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Varicella at "Casa Garrahan", 2008-2013: Assessment of postexposure prophylaxis measures
Silvina Ruvinsky1, Moira Taicz1, M Guadalupe Pérez1
1Servicio de Control Epidemiológico e Infectología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan.
Insights
Prophylaxis measures effectively prevented secondary varicella cases in children with complex conditions. Acyclovir prophylaxis was well-tolerated and effective in both healthy and immunocompromised children.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- Casa Garrahan (CG) serves children with complex conditions nationwide, increasing susceptibility to highly contagious diseases like varicella.
- Varicella outbreaks in closed communities require stringent control measures due to high attack rates in susceptible individuals.
Purpose of the Study:
- To characterize children exposed to varicella at Casa Garrahan.
- To detail implemented varicella prophylaxis measures.
- To evaluate the effectiveness of these prophylaxis strategies.
Main Methods:
- Prospective cohort study conducted between 2008 and 2013.
- Assessment of demographic and clinical characteristics, varicella history, and immunization status of exposed children.
- Evaluation of prophylaxis measures (acyclovir, immunization, gamma globulin) and secondary attack rate.
Main Results:
- 107 children were included; 53% were girls with a median age of 84 months.
- 95% had underlying conditions, and 50% were immunocompromised.
- Prophylaxis with acyclovir was administered to 61%, immunization to 10%, with no adverse effects observed and zero secondary cases within 30 days.
Conclusions:
- Implemented varicella control measures were effective in preventing secondary cases within the CG population.
- Acyclovir prophylaxis demonstrated efficacy and good tolerability in both healthy and immunocompromised children.
- These findings support the successful management of varicella exposure in a high-risk pediatric population.
Introduction:
Casa Garrahan (CG) accommodates children with complex conditions referred nationwide; these children are seen in children's hospitals located in the Autonomous City of Buenos Aires. Varicella is a highly-contagious disease, with attack rates of up to 90% among susceptible individuals. In closed communities, the implementation of outbreak control measures is critical.
Objectives:
To describe the characteristics of children exposed to varicella at CG, the implemented prophylaxis measures and their effectiveness.
Methods:
Prospective, cohort study. Children exposed to varicella at CG between2008 and 2013, their demographic and clinical characteristics, immunization and/or history of varicella, prophylaxis measures, and secondary attack rate were assessed.
Results:
N: 107. Fifty-three percent (n: 57) were girls. Their median age was 84 months old [interquartile range (IQR): 24-144]. Ninety-five percent (n: 102) had an underlying disease [hemato-oncological disease: 39% (n: 42); neurological disease: 18% (n: 19); congenital heart disease: 9% (n: 10); and post-operative period: 65 (n: 6)]. Fifty percent had some degree of immunosuppression (n: 54). Twenty-nine percent (n: 31) referred to have had varicella; 27% (n: 29) indicated that they never had the infection; and 41% (n: 44) did not recall a history of varicella. Only 3% (n: 3) had been vaccinated. Based on their immune status, age and history of varicella, acyclovir was indicated as prophylaxis in 61% (n: 65); immunization in 10% (n: 10); and gamma globulin in 1 patient. No adverse effects were observed in relation to the different prophylaxis measures. No secondary cases were observed at 30 days.
Conclusions:
Implemented measures were effective to prevent secondary cases. Among healthy and immunocompromised children, prophylaxis with acyclovir was effective and well-tolerated.