Varicella zoster virus (VZV), human herpesvirus 3, is a highly contagious virus found worldwide. Humans are the only known reservoir. Transmission is via respiratory droplets, aerosolized vesicular contents, or direct contact with skin lesions. After infection, VZV becomes latent in sensory ganglia, with reactivation possible even decades later.

Primary infection with VZV results in varicella (chickenpox), which is typically seen in school-age children in temperate climates in late winter and early spring. Before the varicella vaccine, there were approximately 4 million cases of varicella and 100 varicella-related deaths in the United States per year, whereas after vaccination, the incidence has declined 97%, with no reported pediatric deaths since 2010. Varicella disease presents as a diffuse, pruritic, vesicular rash, with fever and malaise appearing just before or on the day of the rash. The contagious period begins 1 to 2 days before the appearance of the rash and continues until all...

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