Fatal infection with varicella in an adult

Learning Objectives for this Presentation:
1. By the end of the presentation participants will understand the risk of varicella in an adult on immunosupressive medication, be be able to describe varicella in an immunosupressed adult, and understand the non-cutaneous manifestations and complications of varicella.

Background:
Varicella is a vaccine-preventable disease that can be fatal.Varicella vaccination is more than 95% effective against severe disease and, since 1996, has been recommended for routine administration to children aged 12-18 months and to all susceptible persons aged 13 years and over. Varicella deaths were made nationally reportable in 1999. Varicella deaths declined 78% for all age groups in the United States during 1999—2001 (n=118), compared with 1990—1994 (n=525), but continue to occur despite availability of a safe and effective varicella vaccine.

Setting:
Varicella is not a notifiable condition in Washington State. Estimates based on the BRFSS suggest that varicella incidence in Washington has dropped from 11.1 in 2000 to 2.4 per 1000 in 2006. No deaths due to primary varicella disease had been reported in Washington State since 1999.

Population:
Varicella vaccination coverage estimates among Washington's children aged 19--35 months in 2006 was 79.1%. Varicella vaccination coverage for Washington adults is not known.

Project Description:
On November 5, 2007 a death, possibly due to varicella disease, in a 24 -year-old person was reported to the Washington State Department of Health. The death was investigated by Snohomish County Health District, Washington State Department of Health, and Centers for Disease Control and Prevention to learn whether varicella was the primary cause and understand the relationship of the woman's pre-existing health issues and treatment with immunosuppressive medications to the unusual presentation and untoward outcome of her varicella illness.

Results/Lessons Learned:
Information demonstrated an unusual clinical course of illness. The risk for severe outcome of varicella disease may have been increased due to an underlying chronic condition requiring immunosuppressive medications.