Materiały źródłowe

• #1 Laboratory Testing for Varicella-Zoster Virus (VZV) | Chickenpox (Varicella) | CDC

  https://www.cdc.gov/chickenpox/php/laboratories/index.html

  This varicella-zoster virus (VZV) laboratory testing information applies to testing and diagnosis of primary VZV infection (varicella) and reactivation (herpes zoster). […] Polymerase chain reaction (PCR) is the most helpful laboratory test for confirming cases of varicella and herpes zoster. […] Testing is recommended to: Confirm suspected cases of varicella. […] Confirm varicella as the cause of outbreaks. […] Confirm varicella in severe cases (hospitalizations or deaths) or unusual cases. […] Determine susceptibility to varicella. […] Determine if suspected vaccine-related adverse events were caused by vaccine-strain VZV. […] The preferred diagnosis method is a demonstration of VZV DNA by PCR tests from a clinical specimen, ideally scabs, vesicular fluid, or cells from the base of a lesion.

• #2 Chickenpox and Shingles Tests: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/chickenpox-and-shingles-tests/

  Chickenpox and shingles tests check to see if you are or have ever been infected with the varicella zoster virus (VZV). […] Testing for VZV involves checking for VZV in a blood, fluid, or tissue sample. […] Health care providers can usually diagnose chickenpox or shingles with a visual examination. But in some cases, your provider may also order a chickenpox or shingles test to confirm the diagnosis. […] These tests are also sometimes ordered to check for immunity to the varicella zoster virus (VZV). […] You may need a chickenpox or shingles test if you are at higher risk of complications, are not immune to VZV, and/or have symptoms of infection. […] If you have symptoms and your test results show VZV antibodies or the virus itself, it’s likely you have chickenpox or shingles. […] If you don’t have symptoms and your results show antibodies to the virus or the virus itself, you either had chickenpox at one point or received the chickenpox vaccine. […] The best way to prevent chickenpox is to get the chickenpox vaccine. […] There is also a vaccine for shingles. It’s called Shingrix.

• #2 Chickenpox Workup: Approach Considerations, Polymerase chain reaction (PCR), Tzanck Smear

  https://emedicine.medscape.com/article/1131785-workup

  Chickenpox typically is suspected in patients who present with its distinctive rash, which is commonly used for clinical diagnosis. However, this rash also may resemble those associated with other viral dermatoses, necessitating laboratory confirmation in uncertain cases. […] For definitive diagnosis, several laboratory techniques are available: Immunofluorescence identifies viral antigens in lesion samples. Polymerase chain reaction (PCR) is highly recommended for its sensitivity in detecting viral DNA. Serologic assay tests measure IgM antibodies specific to varicella-zoster virus (VZV) or demonstrate seroconversion from negative to positive VZV antibody titers, indicating an acute infection. Tzanck smear is useful for visualizing cellular changes associated with herpes virus infections but does not differentiate between VZV and HSV. Viral culture, although definitive, is less sensitive than PCR and has a longer turnaround time.

• #3 Diagnostic and Immunologic Testing for Varicella in the Era of High-Impact Varicella Vaccination: An Evolving Problem – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36265850/

  The clinical presentation of varicella in unvaccinated persons, with skin vesicles and scabs, has facilitated the use of rapid diagnostic methods for confirming disease. Polymerase chain reaction (PCR) assays are the diagnostic method of choice. […] The sharp decline in unmodified cases of varicella due to the US varicella vaccination program has led to fewer healthcare providers being familiar with varicella presentation and an increased reliance on laboratory diagnosis to confirm suspected cases. […] The mild, atypical presentation of the disease in vaccinated persons (fewer skin lesions, mostly maculopapular) has made it more challenging for providers to recognize and also to collect samples to detect the virus. […] Nonetheless, PCR is highly sensitive and specific in confirming modified disease if adequate samples are provided.

