INTRODUCTION:
Chicken Pox is caused by the Varicella zoster virusand is a common childhood illness.1 The disease spreads through the population very easily. In rare cases, this disease may exhibit its severity in adults in the form of complications like hepatitis, pneumonia, encephalitis.2 But the primary targets of the virus are children, with an estimated household secondary attack rate of 90%. During the viral incubation period (10–21 days), it reproduces in the upper respiratory tract in the beginning and later, spreads to the reticuloendothelial system (liver, spleen) and other organs.3 For diseases caused by VZV, specific cell-mediated immunity plays a major role in the defence mechanism.4 VZV presents itself as chicken pox at first, most often in childhood, and can remain asymptomatically latent in nerve tissues for several years and often appear as shingles later in life.5 Within 3 days from the onset of the disease rashes scatter from the chest to the periphery, and then to the whole body.
Rash patterns include the earlymanifestation of vesicles in a teardrop shape, followed by appearance of macular rashes with crusting.6 These rashes occur with 5-6 days of severe pruritus. Isolation of patients is important until crusting of rashes is complete, as the disease remainsinfectious.7 Reactivation of latent VZV infection can cause an HZ infection in the dorsal root ganglia, also known as shingles.8 The presence of multiple, painful, unilateral vesicles, ulceration, and a single dermatome innervated by single dorsal root or cranial sensory ganglion characterize this condition9 Typically, this lasts 4-5 weeks. Often described as an intense burning, itching sensation, the pain can be significant to the point of being debilitating, and as such can greatly affect quality of life.10 Aging or immunosuppression is the primary factors for the reactivation of the virus and the risk of this condition increases steeply after the age of 50 years.11 When observed in children, unlike in adults, local pain, hyperesthesia and pruritus are rare. The diseasegenerallycontinuesup to 15 days however the entire healing of skin taken more than a month.Post-herpetic neuralgia, iridocyclitis, secondary glaucoma, meningoencephalitis and encephalitis are few complications that are associated with HZ.3 Shingles are rare in children. But in few cases demonstrating failure in secondary response against chicken pox have been encountered in the age group of 18-24 years. Prevention of any sort of latency of vzv and also its manifestation itself is required at the moment as major functions of the vaccine.12
Our survey is mainly directed to understand the proportions of different factors (like, nutrition, stress etc) contributing to the failure of this secondary response. Factors like age, sex, BMI, nutrition, stress, temperature and location of probable contraction. We considered the age group of 18-24 years for the collection of data. Consideration is also given to sex of the subject in failure of secondary response. Weight was taken into consideration by calculating BMI of the subject’s involved and successive analysis of whether conditions like obesity affected contraction of this disease. Appropriate nutrient intake and nutrient supplements were also considered. Also,as is widely acknowledged, the impact of stress during contraction as well as in general, was duly noted. The effect of temperature and location of contraction was taken as one of the factors. The effect of established vaccination on the health of the individual and susceptibility to the disease was studied.
METHODS:
A widespread survey of approximately 80 consenting participants was conducted on the following survey form-
Epidemiological Survey for Failed Secondary Response to Varicella Zoster Virus (VZV)
Therefore, the following methods were deemed useful for data collection and interpretation
1. Google form, drive - for data collection
a. Age of participants, to screen population for focused age group.
b. Sex of participants, to differentiate between response patterns.
c. Weight and height statistics, to calculate BMI and to categorize participants as underweight, normal, or overweight.
d. Nutrient intake of participants (including nutritional supplements), to evaluate their regular eating habits.
e. Immune strength of participants estimated, to check for vulnerability to disease in general.
f. Stress toll on body was accounted for, to find if there exists a correlation between stress, immune strength and failure of appropriate immune response.
g. Time of year, location of diagnosis, and frequency of using air-conditioners, to identify if a certain kind of climatic condition promotes the contraction of chickenpox.
2. Calculation of body mass index
RESULTS:
Of the 104 consenting participants in the age group of 18-24 years, 43.269% were females and remaining 56.73% were males.
Nutrition:
Fromthe responses collected it was found that 1.92% consumed 1meal a day, 17.307% consumed 2meals a day, and 55.76 % consumed 3meals a day and 25.00% 4 meals a day.
