Varicella, a contagious viral disease, is typically self-limited but can result in serious complications, especially among persons who are immunocompromised. On April 10, 2012, a girl aged 4 years with acute lymphoblastic leukemia (ALL) was exposed to a mildly ill cousin who developed a varicella rash 2 days later. The episode was reported to the child's oncologist after 13 days. The girl was prescribed 7 days of oral acyclovir for prophylaxis and concurrently began her scheduled chemotherapy, which included a 5-day course of dexamethasone (prednisone equivalent dose of 23 mg/day). Twenty-two days after her varicella exposure, the girl was taken to an emergency department for fever and abdominal pain. She was treated symptomatically; her caretakers were instructed to discontinue chemotherapy and to follow up with her oncologist. Two days later, the girl returned to the emergency department with a generalized rash. She was hospitalized and treated with intravenous acyclovir and antibiotics. However, she developed multiorgan failure and died on May 7. Varicella was confirmed by polymerase chain reaction testing, and no alternative diagnoses were found for her acute illness.
[Show abstract][Hide abstract] ABSTRACT: Military personnel are deployed abroad for missions ranging from humanitarian relief efforts to combat actions; delay or interruption in these activities due to disease transmission can cause operational disruptions, significant economic loss, and stressed or exceeded military medical resources. Deployed troops function in environments favorable to the rapid and efficient transmission of many viruses particularly when levels of protection are suboptimal. When immunity among deployed military populations is low, the risk of vaccine-preventable disease outbreaks increases, impacting troop readiness and achievement of mission objectives. However, targeted vaccination and the optimization of preexisting immunity among deployed populations can decrease the threat of outbreaks among deployed troops. Here we describe methods for the computational modeling of disease transmission to explore how preexisting immunity compares with vaccination at the time of deployment as a means of preventing outbreaks and protecting troops and mission objectives during extended military deployment actions. These methods are illustrated with five modeling case studies for separate diseases common in many parts of the world, to show different approaches required in varying epidemiological settings.
Computational and Mathematical Methods in Medicine 06/2014; 2014:785752. DOI:10.1155/2014/785752 · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This manuscript describes trends in US varicella mortality using national vital statistics system data for 2008-2011, the first years of the routine 2-dose varicella vaccination program, and characteristics of varicella deaths reported to CDC during 1996-2013. We obtained data on deaths with varicella as underlying or contributing cause from the 2008-2011 Mortality Multiple Cause-of Death records and calculated rates to compare with the prevaccine and mature 1-dose varicella vaccination program eras. We also reviewed available records of varicella deaths reported to CDC through the national varicella death surveillance. The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.05 per million population during 2008-2011, an 87% reduction from the prevaccine years. Varicella deaths among persons aged <20 years declined by 99% in 2008-2011 compared with prevaccine years. There was a 70% decline in varicella mortality rates among those <20 years in 2008-2011 compared to 2005-2007. Among the 83 deaths reported to CDC during 1996-2013 classified as likely due to varicella, 24 (29%) were among immunocompromised individuals. Five were among persons previously vaccinated with 1 dose of varicella vaccine. In conclusion, although the US varicella vaccination program has significantly reduced varicella disease burden, there are still opportunities to prevent varicella and its associated morbidity and mortality through routine varicella vaccination, catch-up vaccination, and ensuring that household contact of immunocompromised persons have evidence of immunity.
Human Vaccines and Immunotherapeutics 02/2015; 11(3). DOI:10.1080/21645515.2015.1008880 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report two children with life-threatening breakthrough varicella. Both had received one varicella vaccination before onset of cancer. Despite treatment with intravenous acyclovir, one child died of disseminated varicella. Because similar fatal cases have been reported, high-risk immunocompromised children with one varicella vaccination may warrant the same varicella prophylaxis as immunocompromised children who have never been vaccinated.
Plastic & Reconstructive Surgery 04/2015; Publish Ahead of Print. DOI:10.1097/INF.0000000000000737 · 2.99 Impact Factor
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