Varicella outbreak in a pediatric oncology ward: the Manado experience
Stefanus Gunawan1, Paulus Linardi, Konda Tawaluyan
1Estella Children Cancer Center, RD Kandou General Hospital, Manado, Indonesia. stefledi2000@yahoo.com
Insights
Varicella outbreaks in pediatric cancer centers are dangerous. Prompt prevention and management are crucial for immunocompromised children, as seen in an Indonesian cancer center outbreak.
Area of Science:
- Infectious Disease Epidemiology
- Pediatric Oncology
- Public Health
Background:
- Varicella (chickenpox) poses significant risks, particularly to immunocompromised individuals.
- Children undergoing cancer treatment are highly susceptible to severe varicella complications and mortality.
- The study focuses on an outbreak within a dedicated pediatric cancer center.
Observation:
- An outbreak of varicella occurred at the Estella Children Cancer Center in Manado, Indonesia.
- The outbreak affected pediatric cancer patients, a family member, and a housekeeping staff member.
- Despite interventions like oral acyclovir, isolation, and disinfection, multiple waves of infection occurred.
Findings:
- Four out of eight leukemia patients contracted varicella.
- The index case, a child with leukemia, unfortunately died from encephalitis.
- While most other patients recovered, one child was lost to follow-up.
Implications:
- This outbreak underscores the critical need for robust varicella prevention strategies in high-risk settings.
- Effective management protocols are essential for immunocompromised pediatric cancer patients.
- Development of simple, locally adaptable guidelines for varicella control in such centers is recommended.
Background:
Varicella is highly contagious and dangerous disease, especially in immunocompromised patients. Children with cancer are at increased risk of severe illness and fatal cases occur.
Objective:
To describe an outbreak of varicella among in-patient cancer children, family members and staff. Estella Children Cancer Center in Manado, Indonesia with 14 beds and a 15 bed capacity guest house for family members.
Methods:
A retrospective study of patients, family members and staff who were diagnosed with varicella based on clinical appearance was performed. Follow up was until 28 days from the last patient diagnosis' date.
Results:
From late February to early May 2009, varicella was affecting 4 among 8 children with leukemia, 1 family member and 1 housekeeping staff. Measurers taken after the index case were oral acyclovir both for patients and contacts, patient isolation, ward disinfection and some chemotherapy interruption. Nevertheless, a second and third wave of varicella occurred. The index case died due to encephalitis. Other patients were non-severe and cured, but one child was lost to follow up.
Conclusions:
This outbreak highlights the importance of proper prevention and prompt management of varicella in immunocompromised patients. Simple and locally applicable guidelines are needed.
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Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.