VARICELLA (CHICKENPOX)

Introduction
Virus is a small collection of genetic code, either DNA or RNA, surrounded by a
protein coat. A virus cannot replicate alone. Viruses must infect cells and use
components of the host cell to make copies of themselves. Often, they kill the host
cell in the process, and cause damage to the host organism. Viruses have been
found everywhere on Earth. Researchers estimate that viruses outnumber bacteria
by 10 to 1. Viruses include varicella (chickenpox) most common disease in
children.
Chickenpox is a highly contagious disease caused by the varicella-zoster virus
(VZV). It can cause an itchy, blister-like rash. The rash appears first on the chest,
back, and face, and then spreads over the entire body. Chickenpox is very
contagious. If one person has it, up to 90% of the people close to that person who
are not immune will also become infected. Chickenpox can also be serious, even
life-threatening, especially in babies, adolescents, adults, pregnant women and
people with weakened immune systems. Before the vaccine was available, about 4
million people got chickenpox each year in the United States, over 10,500 of those
people were hospitalized, and about 100-150 people died.

Background of the Disease

VZV is a DNA virus and is a member of the herpesvirus group. Like other
herpesviruses, VZV persists in the body as a latent infection after the primary
(first) infection; VZV persists in sensory nerve ganglia. Primary infection with
VZV results in varicella. Latent infection can reactivate resulting in herpes zoster
(shingles). The virus has a short survival time in the environment.

Origin of the Disease

Varicella is an acute infectious disease caused by varicella-zoster virus (VZV).
Primary varicella infection (chickenpox) was not reliably distinguished from
smallpox until the end of the 19th century. In 1875, Rudolf Steiner demonstrated
that chickenpox was caused by an infectious agent by inoculating volunteers with
the vesicular fluid from a patient with acute varicella. In 1954, Thomas Weller
used cell culture to isolate VZV from vesicular fluid of patients with varicella or
zoster. A live, attenuated varicella vaccine was developed in Japan in the 1970s.
The vaccine virus was developed from virus isolated by Michiaki Takahashi from
vesicular fluid from an otherwise healthy child with varicella disease. Varicella
vaccine was licensed for general use in Japan and Korea in 1988, and in the United
States in 1995 for persons age 12 months or older. In 2005, a combination measles,
mumps, rubella, and varicella (MMRV) vaccine was licensed in the United States
for persons age 12 months through 12 years.
Signs and Symptoms
Chickenpox often starts without the classic rash, with a fever, headache, sore
throat, or stomachache. These symptoms may last for a few days, with the fever in
the 101°–102°F (38.3°–38.8°C) range. The red, itchy skin rash usually starts on the
belly or back and face. Then it spreads to almost everywhere else on the body,
including the scalp, mouth, arms, legs, and genitals. The rash begins as many small
red bumps that look like pimples or insect bites. They appear in waves over 2 to 4
days, then develop into thin-walled blisters filled with fluid. The blister walls
break, leaving open sores, which finally crust over to become dry, brown scabs. All
three stages of the chickenpox rash (red bumps, blisters, and scabs) appear on the
body at the same time. The rash may spread wider or be more severe in kids who
have weak immune systems or skin disorders like eczema.

Mode of Transmission
The disease is most commonly transmitted by inhalation of respiratory droplets but
may also be transmitted by direct contact with the lesions.

References:
National Human Genome Research Institute
Centers for Disease Control and Prevention
Nemours Kids Health
Microbiology and Parasitology, Second Edition