1
|
Kujawski SA, Casey CS, Haas H, Patel A, Diomatari C, Holbrook T, Pawaskar M. Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France. Pediatr Infect Dis J 2024; 43:393-399. [PMID: 38456715 PMCID: PMC10919277 DOI: 10.1097/inf.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. METHODS A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. RESULTS Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. CONCLUSION This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.
Collapse
Affiliation(s)
- Stephanie A. Kujawski
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Hervé Haas
- Department of Pediatrics and Neonatalogy, Centre Hospitalier Princesse Grace, Monaco
| | | | | | | | - Manjiri Pawaskar
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
| |
Collapse
|
2
|
Shah HA, Meiwald A, Perera C, Casabona G, Richmond P, Jamet N. Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis. Infect Dis Ther 2024; 13:79-103. [PMID: 38117427 PMCID: PMC10828225 DOI: 10.1007/s40121-023-00899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Varicella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella symptoms are usually self-limiting; however, different complications with widespread and systemic manifestations can occur. This systematic literature review aims to explore and quantify varicella-associated complication rates. METHODS Two databases (Embase and MEDLINE), congress abstracts, and reference lists of systematic reviews were screened to identify evidence on varicella complications. Complications were identified and grouped into 14 clinically relevant categories. Proportional meta-analyses were conducted using a random-effects model and tests for heterogeneity and publication bias were performed. Subgroup, sensitivity, and meta-regression analyses were also conducted. A total of 78 studies, spanning 30 countries, were included in the meta-analysis. RESULTS Pooled prevalence was highest in severe varicella (22.42%; 95% confidence interval [CI] 10.13-37.77), skin-related complications (20.12%; 95% CI 15.48-25.20), and infection-related complications (10.03%; 95% CI 7.47-12.90). Cardiovascular (0.55%; 95% CI 0.08-1.33), genitourinary (1.17%; 95% CI 0.55-1.99), and musculoskeletal (1.54%; 95% CI 1.06-2.11) complications had the lowest pooled prevalence. The remaining complication categories ranged between 1% and 10%. Subgroup analysis showed that complications were more prevalent in children versus adults and in hospitalized patients versus outpatients. Meta-regression analysis found that no ecological level covariates were accurate predictors for the overall prevalence of varicella-associated complications. There was substantial heterogeneity and publication bias across all meta-analyses. CONCLUSION Results suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease.
Collapse
Affiliation(s)
| | | | | | | | - Peter Richmond
- University of Western Australia School of Medicine, Telethon Kids Institute and Perth Children's Hospital, Nedlands, Australia
| | | |
Collapse
|
3
|
Marlow R, Roderick M, Oliver J, Jordan Z, Amirthalingam G, Lopez-Bernal J, Finn A, Rodrigues F. Epidemiology of hospitalisations due to chickenpox and quality of life lost in community and hospital settings: protocol for a prospective cohort study across two countries. BMJ Open 2023; 13:e068611. [PMID: 36990479 PMCID: PMC10069595 DOI: 10.1136/bmjopen-2022-068611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION While still a ubiquitous disease of childhood, chickenpox has been effectively controlled in many countries through the use of vaccination. Previous health economic assessment of the use of these vaccines in the UK were based on limited quality of life data and only routinely collected epidemiological outcomes. METHODS AND ANALYSIS This two armed study will carry prospective surveillance of hospital admissions and recruit from community settings to measure the acute quality of life loss caused by paediatric chickenpox both in the UK and in Portugal. The quality of life effects on children and their primary and secondary caregivers will be assessed using the EuroQol EQ-5D with the Child Health Utility instrument (CHU-9) in addition for children. Results will be used to derive quality-adjusted life year loss estimates for cases of simple varicella and the secondary complications. ETHICS AND DISSEMINATION We have received National Health Service ethical approval (REC ref: 18/ES/0040) for the inpatient arm, university ethical approval (University of Bristol ref: 60721) for the community arm and 10 sites currently are recruiting in the UK and 14 in Portugal. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN15017985.
Collapse
Affiliation(s)
- Robin Marlow
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Marion Roderick
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jennifer Oliver
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Zoe Jordan
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Jamie Lopez-Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Adam Finn
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Fernanda Rodrigues
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
4
|
Sherman SM, Lingley-Heath N, Lai J, Sim J, Bedford H. Parental acceptance of and preferences for administration of routine varicella vaccination in the UK: A study to inform policy. Vaccine 2023; 41:1438-1446. [PMID: 36796935 DOI: 10.1016/j.vaccine.2023.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To explore acceptability of and preferences for the introduction of varicella vaccination to the UK childhood immunisation schedule. DESIGN We conducted an online cross-sectional survey exploring parental attitudes towards vaccines in general, and varicella vaccine specifically, and their preferences for how the vaccine should be administered. PARTICIPANTS 596 parents (76.3% female, 23.3% male, 0.4% other; mean age 33.4 years) whose youngest child was aged 0-5 years. MAIN OUTCOME MEASURES Willingness to accept the vaccine for their child and preferences for how the vaccine should be administered (in combination with the MMR vaccine [MMRV], on the same day as the MMR vaccine but as a separate injection [MMR + V], on a separate additional visit). RESULTS 74.0% of parents (95% CI 70.2% to 77.5%) were extremely/somewhat likely to accept a varicella vaccine for their child if one became available, 18.3% (95% CI 15.3% to 21.8%) were extremely/somewhat unlikely to accept it and 7.7% (95% CI 5.7% to 10.2%) were neither likely nor unlikely. Reasons provided by parents likely to accept the vaccine included protection from complications of chickenpox, trust in the vaccine/healthcare professionals, and wanting their child to avoid their personal experience of chickenpox. Reasons provided by parents who were unlikely included chickenpox not being a serious illness, concern about side effects, and believing it is preferable to catch chickenpox as a child rather than as an adult. A combined MMRV vaccination or additional visit to the surgery were preferred over an additional injection at the same visit. CONCLUSIONS Most parents would accept a varicella vaccination. These findings highlight parents' preferences for varicella vaccine administration, information needed to inform vaccine policy and practice and development of a communication strategy.
Collapse
Affiliation(s)
| | | | - Jasmine Lai
- Division of Biosciences, University College London, London WC1E 6DE, UK
| | - Julius Sim
- School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Helen Bedford
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.
| |
Collapse
|
5
|
Cuerden C, Gower C, Brown K, Heath PT, Andrews N, Amirthalingam G, Bate J. PEPtalk 3: oral aciclovir is equivalent to varicella zoster immunoglobulin as postexposure prophylaxis against chickenpox in children with cancer - results of a multicentre UK evaluation. Arch Dis Child 2022; 107:archdischild-2022-324396. [PMID: 35803693 DOI: 10.1136/archdischild-2022-324396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the occurrence of chickenpox in children with cancer who received varicella immunoglobulin (VZIG) or aciclovir as postexposure prophylaxis (PEP). DESIGN Prospective multicentre service evaluation of children with cancer who received either VZIG or aciclovir as PEP following significant exposure to varicella zoster virus (VZV) over a 24-month period from May 2018. SETTING Data were collected from 9 UK Paediatric Oncology Primary Treatment Centres. PATIENTS Children under 16 years old with a diagnosis of cancer and/or previous haematopoietic stem cell transplant who were VZV seronegative at exposure and/or diagnosis and received PEP following significant VZV exposure. MAIN OUTCOME MEASURES The primary outcome was the incidence of breakthrough varicella within 6 weeks of VZV exposure and treatment with PEP. RESULTS A total of 105 eligible patients were registered with a median age of 4.9 years (range 1.1-10.5 years). Underlying diagnoses were acute leukaemia (64), solid tumours (22), Langerhans cell histiocytosis (9), central nervous system (CNS) tumours (8) and other (2). Aciclovir was received by 86 patients (81.9%), 18 received VZIG (17.1%) and 1 valaciclovir (0.9%). There were seven reported break-through VZV infections in 103 patients at follow-up (7/103, 6.8%). Clinical VZV developed in 5/84 of the aciclovir group (6.0%, 95% CI 2.0 to 13.3) and 2/18 of VZIG group (11.1%, 95% CI 1.4 to 34.7). All breakthrough infections were either mild (5/7) or moderate (2/7) in severity. CONCLUSION Aciclovir is a safe and effective alternative to VZIG as VZV PEP in children with cancer and should be considered as standard of care.
Collapse
Affiliation(s)
- Claire Cuerden
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Charlotte Gower
- Department of Immunisation and Counter Measures, Public Health England Colindale, London, UK
| | - Kevin Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Paul T Heath
- Vaccine Institute, St George's, University of London, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Unit, UK Health Security Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Jessica Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| |
Collapse
|
6
|
Laya BF, Concepcion NDP, Garcia-Peña P, Naidoo J, Kritsaneepaiboon S, Lee EY. Pediatric Lower Respiratory Tract Infections: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:15-40. [PMID: 34836562 DOI: 10.1016/j.rcl.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lower respiratory tract infection (LRTI) remains a major cause of morbidity and mortality in children. Various organisms cause LRTI, including viruses, bacteria, fungi, and parasites, among others. Infections caused by 2 or more organisms also occur, sometimes enhancing the severity of the infection. Medical imaging helps confirm a diagnosis but also plays a role in the evaluation of acute and chronic sequelae. Medical imaging tests help evaluate underlying pathology in pediatric patients with recurrent or long-standing symptoms as well as the immunocompromised.