• #4 Laboratory Testing for Varicella-Zoster Virus (VZV) | Chickenpox (Varicella) | CDC

  https://www.cdc.gov/chickenpox/php/laboratories/index.html

  PCR is also useful for confirming breakthrough varicella. Other methods, such as DFA and culture, are available for diagnosis but are less sensitive and specific than PCR. […] Positive serologic test for varicella-zoster immunoglobulin M (IgM) antibody when a varicella-like rash is present. […] Four-fold or greater rise in serum varicella immunoglobulin G (IgG) antibody titer by any standard serologic assay between acute and convalescent sera. […] For both unvaccinated and vaccinated people, PCR is the most reliable method for confirming a VZV infection. […] PCR testing and genotyping can distinguish between wild-type VZV and vaccine-type (Oka/Merck) strains of VZV. […] Such testing is used in situations when it is important to recognize the two VZV strains, like in suspected vaccine adverse events.

• #5 Chickenpox Workup: Approach Considerations, Polymerase chain reaction (PCR), Tzanck Smear

  https://emedicine.medscape.com/article/1131785-workup

  The study concluded that PCR is a more reliable and effective method for diagnosing both HSV and VZV infections compared to traditional viral cultures, especially for VZV. This suggests that PCR should be considered a preferred diagnostic tool in clinical settings for its higher sensitivity and specificity. […] PCR testing is highly sensitive for detecting varicella-zoster virus (VZV) DNA and is considered the gold standard for laboratory confirmation. Optimal specimens for PCR include vesicular lesions or scabs. […] PCR testing and genotyping are critical tools for distinguishing between wild-type VZV and vaccine-type (Oka/Merck) strains of VZV. This differentiation is particularly important in cases where identifying the specific strain of VZV can inform clinical decisions, such as in suspected vaccine adverse events.

• #6 Chickenpox Vaccine (Varicella Vaccine) Side Effects & Other Facts

  https://my.clevelandclinic.org/health/treatments/22136-chickenpox-vaccine

  The chickenpox vaccine is a two-dose series of shots that protect you or your child from chickenpox. […] The U.S. Centers for Disease Control and Prevention (CDC) recommends the vaccine for children and adults who havent had chickenpox and havent been fully vaccinated. […] So, if youve never been vaccinated and arent sure if youve had chickenpox, talk to a healthcare provider. They may recommend a blood test to check if you have immunity to chickenpox. […] The chickenpox vaccine is an injection you receive from a healthcare provider. […] The chickenpox vaccine is very effective. Two doses provide lifelong protection against infection for most people. […] Theres a small chance (but still a chance) that you can get chickenpox if youve been vaccinated. Healthcare providers call this breakthrough varicella. […] If you only received one dose of the vaccine, you may have symptoms that resemble those of unvaccinated people. […] Your provider will talk to you about the situation and advise you on what to do.

• #7 Laboratory Testing for Varicella-Zoster Virus (VZV) | Chickenpox (Varicella) | CDC

  https://www.cdc.gov/chickenpox/php/laboratories/index.html

  A single serologic IgG test can determine if a person has antibodies to VZV from past varicella disease or who may be candidates for varicella-zoster immune globulin (VZIG). […] A positive IgG ELISA result indicates that a person has antibodies to VZV from past varicella disease or vaccination. This test cannot distinguish whether the antibodies were from a past episode of varicella or vaccination. […] While many commercial VZV IgG ELISAs perform well enough to detect seroconversion for infection by wild-type viruses, the performance specifications (specificity and sensitivity) of these methods vary widely. […] Some commercially available VZV IgG assays are unreliable, even for detecting a natural disease history in people. Currently, commercial VZV IgG methods sensitive and specific enough to reliably detect seroconversion to the vaccine are unavailable.

