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Varicella-Zoster Virus: Overview of Chickenpox and Shingles for Healthcare Professionals, Exams of Epidemiology

An overview of Varicella-Zoster Virus (VZV), including clinical descriptions, epidemiology, impact of vaccination programs, and vaccine information for both varicella (chickenpox) and herpes zoster (shingles). It also covers VZV laboratory testing and contact information for additional resources.

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Varicella (Chickenpox) and Herpes
Zoster (Shingles):
Overview of VZV Disease and Vaccination for
Healthcare Professionals
Epidemiology Branch, Division Viral Diseases
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta, GA, USA
Revised August 2, 2013
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Varicella (Chickenpox) and Herpes

Zoster (Shingles):

Overview of VZV Disease and Vaccination for Healthcare Professionals

Epidemiology Branch, Division Viral Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, GA, USA

Revised August 2, 2013

1

Outline

  • Varicella-Zoster Virus (VZV)
  • Varicella
    • Clinical Description
    • Epidemiology and Impact of the Varicella Vaccination Program
    • Vaccine Information
    • Varicella Vaccination of Healthcare Personnel
  • Herpes Zoster
    • Clinical Description
    • Epidemiology and Vaccination Coverage
    • Vaccine Information
  • VZV Laboratory Testing
  • Contact Information and Additional Resources

VARICELLA

VARICELLA: CLINICAL DESCRIPTION

Varicella: Clinical Features in Vaccinated

Persons (“breakthrough varicella”)

  • Breakthrough varicella is defined as infection with wild-type varicella disease occurring > 42 days after vaccination
  • Approximately 15-20% of 1-dose vaccinated persons may develop varicella if exposed to VZV
  • Usually milder clinical presentation than varicella in unvaccinated cases - Usually low or no fever - Develop < 50 lesions - Experience shorter duration of illness - Rash predominantly maculopapular rather than vesicular
  • 25-30% of breakthrough varicella cases are not mild and have clinical features more similar to varicella in unvaccinated persons Chaves J Infect Dis 2008; Arvin Clin Microb Rev 1996; CDC. Prevention of Varicella. MMWR 2007; 56(No. RR-4)

Varicella: Complications

  • Secondary bacterial infection of skin lesions
  • Central nervous system manifestations (meningoencephalitis, cerebelllar ataxia)
  • Pneumonia (viral or bacterial)
  • Hepatitis, hemorrhagic complications, thrombocytopenia, nephritis occur less frequently
  • Certain groups at increased risk for complications
    • Adults
    • Immunocompromised persons
    • Pregnant Women
    • Newborns

CDC. Prevention of Varicella. MMWR 2007; 56(No. RR-4); Arvin Clin Microb Rev 19

VARICELLA: EPIDEMIOLOGY AND

IMPACT OF THE VARICELLA

VACCINATION PROGRAM

Varicella Disease Burden in the United

States Before Introduction of Varicella

Vaccine in 1995

  • 4 million cases/year
  • 11,0000 - 13,500 hospitalizations/year
  • 100 - 150 deaths/year
  • Greatest disease burden in children
    • 90% cases - 70% hospitalizations - 50% deaths

Wharton Infect Dis Clin North Am 1996; Galil Pediatr Infect Dis J 2002; Davis Pediatrics 2004; Meyer J Infect Dis 2000; Nguyen NEMJ 2005

Varicella and Measles Vaccine Coverage

(1+ doses)*, Children 19-35 Months

National Immunization Survey, 1997-

26

43

58

68

76

81 85

88 88 8

0

10

20

30

40

50

60

70

80

90

100

Coverage (%)

1997 1998 1999 2000 2001 2002 2003 2004 2005 20 *National Immunization Survey (NIS), coverage available at http://www.cdc.gov/vaccines/stats-surv/default.htm#nis Year

Varicella Cases and 1-Dose Vaccine Coverage Varicella Active Surveillance Project Sites, 1995-

Antelope Valley, California

0

20

40

60

80

100

0

500

1000

1500

2000

2500

3000

3500

1995 1997 1999 2001 2003 2005 Year

Varicella Cases

Vaccination coverage

West Philadelphia

-

0

20

40

60

80

100

0

200

400

600

800

1000

1200

1400

1995 1997 1999 2001 2003 2005 Year

Vaccine Coverage

Varicella cases

90% decline in varicella incidence in both sites

Guris J Infect Dis 2008

Reduction in Varicella Health Care Costs

  • Total estimated direct medical expenditures

for varicella hospitalizations and

ambulatory visits

  • 1994-1995 $85 million
  • 2002 $22 million
  • 74% decline in total estimated direct medical expenditures for varicella hospitalizations and ambulatory visits from 85 to 22 million

Zhou JAMA 2005

Decline in Reported Varicella Deaths

<50 years of age, US, 1990-

No. of Deaths

average=

93% decline in deaths in 2005- 2006 compared to pre-vaccine era 1990- 1994

average=

YEAR

National Center for Health Statistics

VARICELLA: VACCINE INFORMATION

Varicella Vaccines

  • Two live attenuated varicella virus vaccines licensed for use in US: Varivax®^ and Proquad®
  • Both vaccines may be used for first and second doses of varicella vaccine
  • Varivax ®^ (1,400 pfu) is the single-antigen varicella vaccine licensed in 1995 for use among healthy persons aged ≥ 12 months
  • Proquad®^ or MMRV (9,800 pfu) is a combination measles, mumps, rubella, and varicella vaccine licensed in 2005 for use among healthy children aged 12 months- 12 years

CDC. Prevention of Varicella_. MMWR_ 2007; 56(No. RR-4)