Varicella

Varicella. The varicella (chicken pox) vacciae was approved ia April 1995 for immunisation of children. A single dose at one year of age is recommended. In the future it may be combiaed with measles, mumps, and mbeUa. 

The sources for this type of control are infectious hospital or clinic patients, w here the infection can be transmitted through the airborne route. The most common application is for control of the spread of tuberculosis, but it could be used for other airborne infections such as varicella or influenza. -... 

Herpes zoster (shingles) is caused by the varicella (chickenpox) virus. It is highly contagious. The virus causes chickenpox in the child and is easily spread via the respiratory system. Recovery from childhood chickenpox results in the infection lying dormant in the nerve cells. The virus may become reactivated later in life as the older adult s immune system... 

Vaccination against varicella in people older than 1 year... 

Passive immunization of exposed, susceptible individuals who are at greater risk of complications from varicella than are healthy individuals... 

Vaccinations containing live organisms are not administered within 3 months of immune globulin administration because antibodies in the globulin preparation may interfere with the immune response to the vaccination. Corticosteroids, antineoplastic dru, and radiation therapy depress the immune system to such a degree that insufficient numbers of antibodies are produced to prevent the disease. When the salicylates are administered with the varicella vaccination, there is an increased risk of Reye s syndrome developing. 

The antibiotic and sulfonamide ophthalmics are contraindicated in patients with a hypersensitivity to the drug or any component of the drug. These dru are also contraindicated in patients with epithelial herpes simplex keratitis, varicella, mycobacterial infection of the eye, and fungal diseases of the eye There are no significant precautions or interactions when the dru are administered as directed by the primary health care provider. 

Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children, ie, those who lack a reliable history of chickenpox. Susceptible persons aged >13 years should receive two doses, given at least 4 weeks apart. 

Boxcar scars are round to oval depressions with sharply demarcated vertical edges, similar to varicella scars (Fig. 11.10).They can be divided into shallow (0.1-0.5 mm) or deep (>0.5 mm). 

In advanced AIDS, MM is usually associated with opportunistic infections such as CMV (Said et al. 1991 RouUet et al. 1994 Kolson and Gonzalez-Scarano 2001) or is secondary to lymphoma (Fuller et al. 1993). Despite a role for other herpes viruses in AIDS-associated myelitis, no substantive evidence has been published in support of a role for other vimses in the development of HIV-associated MM, including herpes simplex 1 or 2, varicella zoster, or Epstein Barr vims (Kolson and Gonzalez-Scarano 2001). MM can occur secondary to hepatitis B and C viruses, which are common co-infections of HIV-infected patients, particularly when there is an associated cryoglobulinemia (Taillan et al. 1993 Caniatti et al. 1996). Rarely... 

Acyclovir (aciclovir) Famciclovir r Herpes simplex and varicella zoster... 

Varicellat Human diploid cell cultures infected with attenuated varicella virus 1 Clarification 2 Freeze-drying Infectivity titration in cell cultures Tests to exclude presence of extraneous viruses... 

Varicella/zoster ELISA in paralled with a standard varicella-zoster immunoglobulin Not less than lOOlUmh ... 

IGIM should be injected into a deltoid or gluteal muscle. It does not affect the immune response of inactivated vaccines, oral polio virus, or yellow fever vaccine. The administration of live vaccines [e.g., measles, mumps, rubella (MMR) vaccine] concomitantly with IGIM may decrease the immune response significantly thus, MMR and varicella vaccine should be delayed for at least 3 and 5 months, respectively, after IGIM has been administered. Additionally, IGIM should not be given within 2 weeks of the MMR administration or within 3 weeks of the varicella vaccine to maximize the efficacy of the immunization.1... 

Human immunodeficiency virus Influenza Kala-azar Malaria Mycobacteria Mycoplasma Paramyxoviruses Rocky Mountain spotted fever Rubella Typhoid Varicella Variola... 

