Home
|
About IAC
|
Contact
|
A-Z Index
|
Donate
|
Shop
|
SUBSCRIBE
Immunization Action Coalition
Unprotected People Reports 
General
Chickenpox (varicella)
Diphtheria
Hib
Hepatitis A
Hepatitis B
HPV
Influenza
Measles
Meningococcal
Mumps
Pertussis
Pneumococcal
Polio
Rabies
Rotavirus
Rubella
Shingles (zoster)
Tetanus
Yellow Fever
Reports by Disease
Reports by Number

Unprotected People Reports: Chickenpox

Three Fatal Varicella Cases in Unvaccinated Young Women 

Click here for a fully-formatted PDF version of this report.
Three fatal varicella cases in young adult women were reported to CDC by state health departments during January-April 1997. All three women were susceptible to varicella, unvaccinated, and infected by exposure to unvaccinated preschool-aged children who had contracted varicella. These three cases appeared in the MMWR, May 16, 1997, vol. 46, no.19 and are reprinted below.
Note: There are approximately 100 deaths and 10,000 hospitalizations from varicella each year in the United States. The ACIP recommends that all susceptible children (12 months of age and older) and all susceptible adults be vaccinated. Please recommend varicella vaccine to your susceptible patients of all ages.
Case 1: Death of a 23-year-old woman
On January 19, 1997, a 23-year-old woman in good health had onset of a classic varicella rash. In early January, her 2- and 5-year-old unvaccinated children had had varicella. On January 22, she had onset of shortness of breath and  hemoptysis. When she was admitted to a local hospital on  January 23, a chest radiograph indicated diffuse alveolar density consistent with varicella pneumonia, and treatment was initiated with oxygen and intravenous acyclovir. Her condition worsened, and she required intubation several hours after admission. Because of increasing respiratory distress, she was transferred to a referral hospital where treatment continued with oxygen, antibiotics, and intravenous acyclovir.On January 31, her rash became hemorrhagic, and she developed disseminated intravascular coagulation (DIC) and renal failure, followed by progression to multiple system failure; she died on February 2. Varicella zoster virus was cultured from skin lesions and from a tracheal aspirate.

Case 2: Death of a 25-year-old woman
On March 11, 1997, a 25-year-old woman in good health had onset of a classic varicella rash, fever, and headache. Her 4-year-old unvaccinated child had had onset of a varicella rash on February 23. On March 12, the woman had onset of cough, and on March 13, shortness of breath. On March 14, she sought care at a local emergency department (ED) because of increasing respiratory difficulty and confusion. Chest radiograph indicated bilateral infiltrates consistent with varicella pneumonia, and arterial blood gases indicated hypoxemia. Varicella encephalitis and pneumonia were diagnosed; she was admitted to the hospital, and treatment was initiated with oxygen and intravenous acyclovir. Four hours after admission, her respiratory difficulty increased, and she required intubation. On March 15, a computerized tomography of the brain revealed severe, diffuse cerebral edema, and she developed renal failure and coma. On March 16, she was transferred to a referral hospital for renal dialysis; an electroencephalogram indicated absence of electrical brain activity, and repeat chest radiographs indicated diffuse infiltrates. She died on March 17.

Case 3: Death of a 32-year-old woman
On April 3, 1997, a 32-year-old woman with Crohn's disease sought medical evaluation at a local ED because of onset of abdominal and back pain. On March 7, therapy was initiated with 40 mg prednisone daily for an exacerbation of her Crohn's disease. By April 3, her steroid therapy had been tapered to 20 mg prednisone daily. On physical examination, she had mild, generalized abdominal tenderness with no specific signs or abdominal guarding. She was afebrile, and a white blood cell (WBC) count was normal. A benign abdominal syndrome was presumptively diagnosed, and she was discharged.

Her symptoms persisted, and on April 4, she sought medical evaluation at the office of her health-care provider. Findings on physical examination were unchanged. Although an abdominal radiograph, abdominal and pelvic ultrasounds, and a WBC count were normal, because of her underlying medical condition, she was referred for surgical consultation. On April 5, the abdominal pain persisted, and she returned to the ED for evaluation. A WBC count was 15,000/mm3 (normal: 3200-9800/mm3), and she was admitted to the hospital. Diagnoses of colitis and ileitis with possible perforation and intraabdominal abscess were considered, and treatment was initiated with broad-spectrum antibiotics. On physical examination, a maculopapular, vesicular rash with crusted lesions was observed on her trunk, head, and neck. Varicella was presumptively diagnosed, and she was placed in isolation. The patient reported that she had had onset of a mild macular, nonpruritic rash on her back on April 3 and that she had been exposed on March 12 and 13 to her 4-year-old unvaccinated niece with varicella. On April 6, the vesicles became hemorrhagic, and she began bleeding from intravenous sites. She rapidly developed hypotension and DIC, and died from shock the same day. On autopsy, evidence of viral inclusion bodies in multiple organs was consistent with varicella, and varicella was determined to be the cause of death.
 
