PHARMAZEUTISCHE WISSENSCHAFT Anne-Kristina Frobel und Stephanie Läer Klinische Pharmazie und Pharmakotherapie Heinrich-Heine-Universität, Düsseldorf Besonderheiten der Pharmakotherapie bei Kindern Lektorat: Frau Apothekerin Daniela Hundelshausen, Brunnen-Apotheke, Hallenberg Herr Apotheker Dr. Jürgen Dittrich, Rathaus-Apotheke, Grünwald ABSTRACT: The medical care of the
You've got what - chickenpox and shinglesChickenpox (varicel a) is a viral infection caused A blistering rash, usually associated with severe by the varicel a-zoster virus. Symptoms include pain, occurs on bands of skin overlying the area slight fever and cold-like symptoms, fol owed by supplied by the spinal nerves carrying the dormant a rash. The rash appears as blisters which crust to virus. The rash may be fol owed by persistent pain may appear over several days and various stages of The varicel a-zoster virus is present in the shingles blisters may be present. The rash is more noticeable blister fluid. Direct contact with the blister fluid on the trunk than on the limbs and may affect can cause chickenpox in a non-immune person. the scalp and the inside of the mouth, nose, and There is no airborne droplet spread from cases of shingles, except perhaps in some very severe In childhood, chickenpox is usual y a mild il ness cases of disseminated (widespread) shingles. and can be so mild it might not be noticed. Contact with chickenpox or shingles cannot Infection in adults is uncommon, since more than lead to shingles in the exposed person since 95% of Australians get the infection in childhood, shingles can only fol ow the reactivation of but infection in adults is more severe and may be Chickenpox may be particularly severe in children with leukaemia, pregnant women and young (time between becoming infected and babies. If chickenpox occurs in early pregnancy, the foetus may also be infected, resulting in congenital malformations in up to 2%. If it occurs around the time of delivery, the baby may become infected and up to 30% of newborns will become severely ill.
Chickenpox has a typical appearance and is (time during which an infected person can usual y diagnosed by clinical examination. A blood test can detect if someone has protection from For chickenpox, from 2 days before the rash chickenpox infection in the past, but the test may appears until at least 5 days after the rash not be helpful in determining if there is adequate first appears and all blisters have crusted over. immunity to varicel a fol owing vaccination. For shingles, a person is infectious from when Chickenpox is spread when mucous membranes the rash appears until all blisters have dried up.
(lining of nose and mouth) come into contact with the virus in airborne droplets produced by coughing or sneezing, or with fluid from the Specific antiviral treatment for both chickenpox blisters. Fol owing infection, the virus wil remain and shingles is available. Treatment is only given dormant (resting, as if asleep) in nerve cells of to those with severe disease or at risk of severe the spinal cord for the rest of the person’s life. disease, and to be effective must be commenced Reactivation of this virus causes shingles rather early, usual y within 24 hours of onset of the rash. Shingles (herpes-zoster) follows a previous > a child or adult with chickenpox has a high fever, chickenpox infection, usual y several decades cough, shortness of breath, or chest pain later. Shingles occurs when the body’s immunity to the virus drops and the virus becomes active again after resting in the spinal cord. The elderly, > a newborn baby (up to one month of age) children and adults being treated for cancer and persons infected with HIV virus are at greater risk > a person over 50 years of age has shingles > chickenpox develops in a child or adult with an immune deficiency (including a history of leukaemia, even if in remission).
You’ve Got What? SA Health – August 2009 Communicable Disease Control Branch Telephone: 08 8226 7177 Email: [email protected] For al cases, calamine lotion or promethazine [phenergan] (available from pharmacies) may be useful for the itch. If treatment to reduce temperature or discomfort is necessary, > Varicella-zoster immunoglobulin (VZIG) is made from blood products and contains antibodies to the varicella-zoster virus. VZIG is effective in preventing or reducing the severity of chickenpox if given to non-immune people within 96 hours of exposure to a case of ! Aspirin should not be given to
children or adolescents who
have chickenpox or shingles.
People at high risk of complications from chickenpox infection – for example, people with leukaemia, young babies or pregnant women - should seek medical advice regarding VZIG if they have been exposed to a person with chickenpox or shingles. Only > Vaccination against varicella is recommended people without a history of chickenpox, and in the National Immunisation Program: South with no evidence of immunity on blood testing, Australia for children at 18 months of age and need to receive VZIG. VZIG is only of value if for Year 8 students who have not previously given before chickenpox occurs and is of no had the vaccine or chickenpox infection. use in treatment of chickenpox or shingles.
A few people who have been vaccinated may still get chickenpox, but the illness will > Several studies have shown that varicella vaccine is effective in preventing varicella Mumps-Rubella-Varicella vaccine may become infection, particularly moderate to severe disease, following exposure. This is generally successful when given within three days, and > Exclude persons with chickenpox from child up to five days, after exposure, with earlier care, preschool, school or work until all administration being preferable (Australian blisters have dried (usually about five days). Immunisation Handbook 9th edn).
Note that some remaining scabs are not a reason for continued exclusion.
> A vaccine to prevent shingles has recently been licensed in Australia. It is recommended > Any person with an immune deficiency (for example, leukaemia) or receiving chemotherapy should be excluded from contact with a case of chickenpox or shingles for their own protection.
Varicella infection (chickenpox
> Wash hands after contact with soiled articles (tissues etc.). Keeping areas clean, especially or shingles) is a notifiable disease
where articles have been soiled with nose and throat discharges, will limit the spread of infection. Dispose of tissues appropriately.
> Persons with shingles should cover the rash with a dry bandage to ensure that others are not exposed. You’ve Got What? SA Health – August 2009 Communicable Disease Control Branch Telephone: 08 8226 7177 Email: [email protected]
Agenzia certificata ISO 9001 Relazione del dott. Roberto Paleari (Membro della squadra che ha vinto nel 2008 i campionati mondiali di Hacking. Attuale esperto per la Sicurezza e Reti del Dipartimento di Informatica e Comunicazione dell’Università degli Studi di Milano) “IL BISCOTTO PREFERITO DI UN HACKER (confessioni un “pentito”) La parola hacker è un termine risalente ag