Varicella-Zoster Virus

Johnsy Johnson
2009D004
 Varicella Zoster Virus
Varicella (Chicken Pox)
•Acute, highly contagious viral disease with worldwide
distribution.
•Mostly a mild disorder in childhood.
•Tends to be more severe in adults.
•It may be fatal:
i. Neonates (baby or an infant).
ii. Immunocompromised person.
The Pathogen

•A double stranded DNA virus: human herpesvirus-3

•Only one serotype(it’s a group f microrganisms, viruses, or cells classified
together based on their cell surface antigen) known.
•Humans are the only reservoir.
•VZV enter the host through the nasopharyngeal mucosa,
and almost invariably produces clinical disease in susceptible
individuals.
Transmission

•The virus is transmitted by:

1. Direct contact with the rash.
2. Airborne respiratory droplets.
3. Vertical transmission( mother to baby) during pregnancy.
•Can transmit the virus for up to 48hrs before rash appears
and remains contagious until all spots crust over.
•Little Genetic Variation.
•No animal reservoir.
Signs and Symptoms.

•In healthy children the disease is generally mild.

•The illness is usually 14-16days after exposure.
•Mild headache.
•Malaise or Irritability.
•Red, itchy rash appear first on the scalp, face and trunk.
•Quickly turn into clear fluid-filled vesicles.
•Itching may range mild to intense.
Immune response.

•Natural Infection induces lifelong immunity to clinical Varicella

in almost all immunocompetent persons.
•Newborn babies of immune mothers are protected by
passively acquired antibodies during their first months of life.
•Temporary protection of non-Immune individuals can be
obtained by injection of Varicella-zoster immune globulin
within 3 days of exposure.
•The immunity acquired in the course of Varicella prevents
neither the establishment of a latent VZV infection, nor the
possibility of subsequent reactivation of zoster.
Treatment

•For Healthy children no medical treatment, Only

antihistamine to relieve itching.
•IV Acyclovir (nucleoside analogues)
- Immunocompromised patients
- Patients being treated with chronic corticosteroids
i. Medications to shorten the duration of the infection
ii. Help reduce the risk of complications
•Valacyclovir and Famciclovir
approved for use only in adults
•Complicated cases
Hospitalization
Skin infections and pneumonia : antibiotics
Encephalitis : antiviral drugs
•Don't give Aspirin : *Reye's syndrome.
*Reye's syndrome -
Reye's syndrome is a potentially fatal disease that causes numerous harmful effects
to many organs, especially the brain and liver, as well as causing hypoglycemia(low
level of sugar in blood). The exact cause is unknown, and while it has been
associated with aspirin consumption by children with viral illness, it also occurs in
the absence of aspirin use.
Prevention
•The Varicella vaccine is the best way to prevention.

Vaccine
•Oka strain of VZV
•A single dose of vaccine : *Seroconversion 95%
•Optimal age for Varicella vaccination is 12–24 months.
•In Immunocompromised persons, including patients with
advanced HIV infection
Contraindication : fear of disseminated vaccine-induced
disease
Vaccine safety :
Patients with leukemia(abnormal proliferation of
leucocytes) in remission or solid tumors before
chemotherapy.
Uremic patients waiting for transplantation.
•A killed Varicella vaccine has been studied in VZV-positive
bone marrow transplant patients where a multiple-dose
schedule has been used to
reduce the severity of zoster

*Seroconversion – It is the period of time after a person is infected with an

infectious organism (such as a virus or bacterium) but before enough antibodies
have developed that they can be detected by a test.
Herpes Zoster

•Rash usually resolves within 14-21 days

•Postherpetic neuralgia
-pain persisting at least 1 month after the rash has healed
-incidence increases dramatically with age
4% in aged 30-50 years
50% in older than 80 years
Complications of Herpes Zoster

•Postherpetic neuralgia
•Ocular involvement with facial zoster
•Meningoencephalitis
•Cutaneous dissemination
•Superinfection of skin lesions
•Hepatitis/pneumonitis
•Peripheral motor weakness/segmental myelitis
•Cranial nerve syndromes, particularly ophthalmic and facial
(Ramsay Hunt syndrome)
•Corneal ulceration
•Guillain-Barré syndrome
Thank You!!