title: Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine.
abstract: BACKGROUND
  Since the introduction of live attenuated varicella zoster virus (VZV) vaccine in 1995 there has been a significant reduction in varicella incidence and its associated complications, but the impact on VZV-associated central nervous system (CNS) disease has not been assessed.
  
  
  METHODS
  In this descriptive study we evaluated patients referred to the California Encephalitis Project from 1998 to 2009 with VZV PCR-positive cerebrospinal fluid (CSF). Epidemiological, clinical, and laboratory data were collected using a standardized case form. Specimens were genotyped using multi-single nucleotide polymorphism (SNP) analysis.
  
  
  RESULTS
  Twenty-six specimens were genotyped from patients 12-85 years of age (median, 46 years). Clinical presentations included meningitis (50%), encephalitis (42%), and acute disseminated encephalomyelitis (ADEM) (8%). Only 11 patients (42%) had a concomitant herpes zoster rash. Genotype analysis identified 20 European Group (Clade1, Clade 3) strains; 4 Asian (Clade 2) strains, and 2 Mosaic Group (Clade 4, Clade VI) strains. One specimen was recognized as vaccine strain by identifying vaccine-associated SNPs.
  
  
  CONCLUSIONS
  VZV continues to be associated with CNS disease, with meningitis being the most frequent clinical presentation. CNS VZV disease often presented without accompanying zoster rash. Sequencing data revealed multiple genotypes, including 1 vaccine strain detected in the CSF of a young patient with meningitis.
authors.affiliation: Division of Pediatric Infectious Diseases, University of California, San Francisco, USA. bpahud@stanford.edu
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pahud
authors.forename: Carol A
authors.initials: CA
authors.lastname: Glaser
authors.forename: Cornelia L
authors.initials: CL
authors.lastname: Dekker
authors.forename: Ann M
authors.initials: AM
authors.lastname: Arvin
authors.forename: D Scott
authors.initials: DS
authors.lastname: Schmid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019433:Chickenpox Vaccine / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D020804:Encephalitis, Varicella Zoster / Q000473:pathology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008587:Meningitis, Viral / Q000473:pathology* / Q000517:prevention & control* / Q000821:virology; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine