Chickenpox deaths
Chickenpox  Steroid tuberculosis  [back] Infections from drugs/poisons

"Varicella always runs a favourable course.  It has no sequelae.....PROGNOSIS.—This is always favourable." --Dictionary of Medicine (1894)

[BMJ Letter, July 2002] Letters: Adults still account for many deaths from chickenpox

Steroid varicella citations

Hiding smallpox deaths

[Media UK, 1997] Asthma steroid can kill, health officials admit

[Media UK, 1996 Steroid-chickenpox, death] Steroids killed this little girl.  Why did it happen?

[Media Feb 2001] Doctors warn of painkiller link to flesh-eating disease

Documentation on dangers of using Ibuprofne, tylenol, etc in illness

"Doctors have been told to be careful when using a common painkiller (Nurofen) when treating children with chickenpox - because of a link to a deadly flesh-eating disease."--Media

"Dr. Ogle, the chief in the Registrar-General’s Department, told the Royal Commission as a witness before it, that he had never known chicken-pox kill a child in his life."--Dr Hadwen (1896)

"MILD--Mumps, Chickenpox and rubella...are mild.  In other words there's not much point in trying to avoid them.  They don't do much to young children and they do build up their general immunity and resistance."--T Anderson MD, British Medical Journal booklet (c 1953)

"The last issue of the Registrar-General thus, [p. xiii.,] refers to this: "The deaths ascribed to Small-pox in 1886 numbered 275, and were far lower in proportion to the population than in any previous year. There were, however, also 93 deaths ascribed to Chicken-pox; and as this ailment is rarely, if ever, fatal, in all probability most or all of these deaths were really due to Small-pox."--ALEXANDER WHEELER

"In the thirty years ending in 1934, 3,112 people are stated to have died of "chicken-pox," and only 579 of smallpox in England and Wales. Yet all the authorities are agreed that chicken-pox is a nonfatal disease"—M. Beddow Bayly, Case Against Vaccination, London, June 1936, p. 5.

"In 1997, 3 deaths reported by two states did not occur from chicken pox, but rather from the unnecessary drugs they used to treat it."--Gary Krasner

"Diseases such as chickenpox or measles can be very serious or even fatal in both children and adults who take this drug (Deltason/Orasone--generic name Prednison, a steroid)."--PDR

"Lack of zinc prevents normal release of vitamin A from the liver...Low blood zinc concentrations have been found in...TB, Crohn's Disease, lung infection...many drugs cause excessive excretion of the element.  These include...corticosteroids."---Dr Len Mervyn's Minerals and Your Health (p98)

"The proponents of mandated chickenpox vaccination of children pronounce that over 100 die of chickenpox each year. They do not emphasize, however, that it is adults who are at higher risk and that they will not be required to be vaccinated!  The numbers above show that in 1997 (the last year available) no children died from chickenpox in New York."--Gary Null

"Father dies after catching chickenpox from his sons....the inquest heard he was susceptible to the illness after being put on a high dose of steroids to treat kidney problems."--(Daily Express Sept 9, 2000)

"On June 30, 1988, my oldest child, Christopher, died of chickenpox. He was normally a healthy child with very mild asthma. He'd never been on corticosteroids, and had never been hospitalized. On June 16th 1988, he suffered his first severe asthma attack and was hospitalized for four days. Christopher was put on commonly used asthma medications including corticosteroids. Exactly one week following the asthma attack he broke out with chickenpox. Unfortunately, the corticosteroids lowered his body's response, (immune system) and he could not fight the chickenpox virus. It destroyed every organ in his body, and on June 30, 1988, Christopher died at the age of 12. The vaccine wasn't licensed then, but it is now. I worked for years to see warnings added to corticosteroid labels, and the vaccine (Varivax) licensed. " Rebecca E. Cole

"About half the deaths from measles in the past were in children with illnesses like leukemia who could not be immunised because of the suppression of their immune system by disease or therapies such as anti-cancer drugs and steroids."--Paul Ince, Prof of neuropathology, Sheffield University

