OBJECTIVE: An effective vaccine for chicken pox has been included in immunisation schedules since the 1990s. In the UK the recommendation for routine inclusion came in November 2023; it has not yet been implemented. We explored paediatricians\' attitudes towards the vaccine and their personal and professional use; as this has been shown to be an influential factor in parents\' vaccine decision making.
METHODS: We conducted a cross-sectional online survey using a structured questionnaire exploring attitudes and knowledge towards the chicken pox vaccine of UK based paediatricians between June and September 2023.
RESULTS: We received 272 responses, 211 female (78%), 228 based in England (85%) with remainder in Wales (23), Scotland (8) and Northern Ireland (9); 150 (56%) reporting practicing paediatrics <10 years. The majority (n = 207; 78%) agreed that the chicken pox vaccine should be included in the UK routine schedule. Half the cohort, 52% (n = 135), reported having their own children vaccinated against chicken pox, 73% of those with appropriately aged children. Most, 86% (n = 225), recommended the vaccine to family and friends routinely or when asked; however, 42% (n = 108) did not feel able to advise patients\' parents due to insufficient information. Of those who do not recommend the vaccine to family and friends, 22 (59%) reported insufficient information to discuss in a professional setting. Of those who did not think it should be included, or were unsure, 38/55 (69%) also felt they had insufficient information to advise parents regarding the vaccine.
CONCLUSIONS: Whilst many paediatricians choose to vaccinate their children and agreed the chicken pox vaccine should be added to the routine schedule, the proportion disagreeing is not insignificant. Targeted education to improve paediatricians\' knowledge of the chicken pox vaccine and their confidence discussing it should be implemented prior to the national roll out.

BACKGROUND: Facial herpes is a common form of the herpes simplex virus-1 infection and usually presents as vesicles near the mouth, nose, and periocular sites. In contrast, we observed a new facial symptom of herpes on the entire face without vesicles.
METHODS: A 33-year-old woman with a history of varicella infection and shingles since an early age presented with sarcoidosis of the entire face and neuralgia without oral lesions. The patient was prescribed antiviral treatment with valacyclovir and acyclovir cream. One day after drug administration, facial skin lesions and neurological pain improved. Herpes simplex without oral blisters can easily be misdiagnosed as pimples upon visual examination in an outpatient clinic.
CONCLUSIONS: As acute herpes simplex is accompanied by neuralgia, prompt diagnosis and prescription are necessary, considering the pathological history and health conditions.

We describe a case of an immunocompetent adult male patient originally from the Democratic Republic of Congo (DRC), who was referred to our unit for a several-day history of fever and a pruritic, vesicular rash. There was initial concern in the Emergency Department for Mpox (formerly known as \"monkeypox\") given the current epidemiology versus other viral etiologies. Primary varicella zoster virus (pVZV) infection was ultimately diagnosed by PCR from a swabbed, unroofed lesion, and he recovered completely with supportive management and without antiviral therapy. We herein describe how common viral exanthems may best be differentiated in an emergency or outpatient setting.

Recently, live-attenuated measles, rubella, varicella, and mumps vaccines have been administered to carefully selected post-liver transplant patients. Although attention has been focused on post-vaccination antibody titers and adverse events, the real-life clinical benefits remain unclear. A comprehensive analysis of breakthrough infections and natural boosters (asymptomatic cases with significant elevation in virus antibody titers) following immunization post-liver transplantation was conducted from 2002-2023, exploring the timing, frequency, correlation with domestic outbreaks, and degree of antibody elevation. During the median 10-year observation period among 68 post-liver transplant patients, breakthrough infections occurred only in chickenpox, with 7 mild cases (1 episode/64 person-years). A total of 59 natural booster episodes (1, 5, 20, and 33 for measles, rubella, chickenpox, and mumps, respectively) were observed, with incidence rates of 1 per 569, 110, 22, and 17 person-years, respectively. The timing of natural boosters closely correlated with domestic outbreaks (P < .05 in chickenpox and mumps), influenced by local vaccine coverage. The degree of antibody elevation was significantly higher in individuals with breakthrough infections than in those with natural boosters (P < .05). These findings suggest that immunization with live-attenuated vaccines for post-liver transplant patients has demonstrated clinical benefits. Furthermore, mass vaccination has a positive impact on post-transplant patient outcomes.

