Varicella (Chickenpox) Deaths

Infectious agent: :  Varicella-zoster virus

Description of illness:  

Deaths due to primary infection with varicella zoster virus (VZV), or chickenpox, are extremely rare in the United States due to high rates of routine childhood immunization. Although people with weakened immune systems are at highest risk of fatal infection, death can occur in healthy, unvaccinated children or adults. A primary infection of varicella may start with a 1-2 days of fever and malaise prior to rash onset in adults. In children, the first sign of disease is rash. The rash, which is composed of crops or waves of itchy, blister-like lesions that crust over as they resolve, usually starts on the head and descends to the trunk and extremities. A person can spread varicella 1-2 days prior to rash onset until all blisters have dried and scabbed-over (usually 5-7 days). Primary varicella in previously vaccinated persons is usually much milder, and may have fewer than 50 lesions. Deaths may result from primary varicella infection of the brain (encephalitis), pneumonia, or secondary bacterial infections.

Individual cases of varicella are not reportable in Tennessee: only varicella outbreaks or deaths associated with primary varicella infection are reportable. Deaths related to reactivation of latent infection (herpes zoster/shingles) are not reportable – herpes zoster is most likely to occur in the elderly, but can occur in any person who has ever had chickenpox.