Where is chicken pox found in the world

Based on our findings, children were the most affected age group, but there are also adult cases due to high number of expatriates, especially in Gulf Cooperation Council countries.

Central nervous system involvements and skin diseases followed by varicella pneumonia were the most varicella-associated complications. Varicella vaccine was introduced in most Middle East countries, either mandatory by the Ministries of Health or optional in the private clinics. Few numbers of studies have reported an obvious reduction in varicella prevalence, hospitalizations, and deaths in the Middle East following varicella vaccination.

A basic database about varicella infection before the initiation and implementation of a vaccination policy is essential to determine the target group of individuals.

As far as our knowledge, this is the first review about varicella infection in the Middle East. Varicella is a childhood illness with highest incidence between 1 and 9 years of age, characterized by fever and a generalized pruritic vesicular rash.

It is usually a mild-to-moderate illness in immunocompetent individuals but sometimes can cause serious complications such as central nervous system CNS involvement, pneumonia, secondary bacterial infections, and death. The severity of varicella is highly associated with pregnancy, infancy, elderly, and among immunocompromised individuals. Varicella infection usually results in lifetime immunity, and varicella reinfection is very rare; however, in immunocompromised individuals, the reactivation of latent VZV results in more serious painful illness, the HZ known also as shingles.

In developing countries generally and in the Middle East particularly, the status of varicella infection and vaccination is unclear. Some Middle East countries have reported on varicella burden, seroprevalence, complications, and eventually the cost of medical care of hospitalization.

To develop a vaccination protocol and appropriate preventive health care measures against a disease in different countries, it is very important to know the seroprevalence of any disease for an individual country. The seasonality of varicella, complications, vaccination program, and VZV genotypes is outlined according to the availability of published data. The seroprevalence and the age of primary VZV infection were investigated early in Saudi Arabia in on Saudi children aged from 1 to 15 years and on healthy adult male blood donors and pregnant women.

The number of varicella cases was slightly higher in males than females and that varicella peaked in spring season, between March and April. Furthermore, a study was initiated in to assess varicella status in multinational HCWs of Saudi Arabian Hospital.

A prospective study conducted at the King Abdul-Aziz Medical City, Riyadh, on chickenpox cases from to has investigated the development of complications after VZV infection. The overall fatality rate was 0. The authors recommended the introduction of varicella vaccine within the National Immunization Program. In terms of varicella vaccination, the childhood varicella vaccination was introduced in Saudi Arabia population in and become mandatory in January A case study described the complications of VZV infection during pregnancy.

Although the baby had VZV antibodies and characteristics of the congenital varicella syndrome, no vesicles or depigmented skin areas were seen. Moreover, a case study on a 6-year-old boy highlighted the association of chickenpox with complications of purpura fulminans. The authors suggested an early and aggressive treatment of postchickenpox purpura fulminans might reduce the mortality and morbidity associated with this condition.

Three unvaccinated ICU staff nurses developed chickenpox 16—21 days following exposure, and they were also transferred to Infectious Diseases Hospital.

Authors suggested that some precautions should be taken during patient isolation, exclusion of susceptible staff from attending the affected patient, preemployment anti-VZV-IgG screening, and vaccine coverage of staff to prevent the occurrence of such outbreak.

Furthermore, a case study reported morphologic changes in fibroadenoma of a year-old woman breast recovering from chickenpox with suspicious cytology in fine needle aspiration smears. Thus, physicians were advised to be more aware of chickenpox complications and to refer those suffered of early stage complications to specialists.

VZV vaccination was introduced and available in most private clinics and hospitals of Kuwait since , and from January , varicella vaccination became mandatory as part of the National Immunization Program. There are no reference data regarding the incidence of pediatric varicella in Kuwait before the introduction of varicella vaccine.

A study published earlier in the UAE investigated the susceptibility of varicella among children and healthy adults. Of individuals, Furthermore, it was found that the rate of nationals' seroprevalence increased by age from The study strongly recommended the introduction of an early varicella vaccination program. In addition, a 5-year descriptive study investigated the seroprevalence of varicella and varicella-associated complications in Al-Ain from to Authors highlighted how varicella and varicella-associated complications turn to be a public health issue in the UAE.

Several studies investigated varicella complications in the UAE. One study detected the risk of developing varicella pneumonia among hospitalized adults with chickenpox from to in Al-Ain Hospital. The authors suggested an early aggressive therapy for those at risk of developing pneumonia.

The mortality rate of primary VZV infection was high 4. The study showed the association of VZV infection with the clinical complications in immunosuppressed patients. Varicella vaccine has been available in the UAE for more than 10 years, but it was introduced to the National Immunization Program in The high seropositive rate was attributed to a recent introduction of varicella vaccination into the National Immunization Program and to acquired immunity from natural infection in the childhood.

