Determination and importance of varicella immune status of nursing staff in a children's hospital

Ferson, Mark J; Bell, Sydney M.; Robertson, Peter

doi:10.1016/0195-6701(90)90091-2

Cited by 33 publications

(10 citation statements)

References 12 publications

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“…13 14 18 19 The NPV (3.4%) was low compared with similar studies where this figure varied from 11.1% to 60%. Our very low NPV could be due to the fact that historical information was obtained by a self administered questionnaire and not by a face to face interview of the participants, during which additional information on the illness could have been provided.…”

Section: Discussionmentioning

confidence: 66%

“…9 Most of them consider a positive history of varicella sufficiently predictive for immunity and restrict serological screening and subsequent vaccination to those with a negative or uncertain history of varicella 311 14 15 19 They also assume that screening of this group is cost effective because the negative predictive value of history is low. Only a few authors consider the risk of missing non-immune employees unacceptable and advise testing all healthcare workers irrespective of their history 9…”

Section: Discussionmentioning

confidence: 99%

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Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study

Vandersmissen

2000

Occup Environ Med

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Objectives-To assess the prevalence of varicella zoster virus (VZV) antibodies in Flemish (Belgian) healthcare workers, to investigate the association between seronegativity and selected variables, and to assess the reliability of recall about disease as a predictor of immunity. Methods-A seroprevalence study of VZV antibodies (IgG) was conducted among a systematic sample of 4923 employees in various professional groups, employed in 22 hospitals in Flanders and Brussels (Belgium). Information about sex, age, department, job, and years of employment, the country of origin, and history of varicella was obtained. The presence of VZV antibodies was investigated with the enzyme linked immunosorbent assay (ELISA), Enzygnost anti VZV / IgG (Dade Behring, Marburg, Germany). Statistical analysis was performed by calculating prevalences and prevalence ratios (PRs) and their 95% confidence intervals (95% CIs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the recalled history were determined. Results-The prevalence of VZV seropositivity in Flemish healthcare workers was 98.5% (95% CI 98.1 to 98.8). Seronegativity was significantly associated with age and job, increasing with both older and younger age. The prevalence of seronegative workers was significantly less in nursing staV than non-nursing staV. There was no significant diVerence for sex and years of employment. The PPV and NPV of recalled history were 98.9% and 3.4%. Sensitivity and specificity were 83% and 38.9%. Conclusion-The prevalence of VZV seropositivity was very high in this sample of Flemish healthcare workers. Because of this low overall susceptibility, VZV infection seems not to be an important occupational risk among healthcare workers in Flanders. The increasing seronegativity above the age of 45 is possibly due to a loss of detectable antibodies. A positive history of varicella was a good predictor of immunity, but a negative history had no value as a predictor of susceptibility in adults. (Occup Environ Med 2000;57:621-626)

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study

Vandersmissen

2000

Occup Environ Med

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“…24 In the prevaccine era, 97% to 99% of adults with a positive history of varicella were seropositive, and the majority of adults with negative or uncertain histories were seropositive (range: 71%-93%). [25][26][27][28] No published data were available on the predictive value of a positive history of varicella disease in children during that time period. History of varicella may be becoming less reliable in the vaccine era, with only 75% of unimmunized children 1 to 4 years of age who report a positive history of chickenpox actually being seropositive.…”

Section: Epidemiology Of the Diseasementioning

confidence: 99%

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Bocchini¹,

Baltimore²,

Bernstein³

et al. 2007

Pediatrics

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National varicella immunization coverage using the current 1-dose immunization strategy has increased among vaccine-eligible children 19 through 35 months of age from 27% in 1997 to 88% by 2005. These high immunization rates have resulted in a 71% to 84% decrease in the reported number of varicella cases, an 88% decrease in varicella-related hospitalizations, a 59% decrease in varicellarelated ambulatory care visits, and a 92% decrease in varicella-related deaths in 1-to 4-year-old children when compared with data from the prevaccine era. Despite this significant decrease, the number of reported cases of varicella has remained relatively constant during the past 5 to 6 years. Since vaccine effectiveness for prevention of disease of any severity has been 80% to 85%, a large number of cases of varicella continue to occur among people who already have received the vaccine (breakthrough varicella), and outbreaks of varicella have been reported among highly immunized populations of schoolchildren. The peak age-specific incidence has shifted from 3-to 6-year-old children in the prevaccine era to 9-to 11-year-old children in the postvaccine era for cases in both immunized and unimmunized children during these outbreaks. Outbreaks of varicella are likely to continue with the current 1-dose immunization strategy.After administration of 2 doses of varicella vaccine in children, the immune response is markedly enhanced, with Ͼ99% of children achieving an antibody concentration (determined by glycoprotein enzyme-linked immunosorbent assay) of Ն5 U/mL (an approximate correlate of protection) and a marked increase in geometric mean antibody titers after the second vaccine dose. The estimated vaccine efficacy over a 10-year observation period of 2 doses for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella, compared with those who are given 1 dose, during the first 10 years after immunization.To achieve greater levels of immunity with fewer serosusceptible people, greater protection against breakthrough varicella disease, and reduction in the number of outbreaks that occur nationwide among school-aged populations, a 2-dose varicella immunization strategy is now recommended for children Ն12 months of age. All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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“…A history of previous varicella infection is therefore generally accepted as proof of immunity. However, even among subjects who could recall suffering a varicella infection 0.9-3.2% were found to benon-immune 11. None the less, screening only women with a negative history will significantly decrease the number of women who receive the vaccine.…”

Section: Routine Screening and Vaccination Should Be Consideredmentioning

confidence: 99%

“…The proportion of women who would be vaccinated, based on a negative history without serological confirmation, would vary widely between different populations as the number of adults who could not recall a history of chickenpox ranged from 19% in Ohio12 to 49% in Australia 10. However, even among subjects with no, or uncertain, prior exposure to varicella, only 10-36% were non-immune 11 12…”

Section: Routine Screening and Vaccination Should Be Consideredmentioning

confidence: 99%

Varicella vaccine in pregnancy

Seidman

Stevenson

Arvin

1996

BMJ

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Determination and importance of varicella immune status of nursing staff in a children's hospital

Cited by 33 publications

References 12 publications

Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study

Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Varicella vaccine in pregnancy

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