On January 19, 1997, a 23-year-old woman in good health had onset of a classic varicella rash. In early January, her 2- and 5-year-old unvaccinated children had had varicella. On January 22, she had onset of shortness of breath and hemoptysis. When she was admitted to a local hospital on January 23, a chest radiograph indicated diffuse alveolar density consistent with varicella pneumonia, and treatment was initiated with oxygen and intravenous acyclovir. Her condition worsened, and she required intubation several hours after admission. Because of increasing respiratory distress, she was transferred to a referral hospital where treatment continued with oxygen, antibiotics, and intravenous acyclovir. On January 31, her rash became hemorrhagic, and she developed disseminated intravascular coagulation (DIC) and renal failure, followed by progression to multiple system failure; she died on February 2. Varicella zoster virus was cultured from skin lesions and from a tracheal aspirate. Case 2

On March 11, 1997, a 25-year-old woman in good health had onset of a classic varicella rash, fever, and headache. Her 4-year-old unvaccinated child had had onset of a varicella rash on February 23. On March 12, the woman had onset of cough, and on March 13, shortness of breath. On March 14, she sought care at a local emergency department (ED) because of increasing respiratory difficulty and confusion. Chest radiograph indicated bilateral infiltrates consistent with varicella pneumonia, and arterial blood gases indicated hypoxemia. Varicella encephalitis and pneumonia were diagnosed; she was admitted to the hospital, and treatment was initiated with oxygen and intravenous acyclovir. Four hours after admission, her respiratory difficulty increased, and she required intubation. On March 15, a computerized tomography of the brain revealed severe, diffuse cerebral edema, and she developed renal failure and coma. On March 16, she was transferred to a referral hospital for renal dialysis; an electroencephalogram indicated absence of electrical brain activity, and repeat chest radiographs indicated diffuse infiltrates. She died on March 17. Case 3

On April 3, 1997, a 32-year-old woman with Crohn's disease sought medical evaluation at a local ED because of onset of abdominal and back pain. On March 7, therapy was initiated with 40 mg prednisone daily for an exacerbation of her Crohn's disease. By April 3, her steroid therapy had been tapered to 20 mg prednisone daily. On physical examination, she had mild, generalized abdominal tenderness with no specific signs or abdominal guarding. She was afebrile, and a white blood cell (WBC) count was normal. A benign abdominal syndrome was presumptively diagnosed, and she was discharged.

Her symptoms persisted, and on April 4, she sought medical evaluation at the office of her health-care provider. Findings on physical examination were unchanged. Although an abdominal radiograph, abdominal and pelvic ultrasounds, and a WBC count were normal, because of her underlying medical condition, she was referred for surgical consultation. On April 5, the abdominal pain persisted, and she returned to the ED for evaluation. A WBC count was 15,000/mm3 (normal: 3200-9800/mm3), and she was admitted to the hospital. Diagnoses of colitis and ileitis with possible perforation and intraabdominal abscess were considered, and treatment was initiated with broad-spectrum antibiotics. On physical examination, a maculopapular, vesicular rash with crusted lesions was observed on her trunk, head, and neck. Varicella was presumptively diagnosed, and she was placed in isolation. The patient reported that she had had onset of a mild macular, nonpruritic rash on her back on April 3 and that she had been exposed on March 12 and 13 to her 4-year-old unvaccinated niece with varicella. On April 6, the vesicles became hemorrhagic, and she began bleeding from intravenous sites. She rapidly developed hypotension and DIC, and died from shock the same day. On autopsy, evidence of viral inclusion bodies in multiple organs was consistent with varicella, and varicella was determined to be the cause of death.

