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Varicella exposure in a neonatal intensive care unit: case report and control measures
1Infectious Disease Section, University of Louisville School of Medicine, KY.
Insights
Rapid intervention prevented varicella outbreaks in neonatal intensive care units. Emergency control measures effectively protected infants and health care workers from varicella zoster virus exposure.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Medicine
- Infectious Disease Control
- Pediatric Public Health
Background:
- Varicella (chickenpox) outbreaks pose significant risks in neonatal intensive care units (NICUs).
- Unrecognized varicella in healthcare workers can lead to widespread exposure in vulnerable infant populations.
Observation:
- A pediatric resident with unrecognized varicella exposed 46 neonates and 138 healthcare workers.
- Passive maternal antibodies were present in 44 of the exposed neonates.
Findings:
- Rapid implementation of emergency control measures, including antibody testing and varicella zoster immune globulin (VZIG) administration, was crucial.
- 26 of 27 healthcare workers with uncertain varicella history had detectable antibodies, indicating prior immunity.
- No overt cases of varicella occurred among exposed neonates or personnel.
Implications:
- Proactive and rapid response protocols are essential for preventing varicella transmission in NICUs.
- Serological screening and timely administration of VZIG can effectively mitigate outbreaks.
- Robust infection control strategies protect both high-risk infants and healthcare professionals.
Abstract:
Forty-six infants in a neonatal intensive care unit and 138 health care workers were exposed to a pediatric medical resident during the prodromal period and the early days of unrecognized varicella. An attempt was made to prevent an outbreak of additional cases by the institution of emergency control measures. These measures included rapid identification of varicella antibody status in exposed neonates, varicella antibody testing of health care workers with unknown or uncertain history of varicella, prompt administration of varicella zoster immune globulin to potentially susceptible persons, and cohorting neonates on the basis of exposure and antibody status. Passive maternal antibody was detected in 44 of the neonates. Of 27 health care workers who reported either a negative or an uncertain history of varicella, 26 had detectable antibody. No overt cases of varicella occurred in exposed patients or personnel.