• #8 Shop Varicella Titer: Chickenpox Immunity Test by Labcorp OnDemand

  https://www.ondemand.labcorp.com/lab-tests/chickenpox-immunity-test?srsltid=AfmBOorcXNtpHMaSUQ28WGLPmt2oDq5QcTqaBD-C_3RSobNMxGnsozKS

  Chickenpox is a highly contagious disease thats caused by the varicella zoster virus (VZV). […] This chickenpox test can determine your immunity to VZV from either past infection or vaccination. […] Note: This test is not intended to be used to diagnose a current active Chickenpox infection. […] If youre not sure whether you have varicella (chickenpox) immunity, a chickenpox test may be right for you. Taking a chickenpox immunity test will let you know if you have developed antibodies against the varicella-zoster virus (VZV) in response to a prior chickenpox infection or vaccination. […] Your testing will be performed in a CLIA-certified clinical laboratory. […] Labcorp provides leading-edge medical laboratory tests and services through a national network of primary clinical laboratories and specialty testing laboratories.

• #9 Chickenpox – immunisation | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/chickenpox-immunisation

  Chickenpox (also called varicella) is a highly infectious disease that sometimes causes complications. […] The chickenpox vaccine is of greatest benefit to children over 12 months and people who live with someone with lowered immunity. […] Immunisation against chickenpox is included in the combination measles, mumps, rubella and varicella (MMRV) vaccine recommended for children at 18 months of age. […] Adults who do not know if they have had chickenpox disease can have a blood test to check their immunity. […] If you are not immune during your pregnancy, avoid contact with people who have known cases of chickenpox. […] The chickenpox vaccine is effective and safe, but all medications can have unwanted side effects. […] Side effects from chickenpox vaccine can occur 5 to 26 days after immunisation and include a mild chickenpox-like rash, usually at the injection site, but occasionally elsewhere on the body.

• #10 Chickenpox | Interpreting Laboratory Tests | Varicella | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/chickenpox/hcp/lab-tests.html

  Varicella used to be very common in the United States before varicella vaccine became available. […] However, clinical diagnosis is becoming more challenging because fewer people get varicella and varicella in vaccinated people is often mild and atypical in presentation. Therefore, laboratory confirmation of varicella is becoming increasingly important in routine clinical practice. […] Laboratory testing is also recommended to confirm varicella as the cause of outbreaks. […] Finally, specialized laboratory testing can be used to determine if suspected vaccine-related adverse events were caused by vaccine-strain VZV. […] The most sensitive method for confirming a diagnosis of varicella is the use of PCR to detect VZV in skin lesions. […] A positive IgM ELISA result, although suggestive of a primary infection, does not exclude re-infection or reactivation of latent VZV. […] A positive IgG ELISA result indicates that a person has antibodies to VZV either from past varicella disease history or vaccination. […] There are currently no commercially available VZV IgG methods sensitive and specific enough to reliably detect seroconversion to vaccine.

• #11 Ask The Experts About Vaccines: Varicella (Chickenpox) | Immunize.org

  https://www.immunize.org/ask-experts/topic/varicella/

  How is varicella transmitted and for how long is an infected person contagious? The varicella zoster virus (VZV) spreads from person to person by direct contact or through the air by coughing or sneezing. It is highly contagious. It can also be spread through direct contact with fluid from a blister of a person infected with varicella, or from direct contact with a skin lesion from a person with zoster (shingles). People with varicella are infectious 1 to 2 days before skin lesions appear until all lesions have crusted over, usually 4 to 7 days after the appearance of skin lesions. […] What can be done to protect a patient without evidence of immunity who is exposed to varicella and is at high risk for severe disease and complications? ACIP recommends administration of varicella zoster immune globulin (VariZIG, Saol Therapeutics) to certain people up to 10 days following exposure to varicella or herpes zoster. People for whom VariZIG is recommended are those without evidence of immunity to varicella who are at high risk of severe disease and complications of varicella illness and are ineligible for varicella vaccination. VariZIG given up to 10 days after an exposure can modify or prevent clinical varicella disease.

• #12 Varicella Diagnosis Fact Sheet | Chickenpox (Varicella) | CDC

  https://www.cdc.gov/chickenpox/hcp/communication-resources/varicella-diagnosis-fact-sheet.html

  Varicella is a highly contagious disease caused by the varicella-zoster virus (VZV). It usually presents as a generalized pruritic maculopapulovesicular rash. […] Two doses of the varicella vaccine are more than 90% effective at preventing varicella. […] The best method for laboratory confirmation of varicella is PCR testing of skin lesions (scabs and vesicular fluid.) […] Two doses of the varicella vaccine are more than 90% effective at preventing varicella.

