Varicella Disease and Transmission in Pediatric House Officers

Oshiro, A; Bégué, Rodolfo E.; Steele, Russell W.

doi:10.1097/00006454-199605000-00016

Cited by 12 publications

(5 citation statements)

References 7 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: 65%

“…3 9 11 13 18 19 Therefore, advice has been given to screen for VZV immunity at the time of initial employment and to vaccinate employees that are not immune 39 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 3…”

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: 65%

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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“…In contrast the attack rate of nonimmune household contacts is 87%, 92 and the attack rate among nonimmune, unimmunized health care workers after workrelated exposure to chickenpox is 85 to 100%. 93,94 Transmission of vaccine virus is rare and has been documented in immunocompetent persons by PCR analysis on only 3 occasions for 15 million doses of varicella vaccine distributed. All 3 cases resulted in mild disease without complications.…”

Section: Other Varicella Vaccination Issuesmentioning

confidence: 99%

Consensus: Varicella Vaccination of Healthy Children

Rentier¹,

Gershon²

2004

The Pediatric Infectious Disease Journal

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The seriousness of varicella-zoster virus (VZV) infection as a public health issue is becoming clearer as country-specific epidemiologic and pharmacoeconomic data become available. In Germany, for example, studies have shown that >5.5% of immunologically healthy individuals develop varicella-related complications such as bacterial superinfections, acute neurologic disorders, pneumonia, bronchitis and otitis media; whereas in Italy, 3.5 to 5% of childhood cases of varicella cause complications such as upper respiratory tract and cutaneous infections. Varicella vaccines are now available. These live attenuated Oka strain vaccines have been shown in extensive studies to be highly immunogenic and well-tolerated in immunocompetent and immunocompromised children, with seroconversion rates ranging from 94 to 100% and 53 to 100%, respectively. These vaccines are also highly effective against clinical disease. These considerations led to a reevaluation of varicella vaccination policies. A routine varicella vaccination program targeting healthy children has already been implemented in the US, and data produced are encouraging and valuable. Similar strategies have not yet been adopted across Europe. The European Working Group on Varicella (EuroVar) was formed in 1998 to address the issues surrounding varicella epidemiology in Europe. After a series of meetings, the EuroVar members prepared a consensus statement recommending routine varicella vaccination for all healthy children between 12 and 18 months and to all susceptible children before their 13th birthday, in addition to catch-up vaccination in older children and adults who have no reliable history of varicella and who are at high risk of transmission and exposure. However, such a policy is recommended only if a very high coverage rate can be achieved. This could be reached with a measles-mumps-rubella-varicella combined vaccine.

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“…In contrast, the attack rate of non-immune household contacts is 87%, 13 and the attack rate among non-immune, unimmunized HCWs following work-related exposure to chickenpox is 85% to 100%. 14,15 Previous studies established that immunized adults are less wellprotected from varicella than children; thus, two doses of VZV vaccine are recommended for adults. 5,16 However, the 18% attack rate after household exposure in this study is lower than the 30% attack rate in adults reported previously by our group 7 and similar to the 20% (53/267) rate reported in vaccinated, healthy children after household exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Varicella-zoster virus (VZV) remains an important nosocomial pathogen. Immunization with VZV vaccine is recommended to protect susceptible healthcare workers (HCWs) from serious disease and to prevent nosocomial spread of VZV 15 However, long-term serological data from immunized HCWs using commercially available serological tests are scant, as are long-term clinical data evaluating protection from VZV disease. 6 " 8 In this study, we sought to determine if vaccinated HCWs were protected from developing chickenpox and to determine the utility of commercial serological assays for measuring antibodies to VZV compared with the gold standard test, fluorescent antibody to membrane antigen (FAMA).…”

mentioning

confidence: 99%