Collapse
Affiliation(s)
- Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines.
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center-Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112 Philippines
| | - Pilar Garcia-Peña
- Autonomous University of Barcelona (AUB), University Hospital Materno-Infantil Vall d'Hebron, Pso. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jaishree Naidoo
- Paeds Diagnostic Imaging and Envisionit Deep AI, 2nd Floor, One-on Jameson Building, 1 Jameson Avenue, Melrose Estate, Johannesburg, 2196, South Africa
| | - Supika Kritsaneepaiboon
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Road, Hat Yai, 90110, Thailand
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| |
Collapse
|
7
|
Zhang H, Qiu S, Zhong C, Shi L, Li J, Zhang T, Zhu X, Wang M. Risk Factors for Poor Prognosis of Severe Infection in Children With Idiopathic Nephrotic Syndrome: A Double-Center, Retrospective Study. Front Pediatr 2021; 9:656215. [PMID: 34336733 PMCID: PMC8316585 DOI: 10.3389/fped.2021.656215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Infection is the most common complication of Idiopathic Nephrotic Syndrome (INS) and the main cause of INS recurrence, severe infection and even leading to mortality. The purpose of this study was to investigate the risk factors of severe infection in INS children and the clinical parameters influencing prognosis. Methods: Totally 147 children with INS and concomitant infections were enrolled and classified into the severe infection group (SIG) and Non-severe infection group (Non-SIG). The clinical characteristics and auxiliary examination results were compared between the two groups, and the early-warning parameters for severe infection and risk factors for poor prognosis were evaluated. Results: There were 49 patients in the SIG, 98 patients in the Non-SIG. In the SIG, the most common severe infections disease included severe pneumonia (63.6%), severe sepsis (30.6%), septic shock (4.1%). In SIG, Gram-positive bacteria (GPB) were more common, as was respiratory syncytial virus (RSV), and the three most common strains were Pseudomonas aeruginosa, Staphylococcus aureus (SA) and Staphylococcus epidermidis. There were more steroid-resistant nephrotic syndrome and combination of steroids and immunosuppressants in SIG, compared with the Non-SIG (P = 0.000). Patients in the SIG has lower complement 3 (C3, ≤ 0.55 g/L,) and absolute lymphocyte count (ALC, ≤ 1.5 × 109/L) (P = 0.004). Logistic regression analysis revealed that the independent risk factors for severe infections were the combined use of immunosuppressants [95% confidence interval (CI):1.569-463.541, P = 0.023], steroid resistance (95% CI: 4.845-2,071.880, P = 0.003), C-reactive protein (CRP) ≥8 mg/L (95% CI: 43.581-959, 935.668, P = 0.001), and infections caused by GPB (95% CI: 27.126-2,118, 452.938, P = 0.002), influenza (95% CI: 2.494-1, 932.221, P = 0.012) and RSV (95% CI: 5.011-24 963.819, P = 0.007). The patients in the SIG were classified into the survival group (N = 39) and the mortality group (N = 5). Logistic regression analysis showed that white blood cell count (WBC) >15 × 109/L (95% CI: 1.046-2.844, P = 0.033) was an independent risk factor of poor prognosis for these patients. Conclusions: Resistance to steroids, combined with steroids and IS agents, and GPB infections (especially SA) are high-risk factors for severe infection in children with INS. We should monitor CRP ≥ 8 mg/L, C3 ≤ 0.55 g/L and ALC ≤ 1.5 × 109/L to avoid developing severe infection. Accompanied by an increase in ANC, WBC significantly increased, suggesting a fatal infection.
Collapse
Affiliation(s)
- Hengci Zhang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Western Pediatric Development Union, Chongqing, China
| | - Shiyuan Qiu
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Pediatric Internal Medicine Department, Chongqing You You Baobei Women's and Children's Hospital, Chongqing, China
| | - Cheng Zhong
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Western Pediatric Development Union, Chongqing, China
| | - Lin Shi
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Western Pediatric Development Union, Chongqing, China
| | - Jiacheng Li
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Western Pediatric Development Union, Chongqing, China
| | - Tao Zhang
- Western Pediatric Development Union, Chongqing, China.,Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaoping Zhu
- Western Pediatric Development Union, Chongqing, China.,Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mo Wang
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Western Pediatric Development Union, Chongqing, China
| |
Collapse
|
8
|
Diniz LMO, Maia MMM, Oliveira YVD, Mourão MSF, Couto AV, Mota VC, Versiani CM, Silveira PODC, Romanelli RMC. Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment. Hosp Pediatr 2019; 8:419-425. [PMID: 29921616 DOI: 10.1542/hpeds.2017-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Varicella is a disease with potentially severe complications. We aimed to investigate characteristics of hospitalized children with varicella in Brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. METHODS A prospective cohort study was conducted from May 2011 to April 2014. Patients up to 13 years of age with varicella diagnosis were included. Information was collected through interview and review of medical records. Logistic regression analysis was performed. RESULTS A total of 669 patients were admitted. The median age of subjects was 2.7 years (range 0-14 years) with a predominance of boys (56.6%). The main causes of hospitalization were bacterial complications (77.7%), viral complications (11.4%), and at-risk patients (10.9%). Main bacterial complications were skin infection and pneumonia. Main viral complications were herpes zoster, cerebellitis, and encephalitis. Most at-risk patients used corticosteroids or had a diagnosis of leukemia. At-risk patients were hospitalized earlier (P < .01) and remained hospitalized for longer periods (P = .03). A total of 44 patients (6.6%) were admitted to the ICU, and 5 (0.8%) died of septic shock. Thrombocytopenia was associated with more severe illness in patients with bacterial infections (P = .001). The long-time interval between onset of infection and admission was associated with the need for intensive care in all groups (P = .007). CONCLUSIONS Secondary bacterial infection is the main cause of hospitalization, and thrombocytopenia in these patients leads to worse outcomes. Difficulties of access to the health system and delay in medical care are determining factors of greater severity in this population.
Collapse
Affiliation(s)
| | | | | | | | - Amanda Vieira Couto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vânia Carneiro Mota
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | |
Collapse
|
9
|
Abstract
BackgroundStrategies to control varicella vary across Europe. Evidence from established programmes has prompted the United Kingdom to re-evaluate the need for universal vaccination. The burden of complicated varicella is a key parameter in the cost-effectiveness analysis.AimOur objective was to estimate the burden of complicated varicella in England.MethodsThis electronic health record surveillance study used data from all NHS hospitals in England to identify varicella admissions between 2004 and 2017. The incidence of pre-defined complications of varicella was estimated using ICD-10 codes. Inpatient costs were calculated based on the payment rules for providers of NHS services.ResultsThere were 61,024 admissions with varicella between 2004 and 2017 and 38.1% had a recognised varicella complication. Incidence of hospitalisation increased by 25% and the proportion with complicated varicella by 24% from 2004/05 to 2016/17. The most common complications were bacterial skin infections (11.25%), pneumonia (4.82%), febrile convulsions (3.39%) and encephalitis (2.44%). Complication rates were higher in older age groups and the type of complications more severe. Length of stay for complicated varicella was 3.1 times longer than for uncomplicated varicella and inpatient costs were 72% greater.ConclusionComplicated varicella has a substantial health and economic burden. These data together with data on impact on quality of life are important in informing the cost-effectiveness analysis of universal varicella vaccination.
Collapse
Affiliation(s)
- James Lopez Bernal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, Colindale, United Kingdom
| | - Peter Hobbelen
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, Colindale, United Kingdom,Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, the Netherlands
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, Colindale, United Kingdom
| |
Collapse
|
10
|
Gabutti G, Bolognesi N, Sandri F, Florescu C, Stefanati A. Varicella zoster virus vaccines: an update. Immunotargets Ther 2019; 8:15-28. [PMID: 31497569 PMCID: PMC6689529 DOI: 10.2147/itt.s176383] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/06/2019] [Indexed: 12/18/2022] Open
Abstract
Varicella zoster virus (VZV) is the etiological agent of varicella, a highly infectious, self-limiting disease with serious complications. The decline in cell-mediated immunity (CMI) that occurs with aging or immunodepression causes a reactivation of the latent VZV as herpes zoster (HZ). Prevention of VZV through varicella vaccination strategies allows to avoid the primary infection in newborns and susceptible subjects. Available monovalent and combined VZV vaccines are effective, safe and generally well tolerated. Universal varicella vaccination has significantly impacted on incidence, complications and deaths related to this disease. Prevention of HZ through vaccination is a priority to avoid the significant burden of its incidence and complications. Currently two HZ vaccines are available. The recombinant zoster vaccine (RZV), approved by the FDA in 2017 and Zoster Vaccine Live (ZVL) licensed in the United States by the FDA in 2006. The advisory committee on immunization practices (ACIP) preferentially recommends RZV. ZVL remains an option for prevention of HZ in immunocompetent adults aged ≥60 years, although the CMI tends to wane a few years after vaccination.
