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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]

Objective To analyze the epidemic characteristics of breakthrough cases of varicella in Shapingba District, Chongqing, and provide reference for the prevention and control of the varicella epidemic in the area.[WTHZ]Methods [WTBZ]Collect information on varicella cases and their vaccination in Shapingba District from 2019 to 2023, Use descriptive epidemiological methods to analyze the epidemiological characteristics of varicella breakthrough cases, and use linear regression to analyze the relationship between breakthrough cases and age at the time of vaccination and the time interval between vaccination and onset of disease.[WTHZ]Results [WTBZ]From 2019 to 2023, there were a total of 802 breakthrough cases of varicella in Shapingba District, Chongqing, accounting for 14.87% of the total number of varicella cases. The majority of cases were vaccinated with one dose of varicella (648 cases, accounting for 80.80%), and the differences in composition among different years were statistically significant (χ²=16.400, P<0.005); The epidemic has a bimodal distribution, from October to December and May to July each year. The least cases are in winter (142 cases, accounting for 11.68%), and the most cases are in spring (198 cases, accounting for 17.32%). The composition differences between different seasons are statistically significant (χ2=16.348, P<0.001); The breakthrough cases of chickenpox are mainly male, with the highest incidence among primary school students aged 6～10, and the differences in composition are statistically significant (χ²=877.420, P<0.001); The time interval from the first dose of chickenpox vaccine to the onset of breakthrough cases was 46 days to 17 years, with a median\[M(P25, P75)\] of 7 years (4 years, 10 years). The median time interval between scattered children, primary school students, and middle school students was 3 years (2 years, 4 years), 8 years (6 years, 9 years), and 12 years (11 years, 14 years), respectively, with statistical significance (H=497.280, P<0.001); There is a negative correlation between age at the time of first dose vaccination and the interval between onset of the disease in breakthrough cases, with a correlation coefficient of r=-0.230 (t=-6.693, P<0.001).[WTHZ]Conclusion [WTBZ]Breakthrough cases of varicella in Shapingba, Chongqing are mainly concentrated in primary school students during the start of the school season, with an interval of 7 years between onset. It is necessary to further strengthen the prevention and control of the varicella epidemic in primary schools, further improve the vaccination rate of children with varicella vaccines, and recommend receiving two doses of vaccines before starting primary school to reduce the risk of breakthrough cases. [ABSTRACT FROM AUTHOR]

ObjectiveTo analyze the epidemiological characteristics of varicella in Karamay City, to inform the prevention and control of the local varicella epidemic, and to guide adjustments to the varicella vaccine immunization strategy.MethodsThe data on varicella cases from 2015 to 2022 in Karamay were collected and the epidemiological characteristics were analyzed.ResultsA total of 3 380 varicella cases were reported in Karamay from 2015 to 2022, with an average annual incidence rate of 94.91/105. The incidence of varicella showed a year-on-year downward trend from 2015 to 2022 (AAPC=-16.29%, P

Introduction: Varicella zoster virus (VZV) is a type of alpha-herpesvirus that specifically targets the nervous system. The initial infection, typically occurring during childhood, results in varicella (commonly known as chickenpox), after which the virus enters a dormant state in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia throughout the entire neuroaxis. Aim of the study: Molecular and genetic studies of viruses are an important tool for virus development and identifying viral treatments to combat the diseases. The aim of the study was to determine the whole ORF4 sequence of the local VZV strains for phylogenetic analysis to determine the variability in the viral sequence. Material and methods: Ten samples of VZV DNA were subjected to the sequencing of the whole ORF4 region following identification using the PCR method. Results: Sequences from five samples have been successfully analyzed. All clinical strains were discovered to possess a genome with a length of 124,884 base pairs. The sequences exhibited the occurrence of two distinct mutations, one being a transversion and the other a transition, with the latter resulting in an alteration of the amino acid. A phylogenetic tree was constructed using the maximum likelihood method based on the sequences of five nucleotide sequences from clinical samples and nine reference VZV strains. The tree displayed the evolutionary distances between these sequences. The analysis of the phylogenetic tree revealed the presence of five primary clades, with four of them originating from India (isolates S1, S2, S4, S5), while S3 exhibited similarity to a strain from the United Kingdom.

