chickenpox during his 80-day-long hospitalization. He had different roommates during his long hospital stay but had no physical contact with them and neither had visitors. On most days, the same HCW rendered care to him and his roommates. One of the patient's roommates was found to have herpes zoster and was immediately moved to a different room with appropriate infection prevention measures. The HCW is presumably unimmunized to varicella and sustained significant exposure to the patient with herpes zoster during routine patient care which involved significant physical contact. The HCW was not furloughed, assessed for immunity, or given postexposure prophylaxis (PEP). The HCW had continued contact with our patient as part of routine care. On day 18, after exposure to the patient with herpes zoster, the HCW developed chickenpox. 17 days thereafter, our patient developed chickenpox. The time interval of chickenpox infection in the HCW after one incubation period after exposure to the patient with herpes zoster followed by a similar infection of chickenpox in our patient after another incubation period suggests the spread of varicella zoster virus (VZV) from the herpes zoster patient to the HCW and further from the HCW to our patient. Assessing the immunity of HCWs to varicella at the time of employment, ensuring only HCWs with immunity take care of herpes zoster and varicella patients, furloughing unimmunized exposed HCWs, offering PEP, and documentation of patients' immunity to varicella at the time of hospital admission could help prevent VZV transmission in hospital settings. This is an attempt to publish this novel case due to its high educational value and relevant learning points. [ABSTRACT FROM AUTHOR]

Necrotising fasciitis is a common surgical emergency. Risk factors include immunosuppression, type 2 diabetes mellitus, chronic diseases like cirrhosis of liver and chronic kidney disease, malignancies, intravenous drug use, obesity, and age more than 60 years. Our case is of a 14 years old boy who presented with necrotising fasciitis (NF) of right upper limb post varicella of 10 days duration. Prompt diagnosis with aggressive surgical debridement was lifesaving in this case. Early reconstruction with split skin grafting escalated recovery resulting in a fully functional limb without any residual deficit. This case is a rare example of post varicella NF in a young child without any co-morbidities. Majority such cases are encountered by a general surgeon in an emergency setting. Hence, this report sensitises and enlightens the first responders about the existence of this rare entity. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We encountered an immunocompromised patient with severe respiratory disease immediately after the onset of varicella. Varicella zoster virus infection may be associated with more severe immunosuppressive condition. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective observational study conducted in the district of Dadra and Nagar Haveli, Western India, over the past 9 years aimed to comprehensively investigate the epidemiology of chickenpox. The objectives were to analyze demographic and clinical characteristics, examine temporal trends, identify outbreak locations, assess outbreak intensity and duration, determine laboratory-confirmed cases, and provide insights for public health interventions. Materials and Methods: The study employed a retrospective approach, gathering data on chickenpox cases in the region. Demographic information, clinical profiles, and outbreak details were analyzed. Temporal variations and seasonal trends were assessed. Laboratory confirmation was achieved through serology and molecular methods. Locations of outbreaks were identified, and their characteristics were evaluated. Results: The study revealed that the 6-10 age groups were most vulnerable, with mild-to-moderate symptoms predominantly observed. Significant variations in cases occurred year round, with peaks between November and February. Out of 25 recorded outbreaks and three early warning signals, Aganwadis, play schools, and schools were common outbreak locations. Most outbreaks were low intensity, and laboratory confirmation identified Clade-1 Varicella-Zoster virus as the causative agent. Conclusion: These findings provide essential insights for public health officials. Identifying the vulnerable age group and high-risk locations allows for targeted vaccination campaigns. Moreover, the study underscores the need for continuous monitoring and surveillance to detect outbreaks early and mitigate their spread effectively, emphasizing the importance of proactive prevention and control measures for chickenpox in the region. [ABSTRACT FROM AUTHOR]

