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Varicella in day care centers
Insights
Varicella (chickenpox) control in day care is challenging due to ineffective exclusion policies. Varicella-zoster vaccination (V-Z) shows excellent efficacy, but long-term impacts require further study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Day care exclusion policies for varicella (chickenpox) are often ineffective.
- Minimally ill children may attend day care, posing risks to high-risk individuals.
- Adults face higher morbidity from varicella, though day care worker susceptibility is low.
Purpose of the Study:
- To evaluate the effectiveness of current varicella control measures in day care settings.
- To assess the safety and epidemiological impact of varicella-zoster vaccination (V-Z).
Main Methods:
- Review of existing varicella control strategies in day care.
- Analysis of varicella-zoster vaccination data regarding latent infection, zoster incidence, and antibody titers.
- Comparison of zoster rates in vaccinated versus unvaccinated leukemic children.
Main Results:
- Exclusion of children with early varicella signs is generally ineffective.
- Varicella-zoster vaccination (V-Z) demonstrates excellent efficacy.
- Vaccinated children maintain good antibody titers long-term, comparable to those with natural varicella infection.
- Zoster incidence is not increased in immunized leukemic children.
Conclusions:
- Current varicella control in day care settings needs improvement.
- Varicella-zoster vaccination (V-Z) is a promising intervention with excellent efficacy and a favorable safety profile regarding zoster.
- Further research is needed to fully understand the long-term epidemiological effects of widespread V-Z vaccination.
Abstract:
Spread of varicella in day care is controlled by excluding children at the first signs of illness. Exclusion is generally ineffective. Minimally ill children might be permitted to attend day care. This approach may lead to exposure of those in high-risk groups, i.e., adults or immunocompromised children. Morbidity is greater in adults, but susceptibility among day care workers is probably low. Immunocompromised children can be vaccinated or given varicella-zoster immune globulin (VZIG) after exposure. Questions about the risks of varicella-zoster vaccination (V-Z) concern the production of latent infection and subsequent zoster and the effect on the epidemiology of infection, i.e., its possible delay until adulthood. Zoster has been found not to be more frequent in immunized than in nonimmunized leukemic children, and normal vaccinees retain good antibody titers five years after vaccination and have titers similar to individuals who have had varicella 10 years after vaccination. Vaccine efficacy is excellent, but its desirability will be determined after resolution of questions concerning the long-term impact of its use.