Original articleHerpes Zoster in Childhood
Section snippets
Epidemiology
The incidence of herpes zoster among varicella vaccine recipients is about 14 cases per 100,000 person-years, compared with 20 to 63 cases per 100,000 person-years after natural varicella infection (Takayama et al 2000, Uebe et al 2002). The incidence of herpes zoster in immunocompromised children who received varicella vaccine is less than that experienced by immunocompromised children who experienced natural varicella infection (Rentier, Gershon, & the Members of the European Working Group on
Pathogenesis
A primary infection with either wild-type or vaccine-type varicella-zoster virus is a prerequisite for herpes zoster (Vázquez & Shapiro, 2005). The vaccine-type virus strain is known to establish latent infection in the dorsal root ganglia (Uebe et al., 2002). The virus reaches the sensory ganglia through sensory nerves at the injection site. The relative risk of herpes zoster developing in a vaccine recipient is higher in persons who had a vaccine-associated rash or breakthrough infection
Clinical manifestations
Herpes zoster presents with vesicles clustered in the distribution of the dermatome that corresponds to the infected dorsal root ganglion. In general, the onset of disease is heralded by pain within the dermatome and precedes the lesions by 48 to 72 hours (Whitley, 2005). An area of erythema might precede the development of a group of vesicles. Vesicles may coalesce to form bullous lesions. In young children, herpes zoster has a predilection for areas supplied by the cervical and sacral
Complications
The most common complications of herpes zoster caused by wild-type varicella-zoster virus are secondary bacterial infection, depigmentation, and scarring. Postherpetic neuralgia is uncommon in children. Vaccine-induced herpes zoster in healthy children is usually mild, and complications are uncommon. In immunocompromised patients, the lesions might develop in unusual dermatomes or in viscera, such as the liver. In immunocompromised individuals, the illness is more severe and prolonged. Other
Diagnosis
The diagnosis of herpes zoster is based on the distinctive clinical appearance. Laboratory tests usually are not necessary. A Tzanck smear, performed by scraping the base of the lesion, can demonstrate giant cells. The diagnosis also can be made by the demonstration of specific viral antigens in skin scrapings or immunofluorescence of virus isolated from vesicles. Viral DNA analysis of the lesion by polymerase chain reaction and restriction fragment length polymorphism is necessary to
Management
Affected patients are contagious because the virus can be transmitted by direct contact with herpes zoster lesions (Uebe et al., 2002). Affected children should be kept out of school or day care until crusting appears. Chickenpox may develop in children exposed to herpes zoster. General preventive measures include good personal hygiene, with particular emphasis on hand washing. Fingernails should be trimmed to reduce injury from scratching. Parents should be encouraged to bathe their children
Alexander K.C. Leung is Clinical Associate Professor, Department of Pediatrics, the University of Calgary, and Medical Director, The Asian Medical Centre, an affiliate with The University of Calgary Medical Clinic, Calgary, Alberta, Canada.
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2016, Translational ResearchCitation Excerpt :Current recommendations provide specification for the level of IS therapy for which vaccination with the zoster vaccine can be provided with an acceptable safety risk (Table III), but emphasis should be given to assure that patients at risk for zoster reactivation disease be vaccinated before the start of disease-modifying antirheumatic drug or biologic therapies to both improve vaccine responses and avoid complications.17,23,69,79 Vaccine-associated reactivation disease has been noted in both immunocompetent and immunocompromised patients in large clinical trials and in case reports.29,80-83 The zoster vaccine is FDA approved for patients more than the age of 50 years, but the current ACIP recommendations advise its use in adults more than the age of 60 years.
Alexander K.C. Leung is Clinical Associate Professor, Department of Pediatrics, the University of Calgary, and Medical Director, The Asian Medical Centre, an affiliate with The University of Calgary Medical Clinic, Calgary, Alberta, Canada.
W. Lane M. Robson is a Medical Director of The Children’s Clinic, Calgary, Alberta, Canada.
Alexander G. Leong is a Medical Staff of the Asian Medical Centre, Calgary, Alberta, Canada.