Introduction: Varicella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella symptoms are usually self-limiting; however, different complications with widespread and systemic manifestations can occur. This systematic literature review aims to explore and quantify varicella-associated complication rates. Methods: Two databases (Embase and MEDLINE), congress abstracts, and reference lists of systematic reviews were screened to identify evidence on varicella complications. Complications were identified and grouped into 14 clinically relevant categories. Proportional meta-analyses were conducted using a random-effects model and tests for heterogeneity and publication bias were performed. Subgroup, sensitivity, and meta-regression analyses were also conducted. A total of 78 studies, spanning 30 countries, were included in the meta-analysis. Results: Pooled prevalence was highest in severe varicella (22.42%; 95% confidence interval [CI] 10.13–37.77), skin-related complications (20.12%; 95% CI 15.48–25.20), and infection-related complications (10.03%; 95% CI 7.47–12.90). Cardiovascular (0.55%; 95% CI 0.08–1.33), genitourinary (1.17%; 95% CI 0.55–1.99), and musculoskeletal (1.54%; 95% CI 1.06–2.11) complications had the lowest pooled prevalence. The remaining complication categories ranged between 1% and 10%. Subgroup analysis showed that complications were more prevalent in children versus adults and in hospitalized patients versus outpatients. Meta-regression analysis found that no ecological level covariates were accurate predictors for the overall prevalence of varicella-associated complications. There was substantial heterogeneity and publication bias across all meta-analyses. Conclusion: Results suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease. Plain Language Summary: A graphical plain language summary is available with this article. [ABSTRACT FROM AUTHOR]

The varicella vaccine is not included in the national childhood immunization schedules in China. Varicella epidemics and outbreaks are frequently reported, and the evidence for the effectiveness of the varicella vaccine remains unclear. The aim of this study was to investigate varicella vaccine effectiveness in Wuxi, China. Varicella surveillance data were extracted from the China Information System for Disease Control and Prevention, and vaccination data were obtained from the Vaccination Integrated Service Management Information System of Jiangsu Province, China. Time-series analysis approaches were used to estimate varicella vaccine effectiveness. A total of 16,093 varicella cases among children aged 1–6 years between January 2016 and December 2020 were analysed. A total of 217,297 children completed a two-dose varicella vaccination series. Compared with districts with lower vaccination rates, districts in Wuxi with higher varicella vaccination rates had a lower proportion of cases (p < 0.001). In the time-series approach, 0.8% fewer varicella cases were associated with a 1% increase in the two-dose varicella vaccination rate (p < 0.001), and similar effects were found in both the male and female populations. Two-dose varicella vaccination was recommended as an effective health intervention to prevent varicella in Wuxi, China. Varicella vaccination is urgently needed in routine childhood immunisation programs. The introduction of two-dose varicella vaccination was an effective intervention to prevent varicella in Wuxi, China. Varicella vaccination is urgently needed in routine childhood immunization programmes. [ABSTRACT FROM AUTHOR]

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The use of live attenuated vaccines in patients with immunosuppressive agents is contraindicated in package inserts and guidelines in Japan and other countries. However, patients receiving immunosuppressants have a high risk of infectious disease becoming severe, and the necessity to prevent infectious disease is high. To date, 2,091 vaccinations have been reported in 25 reports of live attenuated vaccines in people receiving immunosuppressants. Twenty-three patients (1.1%) became infected with the virus strain used in the vaccine, which was varicella virus in 21 patients. No reports have described life-threatening complications. A prospective study at the National Center for Child Health and Development conducted under certain immunological conditions (CD4 cell count ≥ 500/mm3, stimulation index of lymphocyte blast transformation by phytohemagglutinin (PHA) ≥ 101.6, serum immunoglobulin G ≥ 300 mg/dL) confirmed the serological effectiveness and safety. The evidence suggests that live attenuated vaccines can be used even in combination with immunosuppressants. Further evidence must be gathered and immunological criteria investigated to determine the conditions for safe use. Depending on the results of these investigations, the wording in package inserts and guidelines may need to be revised. [ABSTRACT FROM AUTHOR]

