A new study says varicella vaccination of children would help eliminate the danger posed by rare but potentially fatal complications, including necrotizing fasciitis.
The study, published in the February issue of the Canadian Journal of Surgery, recommends aggressive surgical debridement and intensive antibiotic treatment for children showing signs of infection with the organisms that cause necrotizing fasciitis in order to prevent muscle necrosis, major limb dysfunction, amputation or death.
“The complications we have described are preventable with vaccination …, which has proved effective in preventing and decreasing the severity of infection,” the authors state.
The study was conducted by physicians in the Orthopedics Division of the Children's Hospital of Eastern Ontario in Ottawa. An increase in the severity of complications in children with chickenpox prompted them to review the incidence of necrotizing fasciitis among these children, and its treatment.
There are about 350 000 cases of chickenpox in Canada each year. Studies estimated the overall complication rate at 2.1%, and about 6% of these complications are musculoskeletal in nature.
The study involved 5 children aged from 2 to 5 who developed necrotizing fasciitis and other complications after getting chickenpox. Each child had surgery immediately after diagnosis, followed by intravenous antibiotic treatment. All recovered.
The researchers concluded that doctors should suspect necrotizing fasciitis in any child with a history of chickenpox who has symptoms such as increasing pain, fever associated with swelling in a particular area, and reddening or blistering of the skin. “Vaccination against varicella infection should become the standard of care in order to prevent these serious complications,” the authors conclude. — Brian Whitwham, CMAJ