Collapse
Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Niccolò Bolognesi
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Caterina Florescu
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| |
Collapse
|
11
|
Guru V, Radhakrishnan V, Sagar T. Varicella vaccination in children with acute lymphoblastic leukemia: Experience from a pediatric cancer centre in India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2019. [DOI: 10.1016/j.phoj.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
12
|
O'Neill J, Newall F, Antolovich G, Lima S, Danchin MH. Adolescent immunisation in young people with disabilities in Australia. Med J Aust 2019; 211:199-200.e1. [PMID: 31342525 DOI: 10.5694/mja2.50293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jenny O'Neill
- University of Melbourne, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC
| | | | - Giuliana Antolovich
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | - Sally Lima
- University of Melbourne, Melbourne, VIC.,Bendigo Health, Bendigo, VIC
| | - Margie H Danchin
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| |
Collapse
|
13
|
O’Neill J, Newall F, Antolovich G, Lima S, Danchin M. Vaccination in people with disability: a review. Hum Vaccin Immunother 2019; 16:7-15. [PMID: 31287773 PMCID: PMC7012164 DOI: 10.1080/21645515.2019.1640556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022] Open
Abstract
People with disabilities are vulnerable to complications from vaccine-preventable diseases, and every effort should be made to ensure equitable access to immunization for this population. This paper aims to summarize the research on immunizations in people with disabilities, in order to ensure a comprehensive understanding of knowledge in this area and direct further research. The literature is weighted towards coverage data that is difficult to synthesize because of the different definitions of disability, and the variety of settings, vaccinations and age groups across the studies. In-depth qualitative data and data from a variety of health-care providers and people with disability is notably lacking. This is vital to redress in order to develop effective immunization interventions in this population.
Collapse
Affiliation(s)
- Jenny O’Neill
- Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Fiona Newall
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Haematology, The Royal Children’s Hospital, Melbourne, Australia
- Nursing Research, The Royal Children’s Hospital, Melbourne, Australia
- Clinical Haematology Research Group, Murdoch Children’s Research Institute, Australia
- The Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Giuliana Antolovich
- Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia
- Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sally Lima
- Nursing Research, The Royal Children’s Hospital, Melbourne, Australia
- The Department of Nursing, The University of Melbourne, Melbourne, Australia
- Clinical Learning and Development Unit, Bendigo Health, Victoria, Australia
| | - Margie Danchin
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of General Medicine, The Royal Children’s Hospital, Melbourne, Australia
- Vaccine and Immunisation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- The School of Population Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
14
|
Abstract
Varicella is a common vaccine-preventable disease that usually presents as a mild disorder but can lead to severe complications. Before the implementation of universal varicella vaccination (UVV) in some European countries, the burden of varicella disease was broadly similar across the region. Despite this, countries adopted heterogeneous varicella vaccination strategies. UVV is currently recommended in 12 European countries. Known barriers to UVV implementation in Europe include (1) a perceived low disease burden and low public health priority; (2) cost-effectiveness and funding availability; (3) concerns related to a shift in varicella disease and incidence of herpes zoster and (4) safety concerns related to measles, mumps, rubella and varicella-associated febrile seizures after the first dose. Countries that implemented UVV experienced decreases in varicella incidence, hospitalizations and complications, showing overall beneficial impact. Alternative strategies targeting susceptible individuals at higher risk of complications have been less effective. This article discusses ways to overcome the barriers to move varicella forward as a truly vaccine preventable disease.
Collapse
|
15
|
Bate J, Baker S, Breuer J, Chisholm JC, Gray J, Hambleton S, Houlton A, Jit M, Lowis S, Makin G, O'Sullivan C, Patel SR, Phillips R, Ransinghe N, Ramsay ME, Skinner R, Wheatley K, Heath PT. PEPtalk2: results of a pilot randomised controlled trial to compare VZIG and aciclovir as postexposure prophylaxis (PEP) against chickenpox in children with cancer. Arch Dis Child 2019; 104:25-29. [PMID: 29730641 DOI: 10.1136/archdischild-2017-314212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/16/2018] [Accepted: 04/17/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the likely rate of patient randomisation and to facilitate sample size calculation for a full-scale phase III trial of varicella zoster immunoglobulin (VZIG) and aciclovir as postexposure prophylaxis against chickenpox in children with cancer. DESIGN Multicentre pilot randomised controlled trial of VZIG and oral aciclovir. SETTING England, UK. PATIENTS Children under 16 years of age with a diagnosis of cancer: currently or within 6 months of receiving cancer treatment and with negative varicella zoster virus (VZV) serostatus at diagnosis or within the last 3 months. INTERVENTIONS Study participants who have a significant VZV exposure were randomised to receive PEP in the form of VZIG or aciclovir after the exposure. MAIN OUTCOME MEASURES Number of patients registered and randomised within 12 months of the trial opening to recruitment and incidence of breakthrough varicella. RESULTS The study opened in six sites over a 13-month period. 482 patients were screened for eligibility, 32 patients were registered and 3 patients were randomised following VZV exposure. All three were randomised to receive aciclovir and there were no cases of breakthrough varicella. CONCLUSIONS Given the limited recruitment to the PEPtalk2 pilot, it is unlikely that the necessary sample size would be achievable using this strategy in a full-scale trial. The study identified factors that could be used to modify the design of a definitive trial but other options for defining the best means to protect such children against VZV should be explored. TRIAL REGISTRATION NUMBER ISRCTN48257441, EudraCT number: 2013-001332-22, sponsor: University of Birmingham.
Collapse
Affiliation(s)
- Jessica Bate
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Baker
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Julia C Chisholm
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aimee Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Lowis
- School of Clinical Sciences, University of Bristol, London, UK
| | - Guy Makin
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
| | - Soonie R Patel
- Department of Paediatrics, Croydon Health Services NHS Trust, London, UK
| | | | - Neil Ransinghe
- Parent representative, Paediatric Oncology Reference Team, UK
| | | | - Roderick Skinner
- Great North Children's Hospital, Department of Paediatric and Adolescent Haematology/Oncology, Newcastle upon Tyne, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
| |
Collapse
|
16
|
The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia. Vaccine 2018; 37:272-279. [PMID: 30522907 DOI: 10.1016/j.vaccine.2018.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND As part of the National Immunisation Program (NIP) students in Australia receive adolescent immunisations through the School Immunisation Program at 12 to 13 years. For children with disabilities attending specialist schools, no vaccine uptake data is collected at this time point. We aimed to determine uptake of diphtheria-tetanus-pertussis (dTpa) and Human Papillomavirus (HPV) immunisations amongst young people with disabilities in specialist schools in Victoria. METHODS A prospective cohort study was conducted in Victoria, Australia. Data was collected on immunisation days in the 2017 school year from specialist schools in Victoria. The school immunisation coordinator entered data online for eligible students for receipt of dTpa and HPV on each school immunisation day. Demographic data, motor and intellectual function of students and reasons for non-receipt of dTpa and HPV vaccine were recorded. Data were analysed using descriptive statistics. RESULTS Of 73 eligible specialist schools in Victoria, 28 (38%) participated. dTpa was received by 63% (237/374) of participating students and HPV dose 1 (HPV1) was received by 66% (76/114) females and 67% (174/260) male students respectively. Three doses of HPV were received by only 41% (100/241) of students. The main reasons for missed immunisation were absence from school, lack of consent and inability to immunise due to the student's behaviour and/or anxiety. CONCLUSION This is the first study in Australia to report that uptake of adolescent immunisations in specialist schools for young people with a disability is significantly lower than in mainstream settings. Comparative data during the same time period for students in mainstream schools demonstrated higher uptake, at 89% for dTpa and 75% for three doses of HPV. These data highlight the inequity of receipt of school-based immunisations for this group of adolescents, the barriers to which could be more thoroughly explored through qualitative inquiry from a socio-ecological perspective.
