Varicella-related deaths in children and adolescents--Germany 2003-2004
Veit Grote1, Rüdiger von Kries, Wolfgang Springer
1Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany. veit.grote@med.uni-muenchen.de
Insights
Varicella (chickenpox) poses a small but significant risk of death in children, particularly those with weakened immune systems. Implementing a widespread varicella vaccination program is crucial for prevention.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Vaccinology
Background:
- Varicella (chickenpox) is a known, though rare, cause of mortality in pediatric populations.
- Comprehensive data on the clinical progression leading to varicella-related deaths in children are limited.
Observation:
- A 2-year nationwide surveillance in Germany identified 10 pediatric deaths associated with varicella.
- Mortality rate was 0.4 per 1,000,000 children annually.
- Deaths occurred in immunocompromised children (leukemia, congenital varicella syndrome) and from complications like pneumonia, sepsis, and myocarditis.
Findings:
- Varicella represents a non-negligible mortality risk for both immunocompetent and immunocompromised children in unvaccinated populations.
- Specific high-risk groups include children with acute lymphocytic leukemia and congenital varicella syndrome.
- Complications such as varicella pneumonia, sepsis, and myocarditis were identified as direct causes of death.
Implications:
- The findings underscore the critical importance of a comprehensive, universally implemented varicella vaccination program.
- Vaccination can significantly reduce varicella-related morbidity and mortality in children.
- Public health strategies should focus on increasing vaccination coverage to mitigate risks.
Aim:
Although varicella is acknowledged as a rare cause of death in children, there are few comprehensive data with respect to the clinical course leading to death.
Methods:
A nationwide, active surveillance was carried out in Germany for children up to age 17 years who were admitted to a paediatric hospital for varicella or associated complications, including deaths.
Results:
A total of 10 children with varicella-associated death were reported over period of 2 years, yielding a mortality rate of 0.4/1 000 000 children per year. Three deaths occurred in children diagnosed with acute lymphocytic leukaemia and disseminated varicella, two shortly after diagnosis of leukaemia and therefore not preventable, and one during remission with an untypical presentation. Two children died with a congenital varicella syndrome. There was no death in children with neonatal varicella. Four other cases were related to varicella pneumonia or septicaemia and one to myocarditis.
Conclusion:
In a population with no general varicella vaccination programme, varicella accounted for a small but not negligible risk for death in immunocompetent and immunocompromised children. Together these data point to the importance of a thoroughly implemented, general varicella vaccination programme.
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