Case of chickenpox in which varicella zoster virus genotype E was identified for the first time in Japan

Varicella zoster virus (VZV) is now classified into seven genotypes, and type J (clade 2) is known as an exclusively prevalent genotype in Japan. Here, we describe an adult Japanese patient who was suffering from chickenpox caused by VZV type E, the most prevalent genotype in Western Europe. Because the eruptions were distributed over the trunk and limbs and the patient had a high titer of immunoglobulin G against VZV, we diagnosed this case as secondary VZV infection. To investigate the current prevalence of VZV genotypes in Japan, we examined the genotype of VZV in an additional 49 Japanese varicella/zoster patients who visited our hospital during 2018-2019. We found that VZV type E was still an exceptionally rare genotype (1/50) in Japan. Because foreign nationals living in Japan who carry VZV genotypes other than type J are increasing in number, secondary chickenpox may increase in Japan in the near future, as well as in the USA where multiple VZV genotypes are distributed.