Collapse
|
17
|
Scrutton Alvarado N, Stevenson TJ. Appetitive information seeking behaviour reveals robust daily rhythmicity for Internet-based food-related keyword searches. ROYAL SOCIETY OPEN SCIENCE 2018; 5:172080. [PMID: 30109051 PMCID: PMC6083665 DOI: 10.1098/rsos.172080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
There has been an exponential growth of information seeking behaviour (ISB) via Internet-based programs over the past decade. The availability of software that record ISB temporal patterns has provided a valuable opportunity to examine biological rhythms in human behaviour. Internet search repositories, such as Google Trends, permit the analyses of large datasets that can be used to track ISB on a domestic and international scale. We examined daily and seasonal Google Trends search patterns for keywords related to food intake, using the most relevant search terms for the USA, UK, Canada, India and Australia. Daily and seasonal ISB rhythmicity were analysed using CircWave v. 1.4. Daily ISB data revealed a robust and significant sine waveform for general terms (e.g. 'pizza delivery') and country-specific search terms (e.g. 'just eat'). The pattern revealed clear evening double-peaks, occurring every day at 19.00 and 02.00. The patterns were consistent across search terms, days of the week and geographical locations, suggesting a common ISB rhythm that is not necessarily culture-dependent. Then, we conducted Cosinor v. 2.4 analyses to examine the daily amplitudes in ISB. The results indicated a non-significant linear increased from Monday to Sunday. Seasonal data did not show consistent significant ISB patterns. It is likely that two different human populations are responsible for the daily 'early' and 'late' evening ISB peaks. We propose that the major factor that contributes to the bimodal evening peak is age-dependent (e.g. adolescent, early adulthood versus midlife and mature adulthood) and a minor role for human chronotypes (e.g. late versus early). Overall, we present novel human appetitive behaviour for information seeking of food resources and propose that Internet-based search patterns reflect a biological rhythm of motivation for energy balance.
Collapse
|
18
|
Shady I. Seroprevalence of antibodies against varicella zoster virus and rubella virus among newly recruited expatriate healthcare workers: a cross-sectional study. BMJ Open 2018; 8:e019339. [PMID: 29567844 PMCID: PMC5875672 DOI: 10.1136/bmjopen-2017-019339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the state of immunity to varicella zoster virus (VZV) and rubella virus (RV) among newly recruited healthcare workers (HCWs) in Kuwait before they begin work, and to determine whether there are differences in the prevalence of seronegativity according to nationality, gender, age group and occupation group. SETTING This cross-sectional study involved analysis of blood samples from workers newly recruited to the Kuwaiti healthcare system. PARTICIPANTS All new non- national HCWs recruited during the study period (n=1540). INTERVENTION Enzyme-linked immunoassays for VZV-specific and RV-specific IgG were performed. RESULTS Among HCWs, 81.9% and 93.5% were immune to VZV and RV, respectively. Male seronegativity was higher than that of females for both viruses. Regarding VZV, the majority of seronegative individuals were Indians (23.5%), followed by Somalis (12.5), Filipinos (6.5) and Egyptians (5.4%); the between-group differences were significant for all groups. The age groups 20-30 and 30-40 years were most likely to be seronegative, with prevalences of 18.2% and 18.9%, respectively. VZV seronegativity was most common among nurses (21.1%) and least common among physicians (9.2%), and the difference was significant. In addition, RV seronegativity was most frequent among Somalis (12.5%) and lowest among Indians (5.3%); other nationalities (Egyptian, Filipino and others) ranged between 9.1% and 9.6%. Seronegative individuals were most frequently in the younger age group (<20 years old) (17.5%), followed by the >40 years old group (10.4%). RV seronegativity was highest among nurses (6.9%) and lowest among physicians (5.2%). CONCLUSION The prevalence of seronegativity is highest among Indians for VZV and Somalis for RV, and HCWs aged 20-40 years for VZV and <20 years for RV. For both viruses, the seronegativity rate was highest for male HCWs, and for nurses compared with other HCWs, with physicians having the lowest prevalence of both viruses.
Collapse
Affiliation(s)
- Ibrahim Shady
- Community Medicine and Public Health Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
19
|
Skin and Soft Tissue Infection as a Complication of Varicella Infection Ended up in Using Intravenous Immunoglobulin Instead of Surgical Debridement: A Case Report and Short Review of Literature. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.66108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
20
|
Abstract
OBJECTIVE The purpose of this study was to evaluate the epidemiology and outcome of hospitalized children with a diagnosis of necrotizing soft-tissue infections (NSTIs). METHODS Demographic and outcome data of children 1 month to 18 years of age with a diagnosis of NSTI (International Classification of Diseases, 9th revision diagnosis codes 728.86 and 729.4) were extracted from the Kids' Inpatient Database 2009 and 2012. Univariate and multivariate analyses were done to determine the factors affecting mortality. The sample data were weighted to get national estimates. RESULTS A total of 446 children with NSTI (prevalence of 1.12/10,000 discharges) were included. Males comprised 54%. The median age was 10 (interquartile range 4-16) years. The mortality rate was 6%. In addition, 29.3% of children with NSTI were discharged to either skilled nursing facilities or to home health care compared with 4.5% of children without NSTI (odds ratio 8.9; 95% confidence interval 7.3-10.9; P < 0001). A bacterial infection was reported in 72.1% of children. An infection with Staphylococcus, Streptococcus, Gram-negative bacteria, anaerobic bacteria, methicillin-resistant Staphylococcus areus and polymicrobia was present in 34.5%, 21.8%, 8.6%, 3.9%, 18.7% and 13.6% of cases, respectively. A compartment syndrome, severe sepsis/septic shock and toxic shock were documented in 4.4%, 22.2% and 3.2% of the cases, respectively. Severe sepsis/septic shock, the need for mechanical ventilation and Hispanic race were associated with increased mortality, whereas skin/muscle surgery was associated with lower mortality. CONCLUSIONS NSTI in children is associated with high morbidity. The mortality is higher with the presence of severe sepsis/septic shock and among Hispanics and lower with surgical intervention.
Collapse
|
21
|
Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy. Ital J Pediatr 2017; 43:54. [PMID: 28606112 PMCID: PMC5469162 DOI: 10.1186/s13052-017-0370-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background Acute cerebellitis (AC) and acute cerebellar ataxia (ACA) are the principal causes of acute cerebellar dysfunction in childhood. Nevertheless. there is no accepted consensus regarding the best management of children with AC/ACA: the aim of the study is both to assess clinical, neuroimaging and electrophysiologic features of children with AC/ACA and to evaluate the correlation between clinical parameters, therapy and outcome. Methods A multicentric retrospective study was conducted on children ≤ 18 years old admitted to 12 Italian paediatric hospitals for AC/ACA from 01/01/2003 to 31/12/2013. A score based on both cerebellar and extracerebellar signs/symptoms was computed for each patient. One point was given for each sign/symptom reported. Severity was divided in three classes: low, moderate, severe. Results A total of 124 children were included in the study. Of these, 118 children received a final diagnosis of ACA and 6 of AC. The most characteristic finding of AC/ACA was a broad-based gait disturbance. Other common symptoms included balance disturbances, slurred speech, vomiting, headache and fever. Neurological sequelae were reported in 6 cases (5%) There was no correlation among symptoms, cerebrospinal fluid findings, clinical outcome. There was no correlation between clinical manifestations and clinical score on admission and length of hospital stay, sex, age and EEG findings with sequelae (P > 0.05). Children with pathological magnetic resonance imaging (MRI) or computed tomography (CT) had a higher probability of having clinical sequelae. Treatment was decided independently case by case. Patients with a higher clinical score on admission had a higher probability of receiving intravenous steroids. Conclusions We confirmed the literature data about the benign course of AC/ACA in most cases but we also highlighted a considerable rate of patients with neurological sequelae (5%). Pathological MRI or CT findings at admission correlate to neurological sequelae. These findings suggest the indication to perform an instrumental evaluation in all patients with AC/ACA at admission to identify those at higher risk of neurological outcome. These patients may benefit from a more aggressive therapeutic strategy and should have a closer follow-up. Randomized controlled trials are needed to confirm these observations. The ultimate goal of these studies could be to develop a standardized protocol on AC/ACA. The MRI/CT data, associated with the clinical manifestations, may allow us to define the class risk of patients for a neurological outcome.
Collapse
|
22
|
Riera-Montes M, Bollaerts K, Heininger U, Hens N, Gabutti G, Gil A, Nozad B, Mirinaviciute G, Flem E, Souverain A, Verstraeten T, Hartwig S. Estimation of the burden of varicella in Europe before the introduction of universal childhood immunization. BMC Infect Dis 2017; 17:353. [PMID: 28521810 PMCID: PMC5437534 DOI: 10.1186/s12879-017-2445-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Varicella is generally considered a mild disease. Disease burden is not well known and country-level estimation is challenging. As varicella disease is not notifiable, notification criteria and rates vary between countries. In general, existing surveillance systems do not capture cases that do not seek medical care, and most are affected by underreporting and underascertainment. We aimed to estimate the overall varicella disease burden in Europe to provide critical information to support decision-making regarding varicella vaccination. METHODS We conducted a systematic literature review to identify all available epidemiological data on varicella IgG antibody seroprevalence, primary care and hospitalisation incidence, and mortality. We then developed methods to estimate age-specific varicella incidence and annual number of cases by different levels of severity (cases in the community, health care seekers in primary care and hospitals, and deaths) for all countries belonging to the European Medicines Agency (EMA) region and Switzerland. RESULTS In the absence of universal varicella immunization, the burden of varicella would be substantial with a total of 5.5 million (95% CI: 4.7-6.4) varicella cases occurring annually across Europe. Variation exists between countries but overall the majority of cases (3 million; 95% CI: 2.7-3.3) would occur in children <5 years. Annually, 3-3.9 million patients would consult a primary care physician, 18,200-23,500 patients would be hospitalised, and 80 varicella-related deaths would occur (95% CI: 19-822). CONCLUSIONS Varicella disease burden is substantial. Most cases occur in children <5 years old but adults require hospitalisation more often and are at higher risk of death. This information should be considered when planning and evaluating varicella control strategies. A better understanding of the driving factors of country-specific differences in varicella transmission and health care utilization is needed. Improving and standardizing varicella surveillance in Europe, as initiated by the European Centre for Disease Prevention and Control (ECDC), is important to improve data quality to facilitate inter-country comparison.
