Για όσους θεωρούν το εμβόλιο της ανεμευλογιάς δευτερεύον με τη χαρακτηριστική φράση......κι εμείς που περάσαμε ανεμευλογιά, τι πάθαμε;, ιδού η απάντηση: CNS Complications of Varicella-Zoster Virus in the Postvaccine Era Deborah Lehman, MD Reviewing Science M et al., J Pediatr 2014 Jul 22; Unimmunized children are at risk for varicella infection and associated neurologic complications. Encephalitis is the most common central nervous system (CNS) complication of infection with varicella-zoster virus (VZV), but stroke can also occur. Less common complications include Guillain-Barré syndrome and Ramsay-Hunt syndrome. Although VZV vaccination has reduced the incidence of primary varicella disease and associated complications (NEJM JW Pediatr Adolesc Med Jul 16 2014), risk remains in unvaccinated children. To describe neurologic complications in the post-VZV vaccine era, researchers retrospectively examined records of all children with neurologic complications of VZV infection who were admitted to a single Canadian childrens hospital between 1999 and 2012. VZV vaccine was introduced in Canada in 1999, and full coverage in children began in 2004. During the 13-year period, 84 children with varicella-related neurologic complications were admitted. Following full coverage in 2004, the rate of admissions for VZV-related CNS complications fell by more than 50%. Only 5% of children had documentation of having received varicella vaccine, although 82% of unvaccinated patients were eligible. Most children (81%) did not have underlying conditions. Cerebellar ataxia was the most common neurologic complication (31%), followed by encephalitis (20%), seizures (19%), and meningitis (12%). Neurologic symptoms predated the varicella exanthema in five children. At 1-year follow-up, patients with encephalitis and stroke had the highest rate of neurologic sequelae, and all those with acute cerebellar ataxia had normal exams. Comment VZV infection can cause neurologic complication even before development of the recognizable exanthema. Unimmunized children are at risk for infection and its complications, and that risk can only be reduced if vaccine is administered. This retrospective review reminds us that complications of vaccine-preventable diseases will not be stopped if the disease itself is not prevented. Editor Disclosures at Time of Publication Disclosures for Deborah Lehman, MD at time of publication Nothing to disclose Citation(s): Science M et al. Central nervous system complications of varicella-zoster virus. J Pediatr 2014 Jul 22; [e-pub ahead of print]. (dx.doi.org/10.1016/j.jpeds.2014.06.014)
Posted on: Wed, 13 Aug 2014 08:52:55 +0000