• #13 News & Views — Chickenpox: Fast Facts for Healthcare Providers | Children’s Hospital of Philadelphia

  https://www.chop.edu/vaccine-update-healthcare-professionals/newsletter/chickenpox-fast-facts-healthcare-providers

  Chickenpox typically begins with a mild fever and lack of energy, followed by the development of an itchy rash consisting of fluid-filled pustules on a red base. […] Vaccinated people with breakthrough chickenpox, meaning an infection with the wild-type varicella-zoster virus, typically experience milder symptoms with fewer lesions and little or no fever. […] Importantly, chickenpox can be confused with several other skin conditions, including herpes simplex virus (HSV), impetigo and insect bites. […] Most chickenpox cases are diagnosed clinically. However, if diagnosis is uncertain, such as in vaccinated individuals experiencing a breakthrough case with atypical lesions, laboratory testing can help. […] PCR testing of lesion fluid or crusts is the most sensitive method. […] Serologic testing (IgM/IgG) has only limited use. […] Two measurements of IgG over time may help identify a new varicella infection if IgG levels increase; however, this strategy requires two blood draws (and two visits), so it should be reserved for use only when PCR is not available.

• #14 Lab Tests Are Key for Diagnosing Chickenpox | MDedge

  https://www.mdedge.com/edermatologynews/article/268480/infectious-diseases/lab-tests-are-key-diagnosing-chickenpox

  The researchers found that among 208 patients receiving a clinical diagnosis of varicella after only examination at a medical facility, fewer than half (45%) had positive varicella-zoster virus (VZV) lab test results. VZV detection was 66% lower in those who received varicella vaccine compared with those who did not. […] “Clinicians should incorporate routine laboratory testing whenever varicella is suspected,” the researchers wrote. “Public health and school health professionals should emphasize the importance of laboratory confirmation in their recommendations to clinicians and parents.” […] In addition to presentation being harder to recognize in those who are vaccinated, varicella is harder to diagnose in the immunocompromised population, where the rash may not be as prominent or more localized or appear in any number of atypical presentations. […] But when clinicians aren’t confident in their diagnosis, “I think in those scenarios, testing can be very helpful in terms of management from a treatment standpoint as well as a potential infection control standpoint,” he said.

• #14 Lab Tests Are Key for Diagnosing Chickenpox | MDedge

  https://www.mdedge.com/edermatologynews/article/268480/infectious-diseases/lab-tests-are-key-diagnosing-chickenpox

  Lab Tests Are Key for Diagnosing Chickenpox […] Data from the Minnesota Department of Health (MDH) underscore the often poor reliability of a clinical diagnosis of varicella (chickenpox) in children without laboratory test confirmation, according to a report featured in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. […] Only about half of clinically diagnosed varicella cases — cases diagnosed by examining rashes without laboratory testing — were positive for the varicella-zoster virus (VZV), suggesting lab testing is important to avoid consequences such as children being kept out of school longer than necessary. […] Clinical diagnosis continues to be the primary method for diagnosing varicella, said authors of the report, led by Alison Ruprecht, MPH, a state epidemiologist with the MDH. But the signs and symptoms of those who have received the varicella vaccine (including fewer skin lesions, mostly maculopapular) make it difficult to diagnose.

• #15 Diagnostic and Immunologic Testing for Varicella in the Era of High-Impact Varicella Vaccination: An Evolving Problem – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36265850/

  While a positive PCR result is confirmatory, interpreting a negative result can prove to be more challenging in determining whether suspected varicella is falsely negative or attributable to other causes. Enhanced education of healthcare providers is critical for adequate specimen collection from modified varicella cases. […] In addition, more sensitive commercial serologic assays are needed in the United States for varicella immunity testing in the vaccine era.