Collapse
Affiliation(s)
- Margarita Riera-Montes
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium.
| | - Kaatje Bollaerts
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium
| | - Ulrich Heininger
- Division of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, CH-4056, Basel, Switzerland
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Antwerp, Belgium.,Centre for Health Economics Research and Modelling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Angel Gil
- Universidad Rey Juan Carlos, Madrid, Spain
| | - Bayad Nozad
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Grazina Mirinaviciute
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Elmira Flem
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Thomas Verstraeten
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium
| | - Susanne Hartwig
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, 69007, Lyon, France
| |
Collapse
|
23
|
Chen KYH, Cheung M, Burgner DP, Curtis N. Toxic shock syndrome in Australian children. Arch Dis Child 2016; 101:736-40. [PMID: 27117838 DOI: 10.1136/archdischild-2015-310121] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/30/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are limited data describing the epidemiology, management and outcomes of children with toxic shock syndrome (TSS), a potentially life-threatening illness. Here, we describe the incidence, clinical features, treatment and outcome of children with staphylococcal and streptococcal TSS in Victoria, Australia. METHODS Retrospective chart review of children admitted between 2003 and 2014 to two tertiary paediatric referral centres who fulfilled the Centers for Disease Control and Prevention case definition of TSS. RESULTS There were 62 cases over the 11-year period; 43 staphylococcal TSS and 19 streptococcal TSS. The majority (46 (74%)) of cases were admitted to an intensive care unit and 44 (71%) required inotropic support. Compared with those with staphylococcal TSS, patients with streptococcal TSS were younger, more unwell and more likely to have residual morbidity. Adjunctive therapy with intravenous immunoglobulin or clindamycin was used in 58 (94%) of cases and fresh frozen plasma was used in 15 (24%). Seven patients received extracorporeal membrane oxygenation. All patients survived. CONCLUSIONS This study highlights the importance of early recognition of TSS and supports rapid tertiary referral and intensive care management, which includes the use of adjunctive therapy with intravenous immunoglobulin and clindamycin.
Collapse
Affiliation(s)
- Katherine Y H Chen
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Department of Cardiology, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Department of Paediatrics, Monash University, Clayton, Australia
| | - Nigel Curtis
- Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
| |
Collapse
|
24
|
Bozzola E, Bozzola M, Krzysztofiak A, Tozzi AE, El Hachem M, Villani A. Varicella Skin Complications in Childhood: A Case Series and a Systematic Review of the Literature. Int J Mol Sci 2016; 17:ijms17050688. [PMID: 27164095 PMCID: PMC4881514 DOI: 10.3390/ijms17050688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 11/03/2022] Open
Abstract
Even if varicella is generally considered a harmless disease in childhood, severe complications may occur. We examined varicella skin complications (VSCs) in hospitalized immunologically healthy children, over a nine-year period. We also systematically analyzed previous reports to calculate the rate of VSCs in the literature. VSCs occurred in 16.4% of children hospitalized for varicella. This figure is in accordance with the literature, as the range of VSCs was 2.6%-41.2%. Skin complications may represent determinants of hospitalization and of other indirect costs in young children.
Collapse
Affiliation(s)
- Elena Bozzola
- Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
| | - Andrzej Krzysztofiak
- Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alberto Eugenio Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - May El Hachem
- Department of Pediatrics, Dermatologocical Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alberto Villani
- Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| |
Collapse
|
25
|
Complications of Varicella in Unvaccinated Children From Romania, 2002-2013: A Retrospective Study. Pediatr Infect Dis J 2016; 35:211-2. [PMID: 26544989 DOI: 10.1097/inf.0000000000000969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The epidemiologic and clinical pattern of varicella-related hospitalizations recorded during 2002-2013 in Romania showed the highest hospitalization rate in the 0-1 year age group. Younger age and diagnosis after 2007 were independent predictors of varicella-related complications, recorded in half of the hospitalized cases.
Collapse
|
26
|
Amirthalingam G, Ramsay M. Should the UK introduce a universal childhood varicella vaccination programme? Arch Dis Child 2016; 101:2-3. [PMID: 26342095 DOI: 10.1136/archdischild-2015-308730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK Correspondence to Dr Gayatri Amirthalingam, Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| | - Mary Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK Correspondence to Dr Gayatri Amirthalingam, Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| |
Collapse
|
27
|
Blumental S, Sabbe M, Lepage P. Varicella paediatric hospitalisations in Belgium: a 1-year national survey. Arch Dis Child 2016; 101:16-22. [PMID: 26130380 PMCID: PMC4717424 DOI: 10.1136/archdischild-2015-308283] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/26/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Varicella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period. METHODS Data on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash. RESULTS Participation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/10(5) person-years, with the highest impact among those 0-4 years old (global incidence and odds of hospitalisation: 79/10(5) person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/10(5) person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/10(6) and fatality ratio 0.2% among our cohort. CONCLUSIONS Varicella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium.
Collapse
Affiliation(s)
- Sophie Blumental
- Paediatric Infectious Disease Unit, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium
| | - Martine Sabbe
- Unit of Epidemiology and Infectious Diseases, Scientific Institute of Public Health (SIPH), Brussels, Belgium
| | - Philippe Lepage
- Paediatric Infectious Disease Unit, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles, Brussels, Belgium
| | | |
Collapse
|
28
|
Wen SCH, Best E, Walls T, Dickson N, McCay H, Wilson E. Prospective surveillance of hospitalisations associated with varicella in New Zealand children. J Paediatr Child Health 2015; 51:1078-83. [PMID: 26041441 DOI: 10.1111/jpc.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
Abstract
AIM Varicella is a vaccine-preventable disease not notifiable in New Zealand (NZ), and varicella vaccine is not funded in the National Immunisation Schedule (NIS). Hospitalisations can occur because of bacterial secondary infection and other complications, which can result in long-term sequelae. Varicella may not be acknowledged in discharge coding when complications occur weeks after infection. Using the New Zealand Paediatric Surveillance Unit (NZPSU), the aim of this study was to document the hospitalisation burden of this disease. METHODS Cases (0-14 years) of varicella and post-varicella complications requiring hospitalisation, including stroke syndromes where varicella occurred in the preceding 6 months, were notified to NZPSU between 1 November 2011 and 31 October 2013. Herpes zoster cases were excluded. Questionnaires were used to capture demographics, clinical features, management and short-term outcomes. RESULTS One hundred seventy-eight notifications were received and 144 were confirmed cases. Overall incidence was 8.3/100,000 children per year. Fifty-two percent were women with a median age of 2.4 years. Māori and Pacific Island (PI) children accounted for 74% of hospitalisations, with incidence rate ratios compared with European children of 2.8 and 3.9, respectively (P < 0.01). Complications included: infection (75%), respiratory (11%), neurological (11%), electrolyte disturbance (6%) and haemorrhagic varicella (4%). Nine percent were immunocompromised. Median duration of hospital admission was 4 days with 9% requiring intensive care admission. There were no reported deaths; however, 19% had ongoing problems at discharge. CONCLUSION Varicella has more associated morbidity than commonly perceived in immunocompetent children. Māori and PI children are more likely to have complications. This surveillance gives support for inclusion of universal varicella vaccine in the NZ NIS.
