Varicella zoster – HSV – 3

( Chicken pox )
Introduction
• Double stranded DNA Virus.
• Contagious disease
• Mainly affects children & Only
Humans are reservoir
• It causes two diseases
1.Chicken pox
2.Shingles ( Herpes zoster )
• Generalized vesicular eruptions on
skin and mucous membrane
• Severe manifestations in adults
and Immune compromised
Properties of virus
• Spherical in shape & 180 - 200 nm in diameter
• Enveloped viruses & Can be inactivated by fat solvents like alcohol,
ether.
• Can cause latent infection and periodic reactivation
 Chicken pox
• Acute ,Highly contagious viral disease with
worldwide distribution
• It is a childhood disease
• 5 years of age : Infection rate 50%
• 12 years of age : Infection rate 90 %
• Tends to be more severe in adults, sometimes may
be fatal
• Immunocompromised person
• Young age for infection - < 12 months
• Fatality rates
• Adults – 30 deaths / 100000 cases
• Infants - 7 deaths / 100000 cases
• 1 – 19 yrs - 1 – 1.5 deaths / 100000 cases
Herpes zoster
• Reactivation of latent VZV
• But it is uncommon in child
• It is not caused by exposure to a patient
with varicella
• 75 % of cases occurring after 45 years of
age, rare in healthy children
• It is more severe in children with HIV
infection & Children under
Immunosuppressive therapy
Pathogenesis of chicken pox
• Enters through Respiratory tract & Conjunctiva

• Virus enters blood stream and Lymphatic system

• Replicates in regional lymph nodes ( Primary viremia )

• Virus spreads to the reticuloendothelial system

• Cutaneous lesions starts to appear ( Secondary viremia )

• VZV is transported back to the mucosa of upper respiratory tract and

oropharynx
Pathogenesis of Herpes zoster
• Virus is transported in a retrograde manner through

Sensory axons

Dorsal root ganglia throughout the spinal cord

Virus establishes latent infection in the neurons and satelite

cells

Herpes zoster
Pathogenesis
SYMPTOMS

The itchy blister rash - appears 10 to 21 days after exposure to the

virus and usually lasts about five to 10 days.
More than 200 to 500 rashes will be appear
Other signs and symptoms, which may appear one to two days
before the rash, include:
•Fever
•Loss of appetite
•Headache
•Tiredness and a general feeling of being unwell (malaise)
Once the chickenpox rash appears,
it goes through three phases:

•Raised pink or red bumps (papules), which break out over

several days
•Small fluid-filled blisters (vesicles), which form in about one
day and then break and leak
•Crusts and scabs, which cover the broken blisters and take
several more days to heal
• Prodromal symptoms
• Fever
• Malaise
• Anorexia
• Headache
• Mild abdominal pain

Shingles
• Pain, burning or tingling
• Sensitivity to touch
• A red rash that begins a few days after the pain
• Fluid-filled blisters that break open and crust over
• Itching
Transmission
• Acquired by Inhaling viral containing particles, trapped in tiny
droplets released into the air from the nose or throat of an infected
person
• Virus enters the body by infecting cells in the RSPT.
• It spreads to other parts of the body including skin where it causes the
characteristic rash.
• A person with chickenpox is contagious 1 - 2 days before the rash
appears and until all blisters have formed scabs
• It makes from 10 – 21 days after an infected person for someone to
develop chicken pox.
Vaccination
• Varicella vaccination is Live attenuated vaccine
• Shots of Vaccines
• 1St shot – 12 -18 months
• 2nd shot - 4 – 6 years
• Children 13 years of age who never had chicken pox or received vaccine
should get two doses at least 28 days apart.

• MMRV – Given upto 13 years of age

Types of Chickenpox Vaccine
• There are two chickenpox vaccines that are licensed in the United States—Varivax
and ProQuad.
• Varivax
• Contains only chickenpox vaccine.
• Is licensed for use in people 12 months of age or older.
• Can be given to children for their routine two doses of chickenpox vaccine at 12
through 15 months old and age 4 through 6 years old.
• ProQuad
• Contains a combination of measles, mumps, rubella, and varicella (chickenpox)
vaccines, which is also called MMRV.
• Is only licensed for use in children 12 months through 12 years of age.
Vaccine for Shingles
• Live virus vaccine
• Recommends that healthy adults 50 years,
• Vaccines
• Zostavax
• Shingrix