• #16 Chickenpox Workup: Approach Considerations, Polymerase chain reaction (PCR), Tzanck Smear

  https://emedicine.medscape.com/article/1131785-workup

  To confirm the etiology and identify a vaccine-related adverse event, samples such as blood, cerebrospinal fluid, biopsies, or autopsy specimens may be tested to differentiate between vaccine-strain and wild-type VZV. However, it is important to note that these specimens might yield false negative results, which can complicate the diagnostic process. […] Serologic testing is utilized to identify VZV-specific antibodies (IgM and IgG) and can indicate acute infection through seroconversion. Various assays are employed, including complement fixation, enzyme immunoassay, fluorescent antibody to membrane assay, indirect fluorescent antibody, and latex agglutination test. […] Serologic tests can retrospectively confirm a diagnosis through a substantial rise in serum varicella IgG titers from acute- and convalescent-phase samples by any standard serologic assay. However, these antibody tests might not be reliable in immunocompromised individuals.

• #17 Chickenpox: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4017-chickenpox

  Yes, theres a vaccine for chickenpox. Your childs pediatrician will give it in two doses. […] Vaccination is over 90% effective at preventing chickenpox. Since 1995, the vaccine has prevented at least 91 million cases of chickenpox. […] The chickenpox vaccine is over 90% effective at preventing this once-common childhood illness. You can still get chickenpox if you dont get the vaccine even as an adult. Talk to your healthcare provider about getting vaccinated if you never had chickenpox.

• #18 Varicella (Chickenpox): The Disease & Vaccines | Children’s Hospital of Philadelphia

  https://www.chop.edu/vaccine-education-center/vaccine-details/varicella-vaccine

  In 1998, an 8-year-old girl was seen in the Emergency Department of a hospital. For several days she had low-grade fever and blisters appearing over her entire body. The girl had chickenpox. […] Before the chickenpox vaccine, one or two children in this country would die every week from chickenpox — most of these children were previously healthy. […] The varicella vaccine is given to children between 12 and 15 months and again between 4 and 6 years of age. Children, adolescents and adults who have received only one dose should get a second dose. For previously unimmunized adolescents (13 to 18 years old) or adults, the vaccine is given as a series of two shots, separated by four to eight weeks. […] Since the introduction of the single-dose varicella vaccine into the United States in 1995, and the second-dose vaccine in 2006, the number of people infected with chickenpox has decreased by about 97%, but chickenpox infections still occur fairly frequently in the United States.

• #19 Chickenpox | Washington State Department of Health

  https://doh.wa.gov/you-and-your-family/immunization/diseases-and-vaccines/chickenpox

  People who have never been vaccinated should get the chickenpox vaccine. […] Older children and adults need 2 doses of chickenpox vaccine if they have not been vaccinated or are not immune to chickenpox. […] People may get vaccinated after chickenpox exposure to prevent or reduce illness. […] Most people experience minor or no side effects. […] The benefits and side effects of this vaccine outweigh the risk of getting chickenpox. […] Getting chickenpox vaccine is over 99% effective at preventing the disease. […] In breakthrough cases where a vaccinated person gets chickenpox, people have milder symptoms such as less blistering, mild or no fever, and a shorter period of illness. […] This vaccine has reduced disease cases by over 97%. […] Even with fewer cases, vaccines are still important because the United States still has outbreaks of disease in unvaccinated populations.

• #20 Varicella (Chickenpox): The Disease & Vaccines | Children’s Hospital of Philadelphia

  https://www.chop.edu/vaccine-education-center/vaccine-details/varicella-vaccine

  The Centers for Disease Control and Prevention (CDC) recommends vaccination of all children at 12 months of age who do not have evidence of immunity. Evidence can include: A diagnosis of chickenpox or shingles made by a healthcare provider, Laboratory confirmation of disease, Laboratory evidence of immunity (blood test). […] Because many rashes are misclassified, the CDC states that “if there is any doubt that the illness was actually varicella [chickenpox], the child should be vaccinated.” […] Any teenager or adult who has not had chickenpox or the chickenpox vaccine should receive the vaccine. Adults are 10 times more likely than children to be hospitalized with the severe consequences of chickenpox. […] Before the varicella vaccine was recommended for use in all children in 1995, about 4 million children were infected every year. In addition, chickenpox caused about 10,000 hospitalizations and 100 deaths a year — most of these hospitalizations and deaths occurred in previously healthy young children.

