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Unprotected People Reports: Chickenpox |
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Three Fatal Varicella Cases in Unvaccinated Young Women |
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| Click here for a fully-formatted PDF version
of this report. |
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| Three fatal varicella cases in young adult women were reported to CDC by state
health departments during January-April 1997. All three women were susceptible
to varicella, unvaccinated, and infected by exposure to unvaccinated
preschool-aged children who had contracted varicella. These three cases appeared
in the MMWR, May 16, 1997, vol. 46, no.19 and are reprinted below. |
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| Note: There are approximately 100 deaths and 10,000
hospitalizations from varicella each year in the United States. The ACIP
recommends that all susceptible children (12 months of age and older) and all
susceptible adults be vaccinated. Please recommend varicella vaccine to your
susceptible patients of all ages. |
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Case 1: Death of a 23-year-old woman
On January 19, 1997, a 23-year-old woman in good health had onset of a
classic varicella rash. In early January, her 2- and 5-year-old unvaccinated
children had had varicella. On January 22, she had onset of shortness of breath
and hemoptysis. When she was admitted to a local hospital on January
23, a chest radiograph indicated diffuse alveolar density consistent with
varicella pneumonia, and treatment was initiated with oxygen and intravenous
acyclovir. Her condition worsened, and she required intubation several hours
after admission. Because of increasing respiratory distress, she was transferred
to a referral hospital where treatment continued with oxygen, antibiotics, and
intravenous acyclovir.On January 31, her
rash became hemorrhagic, and she developed disseminated intravascular
coagulation (DIC) and renal failure, followed by progression to multiple system
failure; she died on February 2. Varicella zoster virus was cultured from skin
lesions and from a tracheal aspirate.
Case 2: Death of a 25-year-old woman
On March 11, 1997, a 25-year-old woman in good health had onset of a classic
varicella rash, fever, and headache. Her 4-year-old unvaccinated child had had
onset of a varicella rash on February 23. On March 12, the woman had onset of
cough, and on March 13, shortness of breath. On March 14, she sought care at a
local emergency department (ED) because of increasing respiratory difficulty and
confusion. Chest radiograph indicated bilateral infiltrates consistent with
varicella pneumonia, and arterial blood gases indicated hypoxemia. Varicella
encephalitis and pneumonia were diagnosed; she was admitted to the hospital, and
treatment was initiated with oxygen and intravenous acyclovir. Four hours after admission, her respiratory
difficulty increased, and she required intubation. On March 15, a
computerized tomography of the brain revealed severe, diffuse cerebral
edema, and she developed renal failure and coma. On March 16, she was
transferred to a referral hospital for renal dialysis; an
electroencephalogram indicated absence of electrical brain activity, and
repeat chest radiographs indicated diffuse infiltrates. She died on March
17.
Case 3: Death of a 32-year-old woman
On April 3, 1997, a 32-year-old woman with Crohn's disease sought medical
evaluation at a local ED because of onset of abdominal and back pain. On
March 7, therapy was initiated with 40 mg prednisone daily for an
exacerbation of her Crohn's disease. By April 3, her steroid therapy had
been tapered to 20 mg prednisone daily. On physical examination, she had
mild, generalized abdominal tenderness with no specific signs or abdominal
guarding. She was afebrile, and a white blood cell (WBC) count was normal. A
benign abdominal syndrome was presumptively diagnosed, and she was
discharged.
Her symptoms persisted, and on April 4, she sought medical evaluation at the
office of her health-care provider. Findings on physical examination were
unchanged. Although an abdominal radiograph, abdominal and pelvic
ultrasounds, and a WBC count were normal, because of her underlying medical
condition, she was referred for surgical consultation. On April 5, the
abdominal pain persisted, and she returned to the ED for evaluation. A WBC
count was 15,000/mm3 (normal: 3200-9800/mm3), and she was admitted to the
hospital. Diagnoses of colitis and ileitis with possible perforation and
intraabdominal abscess were considered, and treatment was initiated with
broad-spectrum antibiotics. On physical examination, a maculopapular,
vesicular rash with crusted lesions was observed on her trunk, head, and
neck. Varicella was presumptively diagnosed, and she was placed in isolation. The patient reported that she had had onset of
a mild macular, nonpruritic rash on her back on April 3 and that she had
been exposed on March 12 and 13 to her 4-year-old unvaccinated niece with
varicella. On April 6, the vesicles became hemorrhagic, and she began
bleeding from intravenous sites. She rapidly developed hypotension and DIC,
and died from shock the same day. On autopsy, evidence of viral inclusion
bodies in multiple organs was consistent with varicella, and varicella was
determined to be the cause of death.
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| 11/5/98 • REPORT #4 |
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| Disclaimer: The Immunization Action Coalition (IAC) publishes
Unprotected People Reports for the purpose of making them available
for our readers' review. We have not verified the content of this
report. |
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