Varicella bullosa a rare form of chickenpox in an immunocompromised child: a case study

The common human alpha herpesvirus known as varicella-zoster virus (VZV) causes both varicella (chicken pox) and herpes zoster (shingles). The frequent paediatric illness varicella is characterized by fever, viremia, and sporadic vesicular skin lesions. The bullous onset of chickenpox, is a very uncommon symptom that typically affects children who are immunosuppressed. Modern methods, such as polymerase chain reaction (PCR), have shed new light on this issue and strongly suggest that VZV can be involved in the development of bullae. Adequate prophylaxis and vaccination coverage help high-risk populations avoid complications. A7-year-old girl with polymorphic rash all over the body with comorbid diseases, diabetes mellitus type 1 and celiac disease. Past medical history stated suffering from COVID-19 infection. Physical examination revealed vesicular rashes of healing stages on various parts of the body with intense itching along with other symptoms of weakness, lethargy and lack of appetite. Based on the history, physical exam, and laboratory investigations, a definitive diagnosis of uncomplicated chickenpox, bullous form of moderate severity, was made. Treatment with saline infusion, iodinol, brilliant green solution, loratadine, acyclovir, amoklav, topical levofloxacin, and topical noxivin was initiated. The outcomes demonstrated that immunosuppression, autoimmune diseases and unvaccinated state of immunity might be the predisposing factors for development of bullous varicella. Inspite of its rarity, the disease have a good prognosis.

Varicela neonatal tardía: presentación en un paciente pediátrico / Late neonatalchickenpox: presentation in a pediatric patient

La varicela es una infección poco frecuente durante la gestación, el riesgo para el feto y las manifestaciones clínicas, variarán en función del momento del embarazo en que se produce la infección materna, cuando la erupción maculopapular materna se produce entre los 5 días previos al parto y las 48 horas posteriores, se habla de varicela neonatal tardía. La clínica es grave, con afectación visceral (pulmonar, cerebral, hepática, hemorragias cutáneas, etc.) y un 30 % de los casos desarrollarán una varicela fulminante. Se presenta el caso de neonato masculino que consultó por lesiones en piel, tipo pápulas eritematosas y vesiculares pleomorfas, de distribución dispersa. Con evolución clínica tórpida, permaneció 24 horas en la institución, con franco deterioro respiratorio y neurológico, compatible con cuadro de varicela neonatal tardía fulminante(AU)

Chickenpox is considered a rare infection during pregnancy, the risk to the fetus and the clinical manifestations will vary depending on the time of pregnancy when the maternal infection occurs, when the maternal maculo-papular injuries occurs within the previous 5 days after delivery and 48 hours after, there is talk of late neonatal chickenpox. The symptoms are severe with visceral involvement (lung, brain, liver, skin bleeding, etc.) and 30% of cases will develop fulminant chickenpox. We present the case of a male neonate who consults due to skin lesions, such as erythematous papules and pleomorphic vesicles, with scattered distribution. With a torpid clinical course, who remains in the institution for 24 hours, with frank respiratory and neurological deterioration compatible with late-neonatal fulminant varicella symptoms(AU)

Epidemiological characteristics of varicella epidemic situation at schools and kindergartens in JinShan District of Shanghai during 2015－2022 and antibody level analysis of varicella zoster virus in healthy population / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of varicella epidemic in kindergartens and schools in Jinshan District of Shanghai from 2015 to 2022，and to understand the varicella antibody level in students aged under 30 years old，to provide evidence for developing control and prevention strategies． Methods Data of varicella epidemic situation at schools and kindergartens and varicella cases were analyzed by descriptive methods．Collect serum from healthy individuals under 30 years old to detect IgG antibody levels of varicella zoster virus.Results From 2015 to 2022, a total of 91 cases of chickenpox were reported in kindergartens and schools in Jinshan District, Shanghai, involving 412 cases.The peak incidence occurs from October to December，kindergarten childcare and primary school children were at high risk of varicella .The incidence of fever(χ2=12.93，P＜0.001) and moderate to severe rash(χ2=28.79，P＜0.001) in patients with varicella vaccination was lower than that in patients without varicella vaccination. A total of 227 people were surveyed，the positive rate of varicella antibody was 62. 56%，the geometric mean titer ( GMT) was 2.22±0.68（165.96mIU/ml）．The difference of GMT(F=6.87，P＜0.001) and positive rate (χ2=29.14，P＜0.001)of antibody in different age groups was statistically significant，the positive rate was lowest in the age group of 1-3 years, and gradually increased with the increase of age. Conclusion Autumn and winter in Jinshan District are the seasons with high incidence of chickenpox in kindergartens and primary schools，two doses of chickenpox inoculation can not only reduce clinical symptoms, but also block the transmission of chickenpox epidemic，it is suggested schools and health facilities make chicken pox monitoring work, get the chickenpox vaccine on time.

