Varicella

Photoclinic



One week after vaccination with diphtheria, tetanus, and acellular pertussis/inactivated poliovirus/hepatitis B, Haemophilus influenzae type b, pneumococcal conjugate, and rotavirus, this 2½-month-old infant presented with a vesicular rash. No other children in the home had a rash. The infant's primary caregiver was the grandmother, who had shingles 2 weeks earlier.

Varicella-zoster virus, a herpes virus, causes 2 distinct clinical diseases: varicella (chickenpox) and herpes zoster (shingles). Adults with shingles can infect susceptible children via contact with vesicular fluid, which contains an enormous load of virus particles. In infants, varicella usually has a benign course and does not require treatment.

Because this infant had chickenpox, vaccination after his first birthday may not be required. Consultation with a local infectious disease specialist may provide further clarification.

Treatment of a newborn with varicella-zoster immunoglobulin may be required if a rash develops in the mother within 5 days before or 2 days after childbirth. If varicella lesions subsequently develop in the infant, acyclovir should be administered promptly.^1,2