Varicella and Zoster

  • Patricia PadlipskyEmail author
  • Kelly D. Young


Varicella-zoster virus is an infectious disease that causes fever and a pruritic papulovesicular rash that starts on the face and scalp; progresses to the trunk and, to a lesser extent, the extremities; and emerges in crops of lesions over a few days. Painful mucosal lesions can also occur. Varicella is an airborne disease, spread by respiratory secretions, and is highly contagious. The varicella virus remains latent in sensory ganglion neurons, and zoster is a later reactivation of the virus (typically in patients aged ≥50 years), resulting in a painful vesicular rash localized to a single dermatome. Varicella and zoster are usually diagnosed clinically, although serology or PCR testing may be used. Treatment is supportive in uncomplicated cases in immunocompetent patients; immunocompromised or severely affected patients may be treated with antiviral medications such as acyclovir or valacyclovir. Vaccines are available for both varicella and zoster.


Varicella Zoster Chicken pox Shingles Chicken pox vaccine 


  1. 1.
    Heininger U, Seward JF. Varicella. Lancet. 2006;368:1365–76.CrossRefPubMedGoogle Scholar
  2. 2.
    American Academy of Pediatrics. Varicella-Zoster virus infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Red Book®: 2015 report of the committee on infectious diseases: American Academy of Pediatrics. Elk Grove Village, IL. 2015. p. 846–60.Google Scholar
  3. 3.
    Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med. 2000;342:635–45.CrossRefPubMedGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. In: Hamborsky J, Kroger A, Wolfe S, editors. Chapter 22 Varicella. 13th ed. Washington, DC: Public Health Foundation; 2015, accessed on line at URL on 7/25/2017.Google Scholar
  5. 5.
    Hambleton S, Gershon AA. Preventing varicella-zoster disease. Clin Microbiol Rev. 2005;18(1):70–80.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lopez AS, Zhang J, Marin M. Epidemiology of varicella during the 2-dose varicella vaccination program – United States 2005–2014. MMWR Morb Mortal Wkly Rep. 2016;65(34):902–5.CrossRefPubMedGoogle Scholar
  7. 7.
    American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics. 2007;120:221–31.CrossRefGoogle Scholar
  8. 8.
    Reagan-Steiner S, Yankey D, Jeyarajah J, Elam-Evans LD, Curtis CR, MacNeil J, Markowitz LE, Singleton JA. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years – United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(33):850–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PG, Oxman MN, Seward JF, Yamanishi K. Varicella zoster virus infection. Nat Rev Dis Primers. 2015;1:15016.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. 2005;352(5):450–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Dayan RR, Peleg R. Herpes zoster – typical and atypical presentations. Postgrad Med. 2017;129(6):567–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Dommasch ED, Joyce CJ, Mostaghimi A. Trends in nationwide herpes zoster emergency department utilization from 2006 to 2013. JAMA Dermatol. 2017;153(9):874–81.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Williams WW, Lu PJ, O’Halloran A, Kim DK, Grohskopf LA, Pilishvili T, Skoff TH, Nelson NP, Harpaz R, Markowitz LE, Rodriguez-Lainz A, Fiebelkorn AP. Surveillance of vaccination coverage among adult populations – United States, 2015. MMWR Surveill Summ. 2017;66(11):1–28.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44(Suppl 1):S1–26.CrossRefGoogle Scholar
  15. 15.
    Wutzler P, Knuf M, Liese J. Varicella: efficacy of two-dose vaccination in childhood. Dtsch Arztebl Int. 2008;105(33):567–72.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002;347:340–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Habif TP. Clinical dermatology: a color guide to diagnosis and therapy. St. Louis, Missouri. 6th ed: Elsevier Inc; 2016.Google Scholar
  18. 18.
    Goldsmith LA, editor. VisualDx. Rochester: VisualDx; 2016. URL:

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.David Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Harbor-UCLA Medical Center, Department of Emergency MedicineTorranceUSA
  3. 3.Health Sciences Clinical Professor of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA

Personalised recommendations