Part II
DISEASES TRANSMITTED CHIEFLYTHROUGH RESPIRATORY TRACT
Diseases Caused by Viruses
CHAPTER II
Chickenpox
Joseph Stokes, Jr., M. D.
HISTORICAL NOTE 1
Chickenpox has not been a serious problem amongthe armed services in any recent war. This isnot only the result of low incidence but also because there are usuallyno complications, so thatrelatively few days are lost from duty.In World War I, it resulted in31,534 days lost from duty, anoneffective rate of 0.02 per 1,000 average strength. There were 1,757primary admissions forthe total Army. In contrast, measles in World War I caused 1,877,944days lost from duty, anoneffective rate of 1.25 per 1,000 average strength per annum, orabout 62 times that recordedfor chickenpox. Again in contrast, mumps in World War I caused3,884,147 days lost fromduty, a noneffective rate of 2.58 per 1,000 average strength per annum,or about 129 times thatrecorded for chickenpox. In World War I, the high noneffective ratesfor measles and mumpsresulted 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 readilytransmissible of all infectious diseases, and nomethod of control was available in World War I. Between World War I andWorld War II,evidence was obtained by Wells and. his coworkers 2 that,in various aggregations, ultravioletlight was effective in preventing cross infection, particularly inchickenpox and measles. It ishighly probably that in certain installations, particularly atinduction centers,
1 The Medical Department of theUnited States Army in the World War. Communicable andOther 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 thespread of such infection. If thuscontrolled, it is also highly probable that many men would later havecontracted these diseasesunder much less favorable circumstances--on foreign soil or undercombat conditions. It wasthus particularly important, that such possible means for control ofchickenpox should not beused, 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 chickenpoxduring 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
