Television journalist Barbara Walters was recently diagnosed with chickenpox. Chickenpox is a common disease usually acquired in childhood. The condition is less frequently seen in adults and is rarely seen in the elderly. As such, the medical complications of chicken pox at Ms. Walters age can be quite serious – even life-threatening. (1, 2, 3)
The advent of the chickenpox vaccine has helped quell the disease in all age groups over the last 15 years. Prior to the introduction of the chickenpox vaccine, infected adults had a risk of death 25 times greater than similarly-infected young children aged 1-4. The elderly have an even higher risk of mortality from chicken pox. (3, 4, 5)
Chickenpox is caused by the varicella zoster virus (VZV), a double-stranded DNA virus that is transmitted through the spread and inhalation of VZV particles from an infected individual. The course of the disease is marked by 2-4 days of upper respiratory tract infection (URI) and viral incubation in the lymph nodes of the upper respiratory tract. Disease symptoms include headache, fever, loss of appetite, irritability, and a dry cough. Viremia, a spread of the virus throughout the bloodstream and internal organs, ensues. After 14-16 days, hallmarks of the disease appear on the skin. These include a rash characterized by raised, itchy red papules (bumps), followed by vesicles (blisters filled with fluid). The vesicles then rupture and leak clear fluid. Finally, crusting of the blisters appears. Common complications include secondary bacterial infection of the rash and/or blisters and permanent scarring. (3, 6)
Severe complications include hearing loss and a recurrence of varicella infection later in life in the form of shingles. Shingles, characterized by a skin rash with a dermatomal distribution, causes severe and sometimes debilitating pain in those affected. Shingles can be deadly, as well. It is estimated that approximately 96 people die annually from shingles – almost all of these deaths are in the elderly. (3, 7, 8)
Varicella pneumonia and encephalitis – a serious inflammation of the tissues of the brain – are two life-threatening complications of VZV infection. Disseminated varicella is an ominous systemic complication of chickenpox. (3, 9)
Chickenpox still affects multitudes of people annually. One source cites Centers for Disease Control and Prevention (CDC) statistics of 1 out of every 10,000 people in the United States as being infected annually.(1) However, it has become more difficult to accurately quantify the specific incidence and prevalence of chicken pox in the general United States population, as a whole. The decline in the number of chickenpox cases is primarily due to the overwhelming success of the VZV vaccine, which has been available since 1995. In fact, cases of chicken pox have decreased nearly 80% as a result. Another significant finding is that nearly 50,000 chickenpox-associated hospitalizations were prevented in a five-year period between 2002 and 2006. (10, 11, 12, 13)
It is quite possible that Ms. Walters chicken pox episode could have been prevented with the VZV vaccine, as well. However, perhaps there was a mitigating medical circumstance for which vaccination would not have been advised for her. Although the shingles vaccine is frequently administered in the elderly, it does not necessarily confer immunity to chickenpox.(14)
Fortunately, Ms. Walters is now resting comfortably at home. May she have a speedy recovery.
1. ” Barbara Walters Has Chicken Pox.” ABC News. Website. January 28, 2013. http://abcnews.go.com/Entertainment/barbara-walters-chicken-pox/story?id=18334962. Retrieved January 30, 2013.
2. Mayo Clinic Staff. “Chickenpox.” Mayo Clinic Website. September 3, 2010. http://www.mayoclinic.com/health/chickenpox/DS00053. Retrieved January 30, 2013.
3. “Health Guide.” New York Times. January 30, 2013. Website. http://health.nytimes.com/health/guides/disease/chickenpox/possible-complications.html. Retrieved January 30, 2013.
4. Meyer, Pamela, Seward, Jane F, Jumaan, Aisha O., Wharton, Melinda. ” Varicella Mortality: Trends before Vaccine Licensure in the United States, 1970–1994.” The Journal of Infectious Diseases.” 182:2. 383-390. 2000. Website. http://jid.oxfordjournals.org/content/182/2/383.long. Retrieved January 30, 2013.
5. Noah, Norman. ” Adults still account for many deaths from chickenpox .” British Medical Journal. 325:7357. 221. July 27, 2002. Website. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123733/. Retrieved January 30, 2013.
6. Papadopoulos, Anthony J. “Chickenpox.” Medscape Reference. Updated December 28, 2012. http://emedicine.medscape.com/article/1131785-overview. Retrieved January 30, 2013.
7. “Shingles Health Center.” WebMD. Website. Last Updated August 1, 2011. http://www.webmd.com/skin-problems-and-treatments/shingles/shingles-topic-overview. Retrieved January 30, 2013.
8. “Shingles (Herpes Zoster).” Centers for Disease Control and Prevention. Website. Last Updated October 23, 2012. http://www.cdc.gov/shingles/hcp/clinical-overview.html. Retrieved January 30, 2013.
9. “Encephalitis.” PubMed Health. Website. Last reviewed: August 1, 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002388/. Retrieved January 30, 2013.
10. “Evolution of Varicella Surveillance — Selected States, 2000–2010.” Morbidity and Mortality
Weekly Report (MMWR). Centers for Disease Control and Prevention. Website. 61:32. 609-612. August 17, 2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a2.htm?s_cid=mm6132a2_w. Retrieved January 30, 2013.
11. ” Vaccines and Preventable Diseases. Chickenpox Vaccination: What Everyone Should Know.” Centers for Disease Control and Prevention. Website. April 5, 2012. http://www.cdc.gov/vaccines/vpd-vac/varicella/default-basic.htm. Retrieved January 30, 2013.
12. Yandell, Kate. “Chickenpox Down 80 Percent Since 2000.” New York Times. Website. August 20, 2012. http://well.blogs.nytimes.com/2012/08/20/chickenpox-down-80-percent-since-2000/. Retrieved January 30, 2013.
13. Tinder, Paul. “Chicken pox incidence dropping, study shows.” Vaccine News Daily. Website. January 11, 2011. http://vaccinenewsdaily.com/news/226257-chicken-pox-incidence-dropping-study-shows/
14. “Herpes Zoster Vaccination for Health Care Professionals.” Centers for Disease Control and Prevention. December 14, 2012. Website. http://www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm. Retrieved January 31, 2013.