Screening healthcare workers for varicella-zoster virus: can we trust the history?

To determine the relationship between immunity and a history of chickenpox based on a self-administered questionnaire.

We investigated immunity to varicella-zoster virus in a cohort of newly recruited employees with different job categories and different nationalities using enzyme-linked immunosorbent assay IgG.

There were 1,058 new recruits. Of these, 890 (84%) were immune and 168 (16%) were susceptible. The susceptibility rate was 23% (n = 77) for Asian, 15% (n = 14) for South African, 13% (n = 66) for Middle Eastern, and 9% (n = 11) for Western employees. Physicians were more likely to be immune (93%) than were nurses (85%), medical technicians (75%), or administrative clerks (84%). Seropositivity was not affected by age or gender. The positive predictive value of a history of chickenpox for the seropositivity was 89% (511 of 574); the negative predictive value was 22% (105 of 484). History of chickenpox had a sensitivity of 57% (511 of 890) and a specificity of 63% (105 of 168).

The varicella-zoster virus seroprevalence among new employees was low, posing an important risk to existing employees and patients. Positive or negative history of chickenpox was an unreliable indicator of susceptibility among healthcare workers of different nationalities. Serologic screening of all employees and vaccination of those susceptible was recommended.