Formerly a common childhood infection that affected almost all children, varicella (chickenpox) is now relatively uncommon because of successful prevention with universal vaccination. Before available immunization, approximately 4 million cases of varicella disease were reported annually. By 2005, active surveillance sites documented a decrease in the incidence of varicella of approximately 90%. Varicella is the primary clinical manifestation of infection with varicella-zoster virus. The initial infection with the virus occurs from exposure to an infected person, and transmission occurs through contact with the respiratory tract, conjunctiva, and skin lesions. Approximately 80% to 90% of susceptible individuals will acquire the infection after exposure to an infected individual.

After an incubation period of 10 to 21 days, an infected individual may experience a brief prodrome, including fever and malaise, for 2 days before the development of a pruritic rash containing 250 to 500 lesions in an unimmunized person. Lesions appear in crops...

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