ObjectiveTo explore the exposure-lag-response relationship between temperature and risk of varicella incidence,and to provide a scientific evidence for early warning and precise prevention and control of varicella epidemic.MethodsDaily varicella cases and daily meteorological data were collected in Minhang District, Shanghai from 2010 to 2022. A distributed lag nonlinear model was used to determine the exposure-lag-response relationship between temperature and risk of varicella incidence. Furthermore, effect of temperature on the incidence risk was determined across different age groups.ResultsIn 2010‒2022, the total number of notified varicella cases was 26 207 in Minhang District, with the highest incidence in the group aged 3‒14 years (50.35%). The seasonal pattern of daily varicella cases showed a double peak. The large peak was found in November and December, followed by a smaller peak in May and June. Moreover, the distributed lag nonlinear model showed a unimodal curve in the relationship between temperature and varicella incidence. The RR value reached its maximum peak of 1.90 (95%CI: 1.25‒2.87) at 7 ℃. A reverse U-shape was found in the lag-response curves between temperature and varicella incidence. Furthermore, the effect of temperature on the varicella incidence showed a unimodal pattern in the varicella cases aged 3‒14 years. The RR value reached its peak at 11 ℃ (RR=2.89, 95%CI: 1.33‒6.24). In contrast, the effect of temperature on the varicella incidence in the cases aged 15 years and above showed a unimodal pattern, with RR value reaching the peak at 5 ℃ (RR=2.14, 95%CI: 1.33‒3.44).ConclusionThe unimodal curve is found in the relationship between temperature and varicella incidence. Low temperature is associated with increased risk of varicella incidence. Children aged 3‒14 years are more susceptible to the effect of temperature on the varicella incidence.

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]

La varicelle est une maladie infantile fréquente due au virus VZV responsable d'épidémies touchant principalement les enfants de moins de 10 ans. Bien qu'elle soit bénigne dans la plupart des cas, elle peut entraîner des complications sévères dont les plus fréquentes sont les surinfections cutanées bactériennes. Du fait de la mise en place de la vaccination systématique dans de nombreux pays, l'épidémiologie de la varicelle a beaucoup évolué ces dernières années avec une nette diminution de l'incidence de la varicelle et de ses complications dans les pays ou la vaccination a été mise en place. Afin d'étudier les caractéristiques épidémiologiques, cliniques et thérapeutiques des enfants hospitalisés pour varicelle, nous avons réalisé une étude rétrospective dans les différents services de pédiatrie de l'hôpital Armand Trousseau à Paris incluant tous les enfants de moins de 18 ans, avec ou sans antécédents, hospitalisés pour une varicelle entre le 1er janvier 2021 et le 1er juin 2023. Cent cinq patients ont été inclus dans l'étude. L'âge médian était de 2,1 ans [1–4,2]. On retrouvait des complications chez 75 % (n = 79) des enfants hospitalisés avec une prédominance de surinfections cutanées bactériennes (n = 53, 67 %), suivies des complications neurologiques (n = 11, 14 %), respiratoires (n = 7, 9 %) et ostéoarticulaires (n = 5, 6 %). Staphylococcus aureus était la bactérie la plus fréquemment retrouvée (11 prélèvements positifs soit 26 % des prélèvements). En moyenne, la durée de traitement par antibiotique était de 7,5 j [écart-type : 7,2] avec une médiane à 7 j [1–10]. La durée moyenne de traitement antiviral était de 4,2 j. Notre étude confirme la gravité potentielle de la varicelle qui n'est pas toujours une maladie bénigne. La mise en place d'une vaccination systématique chez tous les enfants, en place dans de nombreux pays déjà depuis plusieurs années, pourrait permettre de diminuer l'incidence du nombre de cas de varicelle annuel, ainsi que le nombre de complication, encore responsables de 20 décès par an en France pouvant être évités. Varicella is a common childhood disease due to the varicella-zoster virus, which is responsible for epidemics mainly affecting children under the age of 10. Although benign in most cases, it can lead to severe complications, the most frequent of which are bacterial skin infections. With the introduction of systematic vaccination in many countries, the epidemiology of varicella has evolved considerably in recent years, with a clear reduction in the incidence of varicella and its complications in countries where vaccination has been introduced. In order to study the epidemiological, clinical and therapeutic characteristics of children hospitalized for varicella, we carried out a retrospective study in the various pediatric wards of the Armand Trousseau Hospital in Paris, including all children under 18 years of age, with or without previous history, hospitalized for varicella between January 1, 2021 and June 1, 2023. One hundred and five patients were included in the study. The median age was 2.1 years [1–4.2]. Complications occurred in 75 % (n = 79) of hospitalized children, with a predominance of bacterial skin infections (n = 53, 67 %), followed by neurological (n = 11, 14 %), respiratory (n = 7, 9 %) and osteoarticular (n = 5, 6 %) complications. Staphylococcus aureus was the most frequently found bacterium (11 positive samples, i.e. 26 % of all samples). On average, the duration of antibiotic treatment was 7.5 days [standard deviation: 7.2], with a median of 7 days [1–10]. The mean duration of antiviral treatment was 4.2 days. Our study confirms the potential seriousness of varicella, which is not always a benign disease. The introduction of systematic vaccination of all children, which has already been in place in many countries for several years, could help to reduce the incidence of annual cases of varicella, as well as the number of complications, which are still responsible for 20 preventable deaths per year in France. [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]

