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Chapter II

Contents

Part II

DISEASES TRANSMITTED CHIEFLY THROUGH RESPIRATORY TRACT

Diseases Caused by Viruses


CHAPTER II

Chickenpox

Joseph Stokes, Jr., M. D.

HISTORICAL NOTE 1

Chickenpox has not been a serious problem among the armed services in any recent war. This is not only the result of low incidence but also because there are usually no complications, so that relatively few days are lost from duty.In World War I, it resulted in 31,534 days lost from duty, a noneffective rate of 0.02 per 1,000 average strength. There were 1,757 primary admissions for the total Army. In contrast, measles in World War I caused 1,877,944 days lost from duty, a noneffective rate of 1.25 per 1,000 average strength per annum, or about 62 times that recorded for chickenpox. Again in contrast, mumps in World War I caused 3,884,147 days lost from duty, a noneffective rate of 2.58 per 1,000 average strength per annum, or about 129 times that recorded for chickenpox. In World War I, the high noneffective rates for measles and mumps resulted to a considerable extent from complications.

Chickenpox and the other communicable diseases of childhood were common among troops in the United States in World War I, with a particularly high incidence in induction centers, whereas they were far less common in Europe. Also, in World War I, Negro troops had higher rates for chickenpox than white troops—a ratio of almost 4:1. All of these communicable diseases reached a peak in about January 1918. Since induction began late in the spring of 1917 and summer intervened, it was not unexpected that such epidemics would occur in the inducted troops during their first winter.

CONTROL MEASURES

Chickenpox appears to be one of the most readily transmissible of all infectious diseases, and no method of control was available in World War I. Between World War I and World War II, evidence was obtained by Wells and. his coworkers 2 that, in various aggregations, ultraviolet light was effective in preventing cross infection, particularly in chickenpox and measles. It is highly probably that in certain installations, particularly at induction centers,

1 The Medical Department of the United States Army in the World War. Communicable and Other Diseases. Washington: U. S. Government Printing Office, 1928, vcl. IX, pp. 387-390, 411, 451.

2 Wells, W. F., Wells, M. W., and Wilder, T. S.: Environmental Control of Epidemic Contagion. I. An Epidemiologic Study of Radiant Disinfection of Air in Day Schools. Am. J. Hyg. 35: 97-121, January 1942.


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proper ultraviolet irradiation would have materially reduced the spread of such infection. If thus controlled, it is also highly probable that many men would later have contracted these diseases under much less favorable circumstances--on foreign soil or under combat conditions. It was thus particularly important, that such possible means for control of chickenpox should not be used, at least in the United States.

The question has been raised repeatedly as to whether convalescent serum or gamma globulin was effective when injected during the incubation period in preventing or in attenuating chickenpox. There has been no conclusive evidence since World War I, or during World War II, that such attempts at passive immunization have been successful.

INCIDENCE

Table 14 outlines the incidence of chickenpox during World War II.

It is of some interest that, while the annual rates of chickenpox in the Latin American area for 1942 and 1943 were only slightly higlier (0.45 and 0.74) than those recorded for the same years in the continental United States (0.42 and 0.54), during the next 2 years they rose considerably above the rates in the United States. The annual rates per 1,000 average strength for 1944 and 1945 in the Latin American area are reported as 1.41 and 2.27, respectively, as compared with 0.71 and 0.61 for the same years in the United States. There was at least a strength of 100,000 in the area at this period. An adequate explanation of the difference in annual rates is not available.

No satisfactory method of control of chickenpox was available for World War II nor were any investigations conducted on this disease, because of its relative unimportance to the United States Army.

TABLE 14.-Incidence of chickenpox in the U. S. Army, 1940-45