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Varicella-zoster virus. Arvin AM, Gershon AE. (Pp 531) UK: Cambridge University Press. ISBN: 0-521-66024-6
If I were a betting man, and one could bet on such matters, I would stake the price of a new stethoscope that chicken pox will soon be a subject of media and thus public (and thus political) interest, at least in the UK. The vaccine—developed twenty five years ago—has been in general use in the USA for around five years and it cannot be long before it begins to be used more widely in Europe too. The most likely formulation to find general acceptance in national programmes will be a combination with the existing MMR vaccine and, as at least readers of the Daily Mailwill know, the current word on the block is that combining vaccine viruses in this way is “a bad thing”. I have already been interviewed at length by a journalist purporting to be interested in the primary prevention of varicella who then proceeded to publish a piece about an actually non-existent but implicitly fiendish sounding study of MMRV vaccine “going on” under my supervision.
So it may be a good time for paediatricians to inform themselves about this common but little discussed infection, which is most commonly acquired in childhood. Right on queue, this opportunity arrives to do so.
It has recently become fashionable in certain circles to assert that various infectious scourges of the past, now gone thanks to immunisation, were actually really rather innocuous (or perhaps even beneficial!) and—in a vaguely contradictory way—that they were vanishing away anyway, not thanks to vaccines at all. In the case of varicella the former notion (or at least the first part of it: I've not yet heard the assertion that chickenpox, specifically, is good for you) is widely prevalent, despite the continuing ubiquity of the infection. Paediatricians will be aware that such dismissals are misplaced. Not only do their oncology patients, those on steroids and children undergoing transplantation, to name a few, risk severe illness or rapid death following exposure to varicella, but many more healthy children develop common but unpleasant complications of varicella such as bacterial cellulitis, and a few more serious ones, such as ataxia or purpura fulminans. To be sure, many children are little troubled by primary infection, like my youngest son whose three lesions, which appeared while he remained entirely well and were dismissed as mosquito bites by me, were only correctly diagnosed by my non-medical wife. Some of these folk might be glad to be without residual facial scars but, among those many infected but hardly touched by varicella-zoster virus in childhood, there are those whose later lives will be blighted by zoster and post-herpetic neuralgia— a growing problem with rising longevity.
This monograph is timed to give an account of the enormous recent advances in understanding of the pathogenesis of human infection with this herpes virus and of the availability of tools with which to treat, attenuate, and prevent infection. But it also points out that the tale remains far from over: here is an infection that, unlike the superficially clinically similar, and now defunct, smallpox, lies latent lifelong in the human host and, worryingly, is more likely to cause severe primary illness in a non-immune adult than in a children. This story is set to run and run, with no easy bets on global eradication.
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