Viral pneumonia chest x ray findings12/9/2023 ![]() People with breakthrough varicella are also contagious. Although limited data are available to assess the risk of VZV transmission from zoster, one household study found that the risk for VZV transmission from herpes zoster was approximately 20% of the risk for transmission from varicella. Based on studies of transmission among household members, about 90% of susceptible close contacts will get varicella after exposure to a person with disease. It takes from 10 to 21 days after exposure to the virus for someone to develop varicella. These people are considered contagious until no new lesions have appeared for 24 hours. Vaccinated people may develop lesions that do not crust. A person with varicella is considered contagious beginning one to two days before rash onset until all the chickenpox lesions have crusted. The virus can be spread from person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster, and possibly through infected respiratory secretions that also may be aerosolized. Breakthrough varicella occurs less frequently among those who have received two doses of vaccine compared with those who have received only one dose disease may be even milder among two-dose vaccine recipients, although the information about this is limited. Laboratory testing is increasingly important for confirming varicella and appropriately managing the patients and their contacts. Since the clinical features of breakthrough varicella are often mild, it can be difficult to make a diagnosis on clinical presentation alone. However, 25% to 30% of people vaccinated with one dose who get breakthrough varicella will have clinical features similar to unvaccinated people with varicella. The rash is more likely to be predominantly maculopapular rather than vesicular. They usually have a shorter illness compared to unvaccinated people who get varicella. Patients typically are afebrile or have low fever and develop fewer than 50 skin lesions. As with other viral infections, re-exposure to natural (wild-type) varicella may lead to re-infection that boosts antibody titers without causing illness or detectable viremia.īreakthrough varicella on the abdomen of a vaccinated child.īreakthrough varicella is infection with wild-type varicella-zoster virus (VZV) occurring in a vaccinated person more than 42 days after varicella vaccination. Second occurrence of varicella may be more likely to occur in people who are immunocompromised. In otherwise healthy people, a second occurrence of varicella is uncommon. Recovery from primary varicella infection usually provides immunity for life. Infants, adolescents, adults, pregnant women, and immunocompromised people are at risk for more severe disease and have a higher incidence of complications. In healthy children, varicella is generally mild, with an itchy rash, malaise, and temperature up to 102☏ for 2 to 3 days. The lesions are usually most concentrated on the chest and back. The rash usually appears first on the chest, back, and face, then spreads over the entire body. Lesions are typically present in all stages of development at the same time. It progresses rapidly from macular to papular to vesicular lesions before crusting.
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