Commentary: severe varicella/zoster and adenovirus infections in immunocompromised patients.

of symptoms, and the late onset ofthe vesicular rash. As a result of our experience in this case we recommend that varicella zoster antibodies should be measured in all patients receiving methotrexate and, if the result is negative, patients should be advised to seek medical attention when there is contact with chickenpox so that passive immunisation with varicella zos-ter immunoglobulins can be given. Active immunisation with varicella vaccine is available at present in the UK on a named patient basis. Trials with the vaccine have been performed in healthy adults and in healthy children and those suffering from leukaemia. More than 95% ofhealthy children seroconvert following vaccination, and more than 90% are fully protected on subsequent exposure to the virus. In children with leukaemia two doses were required to induce seroconversion in 90%, with a protection rate of 85%. In healthy adults seroconversion was harder to achieve and there was a lower protection rate of 70%.67 Protection ofimmunosuppressed adults may therefore be harder to achieve and, at present, active vaccination cannot be recommended. Increased awareness, prevention of exposure, passive immunisation, and antiviral therapy are all required in the management of this complication of immunosuppression. adult: case report and review of the gastrointestinal complications of chickenpox. varicella vaccine in healthy children: final report of a 2 year efficacy study and 7 year follow up study. Both chickenpox and shingles have reputations for being relatively mild. One tends to be regarded as a routine childhood infection, the other as a nuisance-sometimes considerable-in old age. Adenoviruses affecting the im-munocompetent host likewise have a reasonably benign clinical repertoire. The advent of powerful immunosuppressive therapies and HIV infections, together with an aging population , has altered this benign scenario. Nonetheless , death from infectious disease-even in immunocompromised patients-should always be regarded as preventable. In the April issue of Thorax (pages 422-3) Gatnash and Connolly described the case of a 49 year old asthmatic man, immuno-compromised by oral corticosteroids and weekly doses of methotrexate, who acquired chickenpox from his son. The son's rash had appeared three weeks before his father was admitted with chickenpox pneumonia which caused his death. The father's rash had developed five days before his admission and treatment with intravenous acyclovir was started on the day of admission. Ideally, he should have had serological testing for herpes virus varicella/zoster at the time his son's chickenpox first appeared. A negative result would have prompted …