Chickenpox
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Chickenpox Zoster encephalitis is a feared complication Zoster sine herpete is zoster without vesicles Mentally the virus destroys the neurons in the brain leaving behind derangements It infects the nerves and arteries When immunity drops the virus reemerges. Typically only ONE dorsal nerve ganglion is involved It disseminates when the virus enters the blood stream If immunity is poor there may be no vesicles but papules instead. 1 in 3 adults will develop shingles By 85 years 50% will have shingles Earlier Treatment leads to less neuralgia Post first attack of shingles on unvaccinated people, the zoster vaccine is most effective if given after 18 months from the event. Valacyclovir is superior to acyclovir in zoster treatment Steroids is controversial and if used it must be after there are no active vesicles Pregabalin can be used for the neuralgia Primary chickenpox vaccines MUST be given in the same site as there is risk of post vaccine shingles appearing at the injection site as it requires 2 injections. 2 injections are much more effective than a single injection up to 98% protection. On inhalation of the virus, it takes about 7 days before it becomes viraemic. Hence exposure for the unvaccinated require an immediate injection. Anti viral is helpful too. Intra abdominal shingles may occur in immunocompromised people presenting as Acute Abdomen. At laparotomy vesicles can be seen in the visera Shingles infects arteries as well! This may lead to strokes. 4 times higher risk if shingles affected the face! There is also association below age of 40 years with TIA and Heart Attacks. Higher risk of stroke in the first 6 months Anti viral treatment lowers the risk of stroke The rule of 2/3 Shingle vaccines is only effective in 2/3 in younger people above 50 years old for prevention And if shingles occur it reduces the pain by 2/3 The protection from the vaccine lasts about 7 to 10 years only. Even with the wild strain our immunity vanes let alone the weaken strain. The need for revaccination after 10 years is theoretically sound BUT off label. A vaccine in the fridge is USELESS A vaccine in the patient's arm may save a life.
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Chickenpox
Transcript of Chickenpox
ChickenpoxZoster encephalitis is a feared complication
Zoster sine herpete is zoster without vesicles
Mentally the virus destroys the neurons in the brain leaving behind derangements
It infects the nerves and arteries
When immunity drops the virus reemerges.
Typically only ONE dorsal nerve ganglion is involved
It disseminates when the virus enters the blood stream
If immunity is poor there may be no vesicles but papules instead.
1 in 3 adults will develop shingles
By 85 years 50% will have shingles
Earlier Treatment leads to less neuralgia
Post first attack of shingles on unvaccinated people, the zoster vaccine is most effective if given after 18 months from the
event.
Valacyclovir is superior to acyclovir in zoster treatment
Steroids is controversial and if used it must be after there are no active vesicles
Pregabalin can be used for the neuralgia
Primary chickenpox vaccines MUST be given in the same site as there is risk of post vaccine shingles appearing at the
injection site as it requires 2 injections. 2 injections are much more effective than a single injection up to 98% protection.
On inhalation of the virus, it takes about 7 days before it becomes viraemic. Hence exposure for the unvaccinated require
an immediate injection. Anti viral is helpful too.
Intra abdominal shingles may occur in immunocompromised people presenting as Acute Abdomen. At laparotomy
vesicles can be seen in the visera
Shingles infects arteries as well!
This may lead to strokes.
4 times higher risk if shingles affected the face!
There is also association below age of 40 years with TIA and Heart Attacks.
Higher risk of stroke in the first 6 months
Anti viral treatment lowers the risk of stroke
The rule of 2/3
Shingle vaccines is only effective in 2/3 in younger people above 50 years old for prevention
And if shingles occur it reduces the pain by 2/3
The protection from the vaccine lasts about 7 to 10 years only. Even with the wild strain our immunity vanes let alone the
weaken strain.
The need for revaccination after 10 years is theoretically sound BUT off label.
A vaccine in the fridge is USELESS
A vaccine in the patient's arm may save a life.
As to why chickenpox is much more serious in adults compared to children we do not know the answer!
