Epidemiological investigation of a varicella outbreak in an Italian prison

Abstract

Five cases of varicella occurred in a women's prison in Rome. A serosurvey conducted in the prison found that 14.5% of the inmates were susceptible. The sensitivity and positive predictive value of a history of varicella were high, whereas specificity was rather low. The attack rate among susceptible inmates was approximately 22%. Preventive measures probably contributed to reduce infection spread.

Herpes Zoster Risk Reduction through Exposure to Chickenpox Patients: A Systematic Multidisciplinary Review

“…Saadatian-Elahi et al (quality: low, relevance: D) studied pregnant women and found no effect of the number of children in the household on VZV IgG titers [56]. Valdarchi et al (quality: low, relevance: D) noted during a prison CP outbreak study that some asymptomatic inmates developed VZV IgM, suggesting re-exposure, although only two had a known CP contact [57]. Toyama et al (quality: low, relevance: A) suggested a short term influence of CP on HZ incidence through visual inspection of plots, showing an increase in HZ during the summer period when CP circulation is at its lowest [58].…”

Challenges With Controlling Varicella in Prison Settings

“…Although no complications were reported among case-patients in this outbreak, VZV infection can lead to severe disease in populations with higher proportions of immunocompromising conditions, as evidenced by a fatal case of varicella pneumonia previously reported in a HIV-positive inmate (Valdarchi et al, 2008). Our investigation highlights the challenges in controlling disease transmission in this high exposure setting (Baillargeon et al, 2004; Bick, 2007; Breuer, 2004; Restum, 2005).…”

“…Facilities may choose to screen by asking about varicella disease history or by serologic testing. In general, studies have found that self-reported history is a reliable marker of varicella history for adults (Getaz et al, 2010; Perella et al, 2009; Valdarchi et al, 2008), although one study found that the positive predictive value of reported history was low (Wallace et al, 1997). In 2010, two of the cases of varicella occurred among Prison A inmates with self-reported history of varicella.…”

“…Varicella outbreaks have been reported in residential settings including prisons, adult residential facilities, hospitals, and army barracks (de Valliere et al, 2011; Enright, Mc Mahon, & Washington, 2006; Faoagali & Darcy, 1995; Getaz et al, 2010; Grossberg et al, 2006; Leung et al, 2010; Levy et al, 2003; Longfield, Winn, Gibson, Juchau, & Hoffman, 1990; Noorda & Hoebe, 2004; Valdarchi et al, 2008; Wood & Stevenson, 2004; Zimmerman et al, 2003). In prisons, factors identified as contributing to transmission of infectious diseases include crowding, constant close contact, and movement of inmates into and between prisons (Bick, 2007; “Federal Bureau of Prisons: Management of Varicella Zoster Virus (VZV) Infections: Clinical Practice Guideline,” 2011).…”

Serological Susceptibility to Varicella Among U.S. Immigration and Customs Enforcement Detainees

“…Varicella outbreaks are an ongoing challenge in detention and correctional facilities (Leung et al, 2014; Levy et al, 2003; Public Health England, 2014; Valdarchi et al, 2008), including facilities that house migrants (de Valliere et al, 2011; Gétaz et al, 2010; Haas, Dukhan, Goldstein, Lyandres, & Gdalevich, 2014). Such outbreaks can be disruptive and costly, requiring isolation of cases, identification, assessment of susceptibility and cohorting contacts, staff furloughs, and restriction in movement, gatherings, visitations, and court appearances (Leung et al, 2014).…”