BACKGROUND: Reactivation of the latent varicella-zoster virus can cause herpes zoster (HZ) infection, and renal transplant recipients undergoing immunosuppressive therapy are particularly susceptible to this condition. This study aims to evaluate the potential increase in HZ incidence following influenza vaccination among this specific patient population.
METHODS: This study was a population-based, retrospective, self-controlled case series. Data were retrieved from Taiwan\'s National Health Insurance Research Database spanning the years 2008 to 2017. Patients diagnosed with HZ within a 6-month period before and after receiving the influenza vaccine were eligible for inclusion. Two distinct time intervals were defined for analysis: the initial 15 days and 30 days following vaccination were categorized as risk intervals, while all other periods served as control intervals. Incidence rate ratios (IRRs) were computed to compare HZ incidence during the risk intervals with that during the control intervals.
RESULTS: This study encompassed a cohort of 4,222 renal transplant recipients who had received the influenza vaccine. Among this group, 67 recipients were subsequently diagnosed with HZ. The IRR during both the initial 15 days (IRR = 0.63; 95 % CI, 0.23-1.89) and the first 30 days (IRR = 1.50; 95 % CI, 0.71-3.16) following influenza vaccination did not demonstrate a statistically significant increase when compared to the post-exposure observation times. Comparable results were also observed when comparing these IRR values to the pre-exposure observation times. The subgroup analysis, stratified by age, sex, and underlying medical conditions (including cancer and autoimmune diseases), revealed that the IRRs did not exhibit statistically significant differences.
CONCLUSIONS: No significant association between the influenza vaccine and an elevated risk of HZ was detected. The administration of annual influenza vaccines appears to be a reasonable practice for renal transplant recipients.

BACKGROUND: Varicella is a mild, self-limited disease caused by varicella-zoster virus (VZV) infection. Recently, the disease burden of varicella has been gradually increasing in China; however, the epidemiological characteristics of varicella have not been reported for Anhui Province.
OBJECTIVE: The aim of this study was to analyze the epidemiology of varicella in Anhui from 2012 to 2021, which can provide a basis for the future study and formulation of varicella prevention and control policies in the province.
METHODS: Surveillance data were used to characterize the epidemiology of varicella in Anhui from 2012 to 2021 in terms of population, time, and space. Spatial autocorrelation of varicella was explored using the Moran index (Moran I). The Kulldorff space-time scan statistic was used to analyze the spatiotemporal aggregation of varicella.
RESULTS: A total of 276,115 cases of varicella were reported from 2012 to 2021 in Anhui, with an average annual incidence of 44.8 per 100,000, and the highest incidence was 81.2 per 100,000 in 2019. The male-to-female ratio of cases was approximately 1.26, which has been gradually decreasing in recent years. The population aged 5-14 years comprised the high-incidence group, although the incidence in the population 30 years and older has gradually increased. Students accounted for the majority of cases, and the proportion of cases in both home-reared children (aged 0-7 years who are not sent to nurseries, daycare centers, or school) and kindergarten children (aged 3-6 years) has changed slightly in recent years. There were two peaks of varicella incidence annually, except for 2020, and the incidence was typically higher in the winter peak than in summer. The incidence of varicella in southern Anhui was higher than that in northern Anhui. The average annual incidence at the county level ranged from 6.61 to 152.14 per 100,000, and the varicella epidemics in 2018-2021 were relatively severe. The spatial and temporal distribution of varicella in Anhui was not random, with a positive spatial autocorrelation found at the county level (Moran I=0.412). There were 11 districts or counties with high-high clusters, mainly distributed in the south of Anhui, and 3 districts or counties with high-low or low-high clusters. Space-time scan analysis identified five possible clusters of areas, and the most likely cluster was distributed in the southeastern region of Anhui.
CONCLUSIONS: This study comprehensively describes the epidemiology and changing trend of varicella in Anhui from 2012 to 2021. In the future, preventive and control measures should be strengthened for the key populations and regions of varicella.

Varicella zoster is found exclusively in humans. Infected people with this virus result in chickenpox followed by dormant virus within neural ganglia. This dormant virus, once activated, may affect any ganglia or nerves of the body but most commonly involves the thoracic, cervical and trigeminal nerves in decreasing order of frequency. We review three such cases in which manipulation of the trigeminal ganglion resulted in reactivation of varicella at homologous operative sites. Each patient underwent surgeries in which the trigeminal ganglion was manipulated for the resection of trigeminal schwannoma under a microscope through various approaches. All three patients developed reactivation of varicella at homologous operative sites. A thorough history of chickenpox infection should be taken in patients who are undergoing surgeries for trigeminal pathology. Early diagnosis should be made once any vesicular lesions are seen with prompt treatment. Reassurance and counselling are necessary in these patients. If possible, prophylaxis may be started in all such patients. Further studies are warranted to determine the exact cause of reactivation.