This multicenter study aimed to investigate the relationship between varicella incidence and meteorological factors including mean temperature, relative humidity, sunshine duration, diurnal temperature difference, wind speed, and rainfall, as previous studies have produced varying results. Our study also sought to identify potential sources of heterogeneity. Data on reported daily varicella numbers and meteorological factors were collected for 14 cities in Yunnan Province from 2017 to 2021. A distribution-lagged nonlinear model was constructed to explore the relationship between meteorological conditions and varicella incidence in each included city. We then used multiple meta-regression to explore sources of heterogeneity using demographic economics indicators, air pollutants, and geographic location as potential modifiers. The cumulative hazard effect plot showed an inverted S-shape for the relationship between temperature and varicella, with the smallest RR (relative risk) (0.533, 95% CI: 0.401–0.708) at temperatures up to 27.2 °C. The maximum RR (1.171, 95% CI: 1.001–1.371) was obtained when the relative humidity was equal to 98.5%. The RR (1.164, 95% CI: 1.002–1.352) was greatest at a diurnal temperature range of 2 °C (1.164, 95% CI: 1.002–1.352) and least (0.913, 95% CI: 0.834–0.999) at a diurnal temperature range of 16.1 °C. The maximum RR (1.214, 95% CI: 1.089–1.354) was obtained at 0 h of sunshine, and the minimum RR (0.808, 95% CI: 0.675–0.968) was obtained at 12.4 h of sunshine. The RR (0.792, 95% CI: 0.633–0.992) was minimum at a wind velocity of 4.8 m/s. Residual heterogeneity ranged from 1 to 42.7%, with PM10 (particles with an aerodynamic diameter less than 10 μm), GDP (gross domestic product), and population density explaining some of this heterogeneity. The temperature has a dual effect on varicella incidence. Varicella cases are negatively correlated with diurnal temperature range, sunshine duration, and wind speed, and positively correlated with relative humidity. GDP and PM10 may have a significant role in altering the association between temperature and varicella, while PM10 and population density may alter the association between wind velocity and varicella. [ABSTRACT FROM AUTHOR]

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To evaluate the impact of a two-dose VarV program on varicella incidence among the whole population, considering the influence of public health and social measures (PHSMs), we extracted surveillance data on varicella cases during 2013–2022 in Minhang, Shanghai. Then, we estimated the incidence trend of varicella through interrupted time-series analyses and quantified the impact of the immunization program and PHSMs using Serfling regression. We also explored the associations between PHSMs and varicella cases. The implementation of the two-dose VarV strategy was followed by a significant decrease in varicella incidence (−1.84% per month). After one year of the program, varicella incidence was estimated at a 45.25% reduction, which was higher in children (59.12% and 54.09%) than in adults (19.49%). The decrease attributed to PHSMs was 31.26% during 2020–2022, and school closing was identified as the most relevant PHSM (b = −8.03 cases, r = −0.67 with a 1-week lag). These findings indicate that the two-dose immunization program has more effectively reduced the varicella incidence compared with the one-dose vaccine, and interventions like school closings are also encouraged to serve as supplementary measures to prevent varicella epidemics. [ABSTRACT FROM AUTHOR]

Chickenpox is a common childhood disease caused by varicella-zoster virus (VZV). VZV vaccination is not part of the UK childhood immunisation programme, but its potential inclusion is regularly assessed. It is therefore important to understand the ongoing burden of VZV in the community to inform vaccine policy decisions. General practitioner (GP) chickenpox consultations were studied from 1 September 2016 to 9 December 2022. Over the study period, the mean weekly chickenpox consultation rate per 100,000 population in England was 3.4, with a regular peak occurring between weeks 13 and 15. Overall, rates decreased over time, from a mean weekly rate of 5.5 in 2017 to 4.2 in 2019. The highest mean weekly rates were among children aged 1–4 years. There was no typical epidemic peak during the COVID-19 pandemic, but in 2022, rates were proportionally higher among children aged < 1 year old compared to pre-pandemic years. Chickenpox GP consultation rates decreased in England, continuing a longer-term decline in the community. The COVID-19 pandemic impacted rates, likely caused by the introduction of non-pharmaceutical interventions to prevent SARS-CoV-2 transmission. The lasting impact of the interruption of typical disease transmission remains to be seen, but it is important to monitor the chickenpox burden to inform decisions on vaccine programmes. [ABSTRACT FROM AUTHOR]

We report a case of a 42‐year‐old immunocompromised (human immunodeficiency virus [HIV], CD4 count 86 cells/μL) Black male who presented with fever, oropharyngeal candidiasis, and phimosis, followed by eruption of umbilicated papulovesicles most concentrated on the face. The patient was diagnosed with Mpox (MPXV, formerly monkeypox), herpes simplex virus 1 (HSV1), varicella‐zoster virus (VZV), and late latent syphilis. Tzanck smear of a Mpox lesion proved a useful and rapidly obtained pertinent negative test, lacking the typical changes of HSV/VZV (multinucleation, margination, and molding). A biopsy specimen showed viral changes consistent with both Mpox (ballooning degeneration and multinucleated keratinocytes) and herpesvirus (multinucleated epithelial giant cell within a zone of follicular necrosis). Lesion PCR was positive for HSV1 and MPXV, and negative for HSV2 and VZV. Immunohistochemistry was positive for VZV and orthopoxvirus. Empiric treatment for HSV/VZV in patients with suspected or confirmed Mpox should be considered for patients with HIV or other immunocompromised patients. It is important to recognize that MPXV, HSV, and VZV may all be present and difficult to distinguish clinically. More than one test modality (PCR, H&E, immunohistochemistry, and Tzanck) and multiple lesion samples may be required to thoroughly evaluate widespread papulovesicular eruptions, especially in immunocompromised patients. [ABSTRACT FROM AUTHOR]

