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CDC Prevention Guidelines Database (Archive)


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U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Prevention Services

Publication date: 12/01/1992

Table of Contents

Varicella Zoster Virus
Pathogenesis and Spread
Clinical Manifestations
Differential Diagnosis
Laboratory Diagnosis
Current Methods of Control and Prevention
Varicella Vaccine
Varicella-Zoster Immune Globulin: Regional Distribution Centers
Varicella Workshop

For Additional Information


Efficacy In Children


History --

Varicella (chickenpox) was not reliably distinguished from smallpox until the end of the 19th century. Herpes zoster (shingles) has been recognized since ancient times and was described in the early medical literature. Clinical observations of the relationship between varicella and herpes zoster were made in 1888 by Von Bokay, when susceptible children acquired varicella after contact with herpes zoster. Varicella virus (VZV) was isolated from vesicular fluid of both chickenpox and zoster lesions in cell culture by Weller in 1954. Subsequent laboratory studies of the virus have led to the development of a live attenuated varicella vaccine, Oka strain, in Japan in the 1970s. The vaccine has been shown to be safe and effective in healthy and immunocompromised children, and healthy adults. It will soon be licensed in the U.S., probably for use in healthy children.

Varicella Zoster Virus

VZV is a member of the herpes virus group, (alpha) herpes virus 3. It is a DNA virus. VZV has the capacity to persist as a latent infection in dorsal root or extra medullary cranial ganglia.


Infectiousness --

Epidemiologic Characteristics --

Morbidity and Mortality --

Herpes Zoster --

Pathogenesis and Spread

Mode of Transmission

Reservoir: Humans

Incubation Period

Period of Communicability

Mild and inapparent infections occur rarely (<5% of infections)

Immunity following primary infection is considered long-lasting

Path of entry of the virus into the susceptible host is assumed to be the upper respiratory tract

Clinical Manifestations


Varicella in Normal Children

Normal Adults

Immunocompromised persons (i.e., persons with congenital or acquired immune deficiencies, malignancies, or on immunosuppressive therapy).

Congenital Infection

Neonatal Infection Due to Maternal Chickenpox Close to Time of Delivery

Infants After Postnatal Exposure

Pregnancy - There is growing evidence that infection during pregnancy carries increased risk for serious varicella. Further study is needed.


Differential Diagnosis

Chickenpox is associated with a very characteristic vesicular rash illness -- "Your grandmother could diagnose it" (Fehrs, 1990). A history of chickenpox has been shown to be a reliable indicator of immunity; however, a lack of such history is not as reliable and does not always correlate with lack of immunity.

The differential diagnosis for chickenpox includes: Herpes Simplex

Enteroviral Infections - Papulovesicular lesions occur on palms and soles, with vesicular lesions on the buccal mucosa; usually self limited.

Impetigo - Erythematous macules progress to vesiculopustular lesions that dry and crust. The infection can spread. Exposed areas such as the face, neck, and limbs are often involved. Skin breaks serve as the portal of entry. Group A Streptococcus is usually the etiologic agent, but superinfection by staphylococci often occurs.


Laboratory Diagnosis

Not routinely required, but useful if confirmation of diagnosis or determination of susceptibility is necessary.

Viral Isolation --

Serologic Testing --

Current Methods of Control and Prevention

Special Varicella Zoster Exposure Situations --

Antiviral Therapy

Varicella Vaccine

Characteristics --

Table 1; Efficacy in Children

Table 1 Normal Adults

Adverse Events Following Varicella Vaccination

This page last reviewed: Friday, July 25, 2014
This information is provided as technical reference material. Please contact us at to request a simple text version of this document.
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