11/5/98 • REPORT #4
Disclaimer: The Immunization Action Coalition (IAC) publishes Unprotected People Reports for the purpose of making them available for our readers' review. We have not verified the content of this report.
 
- Guide to immunize.org -
A-Z INDEX
ABOUT IAC
ACIP RECOMMENDATIONS
ADULT VACCINATION
ADULT VACCINATION GUIDE
ADULT VACCINATION
RESOURCES LIBRARY (AVRL)
ASK THE EXPERTS
Combination Vaccines
Diphtheria
Hepatitis A
Hepatitis B
Question of the Week
Vaccine Storage and Handling
What's New
>> view all
BIRTH DOSE GUIDEBOOK
BOOKS & PERIODICALS
CALENDAR
CDC SCHEDULES
CLINIC RESOURCES
Administering Vaccines
Documenting Vaccination
Coding & Billing
Scheduling Vaccination
Screening for Contraindications
Storage & Handling
Vaccine Recommendations
>> view all
COALITIONS
COCOONING
CONTINUING EDUCATION
CONTRIBUTE TO IAC
DEAR COLLEAGUE LETTER
HPV VACCINE
DEAR COLLEAGUE LETTER
MCV4 DOSE #2
DIRECTORY OF RESOURCES
DISEASES & VACCINES
Diphtheria
Hepatitis A
Hepatitis B
Influenza
Varicella
>> view all
DONATE TO IAC
EDUCATIONAL MATERIALS
FAQs
FDA PRODUCT APPROVALS
GIVE BIRTH TO THE END OF
HEP B
HANDOUTS FOR PATIENTS &
STAFF
Administering Vaccines
Adult Vaccination
Documenting Vaccinations
Medical Management
Parent Handouts
Patient Schedules
Questions & Answers
Recommendations
Screening Questionnaires
Standing Orders
Storage & Handling
Supplies Checklist
Talking with Parents
Temperature Logs
Translations
Vaccine Index
Vaccine Reactions
>> view all
HEPATITIS B BIRTH DOSE
HONOR ROLLS
HepB Birth Dose
Influenza Vaccination for HCP
IAC EXPRESS
IMAGES
IMMUNIZATION TECHNIQUES DVD
IMMUNIZATION TOPICS
Adoption
Healthcare Personnel
Mandates & Exemptions
Pregnancy
Tattoos & Piercings
>> view all
 
LAMINATED SCHEDULES
NEEDLE TIPS
NEWS & INFORMATION
OFFICIAL RELEASES
ACIP
CDC
FDA
>> view all
PACKAGE INSERTS
PHARMACISTS
PHOTOS
POCKET GUIDES
POWERPOINT SLIDE SETS
PRESS ROOM
PROTECT NEWBORNS
FROM HEP B
PUBLICATIONS
IAC Express
Needle Tips
Vaccinate Adults
THE PURPLE BOOK
QUESTION OF THE WEEK
REGISTRIES
RESOURCE DIRECTORY
SCHOOL-LOCATED VACCINATION
SHOP IAC
Immunization Techniques DVD
Laminated Schedules
Patient Record Cards
The Vaccine Handbook
>> view all
SITE MAP
SLIDE SETS
STATE INFORMATION
State Websites
State Laws
State Immunization Managers
>> view all
SUBSCRIBE
SUPPORT IAC
TECHNICALLY SPEAKING
TRANSLATE FOR IAC
TRAVEL (INTERNATIONAL)
UNPROTECTED PEOPLE REPORTS
Chickenpox
Diphtheria
Hepatitis A
Hepatitis B
>> view all
VACCINATE ADULTS
VACCINE CONCERNS
Adjuvants & Ingredients
Alternative Medicine
Autism
Importance of Vaccination
>> view all
THE VACCINE HANDBOOK
VACCINE INFORMATION STATEMENTS
Translations
Vaccine Index
>> view all
VACCINE POLICY & LICENSURE
ACIP
FDA
WHO
>> view all
VACCINE SAFETY
VACCINES & DISEASES
VIDEOS (VIDEO OF THE WEEK)
WHAT'S NEW OR UPDATED AT IAC
Handouts
VISs
Web Sections
>> view all
 
Immunization Action Coalition  •  2550 University Avenue West  •  Suite 415 North  •  Saint Paul, Minnesota  •  55114
tel 651-647-9009  •  fax 651-647-9131
 
 
 
This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.