Collapse
Affiliation(s)
- Sophie Chien-Hui Wen
- Departments of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Emma Best
- Departments of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Nigel Dickson
- New Zealand Paediatric Surveillance Unit, Department of Women's and Children Health, University of Otago, Dunedin, New Zealand
| | - Hamish McCay
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Waikato Hospital, Waikato, Hamilton, New Zealand
| | - Elizabeth Wilson
- Departments of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| |
Collapse
|
29
|
Sundström K, Weibull CE, Söderberg-Löfdal K, Bergström T, Sparén P, Arnheim-Dahlström L. Incidence of herpes zoster and associated events including stroke--a population-based cohort study. BMC Infect Dis 2015; 15:488. [PMID: 26520060 PMCID: PMC4628253 DOI: 10.1186/s12879-015-1170-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/30/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND More detailed understanding of herpes zoster (HZ) is called for in the context of an increasing observed frequency of disease, and ongoing discussions regarding potential consequences of the disease. Thus, population-based data on incidence and complications of HZ are needed. METHODS We conducted a register-based cohort study in Västra Götaland County (population 1.5 million) in Sweden. We collected data on all patients diagnosed with HZ during the years 2008 to 2010 from population-based registers. Incidence rates (IR) of HZ and related complications were calculated and stratified by age and sex. RESULTS There were 13 269 new HZ cases during the study period. Overall, the IR of herpes zoster in both genders was 3.25 (95% CI: 3.16-3.34) per 1000 person years in 2010. The incidence was consistently higher in women than in men and in older than in young. A history of immunosuppression was more common than in the general population. The incidence was highest in individuals over 80 years of age (IR 9.2 per 1000 person years, 95% CI: 8.8-9.6) during 2008-2010. The most common complications to HZ were ocular engagement and postherpetic neuralgia; risks for stroke and sepsis were significantly elevated during the one year following diagnosis, especially in the youngest age group of patients 0-39 years. CONCLUSIONS Herpes zoster is more common in women, the elderly and immunosuppressed individuals. We verify a population-based association between herpes zoster and risk for stroke and sepsis, which may merit concern.
Collapse
Affiliation(s)
- Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, S-141 86, Stockholm, Sweden.
| | - Caroline E Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-141 86, Stockholm, Sweden.
| | - Karin Söderberg-Löfdal
- Division of Clinical Pharmacology, Dept. of Laboratory Medicine, Karolinska Institutet, S-141 86, Stockholm, Sweden.
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, S-405 30, Gothenburg, Sweden.
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-141 86, Stockholm, Sweden.
| | - Lisen Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-141 86, Stockholm, Sweden.
| |
Collapse
|
30
|
Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment. J Infect 2015; 71:281-93. [DOI: 10.1016/j.jinf.2015.06.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/03/2015] [Accepted: 06/06/2015] [Indexed: 11/23/2022]
|
31
|
Abstract
Necrotizing fasciitis (NF) is a rare complication of varicella zoster (chicken pox) infection. Its diagnosis can be delayed or missed, which increases mortality and morbidity, because it initially presents similarly to cellulitis. We present the case of a 5-year-old boy who presented with a swollen leg, the difficulties in the diagnosis of NF, and a review of the literature. Necrotizing fasciitis complicating varicella zoster in children is associated with 3.4% mortality, although this rises to 13.6% in streptococcal toxic shock syndrome. Seventy-one percent of cases are confirmed as being caused by group A β-hemolytic Streptococcus. The association of NF with chicken pox is discussed along with the difficulties in diagnosis and treatment options. Necrotizing fasciitis is a surgical emergency and should be considered by all emergency department acute care practitioners in cases of varicella in which fever is enduring and swelling or pain is disproportionate. Because of the difficulty in diagnosis, senior opinion should be sought early.
Collapse
|
32
|
Helmuth IG, Poulsen A, Suppli CH, Mølbak K. Varicella in Europe-A review of the epidemiology and experience with vaccination. Vaccine 2015; 33:2406-13. [PMID: 25839105 DOI: 10.1016/j.vaccine.2015.03.055] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
There is no consensus as regards the European varicella immunisation policy; some countries have introduced varicella vaccination in their routine childhood immunisation programs whereas others have decided against or are debating. With the aim of providing an overview of the epidemiology of varicella in Europe and addressing the different strategies and the experiences so far, we performed a review of epidemiological studies done in Europe from 2004 to 2014. Varicella is mainly a disease of childhood, but sero-epidemiological studies show regional differences in the proportion of susceptible adults. Hospitalisation due to varicella is not common, but complications and hospitalisation mainly affect previously healthy children, which underlines the importance of not dismissing varicella as a disease of little importance. The experience with universal vaccination in Europe shows that vaccination leads to a rapid reduction of disease incidence. Vaccine effectiveness is high and a protective herd effect is obtained. Experience with vaccination in Europe has not been long enough, though, to draw conclusions on benefits and drawbacks with vaccination as well as the capacity for national programs in Europe to maintain a sufficiently high coverage to prevent a change in age group distribution to older children and young adults or on the impact that varicella immunisation may have on the epidemiology of shingles.
Collapse
Affiliation(s)
- Ida Glode Helmuth
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Camilla Hiul Suppli
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Kåre Mølbak
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| |
Collapse
|
33
|
Trucchi C, Gabutti G, Cristina Rota M, Bella A. Burden of varicella in Italy, 2001-2010: analysis of data from multiple sources and assessment of universal vaccination impact in three pilot regions. J Med Microbiol 2015; 64:1387-1394. [PMID: 25813818 DOI: 10.1099/jmm.0.000061] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Varicella represents the most widespread vaccine-preventable childhood infectious disease in Italy. The purpose of this retrospective study was to assess the burden of varicella in Italy and in three regions that first implemented universal varicella vaccination. Four data sources were analysed: statutory notification data, the National Hospital Discharge Database, mortality data, and the vaccination coverage reached in Sicilia, Veneto and Apulia. The incidence rates per 100,000 population were calculated using the Italian resident population provided by the Italian Institute of Statistics in 2001-2010. In 2001-2010, the mean annual incidence of notifications of varicella was 150.7 cases per 100,000 population, reaching 948.6 cases per 100,000 population in the paediatric age group. The annual incidence declined to 102.6 per 100,000 population in 2010. During the period considered, 20,295 hospitalizations for varicella were observed. The mean annual incidence was 3.4 per 100,000 population, reaching a minimum of 2.5 per 100,000 in 2009 and 2010. Of the hospitalizations, 68.4% occurred in the paediatric age group. The median length of hospital stay was 4 days. During 2001-2003 and 2006-2010, 33 deaths were reported. In the three regions considered, vaccination coverage increased steadily, reaching 81.5% in Sicily, 79.4% in Veneto and 75.6% in Apulia in 2010. During the same period, hospitalization and notification rates decreased significantly. This study demonstrated that varicella continues to represent a relevant health problem in Italy, especially in the paediatric age group. Data obtained from the three Italian regions that first introduced universal vaccination demonstrated that vaccination reduces the incidence of varicella and hospitalization rates.
Collapse
Affiliation(s)
- Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
| | - Giovanni Gabutti
- Department of Medical Sciences, Section of Hygiene, University of Ferrara, Via Fossato di Mortara 64b, 44121 Ferrara, Italy
| | - Maria Cristina Rota
- Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Antonino Bella
- Infectious Diseases Epidemiology Unit, National Center for Epidemiology Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| |
Collapse
|
34
|
Bozzola E, Bozzola M, Tozzi AE, Calcaterra V, Longo D, Krzystofiak A, Villani A. Acute cerebellitis in varicella: a ten year case series and systematic review of the literature. Ital J Pediatr 2014; 40:57. [PMID: 24942129 PMCID: PMC4079178 DOI: 10.1186/1824-7288-40-57] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/11/2014] [Indexed: 12/11/2022] Open
Abstract
Background Acute cerebellitis (AC) is the most common neurological complication of varicella. Nevertheless, it has been scarcely studied. The objective of this study were to asses the occurrence of AC among children hospitalized for varicella and to analyze its specific clinical picture and outcome. Methods We retrospectively reviewed the medical records of children admitted to the hospital for varicella between 1st October 2003 and 1st June 2013 and we compared our results with literature. Children were all unvaccinated for varicella. Results In our case series, AC was found out in 48 out of 457 patients (10.5%). The highest frequency of AC was observed in children from 1 to 5 years of age (60.9%). The most characteristic symptom of AC was a broad-based gait disturbance that progressed gradually over the course of a few days (95.8%). Other common symptoms included slurred speech (37.5%), vomiting (31.25%), headache (29.16%), dysmetry (25%) and tremor (22.91%). After a long hospitalization (median of 11 days), all but one children were dismissed without invalidating sequelae. Conclusions Data from this study may help to better address the problem of varicella cerebellar complications in hospitalized children and to monitor changes over time caused by an increase in vaccination coverage.
Collapse
Affiliation(s)
- Elena Bozzola
- Department of Pediatric, Bambino Gesù Children's Hospital, Pediatric and Infectious Diseases Unit, IRCCS, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
35
|
Wen SCH, Miles F, McSharry B, Wilson E. Varicella in a Paediatric Intensive Care Unit: 10-year review from Starship Children's Hospital, New Zealand. J Paediatr Child Health 2014; 50:280-5. [PMID: 24372783 DOI: 10.1111/jpc.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 11/27/2022]
Abstract
AIMS Varicella is now a vaccine-preventable disease but is generally considered benign, making it a low priority for a funded universal immunisation scheme. We aimed to increase the knowledge of the severity, morbidity and mortality caused by varicella, by a review of cases requiring paediatric intensive care in New Zealand where vaccine is available but not funded. METHODS This is a retrospective chart review of children admitted to the paediatric intensive care unit (PICU) over a 10-year period (July 2001-July 2011) identified from the PICU database with a primary or secondary code for varicella. RESULTS Thirty-four cases were identified and 26 cases were included. Of the 26 cases, 84.6% were Maori or Pacific Island ethnicity, 54% had no preceding medical condition and 23% were immunocompromised. Main PICU admission reasons were neurologic (38.5%), secondary bacterial sepsis or shock (26.9%), respiratory (15.4%), disseminated varicella (11.5%), or other causes (7.7%). Fifty per cent of children required inotropic support and 81% invasive ventilation. Four children died (15%), three of whom were immunocompromised. A further eight children (31%) had ongoing disability at hospital discharge. CONCLUSION Varicella, or its secondary complications, requiring paediatric intensive care, carries high mortality, particularly for immunocompromised patients, and long-term morbidities, mostly affecting previously healthy children.
