Three Chickenpox-Related Deaths Prompt an Alert

By GREG HERNANDEZ

April 7, 1994 12 AM PT

TIMES STAFF WRITER

Three children who had what appeared to be routine cases of chickenpox have died within the last two weeks and may have suffered complications from a severe bacterial infection, county health officials said.

The agency on Wednesday issued a countywide alert to all area hospitals informing them of the deaths, the most recent occurring Tuesday at Samaritan Medical Center-San Clemente.

There is heightened concern among health officials because, in addition to the three who died, at least four other children with chickenpox have been struck with similar but non-fatal bacterial infections this year, said Dr. Hildy Meyers of the Orange County Health Care Agency.

“It’s not unusual for us to have one or two deaths due to chickenpox in a year,” Meyers said. “This is something we are concerned about, but whether we are starting an epidemic or not, we can’t say.”

The streptococcal infection, which can typically cause illnesses such as strep throat and pneumonia, probably entered into the children’s bloodstreams through lesions caused by the chickenpox infections, the health agency doctor said.

“These complications are relatively rare and are something you read about in medical textbooks,” said Meyers. “It doesn’t invariably lead to death. In some people it just takes a drastic course.”

The identities of the seven children recently struck with the infection were not made public by health officials.

Of the three who died, a streptococcal infection has been confirmed as the cause of death only in the case of a 2-year-old Santa Ana girl who died on Sunday.

The child was brought to the emergency room of Children’s Hospital of Orange County in Orange with what appeared to be a standard case of chickenpox, said Abby Rubenstein, infection control coordinator at CHOC.

“She seemed fine, except for a bad case of chickenpox,” Rubenstein said. “She did not suffer from a loss of consciousness, did not have a fever, or seem listless.”

Three hours after the child left CHOC, her parents took her to the emergency room of Coastal Communities Hospital in Santa Ana, where she died.

On March 24, Rubenstein said a 5-year-old Orange girl was “near death” when she was brought to CHOC. The girl, who died that day, had what appeared to be a streptococcal condition, but this was not confirmed by hospital testing.

The most recent death was that of an 18-month-old San Juan Capistrano girl who died Tuesday. It is not known if the streptococcal infection was in her blood because test results are not yet available.

“She had chickenpox for four or five days, then developed a fever and became unresponsive later,” Meyers said.

Little is known about the four non-fatal cases, except that they involved 2-year-old twins, a 2-year-old child and a 5-month-old infant. The cases are not believed to be related, officials said.

Meyers said parents should not be overly alarmed by the recent deaths but she urges them to seek medical attention for any child exhibiting symptoms of chickenpox if there is a change in the course of the illness, such as development of a high fever, nausea, a change in the type of rash, or a change in mental acuity or awareness.

The normal symptoms of chickenpox, which Meyers said afflicts 90% of the population before the age of 15, include moderate fever, headache, occasional sore throat and a pink, spotted rash that turns to tiny blisters then scabs over.

“If they seem to be getting better but new symptoms develop, then seek medical care,” Meyers said. “It may be a sign that they are getting a secondary infection.”

This severe type of streptococcal infection is on the rise throughout the United States among people of all ages and is not always linked to chickenpox. It can be inexplicably deadly to some people and not to others, officials said.

The infection can be treated with antibiotics but, Meyers said, there is little that can be done in some cases.

“Even if they seek medical care, the moment there is a sign, you can’t always save them,” she said. “Sometimes, especially with children, infections go so quickly and the best medical care in the world isn’t going to alter the course.”

Deadly Infection

A rare streptococcal infection may be the cause of death of three Orange County children who had routine cases of chickenpox. The virulent infection can enter the bloodstream through chickenpox lesions and has specific symptoms. What to look for:

NORMAL CHICKENPOX SYMPTOMS

* Moderate fever for first two to three days

* Headache

* Occasional sore throat

* Pink, spotted rash starting on torso, spreads to face, neck, extremities

* Rash turns to tiny blisters, then scabs over

* Lasts a few days to two weeks after onset of symptoms

SIGNS OF COMPLICATIONS

* Long-lasting fever of 102 degrees or higher

* Widespread red rash

* Purple spots

* Vomiting