• The time since the last vaccination should be adjusted when comparing VE among subgroups. • Varicella vaccine was more effective when given at the early stage of the second year of life. • Matched case-control study design based on surveillance platforms could effectively reduce bias. • Logistic regression model with interaction term can be used to evaluate the interaction between factors. Universal varicella vaccination has been introduced in many countries, but there are a number of important differences in their vaccination strategies. It is essential to establish a vaccination program that can maximize the benefits of varicella vaccine, but there is a lack of comprehensive research on the effectiveness of varicella vaccine in different vaccination status. Using data from population-based surveillance platforms we conducted a 1:2 matched case-control study. The cases were clinically diagnosed varicella with onset from 2017 to 2021, 1–14 years old in Chaoyang District, Beijing. The controls were matched according to date of birth (±1 month), sex and residence. The vaccination data of the subjects were obtained from the Childhood Immunization Information Management System in Beijing. Using conditional logistic regression models with or without interaction terms, we evaluated the effectiveness of varicella vaccine in different vaccination status. A total of 2528 cases and 5056 controls were enrolled. This study found that whether the time since last vaccination was adjusted had a substantial effect on the comparing vaccine effectiveness (VE) between subgroups. After adjustment for the time since last vaccination, 1) the incremental VE of 2-dose was 49.6 % (95 % Confidence Interval [CI], 38.8–58.6) compared with 1-dose (93.9 % vs. 88.0 %); 2) Among children who received one dose, the risk of chickenpox in children vaccinated at 18–23 months was 1.382 (95 %CI, 1.084–1.762) times that in children vaccinated at 12–17 months. 3) the VE with less than one, two, and three year intervals is higher than that with six-year-intervals (P < 0.05), respectively. When comparing VE between subgroups of different vaccination status, the time since last vaccination should be adjusted. The first dose of varicella vaccine should be given as early as the second year of life, and the second dose can improve vaccine effectiveness. [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]

The aim of this study was to evaluate seroepidemiology of varicella in Wuxi, China, after two doses of immunization of varicella vaccine (VarV) for better control of varicella transmission. Participants were selected randomly by multistage stratified sampling. The positive rate of antibody and geometric antibody titer (GMC) was determined with enzyme-linked immunosorbent assays. Logistic and linear regressions were used to analyze the correlations between antibody seropositivity, GMCs, and corresponding factors. Serum samples (n = 697) were obtained from healthy children