Establish of the risk predictive model for varicella outbreaks in primary and middle schools / 中国学校卫生

Objective@#To investigate the epidemiological characteristics of varicella outbreaks in primary and middle schools, and to establish a risk predictive model, so as to provide scientific guidance for the prevention of varicella outbreaks in schools.@*Methods@#Based on a nested case-control study, primary and middle schools in 4 districts of Shanghai (Yangpu District and Jingan District) and Hangzhou (Xiaoshan District and Linping District) from January to December 2023 were selected to observe the status of varicella outbreaks. Associated factors of varicella outbreaks were investigated and used for establishing the predictive model, which was evaluated by the Hosmer-Lemeshow(H-L) goodness of fit test, receiver operating characteristic (ROC) curve, Calibration curve, decision curve analysis (DCA).@*Results@#A total of 98 varicella outbreaks were included, with 195 schools without varicella outbreaks during the same period as controls. Eight factors, including the availability of warm water in restroom, availability of hand soap in restroom, average class size, duration of student attendance at school per day, presence of a fulltime school doctor, hesitancy of the school principal towards varicella vaccination, and rates of first and second doses of varicella vaccination, were identified as potential factors for school varicella outbreaks, with statistically significant differences (χ2/Z=10.01, 20.49, 17.43, 9.74, 32.17, 6.60, 2.20, 3.39, P<0.05). The 8 variables above were employed to construct a risk predictive model, and Hosmer-Lemeshow goodness of fit test yielded a χ2 value of 5.863 (P>0.05); the area under the ROC curve (AUC) was 0.846 (95%CI=0.799-0.893); Calibration curve analysis indicated good consistency between predicted and actual values of the model. DCA demonstrated favorable predictive performance of the model over a wide range. @*Conclusions@#The predictive model for school varicella outbreaks demonstrates satisfactory accuracy and efficacy. It suggested to make good use of this prediction model and take relevant measures to reduce the risk of varicella transmission in schools.

Knowledge, perception, and practice of Libyan mothers towards varicella and its vaccination Tripoli, Libya

This study was conducted to ascertain the level of knowledge, perception and practice towards chickenpox infection and its vaccination and to find out the relationship of knowledge to some of related characteristics of the mothers and their children. A cross sectional study was conducted among Libyan mothers in Albadri polyclinic the east district of Tripoli. Data analysis was performed using the SPSS version 26. A total of 204 Libyan mothers attending Albadri polyclinic participated in the study their mean age was 32.06 (± 7.664) years. Most of the respondents (95.6%) had heard about chickenpox and (84%) stated correctly about its mode of transmission. Majority were well aware of the signs and symptoms of the infection, (51%) of the respondents knew about chickenpox vaccination, and only (43.1%) have been known that the vaccine was available in Libya. Concerning perception (81.4%) of respondents had negative perception about their child might get chickenpox. (80.9%) of the respondents were agree about their believing that chickenpox is serious disease and only 12.3% respondents believed that vaccine was effective, (77.9%) of respondents had negative perception about safety of vaccine. Concerning practice approximately (80%) of the respondents had vaccinated or had intension for vaccination their children against chickenpox. The current study indicated considerable knowledge levels and practice on varicella disease and its vaccination were observed among Libyan mothers. Addressing concerns regarding vaccine effectiveness, safety and importance through educational campaigns to ensure that all mothers are informed of the availability and benefits of the varicella vaccine

Monkeypox and chickenpox co-infection in a person living with Human Immunodeficiency Virus

Introduction: The 2022 mpox global outbreak underscores the need for an improved understanding of mpox epidemiology, co-morbidities, and clinical management/outcome. We report a case of a30-year-old Nigerian antiretroviral treatment-experienced person living with human immunodeficiency virus (PLHIV) who had PCR-confirmed mpox and chickenpox co-infection. Case presentation: The patient presented with a generalized itchy rash of three weeks and antecedent low-grade fever. He had no recent travel, animal exposure, or same-sex relationship. Examination revealed generalized pustular and nodular eruptions without peripheral lymphadenopathy. Results: CD4 count was 78 cells/mm3, wound swab microscopy revealed Gram-positive cocci in clusters and Gram-negative bacilli while culture yielded Pseudomonas aeruginosa. Despite supportive care and definitive antimicrobial therapy, his clinical condition deteriorated with sepsis-related multi-organ dysfunction and ultimately death. Conclusions: Mpox and chickenpox co-infection may occur, with potentially fatal complications in the setting of advanced HIV disease. Increased surveillance for co-viral infections in PLHIV with febrile exanthema and aggressive management to improve outcome are recommended.