Collapse
Affiliation(s)
- Sophie Chien-Hui Wen
- Department of Paediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand
| | | | | | | |
Collapse
|
36
|
Gil-Prieto R, Walter S, Gonzalez-Escalada A, Garcia-Garcia L, Marín-García P, Gil-de-Miguel A. Different vaccination strategies in Spain and its impact on severe varicella and zoster. Vaccine 2013; 32:277-83. [PMID: 24275483 DOI: 10.1016/j.vaccine.2013.11.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 11/06/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022]
Abstract
Varicella vaccines available in Spain were marketed in 1998 and 2003 for non-routine use. Since 2006 some regions decided to include varicella vaccination in their regional routine vaccination programmes at 15-18 months of age. Other regions chose the strategy of vaccinating susceptible adolescents. This study shows the trends in severe varicella zoster virus infections through the analysis of the hospital discharges related to varicella and herpes zoster in the general population from 2005 to 2010 in Spain. A total of 11,125 hospital discharges related to varicella and 27,736 related to herpes zoster were reported during the study period. The overall annual rate of hospitalization was 4.14 cases per 100,000 for varicella and 10.33 cases per 100,000 for herpes zoster. In children younger than 5 years old varicella hospitalization rate significantly decreased from 46.77 in 2005 to 26.55 per 100,000 in 2010. The hospitalization rate related to herpes zoster slightly increased from 9.71 in 2005 to 10.90 per 100,000 in 2010. This increase was mainly due to the significant increase occurring in the >84 age group, from 69.55 to 97.68 per 100,000. When gathering for regions taking into account varicella vaccine strategy, varicella related hospitalizations decreased significantly more in those regions which included the vaccine at 15-18 months of age as a routine vaccine comparing with those vaccinating at 10-14 years old. No significant differences were found in herpes zoster hospitalization rates regarding the varicella vaccination strategy among regions. Severe varicella infections decreased after implementation of varicella vaccination in Spain. This decrease was significantly higher in regions including the vaccine at 15-18 months of age compared with those vaccinating susceptible adolescents.
Collapse
Affiliation(s)
- Ruth Gil-Prieto
- Department of Preventive Medicine & Public Health & Medical Immunology & Microbiology, Rey Juan Carlos University, Madrid, Spain; Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
| | - Stefan Walter
- Department of Social and Behavioural Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Alba Gonzalez-Escalada
- Department of Preventive Medicine & Public Health & Medical Immunology & Microbiology, Rey Juan Carlos University, Madrid, Spain
| | - Laura Garcia-Garcia
- Department of Preventive Medicine & Public Health & Medical Immunology & Microbiology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Marín-García
- Department of Preventive Medicine & Public Health & Medical Immunology & Microbiology, Rey Juan Carlos University, Madrid, Spain
| | - Angel Gil-de-Miguel
- Department of Preventive Medicine & Public Health & Medical Immunology & Microbiology, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
37
|
Paul SP, Abdelrhim H, Kane M, Haque SY. Varicella and secondary pneumonia in a healthy child: is it time to introduce varicella vaccine in the UK? Br J Hosp Med (Lond) 2013; 74:590-1. [PMID: 24105315 DOI: 10.12968/hmed.2013.74.10.590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A previously healthy 8-month-old boy presented to the emergency department with a 1-week history of chickenpox infection. His routine immunizations were up-to-date. His parents reported a high temperature (up to 39.5°C) in the preceding 48 hours and that he also had a mild cough, episodes of vomiting and loose stools. He had fed poorly in the 24 hours before presentation. Clinical assessment revealed a temperature of 36.7°C, heart rate 130/min, respiratory rate of 34/min and crusted chickenpox lesions. The infant was alert, smiling and playful, and systemic examination was otherwise unremarkable. He was admitted for monitoring of his fluid intake and temperature. As the infant continued to vomit intermittently in the 6 hours post admission, blood investigations were done and intravenous fluids were commenced. Laboratory investigations did not reveal biochemical evidence of dehydration, but they did show raised inflammatory markers: white blood cell count 24.8 × 109/litre, neutrophil count 19.8 × 109/litre and C-reactive protein 227mg/litre. In view of these results and the ongoing high fever, a chest X-ray was performed, revealing right upper lobe consolidation and collapse (Figure 1). Oral amoxicillin and flucloxacillin were started and oral feeding was successfully reestablished over the next 24 hours. He was discharged home after 48 hours, to complete a full 7-day course of oral antibiotics.
Collapse
Affiliation(s)
- Siba P Paul
- Specialty Trainee Year 5 in Paediatrics in the Department of Paediatrics, Yeovil District Hospital NHS Foundation Trust, Yeovil, Somerset
| | | | | | | |
Collapse
|
38
|
Turel O, Bakir M, Gonen I, Hatipoglu N, Aydogmus C, Hosaf E, Siraneci R. Children Hospitalized for Varicella: Complications and Cost Burden. Value Health Reg Issues 2013; 2:226-230. [PMID: 29702869 DOI: 10.1016/j.vhri.2013.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the direct medical cost of hospital admissions for patients with varicella (i.e., chickenpox) to assess the cost burden of varicella from a health care perspective for ultimate use in health economics studies in Turkey. METHODS Records of children hospitalized with varicella at the Bakirkoy Maternity and Children's Hospital between November of 2006 and June of 2011 were reviewed. Reasons for hospitalization, types of varicella-associated complications, and direct medical cost of hospitalization were noted. Patients with underlying risk factors were excluded. Data obtained from one hospital were used to estimate the national cost of the disease. RESULTS During the 4.5-year study period, 234 patients were hospitalized with varicella. Of these cases, 48 (20%) children previously ill with underlying cancers or chronic diseases were excluded from the study. Ultimately, 186 previously healthy children (age range: 14 days to 159 months, median age: 14 months) were included. The main reasons for hospitalization were complications related to varicella (79%), the most frequent of which was skin and soft tissue infections, followed by neurological complications and pneumonia. The median cost of hospitalization per patient was US $283, 50% of which was attributed to medication costs. The annual cost for varicella hospitalizations in Turkey was estimated at US $396,200. CONCLUSIONS A significant number of healthy children are hospitalized for varicella and associated complications. Descriptions of these complications and their related costs provide important data for cost-effectiveness studies for decisions about the inclusion of the varicella vaccine in a childhood vaccination program.
Collapse
Affiliation(s)
- Ozden Turel
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
| | - Mustafa Bakir
- Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ismail Gonen
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey; Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Nevin Hatipoglu
- Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Cigdem Aydogmus
- Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Emine Hosaf
- Department of Microbiology, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Rengin Siraneci
- Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| |
Collapse
|
39
|
|
40
|
Pourakbari B, Shahbaznezhad L, Parvaneh N, Nikkhah S, Mahmoudi S, Teymuri M, Alyari AE, Mamishi S. Seroepidemiology of Varicella Zoster Virus among children, adolescents and medical students in a referral children medical center, Tehran, Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2012; 4:136-8. [PMID: 23066488 PMCID: PMC3465539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Varicella is a benign childhood infection with considerable complication in none immune adults. The aim of this study was to survey Varicella Zoster Virus (VZV) seroepidemiology in children, adolescents and medical students in Children Medical Center, Tehran, Iran. MATERIAL AND METHODS In this cross sectional study, serum sample of children, adolescents 10 to 18 years old and medical students 18 to 25 years old were tested for VZV IgG with a commercial ELISA kit. RESULTS A total of 412 individuals who were 10 to 25 years of age participated in this study. Overall 269 individuals (65.3%) were seropositive for VZV IgG. Seroprevalence of VZV antibody increased with age of participants, from 59% in 10-11years children to 80% in 20-21 years old young adult students, except in 22-23 and 24-25 years old, whom the frequency of positive results decreased interestingly to 41.7 and 52.8%, respectively. Prevalence of positive VZV antibody between two genders was not statistically different. CONCLUSION On-going monitoring of the seroepidemilogy of VZV is necessary to assess trends of infection in the community. A considerable proportion of young medical students in this study were still susceptible to VZV and consequent complications.