Varicella is a vaccine-preventable disease caused by the varicella zoster virus (VZV), but the varicella incidence among children has increased in recent years. This was a retrospective birth cohort study based on the Zhejiang Provincial Immune Information System (ZJIIS) and the China Information System for Disease Control and Prevention (CISDCP) in Quzhou. A total of 1,291 clinically diagnosed varicella cases born from 2009 to 2014 were collected during 2009–2023, which were analyzed the impact of changes in vaccination strategy on the incidence of varicella based on the Cox-proportional hazards model. It was observed that the onset age of varicella shifted to the older age group and later to 9–11 years. After the change to the two-dose varicella vaccination strategy, the population affected by varicella was concentrated among students and received more than one dose of live attenuated varicella vaccine (VarV). Based on the Coxproportional hazards model and adjusting for all covariates, the risk of varicella infection in children decreased after the introduction of the two-dose varicella vaccination strategy (HR = 0.04, 95% CI: 0.03–0.05). Meanwhile, the Kaplan–Meier curves also showed that the hazards were lower after the change in vaccination strategy. It is recommended that two doses of VarV should be included in the national immunization schedule and that full vaccination should be completed approximately four years after the first dose.

ABSTRACTFew papers focus their attention on VZV vaccination effectiveness among people living with HIV (PLWH). Flanking the live attenuated vaccine (VZL) available, a newly recombinant vaccine (RZV) was recently introduced and approved for HZ prevention among adults. PLWH represents a population on which a particular attention should be applied, in order to guarantee the vaccine efficacy and safety. We performed a literature search in USNLM, PubMed, PubMed Central, PMC and Cochrane Library. From all the publications found eligible, data were extracted and processed per population, vaccine type, immunogenicity and ADRs. The review of the 13 included studies shows that both RZV and VZL are immunogenic and have an acceptable safety profile in adults and children living with HIV. However, given the lack of research available about vaccine efficacy in preventing VZV and HZ in PLWH, additional studies need to be performed, in order to achieve a full completeness of data.

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.

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]

The persistence of varicella outbreaks in Brazil has underscored the high concern with the low vaccine coverage in the last 4 years. Using publicly available data from the Brazilian Health System (SUS), this study analyzed varicella vaccine coverage and incidence trends from 2019 to 2022 in Brazilian States. Vaccine coverage decreased nationally in 2020, possibly influenced by the COVID-19 pandemic's initial phase. In Bahia State, we have the persistence of varicella with an incidence rate of 3.0 cases per 100,000 inhabitants (higher incidence compared to other States) in 2023. Under 15 months children and young children (4–6 Years old) faced the highest risk, urging the importance of vaccination. Despite a monovalent varicella vaccine being available through Brazil's National Immunization Program (NIP), Bahia fell short of achieving the ≥95 % disease control target for coverage. The study highlight the importance of vaccines to prevent some infectious diseases, as varicella, in poor tropical regions. Addressing vaccine hesitancy and misinformation, and augmenting awareness campaigns, are important to achieve and sustain high vaccine coverage over 80% as WHO guidelines to obtain a safe rate of protection for Brazilian population (Brazil's national immunization program has a target of 95% coverage). [ABSTRACT FROM AUTHOR]

The cost effectiveness of childhood varicella vaccination is uncertain, as evidenced by variation in national health policies. Within the European Economic Area (EEA), only 10 of 30 countries offer universally funded childhood varicella vaccination. This study estimates the cost effectiveness of universal childhood varicella vaccination for one EEA country (Ireland), highlighting the difference in cost effectiveness between alternative vaccination strategies. An age-structured dynamic transmission model, simulating varicella zoster virus transmission, was developed to analyse the impact of three vaccination strategies; one-dose at 12 months old, two-dose at 12 and 15 months old (short-interval), and two-dose at 12 months and five years old (long-interval). The analysis adopted an 80-year time horizon and considered payer and societal perspectives. Clinical effectiveness was based on cases of varicella and subsequently herpes zoster and post-herpetic neuralgia avoided, and outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented in 2022 Irish Euro and cost effectiveness was interpreted with reference to a willingness-to-pay threshold of €20,000 per QALY gained. From the payer perspective, the incremental cost-effectiveness ratio (ICER) for a one-dose strategy, compared with no vaccination, was estimated at €8,712 per QALY gained. The ICER for the next least expensive strategy, two-dose long-interval, compared with one-dose, was estimated at €45,090 per QALY gained. From a societal perspective, all three strategies were cost-saving compared with no vaccination; the two-dose short-interval strategy dominated, yielding the largest cost savings and health benefits. Results were stable across a range of sensitivity and scenario analyses. A one-dose strategy was highly cost effective from the payer perspective, driven by a reduction in hospitalisations. Two-dose strategies were cost saving from the societal perspective. These results should be considered alongside other factors such as acceptability of a new vaccine within the overall childhood immunisation schedule, programme objectives and budget impact. [ABSTRACT FROM AUTHOR]