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Background: The real-world data of long-term protection under moderate vaccination coverage is limited. This study aimed to evaluate varicella epidemiology and the long-term effectiveness under moderate coverage levels in Ganyu District, Lianyungang City, Jiangsu Province. Methods: This was a population-based, retrospective birth cohort study based on the immunization information system (IIS) and the National Notifiable Disease Surveillance System (NNDSS) in Ganyu District. Varicella cases reported from 2009 to 2020 were included to describe the epidemiology of varicella, and eleven-year consecutive birth cohorts (2008–2018) were included to estimate the vaccine effectiveness (VE) of varicella by Cox regression analysis. Results: A total of 155,232 native children and 3,251 varicella cases were included. The vaccination coverage was moderate with 37.1%, correspondingly, the annual incidence of varicella infection increased 4.4-fold from 2009 to 2020. A shift of the varicella cases to older age groups was observed, with the peak proportion of cases shifting from 5–6 year-old to 7–8 year-old. The adjusted effectiveness of one dose of vaccine waned over time, and the adjusted VE decreased from 72.9% to 41.8% in the one-dose group. Conclusions: The insufficient vaccination coverage (37.1%) may have contributed in part to the rising annual incidence of varicella infection, and a shift of varicella cases to older age groups occurred. The effectiveness of one dose of varicella vaccine was moderate and waned over time. It is urgent to increase varicella vaccine coverage to 80% to reduce the incidence of varicella and prevent any potential shift in the age at infection in China. [ABSTRACT FROM AUTHOR]

Two live attenuated varicella vaccine (VZV) strains have been mainly used across the globe: MAV/06 and OKA strains. We aimed to explore the safety of interchanging the two VZV strains for primary and booster immunizations. South Korea's vaccine adverse event reporting system (VAERS) was accessed and searched to find filed reports of all adverse events (AEs) following immunization with the second dose of the varicella vaccine. The electronic medical records were reviewed for all visits to the hospital following the second dose of the varicella vaccine. Of the total 406 study participants, 27.5% (n = 112) were in the MAV/06–MAV/06 group, 30.3% (n = 123) in the MAV/06–OKA, 17.5% (n = 71) in the OKA–MAV/06 group, and 24.6% (n = 100) in the OKA–OKA group. Mean age at immunization with the first dose was 1.10 (standard deviation [SD] ±0.34) years old, and second dose was 4.77 (SD ± 1.13) (p = 0.772 and 0.933, respectively). There were no filed reports of AEs following the second dose in the national VAERS. Hospital visit records showed a total of 10.3% (95% confidence interval [CI], 7.6–13.7) (n = 42) had recorded AEs following the 2nd administered dose; however, only 0.7% (95% CI, 0.2–2.4) (n = 3) were regarded as possibly vaccine related. Two patients in the MAV/06–OKA group were diagnosed with Henoch-Schonlein purpura after the second dose; however, both had also received the MMR vaccine on the same day. No safety signals associated with interchanging the MAV/06 and OKA strain live attenuated varicella vaccines were observed in this patient cohort of healthy children. [ABSTRACT FROM AUTHOR]

Korean manufacturers have developed a new varicella vaccine, NBP608. This phase 3, randomized, double-blind, multicenter study aimed to compare the immunogenicity and safety of NBP608 in healthy children to those of VarivaxTM (control). Children aged 12 months to 12 years were randomized in a ratio of 1:1 to receive either NBP608 or the control vaccine. Serum samples were obtained before vaccination and within six to eight weeks after vaccination. In total, 499 participants (NBP608, n = 251; control, n = 248) were enrolled. The seroconversion rate (SCR) measured using a FAMA assay was 99.53% in the NBP608 group, and the lower limit of the 95% confidence interval (95% LCL) for the SCR difference (NBP608 minus the control) was 0.52%. This 95% LCL for the difference was higher than the specified non-inferiority margin of −15%. In an assessment using gpELISA, the SCR was 99.53% in the NBP608 group, and the 95% LCL for the SCR difference was 6.5%, which was higher than the specified non-inferiority margin of −15%. There were no significant differences between the NBP608 and control group with respect to the proportions of participants who demonstrated local and systemic solicited AEs. This study indicated that NBP608 had a clinically acceptable safety profile and was not immunologically inferior to VarivaxTM. [ABSTRACT FROM AUTHOR]

