Vaccines Against Varicella and Hepatitis BCh 13, 14 and 15.ppt

Vaccines Against Varicella and Hepatitis BCh 13, 14 and 15 Varicella Zoster Virus Herpesvirus (DNA) Primary infection results in varicella (chickenpox) Recurrent infection results in herpes zoster (shingles) Short survival in environment Varicella Pathogenesis Respiratory transmission of virus Replication in nasopharynx and regional lymph nodes Repeated episodes of viremia Multiple tissues, including sensory ganglia, infected during viremia Varicella Clinical Features Incubation period 14-16 days (range 10-21 days) Mild prodrome for 1-2 days Rash generally appears first on head; most concentrated on trunk Successive crops over several days with lesions present in several stages of development Herpes Zoster (Shingles) Reactivation of varicella zoster virus Can occur years or even decades after illness with chickenpox Generally associated with normal aging and with anything that causes reduced immunocompetence Lifetime risk of 20 percent in the United States Estimated 500,000- 1 million cases of zoster diagnosed annually in the U.S Varicella Complications Bacterial infection of skin lesions Pneumonia (viral or bacterial) Central nervous system manifestations Reye syndrome Hospitalization: 2-3 per 1,000 cases Death: 1 per 60,000 cases Postherpetic neuraligia (complication of zoster) Groups at Increased Risk of Complications of Varicella Persons older than 15 years Infants younger than 1 year Immunocompromised persons Newborns of women with rash onset within 5 days before to 48 hours after delivery Varicella Fatality Rate-United States, 1990-1994 Varicella Epidemiology Reservoir Human Transmission Airborne droplet Direct contact with lesions Temporal pattern Peak in winter and early spring (U.S.) Communicability 1-2 days before to 4-5 days after onset of rash May be longer in immunocompromised Varicella Age-Specific Incidence United States, 1990-1994 Varicella in the United States Increasing proportion of cases are a result of