Pediatr Infect Vaccine.  2016 Dec;23(3):180-187. 10.14776/piv.2016.23.3.180.

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

• Yang SI
• Lim JH
• Kim EJ
• Park JY
• Yun KW
• Lee HJ
• Choi EH

• KMID: 2362476
• DOI: http://doi.org/10.14776/piv.2016.23.3.180

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.

Keyword

Herpesvirus 3, human; Post-exposure prophylaxis; Child

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
Immunoglobulins

Figure

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

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