Correspondence

More on Acyclovir for Chickenpox

N Engl J Med 1994; 331:59July 7, 1994

Article

To the Editor:

Dunkle et al. (Nov. 28, 1991, issue)1 reported that treatment with acyclovir reduces the duration and severity of chickenpox in normal children when therapy is begun during the first 24 hours after the appearance of rash. The effect of acyclovir treatment on susceptibility to recurrent or reactivated varicella-zoster virus infection is controversial2. In April 1992, the three-year-old daughter of one of us (Patient 1) contracted chickenpox and inadvertently inoculated five children, including her sister (Patient 2) and her best friend (Patient 3). Patient 1 had hundreds of vesicles on her trunk and face and still has scarring. Patient 2 and Patient 3 were treated with oral acyclovir (20 mg per kilogram of body weight four times per day for five days) when the rash of chickenpox first appeared two weeks later. These children had mild chickenpox, with fewer than 10 vesicles and no scarring. The other children -- not treated with acyclovir -- had moderately severe chickenpox.

One year later, Patient 3 had a painful vesicular rash on her left chest, which her pediatrician diagnosed as herpes zoster of the T8 dermatome. Two weeks later, Patient 2, who had been exposed to Patient 3 at that time, had a second case of chickenpox, which was mild and led to no scarring.

These observations suggest that acyclovir, though lessening the severity of chickenpox, may interfere with the development of full immunity to the varicella-zoster virus. One possibility is that the viremia that precedes the appearance of the chickenpox rash by several days3 may not provide sufficient antigenic stimulation before treatment with acyclovir. Should normal children with chickenpox receive acyclovir during the first 24 hours of rash? Although the possibility that acyclovir may alter subsequent immunity is a concern, acyclovir therapy appeared to ameliorate chickenpox and to prevent undesirable scarring.

Madeleine Duvic, M.D.
University of Texas Medical School

Douglas Grossman, Ph.D.
Baylor College of Medicine, Houston, TX 77030

3 References

1. 1

   Dunkle LM, Arvin AM, Whitley RJ, et al. A controlled trial of acyclovir for chickenpox in normal children. N Engl J Med 1991;325:1539-1544
   Full Text | Web of Science | Medline

2. 2

   Acyclovir in chickenpoxN Engl J Med 1992;326:1224-1226
   Full Text | Medline

3. 3

   Asano Y, Itakura N, Kajita Y, et al. Severity of viremia and clinical findings in children with varicella. J Infect Dis 1990;161:1095-1098
   CrossRef | Web of Science | Medline

Citing Articles (3)

Citing Articles

1. 1

   Henry M. Feder, Diane M. Hoss. (2004) Herpes Zoster in Otherwise Healthy Children. The Pediatric Infectious Disease Journal 23:5, 451-457
   CrossRef

2. 2

   N IJICHI, S IJICHI, M OSAME. (1997) RECURRENCE OF CHICKENPOX IN AN ACYCLOVIR-TREATED PATIENT. Journal of Paediatrics and Child Health 33:3, 272-272
   CrossRef

3. 3

   Myron J. Levin, Anthony R. Hayward. (1996) PREVENTION OF HERPES ZOSTER. Infectious Disease Clinics of North America 10:3, 657-675
   CrossRef