Immunisation against herpes zoster is recommended for adults aged ≥ 50 years. Two vaccines, a live attenuated (ZVL, Zostavax®) and an adjuvant recombinant subunit (HZ/su, Shingrix®), are available in Australia. Immunisation guidelines are shifting their recommendations towards HZ/su because of higher efficacy in preventing herpes zoster and associated complications. However, there are limited post-marketing data comparing the safety profiles of these vaccines. Data from SmartVax, an active surveillance system for monitoring adverse events following immunisation (AEFIs) utilised by > 450 clinics throughout Australia, were analysed. Data from patients aged ≥ 50 years, who received ZVL or HZ/su, from 1 June 2021 to 31 May 2022, at clinics that utilised SmartVax were included. The proportion of records where patients who reported any, local, and systemic AEFIs after receiving ZVL or HZ/su were compared using multivariable logistic regression models. Data from 10,392 immunisation records (n = 8341 ZVL; n = 2051 HZ/su) were included. The proportion of AEFIs reported was higher with HZ/su (41.9 % [any], 33.8 % [local], 25.2 % [systemic]) than with ZVL (8.7 % [any], 6.2 % [local], 3.5 % [systemic]). After controlling for demographic variables, HZ/su presented a 6-fold increase in the odds (OR 6.44; 95 %CI: 5.57–7.46) of a reported AEFI compared to ZVL. Only 59 (0.6 %) of vaccinations lead to medical attention being sought due to an AEFI. While rates of AEFIs was higher with HZ/su than ZVL, most AEFIs were mild and did not require medical attention. Our findings support the change in vaccine recommendations and the use of HZ/su in immunisation programs. [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]

Objective: Varicella is a highly contagious illness with potentially severe complications, especially in young children. In Turkey, the varicella vaccine was integrated into the Universal Varicella Vaccination program in 2013, targeting 12-month-old infants. While officially reported varicella cases have decreased considerably in the past two decades, underreporting remains a challenge. This study aimed to investigate varicella seropositivity in a tertiary center. Material and Methods: A qualitative immunoassay, the enzyme-linked immunosorbent assay (ELISA), was employed to detect anti-varicella antibodies. Serum samples were collected from individuals aged 4 to 18 residing in Turkey. Information on vaccination records, varicella history, and disease notification was also collected. Results: The varicella IgG antibody records were accessed for a total of 90 children. The overall prevalence of positive varicella antibodies was 58.0% (n=47) in the study population. Seropositivity rates were 67.2% for the 4-6 age group and 30% for the 7-12 age group. Notably, the 4-6 age group showed a significant association between seropositivity and age [p=0.005; OR=4.85; 95%CI (1.614-14.569)]. Conclusion: The seropositivity rate of 58% for chickenpox is concerning. In light of this, conducting more extensive studies will provide valuable guidance. It may be worth considering the administration of an additional dose of the varicella vaccine within the age range of 4-6 years. Further research is necessary to assess the potential benefits and feasibility of implementing such a vaccination strategy. [ABSTRACT FROM AUTHOR]