A cross-sectional study to assess the epidemiologic profile and complications among chickenpox patients in an infectious disease hospital in a Metropolitan city

Background: Chickenpox is a highly contagious and acute disease caused by the varicella-zoster virus. According to a WHO position paper, varicella has a global disease burden of 140 million infections, 42 million severe sequelae, and 4200 fatalities every year. Chickenpox affects 16 persons per 1,000 people annually in wealthy countries. With a case fatality rate of 3 per 1,000 instances annually, 3% of these cases have problems, and 5% require hospitalization. This cross-sectional study assesses the epidemiological determinants & complications among the patients admitted to infectious disease hospitals. Methods: It was a descriptive, cross sectional and hospital based study. Total duration of study was 18 months (Jan 2020 -August 2021), conducted in infectious hospital of a metropolitan city. A total of 453 patients with confirmed diagnosis of chickenpox and getting admitted in the infectious disease hospital .were selected as study subjects and interviewed by a validated questionnaire. Results: A total of 453 chickenpox patients were included in the study and because of covid pandemic situation only 118 samples are interviewed of which 91 (77.1%) were males, remaining 27 (22.9%) were females and all 118 (100%) patients presented with rash which is the diagnostic feature of chickenpox, out of that 106 had fever, 84 had cough, 74 had malaise and 32, 17 patients had shivering and backache respectively. Conclusions: It was found that about one-quarter of cases recorded were in the age group of 19–40 years. This group most probably comprised those who missed the vaccination when they were children. Health education among the general population is suggested to reduce the secondary cases by early diagnosis and vaccination and isolation to reduce the burden of diseases.

Cobertura y barreras de la vacunación contra la varicela en niños que consultaron a la Fundación Salud Bosque / Coverage of and Barriers to Varicella Vaccination in Children at Fundación Salud Bosque / Cobertura e barreiras à vacinação contra varicela em crianças que consultaram a Fundação Salud Bosque

Introducción. Desde la introducción de la vacuna contra la varicela a Colombia no se ha logrado una cobertura mayor al 90%. El objetivo de este trabajo es identificar las barreras de vacunación contra varicela en niños. Metodología. Estudio descriptivo realizado en la Fundación Salud Bosque; se estudiaron 27 pacientes, 18 hombres (67%) y 9 mujeres (33%), incluyendo menores de 18 años con varicela, y excluyendo pacientes con enfermedades ampollosas distintas a varicela y quemaduras. Se hizo una caracterización demográfica. Para las variables cuantitativas se emplearon promedios y desviación estándar, y para las cualitativas la razón de proporción con Stata V12®. Resultados. La incidencia de varicela fue del 0.2%, solo 9 pacientes (33%) habían recibido la primera dosis de la vacuna, ninguno la segunda dosis. El 92.5% requirió incapacidad; el 89% analgésicos; el 63% antihistamínicos y el 26% antibióticos. Discusión. El estudio realizado demuestra una incidencia significativamente menor en contraste con otras cohortes internacionales. En Colombia no se ha alcanzado la cobertura de la vacunación contra la varicela lograda en Uruguay, Costa Rica, Estados Unidos, Australia, Europa y Taiwán dadas las mismas barreras en su aplicación, mientras que en África no se ha introducido la vacuna contra la varicela porque existen otras prioridades como la desnutrición, la malaria y la infección por Virus de la Inmunodeficiencia Humana. Conclusiones. La cobertura de la vacunación no se ha logrado por barreras modificables que incrementan la incidencia y carga de la enfermedad por costos debido a incapacidad, manejo farmacológico y ausentismo escolar. Palabras clave: Cobertura de Vacunación; Incidencia; Niño; Vacuna contra la Varicela; Varicela.

Introduction. Ever since the introduction of the varicella vaccine in Colombia, coverage has not surpassed 90%. The objective of this work is to identify the barriers to varicella vaccination in children. Methodology. A descriptive study conducted at Fundación Salud Bosque. 27 patients were studied - 18 males (67%) and 9 females (33%) - including children under 18 years of age with varicella, and excluding patients with blistering diseases other than varicella and burns. A demographic characterization was conducted. Averages and standard deviations were used for quantitative variables, and the proportion ratio was used for qualitative variables with Stata V12®. Results. The incidence of varicella was 0.2%. Only 9 patients (33%) had received the first dose of the vaccine, and none had received the second dose. 92.5% required sick leave, 89% required painkillers, 63% required antihistamines, and 26% required antibiotics. Discussion. The conducted study shows a significantly lower incidence compared to other international cohorts. Colombia has not achieved the varicella vaccination coverage of Uruguay, Costa Rica, the United States, Australia, Europe and Taiwan due to the barriers to applying it. Meanwhile, the varicella vaccine has not been introduced in Africa because there are other priorities, such as malnutrition, malaria and the Human Immunodeficiency Virus infection. Conclusions. Vaccination coverage has not been achieved because of modifiable barriers that increase the incidence and burden of the disease due to costs of sick leave, pharmacological treatment and school absenteeism. Keywords: Vaccination Coverage; Incidence; Child; Chickenpox Vaccine; Chikenpox.