• #21 Ask The Experts About Vaccines: Varicella (Chickenpox) | Immunize.org

  https://www.immunize.org/ask-experts/topic/varicella/

  The Advisory Committee on Immunization Practices (ACIP) considers evidence of immunity to varicella to be: Written documentation of 2 doses of varicella vaccine given no earlier than age 12 months with at least 4 weeks between doses. […] ACIP recommends giving a dose of MMR to infants age 6 through 11 months before international travel, but not varicella vaccine. Varicella vaccine is neither approved nor recommended for children younger than age 12 months in any situation. […] Varicella vaccine is neither approved nor recommended for children younger than age 12 months. Assuming that the child is not immunocompromised, varicella zoster immune globulin (VariZIG) is also not recommended. […] A healthcare provider’s diagnosis or verification of a history of shingles is acceptable evidence of immunity to varicella. According to ACIP, acceptable evidence of varicella immunity in healthcare personnel includes (1) documentation of 2 doses of varicella vaccine given at least 28 days apart, (2) history of varicella or herpes zoster based on clinician diagnosis, (3) laboratory evidence of immunity, or (4) laboratory confirmation of disease.

• #22 Chickenpox (varicella) vaccine

  https://info.health.nz/immunisations/vaccines-aotearoa/chickenpox-varicella-vaccine

  Your tamariki can get a free chickenpox vaccination when they are 15 months old. […] It is also free for 11 year olds who have not been immunised already or if they have not had a confirmed chickenpox infection. […] People planning a pregnancy should check their immunity to chickenpox. […] If you are planning a pregnancy and are not able to find out if you have had chickenpox, or if you have not been vaccinated, it is strongly recommended you get a chickenpox vaccine before becoming pregnant. […] For everyone else, chickenpox immunisation is available in Aotearoa New Zealand at a cost. […] Pregnant people and some immunocompromised people cannot have the chickenpox vaccine. […] The free vaccine we use for children in Aotearoa New Zealand is Varivax. […] Serious allergic reactions are extremely rare. Only about 1 in 1 million people will experience this.

• #23 Chickenpox – Wikipedia

  https://en.wikipedia.org/wiki/Chickenpox

  The diagnosis of chickenpox is primarily based on the signs and symptoms, with typical early symptoms followed by a characteristic rash. Confirmation of the diagnosis is by examination of the fluid within the vesicles of the rash, or by testing blood for evidence of an acute immunologic response. […] Vesicular fluid can be examined with a Tzanck smear, or by testing for direct fluorescent antibody. The fluid can also be „cultured”, whereby attempts are made to grow the virus from a fluid sample. Blood tests can be used to identify a response to acute infection (IgM) or previous infection and subsequent immunity (IgG). […] Prenatal diagnosis of fetal varicella infection can be performed using ultrasound, though a delay of 5 weeks following primary maternal infection is advised. A PCR (DNA) test of the mother’s amniotic fluid can also be performed, though the risk of spontaneous abortion due to the amniocentesis procedure is higher than the risk of the baby’s developing fetal varicella syndrome.

• #24 Chickenpox: In Adults, Vaccine, Causes, Contagious, Symptoms &Treatment

  https://www.medicinenet.com/chickenpox_varicella/article.htm

  Chickenpox is caused by the varicella-zoster virus, which also causes shingles. […] The chickenpox vaccine has resulted in a decrease in chickenpox incidence by 90% in the United States. […] Screening and vaccination for chickenpox are strongly recommended for those who will be working in the health care professions. […] The chickenpox rash is very typical, and diagnosis is usually made based on symptoms and appearance of the rash without having to do any tests. However, people with immune system problems may have an atypical case. In situations where the rash is unclear, fluid or tissue biopsy from a blister or sore can be tested for VZV DNA by PCR. […] Yes, it is highly effective and recommended by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP).

