This case study is developed from an incidence report in a past issue of the Mor

Question

This case study is developed from an incidence report in a past issue of the Morbidity and Mortality Report from the Center for Disease Control and Prevention in Atlanta.

Minnesota, July 1989

At a 3-week summer high school wrestling camp many participants began becoming ill. Around day 15 of camp a number of the young men (average age of 16) presented with a fever, malaise, swollen lymph nodes and a painful vesicular skin rash. The rash tended to occur in areas of high contact (the head/neck, extremities, and trunk) though there were 5 students whose eyes were affected. The local urgent care facility took samples of fluid from the vesicles for culturing, but could not culture bacteria or fungi from these samples.

Athletes who had wrestled with a student with a rash were more likely to have the infection as well. Patients with a past history of cold sores were significantly less likely to contract the disease. A phone interview after camp concluded indicated that up to a week after camp more participants developed symptoms. In the end, sixty-one of one hundred seventy-five participants were infected.

1. What is the etiologic agent of this disease?

2. How was this disease transmitted?

3. Why might patients with a history of cold sores be more resistant to this infection?

4. What are the treatment options?

5. How could future outbreaks be prevented?

Explanation / Answer

1 varicella-zoster virus (VZV),

Herpes Zoster

2 The transmission of VZV does not require skin-to-skin contact, and is more commonly transmitted by respiratory secretions via an aerosol route.

3 patients with a history of cold sores be more resistant to this infection because

Zoster appears to be less of a problem after immunization than after natural infection.

4 - Treatments - antiviral drugs, tricyclic antidepressants, and analgesics Fever should be controlled with acetaminophen. .Since varicella is usually a benign, mild, self-limiting disease in most immunocompetent individuals, oral acyclovir (ACV) is not routinely recommended. However, since adolescents and young adults are at a moderately high risk for developing severe illness, oral ACV should be administered for 5 days, ideally starting within 24 h of the development of a varicella rash

5 The development of the live attenuated varicella vaccine was a landmark in vaccine research . It remains the only vaccination in use today against any of the herpesviruses. the live varicella vaccine was found to be extremely safe in susceptible children and adults

.

Live attenuated varicella vaccine is highly immunogenic

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