Does chickenpox vaccine protect against necrotizing
fasciitis (flesh-eating disease) in children?
A recent study published by the Ontario Group
A streptococcal study suggests that the incidence of invasive group
A strep infection associated with chickenpox in children is one
more reason to have your children vaccinated against chickenpox
(1). From 1992 to 1996 there were 1087 case of invasive group A
streptococcal infection identified in residents of Ontario, 243
(22.4%) of these occurred in children (incidence 1.1 per 100,000
population per year in 1992 - 2.3 per 100,000 per year in 1996).
Invasive group A strep disease in children was associated
with a variety of clinical syndromes which include skin infections
(cellulitis-30%) , necrotizing fasciitis (flesh-eating disease -
4%), upper respiratory infection (18%) and pneumonia (6%). Infection
of the bones or joints (osteomyelitis or arthritis) was present
in 19% of cases and 16 % of cases had infections of the blood without
any other site of infection identified.
16% of the children who became infected had some form
of chronic underlying illness such as heart disease, asthma or cancer.
However, 31 of 205 children (15%) for whom a history was available
had had chickenpox within a month before the onset of their group
A strep infection. Infection usually occurred 5 days after the onset
of the chickenpox rash. Children who had chickenpox were more likely
to have a group a strep infection of the skin than infection at
any other site.
The majority of children with invasive group A strep
infection were admitted to the hospital; 12% were admitted to intensive
care units and 4.1% died. Children were more likely to die if they
had an existing chronic illness (other than asthma) prior to infection
and they were more likely to have necrotizing fasciitis (flesh-eating
disease) if they had chickenpox immediately prior to their group
A strep infection.
In this study, risk of acquiring invasive group A strep
infection after chickenpox was increased 58-fold. The reasons for
these increased risks are not entirely clear. This data suggests
that the increased risk may result from the breakdown of the skin
barrier caused by chickenpox lesions. In addition, chickenpox infection
itself may reduce the immune system's ability to fight off bacterial
infections such as group A strep infection.
Information from this study, in addition to other previously
published studies (2-4) confirms chickenpox as one of the single
most important risk factors for acquisition of serious group A streptococcal
infection in children. Childhood vaccination could reduce invasive
disease in children by at least 10% - One more reason why vaccination
of children against chickenpox is a good idea.
KB, Davies HD, Low DE, Schwartz B, Green K, Ontario Group A
Streptococcal Study Group, McGeer A. Invasive group A streptococcal
dsease in children in association with Varicella-Zoster virus
Infection. Pediatrics. 105(5), May 2000.
CA, Bardsley MS, Beall B, et al. Invasive group A streptococcal
disease in metropolitan Atlanta : a population-based assessment.
Clin Inf Dis. 1998;27:150-157.
TV, Nizet V, Walhausen JHT, Rubens CE, Clarke WR. Group A streptococcal
necrotizing fasciitis complicating primary varicella; a series
of fourteen patients. Pediatr Infect Dis J. 1995;14:588-594
DM, Alexander ER, Duchin JS, Koutsky LA, Rubens CE. A case-control
study of necrotizing fasciitis during primary varicella. Pediatrics.
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