Two case studies were reported about varicella complications, but no data were published about varicella seroprevalence in Oman. One case study has reported postvaricella lower limb deep venous thrombosis in two children in Oman.

The study emphasized the role of varicella complications especially in immunosuppressed patients and the need for zoster vaccination in dialysis patients. In Qatar, according to the Qatar Annual Health Report, the number of reported cases of chickenpox among non-Qatari individuals Another clinical study was conducted to determine the seroprevalence of VZV infection among HCWs of a community hospital in Qatar between and Regarding varicella complications, a case study described an immunocompetent adult suffering rhabdomyolysis after a varicella primary infection.

The patient status was only improved by aggressive fluid therapy with an antiviral agent. Accordingly, authors suggested that VZV should be taken into consideration in aseptic meningitis in immunocompetent individual even in the absence of exanthema. The varicella vaccine is given in two doses: one at 12 months and one at 4—6 years of age. A seroepidemiological study has been conducted to study the pattern of exposure and immunological responses to VZV infection among 92 children from hospitals and clinics between and It was also found that a difference in the immune responses to VZV infections between male and females and the rates of exposure to VZV infections was higher in urban areas than in rural areas.

The number of infected males was slightly higher than the number of females, and the highest frequencies were reported in March, April, and May. The prevalence of VZV IgG was determined among unmarried female university students aged from 18 to 30 years. Regarding varicella complications, a clinical case study reported the association of VZV with varicella-induced remission of steroid-nonresponsive nephrotic syndrome. The case represented a Syrian boy with a nephrotic syndrome aged 3 years, who showed nonresponse to steroid therapy and developed chickenpox few days later.

The remission has been sustained even after his full recovery of chickenpox, suggesting varicella-induced remission of steroid-nonresponsive nephrotic syndrome. A study has been carried out for the detection of VZV in skin samples of 33 patients. A total of 11 patients were positive for VZV. A brief report was published in reporting the susceptibility of Filipino nurses working at the American University of Beirut Medical Center to VZV following an outbreak of varicella.

Regarding varicella complications, a study has reported a case of Hughes syndrome 1 week after the occurrence of chickenpox. The authors recommended the dermatologists to consider bullous chickenpox in the differential diagnosis of vesiculobullous diseases. The CNS complications of the exanthematous viral diseases were observed among 26 patients following varicella infection. It was concluded that VZV reactivation might be an important cause of acute peripheral facial paralysis in children.

Several varicella seroprevalence studies were conducted among Iranian population of different age groups according to the published data. It was found that 4. The prevalence of VZV antibodies varies between A seroprevalence study investigated VZV antibody among young women before marriage in Sanandaj and found that A total of It was highlighted the importance of VZV screening in pregnant woman to avoid life-threatening complications for the mother and fetus during pregnancy.

In addition, several varicella seroprevalence studies were conducted among HCWs in Iran. The authors recommended that all medical science students should be tested for varicella immunity regardless of their previous history of varicella infection.

Varicella was further associated with many clinical complications in several reported cases where VZV was found in skin lesions in kidney transplant recipients. It was found that patients The varicella seroprevalence was investigated in a random sample of the Turkish population under age 30 in nine provinces of Turkey.

In a study aimed to determine the seroprevalence of VZV-IgG antibodies among children aged between 0 and 15 years in Turkey, it was found that VZV seropositivity rates were low up to the end of the first year and then showed a gradual increase. The seropositivity rates were Accordingly, authors highlighted the need of the introduction of varicella vaccine into the routine childhood vaccination program in Turkey since majority of varicella infections occur during the early childhood.

Of children, 65 Authors suggested a vaccination policy before the age of 2 to avoid possible complications in the future. Many other studies investigated the varicella seroprevalence in different regions in Turkey. Thus, it was recommended a serological testing for adolescents and adults with negative history of varicella before VZV immunization.

Furthermore, a large proportion of the population in Izmir was naturally immunized against varicella. Several screening studies among HCWs were also conducted in Turkey regarding immunity against varicella and other viruses, and most studies confirmed that screening and vaccination of susceptible HCWs are essential. Regarding varicella complications, a case study reported T-cell lymphoma in leukemic phase with skin infiltration of neoplastic cells in a previous site of VZV infection.

Furthermore, a case study reported a very rare condition of varicella gastritis in an immunocompetent child. Although varicella gastritis is uncommon and most of reported cases were among immunocompromised adult individuals, it was reported in an immunocompetent girl with severe abdominal pain. The authors suggested that early diagnosis and treatment would have a positive effect on disease prognosis. Moreover, a study aimed to assess the outcome of disseminated varicella infection among renal transplant recipients from January to January An active immunization was recommended for all seronegative patients before organ transplantation, and an early initiation of antiviral therapy would prevent further complication.

A study has reported that the time elapsed between vaccination and hospitalization was approximately 5 years, and neurological complications, mainly encephalitis and meningitis, were the most common reasons for hospitalization in previously healthy children.