While 32.69% of the participants believed that the meal they consume consists of proper proportions of nutrients, 36.53% believed that they did not.30.76% were not sure regarding the nutrient contents of their meals.
The participants were also asked about the nutrient supplements to which 22.11% responded affirmatively. Of this, 43.47% agreed that they consume protein supplements 34.78%,that they consume Vitamins and 21.73% Minerals.(fig.1)
Fig.1 Nutrition; Graphical representation on response (%) of the individuals consumed no . of meals per day
Immunity:
The responses collected from the survey indicate that 13.46% of individuals fell sick almost every month. Among these 50.00% are males and rest are females.2.88% fell sick every two months, 26.92% said that they fell sick thrice in a year, out of which 57.14% are males. 28.84% said that they fell sick twice in a year of which 66.66%were males.21.15 % fell sick once in a year among these 50.00% were males. Also 0.96% stated that they never felt sick.
The responses recorded showed that 43.26% never contracted chicken pox during their lifetime, 56.73% contracted it once and a surprising 5.08% even contracted it second time, hence disproving the myth that chickenpox cannot occur twice in the system of a person. Also, it was observed that of the people who were diagnosed with the disease once, a majority contracted it before they crossed 10 years of age, hence establishing that it primarily targets children.(Fig.2)
Fig.2 Immunity:Graphical representation on response (%) of the individuals fell in sickness
BMI:
The average BMI of the respondents was calculated which is equal to 23.4.This BMI falls under normal weight according to WHO accepted standards.(Fig.3)
Fig 3
Fig.3 BMI:Graphical representation of BMI of the individuals
Stress:
The participants were asked to rate their stress level on a scale of 1-5, 1 being minimal stress and 5 being maximum. It was found that the average general stress level was 2.89.Ironicaly the stress level during contraction of the disease was found to be slightly lower i.e.3.61.(Fig.4)
Fig.4 Stress: Graphical representation on stress level of the individuals under normal and sick persons
Physical factors:
The physical factors taken into consideration were month and location of contraction, estimated average temperature and usage of air- conditioner.From the data collected it was inferred that the maximum number of occurrences of the disease was in the month of March and in moderate to high temperature conditions.
DISCUSSION:
This survey led to discovery of various factors involved in the failure of
secondary immune response to Varicella Zoster Virus. We found out that factors
like stress, nutrition and overall fitness have played crucial roles in varying
responses to this virus. As per survey results, the While two of them were
underweight, one was overweight. 2 out of the 3 affected people claimed to have
insufficient nutrient content in their meals, showing that nutrition may play a
role in lowered immunity, which they exhibited with respect to chicken pox as
well subjects who suffered from chicken pox for a second time did not fall in
the WHO accepted ‘normal weight’ range.as other diseases. Though we cannot come
to any definite conclusion regarding this, from the survey it has been observed
that chicken pox is a childhood disease with maximum chances of occurrence in
tropical and sub-tropical climate zones. In the scope of our survey we found
that females were more susceptible to contracting chicken pox more than once
before the age of 25. The reasons could be inadequate care during their early
years. Increased stress levels were observed among the affected individuals
during the contraction, and also in general.
CONCLUSION:
From the survey responses documented and analysed in the project we conclude that failure of secondary response to VZV is not very uncommon in the people ranging 18 to 24 years of age. This highly contradicts the myth that chicken pox as an infection cannot be acquired twice. This failure in appropriate immune response rises from a consortium of various factors including, but not limited to, nutrition, stress, BMI, etc. An attempt has been made on our part to fully understand the underlying causes, but there may still other factors that have not been accounted for in this report.
ACKNOWLEDGEMENTS:
The authors are thankful to VIT University for the constant encouragement, help and support for extending necessary facilities. Also, this project would not have been successful without the help of our enthusiastic participants and well-wishers.
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Received on 30.06.2017 Modified on 22.07.2017
Accepted on 25.08.2017 © RJPT All right reserved
Research J. Pharm. and Tech 2018; 11(7): 2817-2820.
DOI: 10.5958/0974-360X.2018.00520.6