Introdução. Desde a introdução da vacina contra varicela na Colômbia, não foi alcançada uma cobertura superior a 90%. O objetivo deste trabalho é identificar as barreiras à vacinação contra varicela em crianças. Metodologia. Estudo descritivo realizado na Fundação Salud Bosque. Foram estudados 27 pacientes, 18 homens (67%) e 9 mulheres (33%), incluindo crianças menores de 18 anos com varicela e excluindo pacientes com outras doenças bolhosas que não varicela e queimaduras. Foi feita uma caracterização demográfica. Média e desvio padrão foram utilizados para as variáveis quantitativas e, para variáveis qualitativas, a razão de proporção com Stata V12®. Resultados. A incidência de varicela foi de 0.2%, apenas 9 pacientes (33%) receberam a primeira dose da vacina, nenhum a segunda dose. 92,5% requeriam atestado; 89% analgésicos; 63% anti-histamínicos e 26% antibióticos. Discussão. O estudo realizado mostra uma incidência significativamente menor em comparação com outras coortes internacionais. A Colômbia não tem atingido a cobertura vacinal contra a varicela alcançada no Uruguai, Costa Rica, Estados Unidos, Austrália, Europa e Taiwan, dadas as mesmas barreiras em sua aplicação, enquanto na África a vacina contra a varicela não foi introduzida porque existem outras prioridades como a desnutrição, a malária e a infecção pelo Vírus da Imunodeficiência Humana. Conclusões. A cobertura vacinal não foi alcançada dadas as barreiras modificáveis que aumentam a incidência e carga da doença devido aos custos por atestados, manejo farmacológico e absenteísmo escolar. Palavras-chave: Cobertura Vacinal; Incidência; Criança; Vacina contra Varicela; Varicela

Pitiriasis liquenoide varioliforme aguda posterior al inicio de eritropoyetina / Acute varioliform lichenoid pityriasis following the initiation of erythropoietin

Resumen La pitiriasis liquenoide varioliforme aguda (PLEVA) pertenece a un grupo de enfermedades categorizadas como pitiriasis liquenoides, junto con la enfermedad febril úlcero-necrótica de Mucha-Habermann y la pitiriasis liquenoide crónica (PLC). Se caracteriza por la aparición aguda de múltiples pápulas eritemato-violáceas con posterior necrosis, discromía residual y cicatrices varioliformes. Dentro de las teorías patogénicas propuestas se encuentra el posible papel de agentes infecciosos, trastornos linfoproliferativos, complejos inmunes e incluso, asociación a medicamentos. Se presenta un casode una mujer adulta con un cuadro típico de PLEVA con confirmación histopatológica, cuyas lesiones aparecieron posteriormente al inicio de eritropoyetina.

Abstract Pityriasis lichenoides et varioliformes acuta (PLEVA) is part of a group of diseases clustered as pityriasis lichenoides, next to febrile ulceronecrotic Mucha-Habermann disease and pityriasis lichenoides chronica. It's characterized by a sudden onset of multiple erythematous and violaceous papules which develop necrosis, leaving residual dyschromia and varioliform scars. It's been hypothesized the possible role of infectious agents, lymphoproliferative diseases, immune complexes and drugs. We present the case of a woman with a typical PLEVA with histopathological confirmation, whose lesions appeared after therapy with erythropoietin.

Epidemiological evaluation for vaccine effectiveness of varicella attenuated live vaccine among students in collective institutions in Jing an District, Shanghai from 2017 to 2019 / 中国学校卫生

Objective@#To understand the vaccination of varicella attenuated live vaccine (VarV) among students in collective institutions, to provide a basis for analying the protective effect of vaccination.@*Methods@#All collective institutions with chickenpox epidemic and post exposure vaccination in Jing an District from 2017 to 2019 were investigated. All students( n =6 473) in the affected class were included. Vaccination status and the incidence information of disease were collected to analyze vaccine effectiveness (VE).@*Results@#The proportion of study subjects without an immunization history decreased year by year, and 7.5% in 2017, 7.2 % in 2018, and 4.9% in 2019. The proportion with a history of one dose prior to exposure in cases was 90.0%, it was lower than 93.5% in the non cases ( χ 2=6.53, P <0.05). The proportion with one dose as post exposure prophylaxis in cases was 8.3%, it was much lower than 44.1% in the non cases ( χ 2=179.06, P <0.01). The proportion with one dose as post exposure prophylaxis in secondary cases was 28.6%, much lower than 44.1% in the non cases ( χ 2=9.44, P <0.01).Unvaccinated ones and the second dose as post exposure prophylaxis ones in cases had the highest rate of varicella development (11.0%), a history of one dose prior to exposure and one dose as post exposure prophylaxis in cases had the lowest varicella rate (1.0%).There was a clear protective effect within two years after one dose of VarV inoculation, VE was 63.1%(95% CI =11.0%-84.7%).@*Conclusion@#The vaccine effectiveness of one dose VarV was limited. Post exposure prophylaxis as early as possible was highly effective in decreasing secondary attack rate.

