A 2009 Varicella Outbreak in a Connecticut Residential Facility for Adults with Intellectual Disability

Abstract

We investigated a varicella outbreak in a residential facility for adults with intellectual disabilities. A case of varicella was defined as a generalized maculopapular rash that developed in a facility resident or employee. Immunoglobulin M testing was conducted on serologic samples, and polymerase chain reaction testing was performed on environmental and skin lesion samples. Eleven cases were identified among 70 residents and 2 among ∼145 staff. An unrecognized case of herpes zoster was the likely source. Case patients first entered any residential facility at a younger age than non-case residents (9.5 vs 15.0 years; P < .01). Varicella zoster virus DNA was detected 2 months after the outbreak in environmental samples obtained from case patients' residences. This outbreak exemplifies the potential for at-risk pockets of varicella-susceptible adults, especially among those who have lived in residential facilities from a young age. Evidence of immunity should be verified for all adults and healthcare staff in similar residential settings.

Varicella Vaccine Effectiveness in Preventing Community Transmission in the 2-Dose Era

“…15, 24 During May 2009 through July 2010, enrollment was limited to children aged 5 to 14 years with laboratory confirmation of varicella-zoster virus (VZV) by Polymerase Chain Reaction (PCR) testing. During August 2010 through June 2011, enrollment was expanded to include persons 1 to 18 years of age with laboratory and/or clinical diagnosis of varicella by a healthcare provider.…”

Vaccines for Health Care Personnel

“…Occupational exposure to varicella is a serious ongoing hazard to HCP and patients, particularly those with immune compromise. [44][45][46] Airborne transmission occurs with primary chickenpox and disseminated zoster (which may present atypically in immune-compromised individuals), but case reports have described isolated incidents of apparent airborne transmission from single-dermatome shingles. 45,47 Because transmission can occur before onset of rash, susceptible HCP should be removed from the workplace during the incubation period, days 8 to 21 postexposure.…”

Varicella immunization requirements for US colleges: 2014–2015 academic year

“…When outbreaks of vaccine-preventable diseases occur on college campuses, they can be disruptive since students may miss classes and activities and these outbreaks are costly to control 2–6 ; some have resulted in severe disease. There are also challenges with controlling outbreaks in residential settings 7 that include identifying and managing exposed contacts, as well as isolating and providing food and medical care to ill students.…”

“…It is typically a self-limiting disease in children, but it can cause severe disease in adolescents and adults. There have been documented outbreaks of varicella occurring among young adults 11, 12 and in residential settings 7 . These outbreaks can lead to disruption in school attendance and activities 6 ; students with varicella may miss classes and activities for 7 days or more 13 .…”