Teen's death from varicella highlights importance of catch-up vaccines

Teen's death from varicella highlights importance of catch-up vaccines
Teen's death from varicella highlights importance of catch-up vaccines

HealthDay News --The varicella-related death of a previously healthy 15-year-old Ohio girl reported in Morbidity and Mortality and Weekly Report highlights the importance of catch-up vaccines for adolescents, according to CDC officials.

The girl was admitted to the hospital on March 12, 2009, with a three-day history of rash consistent with varicella and a one-day history of fever and dyspnea. Clinicians subsequently identified varicella-zoster virus from vesicular fluid collected from a skin specimen.

Despite treatment with intravenous acyclovir, board spectrum antibiotics and antifungals, the patient died three weeks after hospital admission. According to her vaccination records, she did not receive varicella vaccine, and she lived in a community with low rates of varicella vaccine uptake.

"The case described in this report can serve as a reminder of the importance of catch-up vaccination of older children and adolescents to prevent varicella and its serious complications later in life when disease can be more severe," CDC researchers wrote.

Varicella is usually a self-limited disease but  can sometimes result in severe complications and death. Serious varicella-zoster virus-related complications include secondary bacterial infection and sepsis, pneumonia, encephalitis, cerebellar ataxia and thrombocytopenia, which can occur within a few days of rash onset.

"Health-care providers should remind parents about vaccination during routine visits for children and adolescents, and parents should be informed of the risks, including potentially severe complications, from vaccine-preventable diseases," they wrote.

The Advisory Committee on Immunization Practices currently recommends routine administration of the first dose of varicella vaccine at age 12 to 15 months, followed by a second dose at age 4 to 6 years.

Catch-up vaccination is also recommended. Unvaccinated individuals without evidence of immunity should receive two doses of varicella vaccine at least four weeks apart, and those who have received one dose previously should receive a second dose.

Approaches used to implement catch-up vaccination include school-entry vaccination requirements and routine health-care provider visits. However, in the case of this particular patient, no varicella vaccination school-entry requirements covered her grade.

Ohio currently has a two-dose varicella vaccination requirement for kindergarten admission through 2nd grade, and a one-dose requirement for admission to 3rd through 6th grades. By 2022, the requirement will cover all grades, according to the CDC.

"To cover cohorts of students enrolled in school before elementary school requirements took effect, implementation of varicella vaccination entry requirements for students entering middle school, high school and college should be considered," the researchers wrote. "Routine health-care provider visits, including the recommended visit at age 11 to 12 years, also provide an opportunity to evaluate vaccination status and administer recommended vaccinations."


References

  1. CDC. "Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009." MMWR. 2013: 62(14); 261-263.
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