• #25 Ask The Experts About Vaccines: Varicella (Chickenpox) | Immunize.org

  https://www.immunize.org/ask-experts/topic/varicella/

  The CDC General Best Practice Guidelines for Immunization section on altered immunocompetence recommends varicella vaccination of children with humoral (but not cellular) immunodeficiencies. In addition, single-antigen varicella vaccine should be considered for HIV-infected children age 1 through 5 years with CD4+ T-lymphocyte percentages greater than or equal to 15% for at least 6 months or for children age 6 years and older with CD4+ T-lymphocytes count greater than or equal to 200 cells per microliter for at least 6 months. […] The ACIPs varicella vaccine recommendations state that no adverse events associated with the use of salicylates after varicella vaccination have been reported, however, the vaccine manufacturer recommends that vaccine recipients avoid using salicylates for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella disease (chickenpox).

• #26 Varicella and Herpes Zoster Vaccines – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/100_199/0115.html

  The FDA approved prescribing information indicates that zoster vaccine is not indicated for the treatment of herpes zoster or PHN. […] The Advisory Committee on Immunization Practices (ACIP) currently recommends Zostavax for all adults aged 60 years and older with no contraindications and for adults older than 80 years with chronic illnesses. […] The ACIP recommends the recombinant zoster vaccine, Shingrix, for adults with chronic medical conditions (e.g., chronic renal failure, diabetes mellitus, rheumatoid arthritis, and chronic pulmonary disease). […] The live attenuated virus vaccine Zostavax has been FDA approved for prevention of herpes zoster (shingles) in individuals 50 years of age and older. […] The live attenuated varicella vaccine is recommended for HIV-infected children who are not severely immunosuppressed.

• #27 Chickenpox (Varicella) Facts – MN Dept. of Health

  https://www.health.state.mn.us/diseases/varicella/chknpxfacts.html

  Vaccination, or getting a shot, is the best way to protect against chickenpox. Children, adolescents, and adults should have two doses of chickenpox vaccine. […] It is recommended that all suspected chickenpox cases be confirmed by laboratory testing. The recommended laboratory test is called PCR and can be done by swabbing a lesion or testing a scab.

• #28 Laboratory Testing for Varicella (Chickenpox) and Zoster (Shingles) – MN Dept. of Health

  https://www.health.state.mn.us/diseases/varicella/hcp/labtesting.html

  Testing should be done for all cases of varicella because: […] The MDH Public Health Laboratory (MDH-PHL) and most reference laboratories provide PCR testing for people with suspect varicella. However, MDH requests specimens from lesions or dermal scrapings to be submitted to MDH-PHL for PCR. […] Recommended for testing for immunity. Not recommended for diagnosis of VZV infection. However, a four-fold or greater rise in serum varicella immunoglobulin G (IgG) antibody titer by any standard serologic assay between acute and convalescent sera meets laboratory criteria for current VZV infection. […] Not recommended for diagnosis of VZV infection, However, a positive VZV IgM result in the presence of varicella-like symptoms can indicate an acute VZV infection. […] Samples submitted to MDH-PHL for suspect varicella-zoster virus testing will be run under a panel for common rash-like illnesses, including hand-foot-and-mouth disease (enteroviruses) and herpes simplex.

• #29 Chickenpox (varicella zoster infection)

  https://www.health.ny.gov/diseases/communicable/chickenpox/fact_sheet.htm

  Chickenpox is a highly contagious illness caused by the varicella-zoster virus (VZV), a type of herpes virus. […] Before the availability of the varicella vaccine in the U.S., almost everyone developed chickenpox. Most people who are vaccinated will not get chickenpox. […] A vaccine to protect children against chickenpox was first licensed in 1995. Children who have never had chickenpox should routinely be administered two doses of varicella vaccine with the first dose at 12 to 15 months and the second dose at four to six years of age. […] In New York State, varicella vaccine is required for children enrolled in pre-kindergarten programs and schools. Vaccination is recommended for healthcare personnel and college students who have never had chickenpox. […] Varicella vaccination is recommended for outbreak control. During an outbreak, persons who do not have adequate evidence of immunity should receive their first or second dose as appropriate. […] In 2006, a new product called VariZIG became available to protect patients without evidence of immunity to varicella who are at high risk for severe disease and complications and have been exposed to chickenpox.

