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Steroids Worsen Chickenpox

October 31, 2005

Children who get chickenpox while on steroid therapy may be under a life-threatening risk, according to a study published in the October edition of Pediatrics and reported by Time magazine (online edition) on 20 October 2005.

Steroids are commonly used to treat childhood leukemia and to treat severe asthma. But steroids suppress the immune system, permitting more severe infection by the varicella virus, a herpes virus that causes chickenpox and, in adults, shingles.

Chickenpox derives its name from the appearance of chickpea-like red bumps that appear on the skin. Chickenpox affects about four million people in the US annually; about 100 die of the disease.

Retrospective Study

Researchers Garick Hill et al. conducted a retrospective review of data on 697 patients who had acute lymphoblastic leukemia (ALL) and a history of varicella infection. Individual cases of varicella were graded 1 to 5 based on severity.

Of the 110 (~16%) of patients who contracted chickenpox, 54 had infection rated as 'severe' (i.e., graded 3-5), characterized by requiring hospitalization to being life-threatening. Two children died during the study.

Disease severity was greater in children who contracted chickenpox within a three-week period after steroid treatment: 70% of patients in this group developed severe chickenpox, compared with only 44% who developed chickenpox after that period.

The authors noted that, while the current study concerns only children with ALL, the study's results may apply to other cases where patients are on steroid therapy. They also noted a trend towards greater severity of infection in older patients, as has been previously documented.

Many parents view chickenpox as a one-time inconvenience, but prefer to have their children exposed to varicella early, because of the risk of serious infection associated with contracting chickenpox as an adult.

A chickenpox vaccine with 85% efficacy has been licensed for public use since 1995 for healthy children. However, because the vaccine is a live virus, children with compromised immune systems (such as ALL patients) might have a severe reaction to it.

Steroids Intensify Chickenpox, The Daily Rx/Time magazine online edition, 20 October 2005.
Recent Steroid Therapy Increases Severity of Varicella Infections in Children With Acute Lymphoblastic Leukemia, Pediatrics, volume 116(4), pages e525-e529, October 2005.

Posted: October 2005