A case of primary varicella meningoencephalitis in the absence of cutaneous lesions in a 4-month-old infant

Primary varicella infection has typical cutaneous lesions which aid in clinical diagnosis. Infants with transplacental transfer of varicella antibody can have varied cutaneous lesions. We report a 4-month-old infant with primary varicella meningoencephalitis without cutaneous lesions whose mother had no history of varicella during antenatal or post-natal period. Diagnosis was made possible by CSF DNA PCR. Infants with encephalitis pose diagnostic challenge to clinicians in resource limited settings. Varicella encephalitis is one such aetiology for which definitive therapy with Acyclovir is available. CSF PCR is the definitive and cost-effective test for the diagnosis varicella encephalitis. In children with meningoencephalitis it is prudent to add Acyclovir empirically pending CSF viral PCR results.

Parental acceptance and knowledge of varicella vaccination in relation to socioeconomics in Sweden: A cross-sectional study

Varicella infection is a highly contagious disease which, whilst mild in most cases, can cause severe complications. Varicella vaccination is available privately in Sweden and is currently being reviewed for inclusion in the Swedish Public Health Agency’s national immunisation program (NIP). A cross-sectional study of parents of Swedish children aged 1–8 years (n = 2212) was conducted to understand parental acceptance, beliefs and knowledge around varicella infection and vaccination. Respondents generally viewed varicella infection as a mild disease, with only a small proportion aware of potential severe complications. While 65% of respondents were aware of the vaccine, only 15% had started the course of vaccination as of February 2019. Further, 43% of parents did not intend to vaccinate, most commonly due to lack of inclusion in the NIP, but also due to perception of mild disease. Nevertheless, if offered within the NIP, 85% of parents would be highly likely to vaccinate their child. A number of statistically significant differences in awareness and behaviours were observed between sociodemographic subgroups. In general, women were more aware of vaccination (72%) compared to men (58%). Among unemployed or respondents with elementary school education, awareness was below 43%, and among respondents with high income the awareness was above 75%. Similarly, among unemployed or respondents with a low income the vaccination rate was as low as 30% compared with at least 57% among respondents with a high income. Respondents from metropolitan areas, those with university degrees and respondents with a higher income were more likely to be aware of the varicella vaccine and to have vaccinated their child. Whilst inclusion in the NIP is clearly the main driver for uptake, these identified knowledge gaps should inform educational efforts to ensure that all parents are informed of the availability and benefits of the varicella vaccine independent of socioeconomic status.

Varicella Infection During Pregnancy- Maternal and Fetal Outcome; Case Series and Analysis in a Tertiary Centre in South India!

Background: This is a retrospective study undertaken to analyse the maternal and fetal outcome of varicella infection during pregnancy. Methods: This is a retrospective observational study done in Kerala Institute of Medical Sciences, Trivandrum, a tertiary care hospital in South India. Sixty nine women infected with chickenpox during pregnancy from January 2009 to February 2018 (9 years) were taken for the study. Results: The incidence of chickenpox during pregnancy in our study was 33.7 in 10000 pregnancies. There were no spontaneous miscarriages. The incidence of congenital anomalies was 7.2% and when compared to the overall obstetric population of the nine year study period in which the incidence was 6.5 %, there was no statistical significance (p- 0.99). The incidence of preterm labour was 4.7% and when compared to the overall obstetric population in which the incidence was 15 %, there was a statistically significant less incidence (p- 0.035). The incidence of polyhydramnios was 4.7% and when compared to the overall obstetric population in which the incidence was 1%, there was a statistically significant increased incidence (p - 0.018). The incidence of fetal growth restriction was 13% and when compared to the overall obstetric population in which the incidence was 12.4%, there was no statistically significant difference (p- 0.963) Conclusions: The maternal and fetal complications with chickenpox infection during pregnancy were more when infected in the first trimester. Early treatment, screening and followup will reduce the maternal and fetal morbidity

Varicella outbreak at a nursery school under routine immunization

Background and objective: In Japan, routine administration of two-dose immunization for varicella to one-year-old children was introduced in October, 2014. The objective of this study was measurement of the effectiveness of routine two-dose immunization for varicella to onset and assessment of severity in a nursery school setting. Method: The study period extended from the beginning of April, 2017 through March, 2018. The study area was Nursery school B in a city A. Subjects were 120 children in all. We analyzed vaccine efficacy (VE) as an observational study and assessed severity using Fisher exact test. We also assessed VE for severity using linear regression. Severity was defined as the length of school absence attributable to varicella infection. Results: For one dose or more, VE was 48.1% for all ages and 49.2% among children three years old and older. No significant VE was found. Vaccination using one dose or more can reduce severity significantly. Discussion and conclusion: Low VE was found in a nursery school setting, although results were not significant. VE for severity was confirmed, but a second dose might not reduce severity.

Post Varicella Angiopathy as a Cause of Pediatric Stroke: A Case Report

Varicella-zoster virus is a neurotropic herpes virus that contains double stranded DNA. It can cause primary, latent and reactivation infection. Chickenpox is the primary manifestation and result in life long latent infection of sensory neurons. Varicella infection is usually self limiting and complications occur mostly in immunocompromised patients. The most common neurological complications following varicella infection are cerebellar ataxia and encephalitis but arterial ischemic stroke in pediatric patient is also significant. Post varicella angiopathy also published under transient cerebral arteriopathy and is nearly always self -limited and may be the result of focal inflammation1. Arterial ischemic stroke may occur during the course of varicella infection or one week to several months after the appearance of rash. Here we present a case of 6 years old male who presented with right hemiparesis with right sided facial nerve palsy two months after chickenpox. An MRI was done which was suggestive of hyperintensities in basal ganglia and internal capsule in T-1 weighted MRI. Although the weakness was self-limiting patient was treated with aspirin in addition to supportive measures. Keywords: Arterial ischemic stroke, Post varicella angiopathy, Varicella zoster virus, Middle cerebral artery, Upper motor neuron, Lower motor neuron.