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An Outbreak of Varicella with Likely Breakthrough Disease in a Population of Pediatric Cancer Patients

Published online by Cambridge University Press:  02 January 2015

Amanda L. Adler ,
Corey Casper ,
Michael Boeckh ,
Joan Heath  and
Danielle M. Zerr
Amanda L. Adler
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, Washington
Corey Casper
Affiliation:
Department of Medicine, University of Washington, Seattle, Washington Program in Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, Washington Infection Control Program, Seattle Cancer Care Alliance, Seattle, Washington
Michael Boeckh
Affiliation:
Department of Medicine, University of Washington, Seattle, Washington Program in Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, Washington
Joan Heath
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, Washington
Danielle M. Zerr*
Affiliation:
Department of Pediatrics, University of Washington, Seattle, Washington Children's Hospital and Regional Medical Center, Seattle, Washington
*
4800 Sandpoint Way NE, W-8851, Seattle, WA 98105 ([email protected])
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Abstract

Background.

Varicella is highly contagious, and immunocompromised patients are at increased risk of severe illness, including disseminated disease, pneumonia, and encephalitis. We describe an outbreak of varicella with likely breakthrough disease in a population of pediatric cancer patients in October 2004.

Setting.

A 250-bed tertiary care pediatric facility with a 33-bed oncology unit, outpatient clinics, and affiliated group housing and schoolroom spaces.

Methods.

We defined varicella as an acute illness with a maculopapulovesicular rash, without other apparent cause. We defined breakthrough disease as varicella with onset more than 42 days after vaccination. Cancer patients were considered to be nonimmune if serologic test results were negative for varicella-zoster virus. Family members were considered to be nonimmune if they had no history of infection with wild-type varicella-zoster virus or of varicella vaccination.

Results.

In a period of approximately 16 days, varicella was detected in 7 children (the index case, 5 secondary cases, and 1 tertiary case). Of the 7 identified cases, 4 appeared to be cases of breakthrough disease in previously vaccinated children. The outbreak resulted in the exposure of 82 families at a pediatric group housing facility; 28 children at the schoolroom; and 77 patients, 150 family members, and 9 staff members at 3 outpatient clinics.

Conclusions.

This outbreak highlights the important role that breakthrough varicella can play in healthcare centers with affiliated group housing. Formal recommendations on the management of exposed individuals who have been vaccinated should be made in such settings, especially if immunocompromised hosts are present.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 866 - 870
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed. Washington, DC: Public Health Foundation; 2008.Google Scholar
2.American Academy of Pediatrics. Red Book:2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove, IL: American Academy of Pediatrics; 2006.Google Scholar
3.Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1996;45(RR-11):1–36.Google Scholar
4.Galil, K, Lee, B, Strine, T, et al.Outbreak of varicella at a day-care center despite vaccination. N Engl J Med 2002;347:1909–1915.CrossRefGoogle Scholar
5.Tugwell, BD, Lee, LE, Gillette, H, Lorber, EM, Hedberg, K, Cieslak, PR. Chick-enpox outbreak in a highly vaccinated school population. Pediatrics 2004;113:455–459.Google Scholar
6.Lopez, AS, Guris, D, Zimmerman, L, et al.One dose of varicella vaccine does not prevent school outbreaks: is it time for a second dose? Pediatrics 2006;117:el070–1077.Google Scholar
7.Council of State and Territorial Epidemiologists (CSTE). 1999 Position Statements. CSTE Annual Meeting; 1999; Madison, WI. Position Statements ID-9.Google Scholar
8.Weinstock, DM, Boeckh, M, Boulad, F, et al.Postexposure prophylaxis against varicella-zoster virus infection among recipients of hematopoietic stem cell transplant: unresolved issues. Infect Cont Hosp Epidemiol 2004;25:603–608.Google Scholar
9.Bernstein, HH, Rothstein, EP, Watson, BM, et al.Clinical survey of natural varicella compared with breakthrough varicella after immunization with live attenuated Oka/Merck varicella vaccine. Pediatrics 1993;92:833–837.Google Scholar
10.Seward, JF, Zhang, JX, Maupin, TJ, Mascola, L, Jumaan, AO. Contagiousness of varicella in vaccinated cases. JAMA 2004;292:704–708.Google Scholar
11.Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007;56(RR-4)1–40.Google Scholar
12.Lopez, AS, Burnett-Hartman, A, Nambiar, R, et al.Transmission of a newly characterized strain of varicella-zoster virus from a patient with herpes zoster in a long-term-care facility, West Virginia, 2004. J Infect Dis 2008;197:646–653.Google Scholar
13.Bolyard, EA, Tablan, OC, Williams, WW, Pearson, ML, Shapiro, CN, Deitchmann, SD. Guideline for infection control in healthcare personnel. Infect Control Hosp Epidemiol 1998;19:407–463.Google Scholar
14.Ljungman, P, Lonnqvist, B, Gahrton, G, Ringden, O, Sundqvist, VA, Wahren, B. Clinical and subclinical reactivations of varicella-zoster virus in immunocompromised patients. J Infect Dis 1986;153:840–847.Google Scholar