Immunization with a single dose of VZV vaccine Varilrix, SmithKline Beecham was shown to be safe and effective in children with steroid-sensitive nephrotic syndrome in remission. A prospective seroepidemiological study of varicella was conducted in on Turkish population in Cyprus. Of individuals, were seropositive for VZV antibodies No data were officially published about the VZV infection prevalence, immunization, or complications in these three countries to date. It is a self-limiting illness that lasts few days and provides lifetime immunity against the infection.

However, varicella causes serious complications among immunocompromised individuals and sometimes among immunocompetent as well. VZV vaccine was developed to prevent the spread of varicella infection in a community and to protect those with weak immune system of developing serious illnesses leading to death.

After the introduction of VZV vaccine by the WHO, most developed countries and some developing countries include it in their national vaccination program. Nevertheless, some developing countries are still very far of reaching this goal. Respectively, a general survey of varicella infection among different populations is essential to control and to prevent epidemic occurrence.

VZV infection was reported as childhood infection in the Middle East. The climate of most Middle East countries is temperate where most VZV cases occur, unlike tropical countries where fewer cases are reported. March, April, and May, which is in parallel with most reports from other temperate regions. Middle East includes also countries with high number of population such as Egypt 90,, , Iran 78,, , Turkey 78,, , and Iraq 36,, To overcome this problem, young children and pregnant woman with negative varicella history should be vaccinated.

In addition, according to most published data of VZV seroprevalence in the Middle East, the self-reported history in different groups of population was not reliable, and the history given was not corresponding to most cases after immunity testing.

For example, although the universal screening is more costly than the routine verbal screening, it was more effective in Iran. Further, immunocompromised individuals and some immunocompetent adults with varicella negative history were at high risk of developing serious clinical conditions. The most reported complications due to varicella infection in the Middle East was CNS involvements followed by skin diseases,[ 25 , 26 , 37 , 41 , 51 , 54 , 68 , 72 , 73 , ] varicella pneumonia,[ 24 , 32 , 33 , 37 , 41 ] and gastric diseases.

The introduction and inclusion of varicella vaccine in the national vaccination program were reported in GCC countries and Turkey. Chickenpox is contagious from 2 days before symptom onset until the last lesion scabs over typically days after rash onset. Healthy children usually have a mild infection and often recover without serious complications.

Adults may experience fever and malaise up to 2 days before the rash occurs and are at higher risk of severe disease. Breakthrough varicella a mild infection with wild-type VZV can occur more than 42 days after varicella vaccination 1 or 2 doses but is less contagious than varicella that occurs in unvaccinated persons.

The most common complications are bacterial infection of skin lesions in children and pneumonia usually viral in adults. Inflammation of the brain membranes, blood infection, or infection of a joint may also occur.

Following infection, the varicella virus can reactivate at any time and cause shingles; see Herpes Zoster. Susceptible persons especially pregnant women and individuals with weakened immune systems who have been exposed to chickenpox should seek medical attention. Varicella vaccine, if given within 5 days of exposure, can prevent or reduce the severity of the illness. Varicella zoster immune globulin can be used for persons who cannot receive the vaccine. Observe good respiratory hygiene cough and sneeze etiquette , hand hygiene frequent, thorough handwashing , and social distancing maintaining a distance of 2 m [6 ft] from persons with illness or skin lesions consistent with chickenpox or shingles.

Varicella vaccine is given routinely as a childhood vaccination and to all nonimmune healthy persons, including health care workers, pregnant women after delivery, and persons who are considered high risk. For travelers, vaccination is recommended for persons 12 months of age and older, unless immune. Natural chickenpox infection provides life-long immunity. A combination vaccine is also available. The most common vaccine side effects are mild and include injection-site reactions pain, redness, warmth, and swelling , irritability, and fever.

A localized or generalized varicella-like rash may occur around the injection site within 2 to 3 weeks of vaccination. Serious side effects are rare but can include severe allergic reactions, fluid retention, anemia, vascular disorders, lung tissue inflammation, and various neurological conditions. Persons with underlying medical conditions or who have concerns about the vaccine should speak to their health care provider before vaccine administration.

Duration of vaccine protection is unknown; however, long-term efficacy studies have demonstrated continued protection up to 10 years post vaccination in children. They may need to take antiviral medicines. Once you catch chickenpox, the virus usually stays in your body.

You probably will not get chickenpox again, but the virus can cause shingles in adults. A chickenpox vaccine can help prevent most cases of chickenpox, or make it less severe if you do get it. The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health. Chickenpox Also called: Varicella. Learn More Related Issues Specifics. See, Play and Learn Images. Research Clinical Trials Journal Articles.

Resources Find an Expert. Other symptoms include Fever Headache Tiredness Loss of appetite Chickenpox is usually mild and lasts 5 to 10 days. Centers for Disease Control and Prevention.