Chickenpox - examining our options

Article Abstract:

In the November 28, 1991 issue of The New England Journal of Medicine, two articles report research data on two different aspects of chickenpox. In one article, researchers presented the results of treatment with the antiviral drug acyclovir early in the course of infection, which reduced the severity of chickenpox. The other article reported that the rate of shingles (herpes zoster), a complication of chickenpox, was less common following immunization than following natural infection. These articles highlight some of the decisions that must be made regarding the best method of dealing with chickenpox. Chickenpox is much less serious than many other childhood diseases, and the major part of the economic cost of chickenpox results from parents staying home from work to care for their sick children. Four million children get chickenpox each year, and treating them with acyclovir would cost about $128 million, not counting the cost of the visit to the doctor's office. However, this treatment would reduce suffering, and may get the parents back to work sooner. Since serious complications are not common with chickenpox, the cost of immunization cannot be justified by the number of lives saved or the prevention of serious illness. The Oka vaccine against the chickenpox virus (varicella-zoster) has not yet been approved. Even if it is, it remains uncertain whether immunization would result in life-long immunity. As a result, immunized children may still get chickenpox when they grow up, at an age at which the disease and its complications are worse. If the decision is made not to include chickenpox among the childhood diseases for which immunization is routine, then it might be appropriate to liberalize policies permitting children to return to school sooner after getting chickenpox. This would permit parents to return to work sooner. Since chickenpox is virtually inevitable among children who are not immunized, little is to be lost by letting recovering children return to school. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Prevention

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A controlled trial of acyclovir for chickenpox in normal children

Article Abstract:

Chickenpox is one of the more common childhood diseases. It is caused by the varicella-zoster virus. About 3.5 million cases of chickenpox are thought to occur in the US each year; about 4,500 patients require hospitalization. Complications are not common, but chickenpox may lead to secondary bacterial infection of the skin, inflammation of the lungs, cerebellar ataxia (an abnormality of gait resulting from effects on the cerebellum), and encephalitis. The death rate for otherwise healthy children with chickenpox is about 1 in 50,000. The antiviral drug acyclovir has been used successfully to treat varicella infections in normal adults and immunocompromized patients. A study has now been conducted to evaluate the effectiveness of acyclovir in treating normal children with chickenpox. A total of 815 children with chickenpox were randomly assigned to receive treatment with acyclovir or placebo within the first 24 hours of the appearance of the symptomatic "pocks". The children treated with acyclovir had fewer lesions than the children treated with placebo, with an average of 294 versus 347 lesions, respectively. Furthermore, over 95 percent of the children treated with acyclovir stopped developing new skin lesions by the fourth day of infection. In contrast, one-fifth of the placebo-treated children continued to develop new lesions after day five. Four children in the acyclovir group and six in the placebo group developed bacterial infections as a complication of chicken pox. One case of cerebellar ataxia was noted in the placebo group. The incidence of complications was too small, however, to draw any conclusions. Although the results clearly show that acyclovir reduces the severity and the duration of chickenpox, it remains uncertain if the rate of complications is also decreased by acyclovir treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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Acyclovir: a decade later

Article Abstract:

Acyclovir has been used for approximately 10 years to treat patients with infections caused by herpes virus. It interferes with the replication of herpes simplex virus (HSV) and varicella-zoster virus, the virus that causes chickenpox. Several different forms of acyclovir are available. It has been effective for the treatment of patients with genital herpes, but not for those with oral herpes. Immunocompromised children with chickenpox are treated with acyclovir to prevent complications. It is also used to prevent cytomegalovirus disease in transplant recipients and to treat infections caused by Epstein-Barr virus. HSV and varicella-zoster virus can become resistant to acyclovir over time, especially in AIDS patients. Very few side effects have been reported for acyclovir, but it rarely may cause reversible kidney impairment and disturbances of the central nervous system.

Health aspects, Herpesvirus infections, Herpes

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