Varicella-Related Deaths Among Children—United States, 1997

Varicella-Related Deaths — Continued During the first quarter of 1998, the Texas Department of Health and the Iowa Department of Public Health notified CDC of three fatal cases of varicella (chickenpox) that occurred in children during 1997. All three children were unvaccinated. Two children contracted chickenpox from unvaccinated siblings, and the mode of exposure was unknown for the third. This report summarizes these cases and indicates that varicella-related deaths continue to occur among children in the United States despite the availability of vaccine and recommendations for its use in all susceptible children (1,2). Case 1 On February 28, 1997, a previously healthy, unvaccinated 21-month-old boy developed a typical varicella rash. He had no reported exposure to varicella. On March 1, he was taken to a local emergency department (ED) with a high fever and was started on oral acetaminophen and diphenhydramine. On March 3, his primary-care physician prescribed oral acyclovir. On March 4, his mother noted a new petechial-like rash. The next morning, his primary-care physician noted lethargy, a purpuric rash, and poor perfusion. He was transferred to a local ED. Fluid resuscitation and intravenous ceftriaxone were initiated, but the child continued to deteriorate rapidly, requiring in-tubation, mechanical ventilation, and inotropic support with dopamine. Blood cultures were negative for bacterial pathogens. Laboratory tests indicated disseminated in-travascular coagulation and severe dehydration. Approximately 1 1 ⁄2 hours after arrival at the ED, he was transported to a tertiary-care center. Within 10 minutes of arrival, he suffered cardiac arrest and died. The death was attributed to varicella with hemor-rhagic complications. Case 2 On December 21, 1997, a 5-year-old unvaccinated boy with a history of asthma was taken to a local ED with a fever of 104.5 F (40.3 C) and a typical varicella rash in multiple stages of healing. The child was treated with antipyretic and antipruritic medications and discharged. That evening, the boy developed mild dyspnea and was treated at home for a presumed asthma attack with metered-dose inhalers and one dose of oral prednisone. He