Effectiveness and associated factors of varicella vaccination on school outbreaks / 中国学校卫生

Objective@#To evaluate the effectiveness of varicella vaccine in varicella outbreaks and to analyze the influencing factors, and to provide a reference for making the targeted prevention and controlling measures.@*Methods@#A total of 3 888 students with no history of varicella were selected from 2 schools with varicella outbreak in Guangdong Province in 2021, a retrospective cohort study was conducted by using questionnaire survey, rate ratio ( RR ) and vaccine effectiveness ( VE ) values were calculated and Logistic regression was uses to analyze the factors influencing the protective effect of varicella.@*Results@#There were 138 confirmed cases of varicella among the participants. There was no significant sex difference in the vaccination rate( χ 2=1.36, P =0.51), but there was significant difference in the vaccinattion rate of different age groups( χ 2=555.82, P <0.01). The overall protective effect of VarV was 66.94%(95% CI =56.17%-77.71%), and the protective effect of 2 doses of vaccine( VE = 90.02% , 95% CI =83.13%-96.90%) was higher than that of 1 dose( VE =49.40%, 95% CI =32.36%-66.44%)( χ 2=24.93, P < 0.01 ). The high fever rates in the vaccinated and unvaccinated groups were 7.69% and 25.81%, with significant difference( χ 2= 6.29 , P <0.05). The rates of moderate and severe skin lesions of vaccinated and unvaccinated groups was 20.00% and 50.00%, respectively, and the difference was statistically significant( χ 2=11.32, P <0.01). The protective effects of varicella vaccine against high fever and moderate to severe rash were 70.19%(95% CI =42.11%-98.27%) and 60.00%(95% CI =38.15%-81.85%). Stratified analysis showed that there were significant differences in different years of vaccination( χ 2=37.87, P <0.05), while there were no significant differences in age of vaccination and vaccine manufacturer ( P >0.05).@*Conclusion@#Varicella vaccination can prevent chickenpox infection and reduce the severity of the disease. However, the efficacy of varicella vaccine was affected by vaccination years. It is recommended to improve the vaccination coverage of varicella vaccine to prevent the outbreak of the epidemic.

Current situation and influencing factors of varicella vaccination among left-behind children aged 4-8 years old in Quzhou / 中国学校卫生

Objective@#To understand vaccination coverage and the influencing factors of varicella vaccine (VarV) among left-behind children in Quzhou, which based on protective motivation theory(PMT), so as to provide reference to consolidate VarV vaccination in the next step.@*Methods@#From September to December in 2022, simple random sampling was used to select 628 left-behind children in six counties of Quzhou City. A questionnaire survey on their caregivers was conducted to collect data relating to sociological characteristics and PMT factors, and the influencing factors of VarV were tested by Logistic regression.@*Results@#A total of 628 left-behind children participated in the study. The VarV rate was 69.59%, and 74.83% had received a second dose of VarV. The unvaccinated rate was 30.41%, and caregivers willingness to vaccinate children with VarV was only 10.99%. Logistic regression analysis showed that family relationships, annual household income, number of children in the family, extrinsic rewards and self-efficacy were the influencing factors of VarV among left-behind children ( OR =0.43-3.40， P <0.05). The external reward factor was positively correlated with the vaccination probability ( OR =1.14), and the self-efficacy factor was negatively correlated with the vaccination probability ( OR =0.95).@*Conclusion@#In the context of health education and school promotion, attention should be paid to factors relating to extrinsic rewards and self-efficacy as a means of increasing motivation to seek vaccine protection and improve the use of VarV.