• #30 Chickenpox and shingles (varicella / herpes zoster)

  https://www.health.vic.gov.au/infectious-diseases/chickenpox-and-shingles-varicella-herpes-zoster

  Chickenpox and shingles must be notified by medical practitioners and pathology services in writing within 5 days of diagnosis. […] Confirmation of the diagnosis is generally only required when the clinical picture is atypical. It is made by one of the following: isolation of the virus in cell cultures, visualisation by electron microscopy, serological tests for antibodies, immunofluorescence on a lesion swab or fluid, nucleic acid testing or polymerase chain reaction (PCR) on a lesion swab or fluid. […] Vaccination may be used to prevent or attenuate illness if given to susceptible contacts within 5 days (preferably 72 hours) of first exposure. If varicella vaccine is not contraindicated, it can be offered to non-immune age-eligible children and adults who have had a significant exposure to varicella or herpes zoster and want protection against primary infection with varicella.

• #31 Ask The Experts About Vaccines: Varicella (Chickenpox) | Immunize.org

  https://www.immunize.org/ask-experts/topic/varicella/

  If a susceptible person exposed to varicella or zoster is age 12 months or older, and has no contraindications to varicella vaccination, varicella vaccine can prevent or reduce the severity of infection when administered as post-exposure prophylaxis (PEP) as soon as possible, within 5 days after exposure. There is no evidence that vaccination after infection increases the risk of vaccine-associated adverse reactions. If the patients exposure does not result in infection, vaccination can protect against future exposures. […] The minimum age for varicella vaccine is 12 months. Vaccination is not recommended for infants younger than 12 months of age even as post-exposure prophylaxis. CDC recommends that a healthy infant should receive no specific treatment or vaccination after exposure to VZV. The child can be treated with an appropriate antiviral medication if chickenpox occurs.

• #32 Adult Chickenpox (Varicella) Vaccine Guidelines

  https://www.webmd.com/children/vaccines/chickenpox-varicella-vaccine-guidelines-for-adults

  Vaccination is the best way to prevent chickenpox. A chickenpox vaccine has been available in the U.S. since 1995 and is easy to get from a doctor or a public health clinic. The chickenpox vaccine is very effective at preventing the disease — between 70% and 90% of people who get vaccinated will be completely immune to chickenpox. If a vaccinated person does get chickenpox, the symptoms will be very mild and only last for a few days. […] All adults who have never had chickenpox or received the vaccination should be vaccinated against it. Two doses of the vaccine should be given at least four weeks apart. […] If you’ve never had chickenpox or been vaccinated and you are exposed to chickenpox, being vaccinated right away will greatly reduce your risk of getting sick. Studies have shown that vaccination within three days of exposure is 90% effective at preventing illness; vaccination within five days of exposure is 70% effective. If you do get sick, the symptoms will be milder and shorter in duration.

• #33 Varicella-Zoster Virus – VZV | Choose the Right Test

  https://arupconsult.com/content/varicella-zoster-virus

  Varicella-zoster virus (VZV) is the etiologic agent of chickenpox (varicella) and shingles (herpes zoster). […] Vaccinations against chickenpox and shingles have greatly decreased the incidence and severity of VZV infections. […] Because of this, clinical diagnosis has become more difficult, and laboratory confirmation of VZV is increasingly important in routine clinical practice. Laboratory tests such as polymerase chain reaction (PCR), culture, and direct fluorescent antibody (DFA) stains can identify VZV, but PCR is the preferred test in most situations due to its high specificity and quick turnaround time. […] The CDC criteria for VZV diagnosis includes positive identification of VZV by polymerase chain reaction (PCR) testing, direct fluorescent antibody (DFA) staining, culture, or serology.

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