Incidence and mortality rates of varicella among end stage renal disease (ESRD) patients in Singapore General Hospital, a 12-year review

Abstract

BackgroundEnd stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. It has been reported to cause complications and even death among immunocompetent adults.MethodsA retrospective data collection on patients with varicella infection and ESRD in Singapore General Hospital (SGH) from the year 2005 to 2016 was performed. Continuous data and categorical data were summarized as median (range) and count (%) respectively. The association of health care utilization (total length of hospital stay, readmission related to varicella, intensive care unit admission) and mortality with complication due to varicella were tested using chi-square and Mann-Whitney test for categorical and continuous outcomes respectively.ResultsSixty-six patients with ESRD developed varicella during the study period (2005–2016). The case incidence rates for varicella among ESRD ranges from 97 to 267 per 100,000 populations with ESRD yearly. There were 9 deaths (13.6%). Mortality was higher among the ESRD patients with one or more varicella complications compared to patients without complications ((25% vs 7.1%, 95% CI for difference: − 1.1%, 36.9%, p = .063). Likewise, utilisation of intensive or high dependency units were higher among patients with complications compared to those without (20.8% vs 2.4%, 95% CI for difference: 1.6%, 35.3%, p = .012). Length of stay was twice as long in the group with complications compared to patients without (median (IQR) days: 14 (8, 21) vs 7 (5, 14), p = .065), although it did not reach statistical significance.ConclusionsVaricella is associated with high morbidity and significant mortality rate in ESRD patients. Varicella vaccination is recommended for seronegative ESRD patients.

Varicella infections in patients with end stage renal disease: a systematic review

“…Out of the seven studies on the prevalence of seronegative results; four studies were on the prevalence of seronegativity among ESRD patients upon presentation of the varicella disease [ 9 , 13 – 15 ]. The results showed that 42 to 100% of the patients who contracted varicella had no prior immunity to varicella.…”

“…In this review, the prevalence of seronegativity among varicella-infected ESRD adults was found to be significantly alarming at 42 to 100% [ 9 , 13 – 15 ]. Nineteen deaths were reported in 23 studies that reported the varicella infections.…”

“…(From 1985 to 2011). + Ong CY, et al (2018) [ 15 ] Singapore Retrospective data collection Single centre. Review of all cases with varicella among ESRD patients.…”

“… It also guides VZV vaccination. Level 3 Ong CY, et al (2018) [ 15 ] Among 66 cases of varicella in patients with ESRD (dialysis, transplant, conservative), baseline serology available in 19 patients. 42.1% were seronegative.…”

Modern Features of Chicken Pox Course in Adults

“…The Varicella-Zoster virus (VZV) is epitheliotropic and neurotropic, but it is also possible to generalize the process with damage to the internal organs: liver, lungs, and gastrointestinal tract [12][13][14]. The most important risk factors associated with the severity of varicella, generalization of the process and death are age and impaired function of the immune system [15][16][17].…”