Situação vacinatória da tríplice e da tetra viral em crianças matriculadas na Educação Infantil / The vaccination situation of triple and tetra viral in children enrolled in Early Childhood Education

Objetivo Descrever a situação vacinal de crianças matriculadas nos Centros Municipais de Educação Infantil da Zona Sul do município de Natal, Rio Grande do Norte com relação às vacinas de tríplice e tetra viral. Método Trata-se de um estudo epidemiológico, descritivo e retrospectivo, realizado a partir da análise de cartões de vacina de crianças matriculadas em 15 instituições, nas quais foi possível reunir 773 cartões que foram analisados a partir do calendário básico de vacinação do ano 2015. Os cartões foram classificados em: esquema vacinal completo, incompleto e/ou não vacinado. Resultados Observou-se que 576 (75,51%) crianças estavam com o esquema vacinal completo, sendo o esquema considerado finalizado com a segunda dose da tríplice ou com a tetra viral. A melhor situação vacinal foi atingida nas crianças de dois a quatro anos, com uma cobertura de 84,31%, sendo que 83,3% das crianças dessa faixa etária estavam com o esquema completo e 12,79% das crianças estavam com o esquema vacinal incompleto. Um total de 67 crianças (8,66%) não apresentaram registros de vacina. Com relação à tetra viral, 226 crianças (29,73%) apresentaram esquema vacinal completo. Conclusão Os resultados obtidos no presente estudo revelam uma situação vacinal abaixo da meta estabelecida pelo Programa Nacional de Imunização.

Objective To describe a vaccination situation of children up to 8 years old from the Municipal Centers of Early Childhood Education in the South Zone of the city of Natal, Rio Grande do Norte for vaccines of triple and tetra viral. Method This is an epidemiological, descriptive and retrospective study, carried out based on the analysis of vaccination cards for children from 15 institutions, where it was possible to gather 773 cards, a course based on the basic calendar of the year 2015. They were classified in: complete, incomplete and/or unvaccinated vaccination schedule. Results It is observed that 576 (75.51%) of the children have a complete vaccination schedule, the schedule being completed with a second dose of triple or tetra viral. The best vaccination status was achieved in children aged 2 to 4 years with a coverage of 84.31% and 83.3% children with the complete regimen. We have 12.79% of children with an incomplete vaccination schedule. A total of 67 children (8.66%) who did not have any vaccine records. Regarding Tetra Viral, 226 children (29.73%) had a complete vaccination schedule. Conclusion The results obtained in this study reveal a vaccination situation below the target established by the National Immunization Program.

Correlación entre casos de varicela y búsquedas en Google en Perú / Correlation between cases of chickenpox and Google searches in Peru

Con el objetivo de determinar la correlación entre los casos de varicela notificados en Perú y las búsquedas sobre varicela realizadas en Google a nivel nacional y por regiones se realizaron análisis de correlación de Spearman para las semanas epidemiológicas del 2016 al 2019, así como antes y después de la introducción de la vacuna para varicela en el Perú. A nivel nacional, se encontró una alta correlación antes del inicio de la vacunación (Rho 0,778, p = 0,001) y moderada durante el periodo de vacunación (Rho 0,441, p = 0,001). Algunas regiones tuvieron una correlación baja o muy baja y dejaron de ser estadísticamente significativas luego de la introducción de la vacuna en el Perú. Además, el cambio en la estacionalidad de la varicela durante el periodo de vacunación también tuvo un impacto en las búsquedas que realiza la población en Google.

Abstract In order to determine if there is a correlation between chickenpox cases reported in Peru and the chickenpox searches carried out on Google at national level and by regions, Spearman's correlation analyzes were carried out for the epidemiological weeks from 2016 to 2019, as well as before and after the introduction of the chickenpox vaccine in Peru. At the national level, a high correlation was found before the start of vaccination (Rho 0.778, p = 0.001) and moderate during the vaccination period (Rho 0.441, p = 0.001), some regions had a low or very low correlation and stopped to be statistically significant after the introduction of the vaccine in Peru. In addition, the change in the seasonality of chickenpox during the vaccination period also had an impact on the searches carried out by the population on Google.

Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study

ABSTRACT Objective To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up. Methods Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke. Results All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed. Conclusion We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.

Arteriopathy in pediatric stroke: an underestimated clinical entity / Arteriopatia em crianças com acidente vascular cerebral: uma entidade clínica subestimada

ABSTRACT Background: Pediatric arterial ischemic stroke (AIS), which was thought to be a rare disorder, is being increasingly recognized as an important cause of neurological morbidity, thanks to new advances in neuroimaging. Objective: The aim of this study was to review the main etiologies of stroke due to arteriopathy in children. Methods: Using a series of cases from our institution, we addressed its epidemiological aspects, physiopathology, imaging findings from CT, MR angiography, MR conventional sequences and MR DWI, and nuclear medicine findings. Results: Through discussion of the most recent classification for childhood AIS (Childhood AIS Standardized Classification and Diagnostic Evaluation, CASCADE), we propose a modified classification based on the anatomical site of disease, which includes vasculitis, varicella, arterial dissection, moyamoya, fibromuscular dysplasia, Takayasu's arteritis and genetic causes (such as ACTA-2 mutation, PHACE syndrome and ADA-2 deficiency). We have detailed each of these separately. Conclusions: Prompt recognition of AIS and thorough investigation for potential risk factors are crucial for a better outcome. In this scenario, neurovascular imaging plays an important role in diagnosing AIS and identifying children at high risk of recurrent stroke.