The prevalence of varicella in China has been increasing annually, with a relatively high incidence rate of breakthrough cases. Administering two doses of the varicella vaccine (Varv) proves to be the most effective measure. The objective of this study is to assess the immunogenicity of two doses of the Varv at varying intervals and explore the optimal timing for administering the second dose of the Varv. Utilizing a prospective cohort study design, the quantification of varicella immunoglobulin G (IgG) antibodies' geometric mean concentrations (GMC) is conducted through glycoprotein‐based enzyme‐linked immunosorbent assay (gpELISA). A total of 903 infants were included in the per‐protocol population. After completing the first dose of the Varv, the GMC of antibody after 1 month (Group A) was 463.8 (447.6−480.1) mIU/mL. There was a statistically significant difference in GMC and seroconversion rates among the groups (B/C/D) that received the second dose of the Varv (p < 0.05). Multiple comparisons revealed that the group with a 3‐year interval between the two vaccine doses had a higher GMC of 665.2 (622.6−707.8) mIU/mL compared to the group with a 1‐year interval of 611.1 (577.1−645.3) mIU/mL and the group with a 5‐year interval of 564.7 (540.1−589.4) mIU/mL. To effectively prevent and control the varicella epidemic in Jiangsu Province, two dose Varv vaccination is recommended, the optimal time point for the second dose Varv is 3 years after the first vaccination. [ABSTRACT FROM AUTHOR]

This study aims to provide practical recommendations on prophylaxis for infection in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapy. The results were presented and discussed in a nominal group meeting comprising a committee of 12 pediatric rheumatologists from the Prevention and Treatment of Infections Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and the Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (completely disagree) to 10 (completely agree). Agreement was considered to have been reached if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (23 on infection prophylaxis) and voted by 59 pediatric rheumatologists and other pediatric specialists, all of whom achieved the pre-established level of agreement. The recommendations on prophylaxis of infection cover vaccination and prophylaxis against varicella zoster virus, tuberculosis, Pneumocystis jiroveccii, and invasive fungal infections in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. Conclusion: Based on current evidence and a Delphi process, we provided consensus and updated recommendations on prophylaxis and treatment of infections to guide those caring for pediatric rheumatology patients. What is Known: •Data largely derived from adults find that infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. •It is crucial to be aware of the preventive measures that should be implemented to prevent these infections in children, although most guidelines are often extrapolated from adult cases. What is New: •In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could prove useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists. •The recommendations focus on tuberculosis, herpes zoster virus, fungal infections, and Pneumocystis jirovecii. [ABSTRACT FROM AUTHOR]

Varicella is a highly prevalent infectious disease with a similar transmission pathway to coronavirus disease 2019 (COVID‐19). In the context of the COVID‐19 pandemic, anti‐COVID‐19 nonpharmaceutical interventions (NPIs) have been implemented to prevent the spread of the infection. This study aims to analyze varicella's epidemiological characteristics and further investigate the effect of anti‐COVID‐19 NPIs on varicella in Xi'an, northwestern China. Based on the varicella surveillance data, search engine indices, meteorological factors from 2011 to 2021 in Xi'an, and different levels of emergency response to COVID‐19 during the pandemic, we applied Bayesian Structural Time Series models and interrupted time series analysis to predict the counterfactual incidence of varicella and quantify the impact of varying NPIs intensities on varicella. From 2011 to 2021, varicella incidence increased, especially in 2019, with a high incidence of 111.69/100 000. However, there was a sharp decrease of 43.18% in 2020 compared with 2019, and the peak of varicella incidence in 2020 was lower than in previous years from the 21st to the 25th week. In 2021, the seasonality of varicella incidence gradually returned to a seasonal pattern in 2011–2019. The results suggest that anti‐COVID‐19 NPIs effectively reduce the incidence of varicella, and the reduction has spatiotemporal heterogeneity. [ABSTRACT FROM AUTHOR]