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Can our patients get chickenpox twice?

A Eminent textbooks give an emphatic 'no' in answer to this question, claiming immunity following chickenpox is lifelong. But if this were so then shingles would not occur, as this is a localised reactivation of latent virus, indicating failure of immunological control of latency.

It is noteworthy that shingles occurs with particular severity and can disseminate in patients with impaired cellular immunity. This needs to be distinguished from re-infection.

From the literature it is clear that true re-infection does occur. A study described 14 children between 18 months and 13 years who had between two and five attacks, usually mild, without evidence of significantly abnormal immune responses to varicella-zoster virus (VZV).

But several patients lost their immunity to VZV on long-term follow-up, possibly indicating a subtle failure of immune response. Another study found eight patients with recurrent VZV, despite being seropositive for VZV antibodies.

Infection has been documented in patients who have been vaccinated and been shown to have both antibody and cellular immunity against VZV. Typing of the virus in these cases has shown wild-type virus, not vaccine strain, indicating new infection not reactivation.

Dr Gavin Spickett is consultant clinical immunologist at the regional department of immunology, Royal Victoria Infirmary,

Newcastle upon Tyne

QIs it possible to get chickenpox twice?

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