Varicella (chickenpox) is a highly contagious disease caused by the varicella-zoster virus. Although typically mild, varicella can cause complications leading to severe illness and even death. Safe and effective varicella vaccines are available. The Joint Committee on Vaccination and Immunisation has reviewed the evidence and recommended the introduction of varicella vaccine into the UK's routine childhood immunisation schedule. To explore UK healthcare professionals' (HCPs) knowledge and attitudes towards varicella vaccination, its introduction to the UK routine childhood immunisation schedule, and their preferences for how it should be delivered. We conducted an online cross-sectional survey exploring HCPs' attitudes towards varicella, varicella vaccine, and their preferences for delivery of the vaccine between August and September 2022 prior to the recommendation that varicella vaccine should be introduced. 91 HCPs working in the UK (81 % nurses/health visitors, 9 % doctors, 10 % researcher/other, mean age 48.7 years). All respondents agreed or strongly agreed that vaccines are important for a child's health. However, only 58% agreed or strongly agreed that chicken pox was a disease serious enough to warrant vaccination. Gaps in knowledge about varicella were revealed: 21.0% of respondents disagreed or were unsure that chickenpox can cause serious complications, while 41.8% were unsure or did not believe chickenpox was serious enough to vaccinate against. After receiving some basic information about chickenpox and the vaccine, almost half of the HCPs (47.3%) in our survey would prefer to administer the varicella vaccine combined with MMR. Given the positive influence of HCPs on parents' decisions to vaccinate their children, it is important to understand HCPs' views regarding the introduction of varicella vaccine into the routine schedule. Our findings highlighted areas for training and HCPs' preferences which will have implications for policy and practice when the vaccine is introduced. [ABSTRACT FROM AUTHOR]

• About 40% of two-dose vaccinated nursery school children became ill with varicella. • Outbreaks at nursery schools might be transmitted from older students, perhaps siblings. • Vaccine effectiveness in the nursery school for more than one dose was not confirmed. • Vaccination using one dose or more can reduce severity significantly. In Japan, routine administration to one-year-old children of two-dose immunization for varicella was introduced in October 2014. Object The object of this study was to report outbreaks of varicella under routine immunization at a nursery school and in its surrounding area using data of surrounding areas from the (Nursery) School Absenteeism Surveillance System. Then, we measured the effectiveness of routine two-dose immunization for varicella to onset. We tentatively assessed its severity in a nursery school. The study period extended from April 2017 through March 2018. The study area comprised Nursery school B and other nursery schools, and elementary and junior high schools in City A. Subjects in Nursery school B were 120 children. We analyzed vaccine effectiveness (VE) as an observational study and assessed severity using Fisher's exact test. We also assessed VE for severity using linear regression. Severity was defined as the length of nursery school absence attributable to varicella infection. During the one month preceding a period of two weeks before the initial case at Nursery school B, there were 16 cases of varicella infection in nursery schools, 45 cases in elementary schools, and one case in junior high schools in City A. For children who had received one vaccine dose or more, VE was 48.1% for all ages and 49.2% among children three years old and older. No significant VE against infection was found. Vaccination using one dose or more can reduce severity significantly. Discussion and conclusion: Because many nursery school children who had received two doses of vaccine were infected, VE was estimated as low in the nursery school and not significant. Although VE for severity with more than one dose was confirmed, a second dose might not reduce severity compared to one dose. [ABSTRACT FROM AUTHOR]

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]

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]

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]

Pediculosis and varicella, common in children, typically pose no significant diagnostic or treatment challenges. However, the ongoing full-scale war in Ukraine has led to severe humanitarian consequences, including mass migration and health care infrastructure damage. Under such conditions, standard treatment modalities, including isolation and hygiene measures, may be impracticable. These challenges underscore the need for adapting patient management strategies to crisis conditions. We report a case of a previously well 10-year-old female, presenting with pediculosis capitis and varicella co-infection, complicated by folliculitis. Pediculosis had been detected by the parents one week before the onset of varicella, and they self-administered a topical anti-pediculosis agent based on clearol and dimethicone once. On the 12th day of varicella infection, we found purulent rash elements on the scalp, severe pruritus, and presence of lice eggs and nits. Considering the evidence of folliculitis on the scalp, which complicated the use of external pediculicides and hygienic procedures, the case necessitated a tailored treatment approach. This included oral cefuroxime for bacterial superinfection, and two doses of oral ivermectin for pediculosis 200 mcg/kg one week apart, along with chloropyramine hydrochloride for pruritus management. The strategy resulted in elimination of head lice infestation with no adverse events. This case illustrates the critical need for updated clinical protocols and health care provider education on optimal treatment practices, especially in crisis contexts. The coexistence of varicella with a pediculosis infection precipitated a secondary bacterial infection requiring systemic antibacterial treatment. Clinical research provides evidence of oral ivermectin effectiveness in pediculosis treatment when topical pediculicides cannot be utilized. To mitigate varicella complications and control epidemic processes, integrating varicella vaccination into the national immunization schedule is recommended. Moreover, for cases with varicella and ectoparasitic infections, systemic treatment with antiviral and antiparasitic agents like acyclovir and ivermectin should be considered to minimize the risk of superinfection. The registration of oral ivermectin for pediculosis treatment by state health authorities is advocated to formalize its use in clinical practice.

