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Severe varicella associated with steroid use

S F Dowell¹, J S Bresee

¹Department of Pediatrics, University of Washington School of Medicine, Seattle.

|August 1, 1993

Summary

Systemic corticosteroid use significantly elevates the risk of severe varicella (chickenpox). This association highlights the importance of considering steroid timing, dose, and duration in vulnerable patients.

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Area of Science:

Infectious Diseases
Immunology
Pediatrics

Background:

Varicella (chickenpox) can lead to severe complications, particularly in immunocompromised individuals.
The role of corticosteroid therapy in modulating varicella severity requires further elucidation.

Purpose of the Study:

To investigate the association between systemic corticosteroid use and the risk of developing severe varicella in children.

Main Methods:

A case-control study comparing corticosteroid exposure in 35 children with severe varicella against 10,000 control subjects.
Analysis included patients with and without known immunosuppressive conditions.

Main Results:

Corticosteroid use was strongly associated with severe varicella (odds ratio 178 without known immunosuppression; 420 with known immunosuppression).
Steroid exposure often occurred within the viral incubation period.
Even low-dose prednisone was associated with increased risk.

Conclusions:

Systemic corticosteroids substantially increase the risk of severe or fatal varicella.
Timing, dose, and duration of steroid use are critical factors.
Physicians should counsel varicella-susceptible patients on increased risks when prescribing corticosteroids.

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