Case Report: Occupationally Related Recurrent Varicella (Chickenpox) in a Hospital Nurse

By Ku, Chih-Hung; Liu, Yu-Tien et al. | Environmental Health Perspectives, October 2005 | Go to article overview

Case Report: Occupationally Related Recurrent Varicella (Chickenpox) in a Hospital Nurse


Ku, Chih-Hung, Liu, Yu-Tien, Christian, David C., Environmental Health Perspectives


Commonly accepted outcomes of varicella-zoster virus (VZV) infections include chickenpox (primary) and shingles (recurrence or latency), as well lifetime immunity against chickenpox. We report the case of a registered nurse who worked in a neurologic surgery ward in a general hospital in Taipei, Taiwan. While working there for approximately 1 year, she developed recurrent chickenpox after caring for a paraparesis patient, who had herpes zoster during hospitalization in August 2002. The varicella incubation period was 10 days, which matched the range (10-21 days). Recently negative specific serum IgM and positive specific serum IgG indicated a past VZV infection. The nurse did not get herpes zoster from the second episode of varicella on 9 August 2002 to 4 April 2005 and is now convalescing. We conclude that occupational VZV hazards exist in the health care environment and suggest testing for VZV antibody and a VZV vaccination program for susceptible health care workers. Key words: chickenpox, indirect fluroscent antibody, occupational exposure, polymerase chain reaction, shingles, Taiwan, varicella-zoster virus. Environ Health Perspect 113:1373-1375 (2005). doi:10.1289/ehp.7766 available via http://dx.doi.org/[Online 15 June 2005]

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Varicella (chickenpox), a common contagious disease of childhood, is caused by the varicella zoster virus (VZV) [Centers for Disease Control and Prevention (CDC) 2005]. VZV is characteristic of the alpha herpes viruses and establishes latency in the cells of the dorsal root ganglia after primary infection (Arvin 1996). The etiology of varicella and herpes zoster was first reported by von Bo'kay in 1888 from the observation that susceptible children often developed varicella after exposure to adults with herpes zoster (Arvin 1996; CDC 2005; von Bo'kay 1909). Varicella results from the primary VZV infection, whereas herpes zoster (shingles) is the result of reactivation (Arvin 1996; CDC 2005; Jumaan et al. 2002). Primary varicella infection usually results in lifetime immunity (CDC 2005), and second episodes of varicella are uncommon (CDC 2005; Gershon etal. 1984), but they may occur (CDC 2005). VZV disease history always indicates that varicella is the primary infection, and herpes zoster is a recurrence of the disease (Arvin 1996; CDC 1996, 1997, 2005; Gershon etal. 1984; Jumaan et al. 2002), as well-documented second episodes of varicella are rare (Gershon et al. 1984). Here we report a case of apparent VZV reinfection with recurrent varicella infection in a nurse in a teaching general hospital in Taiwan.

Case Presentation

A 25-year-old nurse, who had childhood chickenpox, was diagnosed with varicella without mention of complication [International Classification of Diseases, Revision 9 (ICD-9) code 052.9; World Health Organization (WHO) 2001] by a dermatologic physician in a teaching general hospital after she cared for a 62-year-old male paraparesis patient who developed herpes zoster during hospitalization. She graduated from nursing school in July 2001, passed the licensing board, and then started to work in the neurologic surgery ward of a general teaching hospital in Taipei, Taiwan.

Toward the end of June, we conducted a study of occupational VZV hazards to health care workers in this hospital. The nurse was one of the volunteers who carried an air sampler for several hours in rotation with her colleagues on 9 July 2002. Saliva was collected simultaneously. Nested polymerase chain reaction (PCR) VZV DNA results were negative both in the personal air samples and in saliva.

On 13 July 2002, a 62-year-old man was sent to the emergency room due to paraparesis after he received Chinese traditional chiropractic treatment from a nonprofessional. He was diagnosed with spondylitis with a T8 compression fracture and T9 myelopathy, suspected tuberculosis (TB) of the spine, and paraparesis and was transferred to a neurologic (internal medicine) ward in the evening. …

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