Paracetamol is considered to be a relatively safe drug, even in the pediatric age group, at the recommended doses. Here we present a case of a six-year-old male presenting with symptoms and signs of Steven Johnson syndrome/toxic epidermal necrosis (SJS/TEN) following the ingestion of paracetamol. Steven Johnson syndrome/toxic epidermal necrosis is a potentially life-threatening dermatological emergency requiring intensive treatment. The patient was initially misdiagnosed as a case of chickenpox and was administered paracetamol. However, upon attending a tertiary care facility, he was diagnosed with TEN and treated with immunosuppressants. He recovered fully without any complications and was discharged within a week.

In Germany, general childhood varicella vaccination has been recommended since 2004. A feared effect of low vaccination coverage is a possible shift in incidence from children to teenagers and young adults who are at higher risk of severe outcomes. If true, this shift would possibly necessitate changes to the national immunization strategy. We aimed to evaluate the effects of the general vaccination recommendation on age-specific varicella incidences in Germany in general and examine specifically whether a shift from children to teenagers (15 to 19 years) has occurred.
Trends in age-specific incidences were evaluated using triangulation with the following datasets: national mandatory notification data (N) (2014-2022), billing data of the statutory health insurance associations (I) (2009-2017) and data from a doctor\'s sentinel system (S) (2006-2017). Similar clinical case definitions were used in N and S, while I used ICD-10-codes. Age groups were stratified as available in all three systems. Incidences per year were calculated based on the total population (N), the number of statutory health insured (I), and extrapolated from S to the total population.
During all years of observation, age-specific incidences have dropped significantly across all age-groups for S und I. The age groups (under 10 years) with initially highest incidences were the ones with the strongest reductions (under 1 year: -90%, 1-4 years: -95.5%, 5-9 years: -89.2% for S; -67.7%, -78%, -79.3% for I). A single 53.1% increase in the low incidence in S among 15-19-year olds observed in 2017 compared to 2016 could not be confirmed in N or I. Increases in incidences during the first two years of N are probably due to improved notification behaviour over these years. In 2019, all age-specific incidences increased (N), with 15 to 19-year olds showing the highest relative increase (28.2%).
Since the introduction of the general vaccine recommendation against varicella, incidences across all age-groups have declined significantly. Available data indicate no evidence for a shift in disease incidence to older age groups. Every incidence increase beyond childhood age should however be followed up closely. So far, children and adolescents have both benefitted from the current vaccination strategy.

Mpox and Chicken pox have similar presentations, sometimes causing a diagnostic dilemma. Reports have emerged of coinfections, mostly in the central African region.
Index patient is a 23-year-old female who presented with a 2-week history of exanthematous vesiculopustular rashes which started from her genital and groin area with accompanying vulvar swelling. It was then followed by other similar rashes involving mainly her face and limbs with some on her trunk. There was also an associated high grade continuous fever. Rashes were painful and itchy with associated cervical and axillary lymphadenopathy. Following admission, patient had increasing dysuria with accompanying acute urinary retention due to the discomfort accompanying micturition which was relieved by urethral catheterization and resolved with intravenous infusion and parenteral empirical antibiotics for superimposed bacterial infection. Polymerase chain reaction from her skin lesion sample was positive for both monkey pox and chicken pox. She was also given a course of acyclovir and made an uneventful recovery after 12 days of admission and was discharged.
We report a rare manifestation of acute urinary retention in a HIV-negative female patient with Mpox and chicken pox co-infection.
La variole du singe et la varicelle ont des présentations similaires, ce qui pose parfois un dilemme diagnostique. Des cas de coinfection ont été signalés, principalement dans la région de l’Afrique centrale.
La patiente de référence est une femme de 23 ans qui a présenté pendant deux semaines des éruptions vésiculo-pustuleuses exanthémateuses qui ont commencé dans la région génitale et l’aine, accompagnées d’un gonflement de la vulve. D’autres éruptions similaires ont suivi, touchant principalement le visage et les membres, mais aussi le tronc.Une fièvre élevée et continue a également été associée à ces éruptions. Les éruptions étaient douloureuses et prurigineuses, avec une lymphadénopathie cervicale et axillaire associée. Aprèsson admission, la patiente a présenté une dysurie croissante accompagnée d’une rétention urinaire aiguë due à l’inconfort de la miction, qui a été soulagée par un cathétérisme urétral et résolue par une perfusion intraveineuse et une antibiothérapie parentérale empirique pour une infection bactérienne superposée. La réaction en chaîne de la polymérase à partir de l’échantillon de sa lésion cutanée était positive pour la variole du singe et la varicelle. Elle a également reçu un traitement à l’acyclovir et s’est rétablie sans incident après 12 jours d’admission et a été autorisée à sortir.
Nous rapportons une manifestation rare de rétention urinaire aiguë chez une femme séronégative atteinte d’une co-infection par la variole du singe et la varicelle.
Mpox, Varicelle, Nigeria, Épidémie, Rétention urinaire, Lymphadénopathie.