Varicella-related deaths--Florida, 1998.  MMWR Morb Mortal Wkly Rep. 1999 May 14;48(18):379-81.PMID: 10369579; UI: 99296270

No authors listed] Varicella-related deaths among children--United States, 1997.JAMA. 1998 Jun 10;279(22):1773-4. No abstract available.PMID: 9628698; UI: 98290662
No authors listed] Varicella-related deaths among children--United States, 1997.Can Commun Dis Rep. 1998 Jul 1;24(13):108-11. English; French. No abstract available.PMID: 9926486; UI: 99125309
 May 16, 1997 / 46(19);409-412 Varicella-Related Deaths Among Adults -- United States, 1997

Varicella-related deaths among children--United States, 1997.MMWR Morb Mortal Wkly Rep. 1998 May 15;47(18):365-8.PMID: 9603627; UI: 98264790

Tinkelman DG. FDA varicella warning. Pediatrics. 1992 Sep;90(3):479-81. No abstract available.PMID: 1518718; UI: 92390242

FDA Press Release

"HHS News, P91-31, December 2, 1991. The Food and Drug Administration has asked the makers of corticosteroid drugs to warn doctors that the long-term or high-dose treatment with these products may place patients exposed to chicken pox or measles at increased risk of unusually severe infections or even death. Corticosteroids are drugs commonly prescribed and used in children to treat a variety of chronic conditions such as asthma, allergies, and juvenile arthritis. One corticosteroid side effect is a suppression of the human immune system. Immunosuppression has been reported with different doses and treatment lengths but, most often, problems occur with either low-dose prolonged treatment or with moderate - to high - dose treatments of varying durations.

In part, because of the efforts of one parent -- Mrs. Rebecca Cole of Jacksonville, NC. -- FDA became concerned that the medical community and many parents may fail to recognize the serious risk to people taking corticosteroids if they become infected with some common virus. Mrs. Cole's 12-year-old asthmatic son Christopher, while undergoing treatment for the first time with a commonly prescribed corticosteroid known as methylprednisolone, died of complications from chicken pox. This case together with other reports of severe illnesses and deaths resulting from chicken pox infections, led the agency to call for a warning to doctors and patients about the potential seriousness of this kind of medical situation. FDA Commissioner David A. Kessler, M.D., said, "As a pediatrician, I am concerned that even though corticosteroids are essential in controlling very serious diseases, some parents may not be aware or their doctors may not have warned them that children undergoing treatment with these drugs may be vulnerable to serious complications. These complications can result from what we usually consider benign childhood virus diseases -- particularly chicken pox, for which there is no preventive vaccine yet available. Many children need these drugs, and stopping them without medical supervision may be very dangerous. But it is also important that parents be alert to the risks if their children are exposed to or get chicken pox or measles while taking corticosteroids. This awareness will hopefully cause them to seek their doctor's advice and treatment," Kessler said. Because of these concerns, the FDA is requesting that all manufacturers of oral, injected, and inhaled corticosteroids include in the "Warnings" section of the physician labeling the following statement: "Children who are on immunosuppressant drugs are more susceptible to infections than healthy children. Chicken pox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. In such children, or in adults who have not had these diseases, particular care should be taken to avoid exposure.

If exposed, therapy with varicella zoster immune globulin (VZIG) or pooled intravenous immunoglobulin (IVIG), as appropriate, may be indicated. If chicken pox develops, treatment with antiviral agents may be considered."

FDA told manufacturers that the "Precautions" section of the physician labeling of corticosteroids should also include the following information for patients: "Patients who are on immunosuppressant doses of corticosteroids should be warned to avoid exposure to chicken pox or measles and if exposed, to obtain medical advice." Manufacturers of corticosteroids have been requested to incorporate the "warning" and "precautions" information in their labeling within 90 days.

James O. Mason, MD, assistant secretary for health, said that despite the new labeling change for these drugs requested by FDA, it is important for patients and parents of children undergoing treatment with corticosteroids to be vigilant. "It is imperative that all children be immunized at an early age against infectious diseases for which we have effective vaccines, and that includes measles. "But in the case of chicken pox, no vaccine is yet available. Therefore, immunosuppressed children and their parents must become educated about their risks of contracting infections such as chicken pox or measles. Even though there are medications that may help infected high - risk patients, the best protection is avoiding exposure," he said. FDA is an agency within the Public Health Service."



Steroid adverse reactions
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Drug Induced Meningitis (DIAM)

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