VARICELLA IN PEDIATRIC-PATIENTS

OBJECTIVE: To summarize the literature describing the epidemiology, tr ansmission, clinical manifestations, diagnosis, treatment, and prevent ion of varicella in the pediatric population. DATA SOURCES: A literatu re search of English-language articles from 1982 to 1992 using MEDLINE and bibliographies of relevant articles. The search term used was var icella. STUDY SELECTION: All review articles and original studies addr essing the epidemiology, transmission, clinical manifestations, compli cations, diagnosis, treatment, and prevention of varicella in pediatri c patients were reviewed. Emphasis was placed on controlled studies do ne in the US. DATA EXTRACTION: Data from human studies were extracted by the authors and evaluated according to patient population, sample s ize, dosing regimen, efficacy, and safety. DATA SYNTHESIS: Varicella-z oster virus is a highly contagious virus that produces a common and co stly disease in the pediatric population. The primary manifestation of varicella is the eruption of vesicular lesions. In most cases varicel la is benign, but it can be associated with serious complications. Dia gnosis is based primarily on clinical findings. Otherwise healthy chil dren have traditionally received only symptomatic treatment for varice lla, but recent literature suggests that antiviral therapy may be usef ul in these patients. Immunocompromised patients benefit from both sym ptomatic and antiviral therapy. Isolation and varicella-zoster immune globulin are used to prevent varicella. In the future, varicella vacci ne will play an important role in preventing the disease. Varicella va ccine has been shown to be immunogenic and clinically effective in bot h healthy and immunocompromised children. Adverse reactions associated with the vaccine include fever, injection-site reactions, and rash. A lthough zoster can follow vaccination, the incidence appears to be low er in vaccinated individuals. Preliminary studies have shown that the vaccine provides protection from varicella-zoster virus for an extende d period of time. CONCLUSIONS: Varicella is a common, usually benign d isease of childhood. All patients may benefit from symptomatic therapy . Current literature does not support the use of antiviral therapy in all pediatric patients with varicella. When commercially available, va ricella vaccine will play an important role in prevention. Long-term s tudies are needed to fully assess the risk of developing varicella and zoster following vaccination.