Collapse
Affiliation(s)
- B Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - L Shahbaznezhad
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - N Parvaneh
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Nikkhah
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Teymuri
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - AE Alyari
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran,Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran,
Corresponding author: Dr. Setare Mamishi, Address: No. 62, Dr. Gharib St., Department of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-21-66428996. Fax: +98-21-66428996. E-mail:
| |
Collapse
|
41
|
Verd S, López E. Management of chickenpox with frozen mother's milk. J Altern Complement Med 2012; 18:808-10. [PMID: 22845343 DOI: 10.1089/acm.2011.0472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES If a mother has contracted chickenpox, the antibodies in her milk confer immunity against chickenpox to her breastfed babies. This passive immunization may avoid or spare the breastfed babies' symptoms of chickenpox. It is hypothesized that frozen breast milk may shorten chickenpox duration because specific antibodies against varicella zoster have been detected in human milk and they are resistant to digestion and are stable in frozen milk. DESIGN The clinical outcomes of chickenpox in a 9-year-old boy and his father on frozen breast milk are reported. SETTINGS The study comprised a varicella-vaccine-refusing family attending a private office of pediatrics. INTERVENTIONS AND RESULTS The boy presented with a crusted varicella rash. The medical history revealed premature cessation of the typical varicella rash on day 3. It was coincidental with a supply of frozen human milk by his mother. Next, the father (41 years old) of this patient contracted chickenpox: he was on frozen breast milk from day 2, and no new pox emerged thereafter. CONCLUSIONS The rash spread and numbered 50 to 150 lesions on day 2. Instead, the typical rash was expected to appear in three successive crops of lesions throughout the first week. The disease usually numbers approximately 250-500 lesions in unvaccinated healthy persons. Frozen breast milk may shorten chickenpox duration.
Collapse
Affiliation(s)
- Sergio Verd
- Department of Pediatrics, Hospital de Santa Cruz y San Pablo, Barcelona, Spain.
| | | |
Collapse
|
42
|
Bozzola E, Tozzi AE, Bozzola M, Krzysztofiak A, Valentini D, Grandin A, Villani A. Neurological complications of varicella in childhood: Case series and a systematic review of the literature. Vaccine 2012; 30:5785-90. [PMID: 22683522 DOI: 10.1016/j.vaccine.2012.05.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/14/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
|
43
|
Lim JBT, Huntley JS. Musculoskeletal sequelae of Varicella-zoster infection: two case reports. Scott Med J 2012; 57:121. [PMID: 22555234 DOI: 10.1258/smj.2011.012010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Varicella-zoster is a common paediatric viral infection that usually runs a benign self-limiting course but has a risk of complications. The most common sequelae are bacterial skin infections, which are usually mild. However, bacteraemia/septic shock, toxic shock syndrome, pneumonia, ataxia, encephalitis and purpura fulminans are also possible. Although rare, musculoskeletal sequelae (osteomyelitis, septic arthritis, pyomyositis and necrotizing fasciitis) can occur in otherwise healthy children. These latter complications are potentially life- and limb-threatening and must be considered in a child post-varicella with pain in a limb or joint. We describe two patients who had musculoskeletal complications after varicella: (1) a 16-month-old boy who developed pyomyositis of the thigh and septic arthritis of the hip and (2) a two-year-seven-month-old girl who developed septic arthritis of the hip and knee and a 'bare area' subperiosteal abscess of the femur. Their clinical presentations, detailed management plans and outcomes are reported. These cases highlight the importance of prompt diagnosis, appropriate investigation (including the important role of magnetic resonance imaging) and surgery when an otherwise healthy post-varicella child deteriorates.
Collapse
Affiliation(s)
- J B T Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | |
Collapse
|
44
|
Dinleyici EC, Kurugol Z, Turel O, Hatipoglu N, Devrim I, Agin H, Gunay I, Yasa O, Erguven M, Bayram N, Kizildemir A, Alhan E, Kocabas E, Tezer H, Aykan HH, Dalgic N, Kilic B, Sensoy G, Belet N, Kulcu NU, Say A, Tas MA, Ciftci E, Ince E, Ozdemir H, Emiroglu M, Odabas D, Yargic ZA, Nuhoglu C, Carman KB, Celebi S, Hacimustafaoglu M, Elevli M, Ekici Z, Celik U, Kondolot M, Ozturk M, Tapisiz A, Ozen M, Tepeli H, Parlakay A, Kara A, Somer A, Caliskan B, Velipasalioglu S, Oncel S, Arisoy ES, Guler E, Dalkiran T, Aygun D, Akarsu S. The epidemiology and economic impact of varicella-related hospitalizations in Turkey from 2008 to 2010: a nationwide survey during the pre-vaccine era (VARICOMP study). Eur J Pediatr 2012; 171:817-25. [PMID: 22170238 DOI: 10.1007/s00431-011-1650-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022]
Abstract
Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (<0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children <1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.
Collapse
|
45
|
Preventing varicella in children with malignancies: what is the evidence? Curr Opin Infect Dis 2011; 24:203-11. [PMID: 21455062 DOI: 10.1097/qco.0b013e328345d666] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The prevention of varicella in children with cancer is generally agreed to be an important goal, because of their elevated risk of varicella zoster virus (VZV)-associated morbidity and mortality. However, there is a lack of consensus on the best means of achieving this. Here, we review the existing evidence in relation to postexposure prophylaxis against varicella in this group and summarize data regarding the role of active vaccination. RECENT FINDINGS Death from varicella during treatment for cancer is now rare, but VZV disease and its prevention remain significant problems in paediatric oncology practice. Measures to reduce VZV exposure amongst seronegative individuals are often neglected. When exposure is known to have occurred, early administration of varicella zoster immune globulin (VZIG) is generally protective against severe and complicated varicella. However, many centres in the UK and Japan use an oral antiviral agent, aciclovir, in place of VZIG. Published evidence for the efficacy of aciclovir as postexposure prophylaxis (PEP) relates mostly to healthy children, with no controlled studies in the immunocompromised. SUMMARY Good evidence already supports the administration of varicella vaccine to healthy susceptible family contacts of children with malignancy, but not to patients themselves. Further data are urgently needed to inform the choice of PEP against VZV in the immunocompromised.
Collapse
|
46
|
Baur A, Pouyau R, Meunier S, Nougier C, Teyssedre S, Javouhey E, Floret D, Gillet Y. Purpura fulminans post-varicelleux et thrombose veineuse : à propos d’un cas pédiatrique. Arch Pediatr 2011; 18:783-6. [DOI: 10.1016/j.arcped.2011.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/24/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
|
47
|
Imöhl M, van der Linden M, Reinert RR, Ritter K. Invasive group A streptococcal disease and association with varicella in Germany, 1996–2009. ACTA ACUST UNITED AC 2011; 62:101-9. [DOI: 10.1111/j.1574-695x.2011.00788.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
48
|
Manikkavasagan G, Dezateux C, Wade A, Bedford H. The epidemiology of chickenpox in UK 5-year olds: An analysis to inform vaccine policy. Vaccine 2010; 28:7699-705. [DOI: 10.1016/j.vaccine.2010.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 09/03/2010] [Accepted: 09/08/2010] [Indexed: 11/24/2022]
|
49
|
Post varicella disseminated intravascular coagulation and transient protein S deficiency in an otherwise healthy 6-year-old boy: a case report. Infection 2010; 38:505-8. [PMID: 20844918 DOI: 10.1007/s15010-010-0053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 08/30/2010] [Indexed: 10/19/2022]
|
50
|
Knuf M, Zepp F, Meyer CU, Habermehl P, Maurer L, Burow HM, Behre U, Janssens M, Willems P, Bisanz H, Vetter V, Schmidt-Ott R. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles-mumps-rubella-varicella vaccine to children aged 11-21 months. Eur J Pediatr 2010; 169:925-33. [PMID: 20148263 DOI: 10.1007/s00431-010-1142-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 01/11/2010] [Indexed: 11/24/2022]
Abstract
This study compared intramuscular and subcutaneous administration of two doses of measles-mumps-rubella-varicella (MMRV) combination vaccine (Priorix-Tetra, GlaxoSmithKline Biologicals) in children. Healthy children (N = 328) were randomised to receive MMRV either intramuscularly or subcutaneously. Reactogenicity was similar between treatment groups for immediate vaccination pain, vaccination site pain, redness and incidence of fever and rashes. Slightly less vaccination site swelling occurred during days 0-3 of the post-vaccination period after intramuscular administration. Seroconversion rates for all components, 42-56 days post-dose 2, ranged from 99.3% to 100% in the intramuscular group and from 98.6% to 100% in the subcutaneous. Cell-mediated immunity data supported the humoral immunogenicity findings. In summary, the MMRV vaccine is well tolerated and highly immunogenic when administered either subcutaneously or intramuscularly to children in the second year of life.
Collapse
Affiliation(s)
- Markus Knuf
- Children's Hospital, Dr. Horst Schmidt Klinik, Ludwig-Erhard-Str. 100, Wiesbaden 65199, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|