A Survey on Awareness Regarding Chickenpox and Determination of Circulating Genotypes of Varicella zoster Virus in Patients Visiting Tertiary Care Hospitals in Islamabad/ Rawalpindi

Abstract

Chickenpox, caused by varicella zoster virus is an endemic disease in most countries which even after implementation of its vaccine in public immunization plans in several countries causes a serious disease burden. The virus responsible for chickenpox is the etiological agent for another type of infection known as shingles or herpes zoster which is more commonly associated with complications such as post herpetic neuralgia. Chickenpox infection in children, unlike adults, is usually mild and can be treated symptomatically. In adults the infection is severe and may result in several types of complications. Chickenpox is highly contagious, and outbreaks are predicted to occur every few years in vulnerable populations resulting in a loss of resources, time, and unnecessary hospital expenses. These issues can be mitigated by implementing provision of chickenpox vaccine to the general population by the Expanded Programme for Immunization in Pakistan. To conduct a situational analysis of chickenpox in this region, the present study was aimed to assess the awareness and practices of the general population regarding chickenpox and also investigate the clinical samples for IgG and IgM antibodies and determine the genotype of the circulating strains in Islamabad/ Rawalpindi. The survey findings have revealed minimal knowledge among the general population about the basic scientific characteristics of the disease. People have been found to harbour positive views about chickenpox vaccination and disease prevalence and vaccination rate were found to be quite low among the children of respondents. It has also been found that the actual number of chickenpox cases are higher than those found in hospital records as people often do not seek medical intervention for this disease. Analysis of demographic data of clinical samples revealed a greater number of male patients in the study and according to age there were more adults overall. A significant association of diagnosis was found with disease severity, seasonality, and antiviral treatment. The seroprevalence analysis revealed greater seropositivity in adult males and an overall seroprevalence of approximately 73 % in active patients. Molecular analysis of varicella zoster virus ORF 21, ORF22, and ORF54 indicated the presence of either M2 or J genotype in this region. Larger scale study would be needed comprising of representative samples and by inclusion of additional ORFs in the analysis to allow discrimination between these genotypes.