Severe complications of chickenpox in hospitalised children in the UK and Ireland

Abstract

Aims: To estimate the annual incidence of hospitalisations due to severe complications of varicella, describe the complications and estimate annual mortality. Methods: Active surveillance throughout the UK and Ireland for 13 months by paediatricians notifying cases to the British Paediatric Surveillance Unit and completing a questionnaire. The case definition was any child aged ,16 years hospitalised with complicated varicella, as defined by a list of conditions, or admitted to ICU/HDU with varicella. Results: 188 cases were notified for the surveillance period, of which 112 (0.82/100 000 children/year) met the case definition and were not duplicates. Confirmed cases had a median age of 3 years (range 0-14). The complications were: bacteraemia/septic shock (n = 30), pneumonia (n = 30), encephalitis (n = 26), ataxia (n = 25), toxic shock syndrome/toxin-mediated disease (n = 14), necrotising fasciitis (n = 7), purpura fulminans/disseminated coagulopathy (n = 5), fulminant varicella (n = 5) and neonatal varicella (n = 3). 52 children (46%) had additional bacterial infections. Six deaths were due, or possibly due, to varicella, including one intrauterine death. Four of the other five children who died (ages 2-14 years) had a preexisting medical condition. Sequelae on discharge were reported for 41 cases (40%), most frequently ataxia or skin scarring. The median length of hospital stay was 7 days (range 1-68).Conclusions: This study provides a minimum estimate of severe complications and death resulting from varicella in children in the UK and Ireland. Most complications, excluding deaths, occur in otherwise healthy children and thus would be preventable only through a universal childhood immunisation programme. V aricella-zoster virus causes varicella (chickenpox) on primary infection and herpes zoster upon reactivation. Varicella is generally mild, but there is an increased risk of complications in immunocompromised individuals and neonates if maternal varicella is temporally close to birth. Nevertheless, severe complications can occur even in previously healthy children, including secondary bacterial infections, central nervous system manifestations and death.

Varicella-Related Hospitalizations Among Immunocompetent and Immunocompromised Children in Pre-Vaccine Era: A Tertiary Care Center Experience in Turkey

“…Although varicella usually results in mild to moderate illness in immunocompetent patients, serious complications can arise (1). Most of the varicella-related complications were reported in children without severe underlying immune compromising conditions (14,17,18). Our study suggests that in previously healthy children, severe complications requiring hospitalization are more than in the immunocompromised children due to the increased risk awareness and early initiation of antiviral treatment in these children.…”

Characteristics of chickenpox in children and adults at a tertiary health center in Sarajevo, Bosnia-Herzegovina

“…The rate of complication is reported to be in 1-27% of cases. 18,22,25 Recent studies show that secondary bacterial skin super infection is present in 14-50% of patients. 18,26,27 We encountered a higher rate.…”

Skin and Soft Tissue Infection as a Complication of Varicella Infection Ended up in Using Intravenous Immunoglobulin Instead of Surgical Debridement: A Case Report and Short Review of Literature

“…VZV infection is responsible for at least 6 reports of death and 103 sever complications per year in the United Kingdom and Ireland (2). NF is an important and rare complication of VZV infection, which requires immediate diagnosis and treatment (4).…”

“…Most of varicella infection complications occur in otherwise healthy children could be prevented by immunization (2). Even healthy children can develop sever complications of VZV infection (2). These complications can be categorized into infectious and noninfectious complications.…”

“…Varicella is a highly contagious and vaccine preventable infection (2). Most of varicella infection complications occur in otherwise healthy children could be prevented by immunization (2).…”