Open Access, Peer-reviewed
pISSN 2384-1079
eISSN 2384-1087
    Pediatr Infect Vaccine. 2016 Dec;23(3):180-187. Korean.
    Published online Dec 20, 2016.
    https://doi.org/10.14776/piv.2016.23.3.180
    Copyright © 2016 The Korean Society of Pediatric Infectious Diseases
    Original Article

    Post-exposure Prophylaxis against Varicella Zoster Virus in Hospitalized Children after Inadvertent Exposure

    Song I Yang,1 Ji Hee Lim,2 Eun Jin Kim,2 Ji Young Park,1 Ki Wook Yun,1 Hoan Jong Lee,1 and Eun Hwa Choi1,2
      • 1Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
      • 2Center for Infection Control and Prevention, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    • Corresponding author (Email: eunchoi@snu.ac.kr )
    Received May 06, 2016; Revised July 08, 2016; Accepted July 08, 2016.

    Abstract

    Purpose

    This study described the post-exposure prophylaxis (PEP) and secondary varicella infection in children inadvertently exposed to varicella zoster virus (VZV) in the hospital.

    Methods

    We retrospectively analyzed data from patients with VZV infection who were initially not properly isolated, as well as children exposed to VZV at the Seoul National University Children's Hospital between January 2010 and December 2015. The PEP measures were determined by the presence of immunity to VZV and immunocompromising conditions. Patient clinical information was reviewed via medical records.

    Results

    Among 147 children hospitalized between 2010 and 2015, 13 inadvertent exposures were notified due to VZV infection. Five index children had a history of VZV vaccination. Eighty-six children were exposed in multi-occupancy rooms and 62.8% (54/86) were immune to VZV. The PEP measures administered to 27 exposed patients included varicella zoster immunoglobulin and VZV vaccination. Four children developed secondary varicella, which was linked to a single index patient, including one child who did not receive PEP and three of the 27 children who received PEP. The rates of secondary varicella and prophylaxis failure were 4.7% (4/85) and 11.1% (3/27), respectively. The secondary varicella rates were 1.9% (1/54) and 9.7% (3/31) among immunocompetent and immunocompromised children, respectively.

    Conclusions

    Delayed diagnosis of VZV infection can lead to unexpected exposure and place susceptible children and immunocompromised patients at risk for developing varicella. The appropriateness of the current PEP strategy based on VZV immunity may require re-evaluation.

    Keywords
    Herpesvirus 3, human; Post-exposure prophylaxis; Child

    Figures

    Fig. 1
    Flow diagram of the subjects who were enrolled in the study. Abbreviation: VZV, varicella zoster virus.

    Tables

    Table 1
    Characteristics of the Index Cases with Varicella in Our Pediatric Wards, 2010 to 2015

    Table 2
    Number of Post-exposure Prophylaxis and Secondary Cases in the Exposed Patients to Varicella Zoster Virus

    Table 3
    Clinical Characteristics of Eight Exposed Patients by an Index Patient 10

    References

      1. Kim KH, editor. The Korean Pediatric Society. Immunization guideline. 8th ed. Seoul: The Korean Pediatric Society; 2015. pp. 163-176.
      1. Ross AH. Modification of chicken pox in family contacts by administration of gamma globulin. N Engl J Med 1962;267:369–376.
      1. Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. American Academy of Pediatrics. Red book: 2015 report of the committee on infectious diseases. 30th ed. Elk Grove Village: American Academy of Pediatrics; 2015. pp. 846-860.
      1. Choi EH. Varicella vaccine. Hanyang Med Rev 2008;28:30–36.
      1. Academy American.Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics 2007;120:221–231.
      1. Adler AL, Casper C, Boeckh M, Heath J, Zerr DM. An outbreak of varicella with likely breakthrough disease in a population of pediatric cancer patients. Infect Control Hosp Epidemiol 2008;29:866–870.
      1. Shinjoh M, Takahashi T. Varicella zoster exposure on paediatric wards between 2000 and 2007: safe and effective post-exposure prophylaxis with oral aciclovir. J Hosp Infect 2009;72:163–168.
      1. Marin M, Guris D, Chaves SS, Schmid S, Seward JF. Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007;56(RR-4):1–40.
      1. Arvin A. Varicella-zoster infections. In: Long S, Pickering L, Prober C, editors. Principles and practice of pediatric infectious diseases. New York: Churchill Livingstone; 1997. pp. 1144-1154.
      1. Kwak BO, Kim DH, Lee HJ, Choi EH. Clinical manifestations of hospitalized children due to varicella-zoster virus infection. Korean J Pediatr Infect Dis 2013;20:161–167.
      1. Marshall HS, McIntyre P, Richmond P, Buttery JP, Royle JA, Gold MS, et al. Changes in patterns of hospitalized children with varicella and of associated varicella genotypes after introduction of varicella vaccine in Australia. Pediatr Infect Dis J 2013;32:530–537.
      1. Kim SH, Lee HJ, Park SE, Oh SH, Lee SY, Choi EH. Seroprevalence rate after one dose of varicella vaccine in infants. J Infect 2010;61:66–72.
      1. Choe YJ, Yang JJ, Park SK, Choi EH, Lee HJ. Comparative estimation of coverage between national immunization program vaccines and non-NIP vaccines in Korea. J Korean Med Sci 2013;28:1283–1288.
      1. Choi EH. Varicella vaccination: worldwide status and provisional updated recommendation in Korea. Korean J Pediatr Infect Dis 2008;15:11–18.
      1. Galil K, Lee B, Strine T, Carraher C, Baughman AL, Eaton M, et al. Outbreak of varicella at a day-care center despite vaccination. N Engl J Med 2002;347:1909–1915.
      1. Langley JM, Hanakowski M. Variation in risk for nosocomial chickenpox after inadvertent exposure. J Hosp Infect 2000;44:224–226.
    MeSH Terms
    Chickenpox*
    Child
    Child, Hospitalized*
    Delayed Diagnosis
    Herpes Zoster
    Herpesvirus 3, Human*
    Humans
    Immunocompromised Host
    Immunoglobulins
    Medical Records
    Post-Exposure Prophylaxis*
    Retrospective Studies
    Seoul
    Vaccination
    Metrics
    Share
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