RESUMO Introdução: O acidente vascular cerebral (AVC) pediátrico, considerado um distúrbio raro, está sendo cada vez mais reconhecido como importante causa de morbidade neurológica, graças aos novos avanços na neuroimagem. Objetivo: Revisar as principais etiologias do AVC por arteriopatia em crianças. Métodos: Utilizando-se de uma série de casos de nossa instituição, abordamos seus aspectos epidemiológicos, fisiopatológicos e de imagem na angiotomografia computadorizada e angiorressonância magnética, sequências convencionais e avançadas de ressonância magnética e medicina nuclear. Resultados: Com base na classificação mais recente de AVC na infância (Classificação Padronizada e Avaliação Diagnóstica do AVC na Infância - CASCADE) propusemos uma classificação modificada com base no local anatômico da doença, que inclui vasculite, varicela, dissecção arterial, Moyamoya, displasia fibromuscular, arterite de Takayasu e causas genéticas (como mutação ACTA-2, síndrome PHACE e deficiência de ADA-2), detalhando cada uma separadamente. Conclusões: O reconhecimento imediato do AVC na infância e a investigação minuciosa de possíveis fatores de risco são cruciais para um melhor resultado. Nesse cenário, a imagem neurovascular desempenha papel importante no diagnóstico de AVC e na identificação de crianças com alto risco de recorrência.

Varicella incidence and vaccination of children in kindergarten and primary school of Longhua District in Shenzhen / 中国学校卫生

Objective@#To understand the situation of varicella prevalence and vaccination of susceptible population in Longhua District，and to provide reference for the varicella immunization program.@*Methods@#A total of 23 706 children from 30 childcare facilities and primary schools in 6 streets were randomly selected throughout the Longhua District. Date on age, grade, recent year and dosage of vaccination, varicella incidence, the overview of vaccination were collected and analyzed.@*Results@#The rate of vaccination in childcare facilities and primary schools was 86.01%, including 55.61% of 1 dose and 30.41% of 2 doses of vaccine. The differences of rate vaccination rate between the childcare facilities and primary schools had statistical significance(χ2=154.95, P<0.05).Rate of no-vaccination,1 dose vaccination and 2 doses vaccination across 6 streets differed significantly(χ2=146.09, 103.93, 127.31, 146.09, P<0.05). There was an increasing positive association between grades and attack rate(χ2=8.65，P<0.05). The differences of attack rate between the childcare facilities and primary schools was of statistical significance(χ2=478.69, P<0.05). The differences of attack rate in street of no vaccination,1 dose vaccination and total attack rate showed statistical significance(χ2=54.49, 74.59, 151.49，P<0.05). There was an increasing linear trend of attack rate of primary school childrenby each year(χ2=24.28，P<0.05). The attack rate increased with time after 1 dose vaccination, immune protection was obtuined for a longer period time after additional doses of vaccine.Negative association was found between grades and protective efficacy rate of varicella. The protective rate and efficacy index of different doses of vaccine in different grades were correlated(r=0.80，0.63，P<0.05). It was most effective after 1 dose vaccination among children in junior grade in kindergarten and 2 dose vaccination in senior grade.@*Conclusion@#After the implementation of vaccination program in Longhua District, the vaccination rate of 2 doses significantly increased, but not for a long time. Varicella vaccine should be included in immunization programme to protect vulnerable populations.

Surto de varicela entre imigrantes venezuelanos alojados em abrigos e ocupações no estado de Roraima, 2019: um estudo descritivo / Brote de varicela entre inmigrantes venezolanos alojados en albergues y ocupaciones en el estado de Roraima, Brasil, 2019: estudio descriptivo / Chickenpox outbreak among Venezuelan immigrants housed in shelters and occupancies in the state of Roraima, Brazil, 2019: a descriptive study

Objetivo: Descrever o surto de varicela entre imigrantes venezuelanos em abrigos e ocupações nos municípios de Pacaraima e Boa Vista, Roraima, Brasil, e as medidas de controle implementadas. Métodos: Estudo descritivo do tipo 'série de casos', realizado entre 21 de novembro e 13 de dezembro de 2019, sobre banco de dados secundários da investigação do surto disponibilizado pela Coordenação-Geral do Programa Nacional de Imunizações. Na análise descritiva, utilizaram-se medidas de frequência simples e relativa e foram calculadas medidas de tendência central e dispersão. Resultados: Dos 9.591 imigrantes, detectaram-se 38 casos ativos e 1.459 suscetíveis à varicela. Dos casos ativos, 23 eram do sexo feminino e a faixa etária mais acometida foi a de menores de 9 anos (17 casos). Conclusão: Identificaram-se pessoas suscetíveis a varicela na investigação; foram adotadas ações de imunização que controlaram a transmissão, evitando casos graves, óbitos e sobrecarga da rede de assistência à saúde local.