Objective To analyze the epidemiological characteristics of notifiable infectious diseases in Tongzhou District of Nantong from 2017 to 2022, and provide scientific basis for developing targeted prevention and control strategies and measures. Methods Descriptive epidemiological methods were used to analyze the reported data of notifiable infectious diseases in Tongzhou District of Nantong from 2017 to 2022. Results From 2017 to 2022, a total of 25 379 cases of 26 types of notifiable infectious diseases were reported in Tongzhou District of Nantong, with an average annual incidence of 33.80 per 10 000. There were 27 deaths, with an average annual mortality rate of 0.04 per 10 000. Among the reported cases, the ratio of male to female reported incidence was 1.34∶1. The highest incidence of infectious diseases was observed in the age group under 10 years, mainly due to cases of varicella and hand-foot-mouth disease. The main occupational groups affected were farmers, preschool children, students, scattered children, and homemakers / unemployed individuals. Digestive tract infectious diseases such as hand-foot-mouth disease and other infectious diarrhea were mainly reported in summer, while respiratory tract infectious diseases such as varicella were more common in winter. The areas with the highest incidence were Xianfeng Street, Jinsha Street, and Xingren Town. The main types of infectious diseases reported were respiratory and intestinal tract infections. The top three reported diseases in terms of incidence rate were varicella, hand-foot-mouth disease, and syphilis. Conclusion In 2017—2022, the reported incidence of notifiable infectious disease in Tongzhou District of Nantong has showed a trend of fluctuating decline. However, it is still necessary to strengthen the monitoring and prevention of varicella and hand-foot-mouth disease, pay attention to the publicity and intervention of sexually transmitted diseases (such as syphilis), and maintain the incidence and mortality of notifiable infectious diseases at a low level compared to the national average.

Abstract 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.

Introduction. Given the unfavorable epidemic situation with chickenpox and shingles in Russia, there is a high risk of virus introduction and spread in healthcare settings, including among medical staff who are not immune to varicella zoster virus (VZV). The objective of this study is to assess the immunity of employees of a multidisciplinary hospital in Moscow to VZV. Materials and methods. A selective screening study was carried out. Venous blood serum samples were taken from 1546 hospital employees as material for detection of IgG antibodies to VZV antigens using a commercial solid-phase enzyme immunoassay (ELISA) test system "Vecto VZV-IgG". All employees were questioned to obtain information about their infectious and vaccine history in relation to VZV. Results and discussion. Screening for antibodies to VZV in the hospital workers revealed that 6.3% of those workers are not immune to VZV. The proportion of seronegative individuals was the highest (12.6 ± 2.4%) in the age group of 29 years and younger. VZV seronegative healthcare workers were found in various departments, but the presence of non-immune individuals among the staff of the obstetrics and gynecology departments (6.5%) is of epidemiologic concern. The results of the survey showed that documented data on infection and vaccination history cannot be used to assess the protection of healthcare workers against VZV infection. Conclusion. The results of serologic screening for antibodies to VZV made it possible to identify a significant number of susceptible employees of the multidisciplinary hospital. In order to prevent the formation of multiple epidemic foci of varicella in medical organizations, it is advisable to include anti-VZV testing of medical staff in the state prevention programs with subsequent vaccination of non-immune individuals.

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]

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]

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]

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]