A Case Series of Vaccine-strain Reactivation Varicella Zoster in Two Pediatric Patients Presenting With Headache and Rash.
Pediatr Infect Dis JJun 3, 2026 (epub)
Victoria Krieg, Nikoli Nickson, Matthew D Eberly et al.
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Case in brief
Two immunocompetent children who had received routine varicella vaccination presented with headache and rash. Cerebrospinal fluid testing confirmed varicella zoster virus meningitis and identified the Oka vaccine strain. Both patients had good outcomes after treatment with acyclovir.
What made this case unusual
Meningitis was associated with reactivation of the vaccine strain in immunocompetent, routinely vaccinated children.
Diagnostic / clinical pearl
In a vaccinated child with headache and rash, cerebrospinal fluid testing can establish varicella zoster meningitis and identify whether the virus is the Oka vaccine strain.