Viruses are a common cause of CAP in children (-65%) and much less common in adults ( 15%).8 Viruses often associated with pneumonia in adults include influenza A and B and adenoviruses, whereas less common causes include rhinoviruses, enteroviruses, cytomegalovirus, varicella-zoster virus, herpes simplex virus, and others. In children, viral pneumonia is caused more commonly by respiratory syncyntial virus, influenza A virus, and parainfluenza virus. The viruses associated with CAP in adults are much less common causes of pneumonia in children. 

Varicella VAR 0.5 mL Subcutaneous Allergic reaction to gelatin or neomycin Pregnant women Immunocompromised host Recently received a blood transfusion Hematopoietic stem cell transplant... 

Later in life, approximately 15% of the population will develop herpes zoster. Herpes zoster is the reactivation of latent varicella zoster virus in the sensory ganglia. Approximately 20% of persons with herpes zoster will develop post-herpetic neuralgia, which is a painful debilitating condition that can persist for months after resolution of the herpes zoster rash. 

The varicella vaccine is relatively new and has only been recommended for use since 1996, therefore its true impact on chickenpox and herpes zoster is not yet known. Its continued use will undoubtedly change the epidemiology of these diseases. 

The varicella vaccine is made up of an attenuated Oka strain of varicella zoster virus. This is a live attenuated vaccine. Attenuation was achieved by performing serial passages through human embryonic lung cells, embryonic guinea pig cells, and human diploid cells. 

Children less than 12 years of age will have a 97% seroconversion rate following a single vaccination. Adolescents and adults more than 13 years old will only have 78% seroconversion after a single inoculation, but will have 99% conversion after the second vaccination administered 4 to 8 weeks after the first. Antibody titers appear to persist for at least 20 years following immunization. Despite excellent seroconversion rates, breakthrough chickenpox is reported at a rate of 1 case per 10,000 doses distributed. Most cases occurred within the first year following vaccination, and were due to wild-type varicella zoster virus. The majority of breakthrough cases were mild and of short duration.12... 

Secondary transmission to household contacts is always a concern with administration of a live vaccine. There are a few cases of possible secondary transmission of varicella following vaccination. Of the cases that varicella typing was done, 62% were wild-type virus, indicating exposure to an unvaccinated person. There are less than 10 confirmed cases of secondary transmission of the Oka vaccine strain following vaccination. A mild rash occurring in less than 5% of persons has been reported following vaccination. The varicella virus may be shed from the rash. Rashes due to the Oka vaccine strain typically occur more than 20 days following vaccination.12... 

Varicella vaccine should be administered after 12 months of age and a second dose at 4 years of age. Adolescents and adults without evidence of immunity to varicella zoster should receive two doses of varicella vaccine given 4 to 8 weeks apart. Varicella vaccine is available as a single-component vaccine or in combination with measles, mumps, and rubella vaccine. 

There are several combination vaccines available in the United States. One of the most popular pediatric combinations is Pediarix a combination of diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, and hepatitis B vaccines. ComVax is a combination of Haemophilus influenzae type b and hepatitis B vaccines. The most recent combination is ProQuad which contains measles, mumps, rubella, and varicella vaccines. The only combination available for adults is Twinrix which has hepatitis A and hepatitis B vaccines. 

Varicella (chickenpox) Anaphylaxis or anaphylactic shock 7 days... 

Following hematopoietic stem cell transplantation the patient will need virtually all routine vaccines to be administered again however, the patient will not be able to mount an adequate response for 6 to 12 months post-transplant. Diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, hepatitis B, pneumococcal, and inactivated poliovirus should be given at 12,14, and 24 months post-hematopoietic stem cell transplantation. Inactivated influenza vaccine should be given yearly, starting 6 months after transplant. Measles, mumps and rubella can be given 2 years after transplant and varicella vaccine is contraindicated.16... 

Household contacts of immunocompromised persons should have all routine vaccines as scheduled, including yearly influenza vaccination. Children in the household may receive live virus vaccines without special precautions however, if a rash develops following varicella vaccination, contact should be avoided with the immunocompromised host until the rash resolves. 

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