Objetivo: Describir el brote de varicela entre inmigrantes venezolanos en albergues y ocupaciones en los municipios de Pacaraima y Boa Vista, Roraima, Brasil, y las medidas de control implementadas. Métodos: Estudio descriptivo del tipo "serie de casos", entre el 21 de noviembre y 13 de diciembre de 2019, utilizando datos secundarios de la investigación del brote, puesto a disposición por la Coordinación General del Programa Nacional de Inmunizaciones. En el análisis descriptivo, se utilizaron medidas de frecuencia simple y relativa y se calcularon medidas de tendencia central y dispersión. Resultados: Entre los 9.591 inmigrantes se detectaron 38 casos activos y 1.500 susceptibles a la varicela. Entre los casos activos, 23 fueron mujeres y el grupo de edad más afectado fue de menores de 9 años (17 casos). Conclusión: Se identificaron personas susceptibles a la varicela, lo que llevó a adopción de acciones de inmunización que controlaran la transmisión, previniendo casos graves, muertes y sobrecarga de la red local de atención.

Objective: To describe chickenpox outbreak among Venezuelan immigrants in shelters and occupancies in the municipalities of Pacaraima and Boa Vista, the state capital of Roraima, Brazil, and the control measures implemented. Methods: This was a descriptive case series study, conducted between November 21 and December 13, 2019, based on secondary database obtained from the outbreak investigation made available by the General Coordination for the National Immunization Program. Descriptive analysis was performed using simple and relative frequency measurements, and measures of central tendency and dispersion were calculated. Results: Of the 9,591 immigrants, 38 active cases and 1,459 susceptible to varicella were identified. With regard to active cases, 23 were female, and those aged under 9 years (17 cases) were the most affected. Conclusion: People susceptible to chickenpox were identified during the investigation. Immunization actions aimed at reducing transmission were adopted, thus preventing severe cases, deaths and overload in local health care system.

Incorporación de segunda dosis de la vacuna de la varicela al Calendario Nacional de Vacunación de Argentina / Incorporation of the second dose of the varicella vaccine to the national vaccination schedule of Argentina

A partir de 2022, a la dosis de vacuna contra la varicela contemplada a los 15 meses de edad en el Calendario Nacional de Vacunación de Argentina, se suma una segunda dosis al ingreso escolar. En este artículo se repasan los aspectos clave para la implementación de esta práctica de inmunización universal, gratuita y obligatoria. (AU)

Starting in 2022, a second dose of the varicella vaccine will be added to the 15-month-old dose included in Argentina's National Vaccination Schedule at school entry. This article reviews the key aspects for the implementation of this universal, free and mandatory immunization practice. (AU)

Number of cases of varicella and hospitalization in a pediatric reference hospital in brazil after introducing the vaccine / Avaliação do número de casos e do perfil de internações por varicela em hospital pediátrico após a introdução da vacina

ABSTRACT Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

RESUMO Objetivo: Avaliar o número de casos e o perfil das internações por varicela após a introdução da vacina quádrupla viral na rede pública. Métodos: Estudo retrospectivo conduzido em hospital pediátrico referência em doenças infectocontagiosas na Região Sudeste do Brasil. Foram avaliados os casos com diagnóstico clínico de varicela, registrados em prontuário por médico pediatra, de janeiro de 2011 até junho de 2016. As internações foram classificadas em grupo pré-vacinal e grupo pós-vacinal, com base na data de introdução da vacina (setembro de 2013). Os grupos foram comparados em relação a: faixa etária, sexo, tempo de hospitalização, causas da internação, complicações hospitalares, tempo da internação em terapia intensiva e desfecho clínico. Resultados: Foram documentadas 830 internações, 543 no período pré-vacinal e 287 no pós-vacinal, ocorrendo redução de 47,1% nas internações (p<0,001). Em ambos os períodos, notou-se um perfil similar das internações, predominantemente: sexo masculino; faixa etária de um a cinco anos; por causas secundárias (principalmente infecções de pele); evoluindo com melhora clínica e alta hospitalar. Em relação ao número de óbitos, ocorreram seis no período pré-vacinal e dois no pós-vacinal. Conclusões: A manutenção do perfil das internações era esperada, visto que o trabalho não comparou crianças vacinadas com não vacinadas, e sim internações pré e pós-vacinais. Observou-se, em concordância com a literatura, queda substancial no número de internações por varicela.