Varicella-Zoster Virus

One-Sentence Definition

Varicella-zoster virus (VZV) is a neurotropic alpha-herpesvirus causing primary varicella (chickenpox) and reactivation zoster (shingles), preventable by live-attenuated or recombinant subunit vaccines.

Taxonomy & Morphology

  • Human herpesvirus 3; dsDNA; envelope; latent in sensory ganglia
  • Related: HSV — similar latency/reactivation biology

Virulence Highlights

  • Respiratory spread (varicella) → viremia → vesicular rash
  • Latency in dorsal root ganglia → zoster with dermatomal rash
  • Immunocompromised: disseminated disease, visceral involvement

Clinical Syndromes

  • Primary varicella (often childhood)
  • Herpes zoster — painful dermatomal vesicles; postherpetic neuralgia
  • Disseminated zoster in immunosuppression
  • CNS: meningitis/encephalitis (less common than HSV Encephalitis)

Diagnosis

  • Clinical often sufficient for typical zoster
  • PCR on vesicle fluid/CSF when atypical or severe
  • Serology: IgG immunity vs acute (context-dependent)

Treatment / Prevention

  • Antivirals (acyclovir/valacyclovir) for zoster/complicated varicella
  • Vaccines: childhood varicella; shingles vaccine (recombinant preferred in older adults)
  • Isolation for susceptible contacts (airborne + contact)

Genomics & Surveillance

  • Clade tracking in research; vaccine strain vs wild-type differentiation occasionally relevant

Active Recall

  1. Where does VZV establish latency?
  2. Live vs recombinant zoster vaccine — key difference?
  3. PCR sample of choice in zoster?