4 Children Die After Chickenpox : Health: Cause of death may have been a result of accompanying strep infections. Officials are monitoring cases.

Four children--three in Orange County and one in Los Angeles--who died within the last two weeks after what appeared to be routine cases of chickenpox may have suffered complications from a severe bacterial infection, according to health officials in both counties.

In addition to the four who died, at least 23 other children with chickenpox have been struck with similar but nonfatal bacterial infections this year in the two counties. In the past two weeks alone, one Los Angeles hospital has reported 15 such infections--the same number that occurred during all of last year.

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

Said Dr. Shirley Fannin, director of disease control programs for Los Angeles County: “This may be relatively early in the problem, or we may be seeing the peak. We don’t know yet. . . . This seems to be more cases in a shorter period of time. That is unusual.”

The streptococcal infection, which typically can cause illnesses such as strep throat and pneumonia, probably entered into the children’s bloodstreams through lesions resulting from the chickenpox infections, the health agency doctors said. Fannin described it as an “unfortunate coincidence” that both the chickenpox virus and the strep infections appear to be occurring in the same population at the same time.

Experts advise parents to keep a close eye on children who have chickenpox, and to check with a doctor if the children have long-lasting high fever or do not appear to be recovering as quickly as expected. Washing children’s skin with antibacterial soap may also help prevent the streptococcal bacteria from invading the chickenpox lesions, Fannin said.

The identities of the children recently struck with the infection were not made public.

Of the three Orange County children 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. A 5-year-old girl died on March 24. In Los Angeles County, laboratory tests have not yet confirmed that the child who died had the streptococcal infection, but Fannin said officials are certain that is the cause.

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. Test results are not yet available.

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

Reports of the Orange County deaths prompted Los Angeles County officials to survey the area’s pediatric hospitals. They found that over the past two weeks, Childrens Hospital-Los Angeles has seen 15 children who have had both chickenpox and the streptococcal infection. Another hospital has seen four cases, Fannin said.

Severe streptococcal infections are on the rise throughout the United States among people of all ages and are not always linked to chickenpox. The infections can be inexplicably lethal for some people and not for others, officials said.

The infections often can be treated with antibiotics, but there is little that can be done in some cases, Meyers said. “These complications are relatively rare and are something you read about in medical textbooks,” Meyers said. “It doesn’t invariably lead to death. In some people it just takes a drastic course.”