Varicella post-exposure management for pediatric oncology patients
Guillaume Costa1, Daniel Orbach2, Juliette Saulpic3
1Centre Hospitalier Sud Francilien, Corbeil-Essonnes, Department of Pediatrics, 40, Avenue Serge Dassault, 91100 Corbeil-Essonnes, France.
Insights
Healthcare providers adhered to varicella post-exposure prophylaxis (PEP) guidelines for children with cancer, demonstrating PEP efficacy. Standardizing PEP and encouraging VZV immunization for family members is recommended.
Area of Science:
- Pediatric Oncology
- Infectious Disease Epidemiology
- Public Health
Background:
- Varicella-zoster virus (VZV) poses a significant risk to immunocompromised children, particularly those undergoing cancer treatment.
- Evaluating the adherence and effectiveness of post-exposure prophylaxis (PEP) for VZV in this vulnerable population is crucial for clinical practice.
Purpose of the Study:
- To assess healthcare providers' (HCP) adherence to VZV PEP recommendations in children with cancer.
- To evaluate the efficacy of different PEP strategies in preventing breakthrough varicella infections.
Main Methods:
- An observational, prospective, multicenter study was conducted in France involving children under 18 with cancer.
- Eligible participants with VZV exposure were assessed for PEP indications, with main outcomes including guideline compliance, VZV serostatus availability, and breakthrough varicella incidence.
Main Results:
- Of 51 patients (52 exposure episodes), 38% of exposures occurred within households. Guideline-compliant PEP (V-ZIG or oral acyclovir) showed higher efficacy in preventing varicella (65% and 87% respectively) compared to non-compliance.
- Breakthrough varicella occurred in 17% of guideline-compliant PEP episodes versus 60% of non-compliant episodes, with all cases presenting mild clinical courses.
Conclusions:
- Current VZV PEP recommendations are generally followed and effective in pediatric cancer patients.
- Standardization of PEP protocols and further studies to determine optimal approaches are warranted.
- Encouraging VZV immunization for seronegative family contacts is advised to reduce transmission risk.
Introduction:
The objective was to evaluate health care providers' (HCP) adherence to and efficacy of varicella post-exposure prophylaxis (PEP) recommendations. It was an observational, prospective, multicenter study set in Ile-de-France, France.
Methods:
All children under 18 with a cancer diagnosis, currently or within 3months of receiving cancer treatment, regardless of varicella zoster virus (VZV) serostatus or previous personal history of varicella, were eligible. Study participants with significant exposure were reviewed prospectively for PEP indications. Main outcome measures were the percentage of exposure situations for which HCP were guideline-compliant, the proportion of available VZV serostatuses and the incidence of breakthrough varicella after different PEP approaches.
Results:
A total of 51 patients from 15 centers were enrolled after 52 exposure episodes. Median age at exposure was 5 years (range, 1-15). Exposure within the household led to 38% of episodes. Prophylactic treatment consisted in specific anti-VZV immunoglobulins (V-ZIG) (n=19) or in oral aciclovir (n=15). No prophylactic treatment was given for 18 patients (in compliance, n=16). In compliance with guidelines, 17 patients received V-ZIG, 11 did not develop varicella (65%, [95% CI, 39-90%]); 15 received aciclovir, 13 did not develop varicella (87%, [95% CI, 67-100%]). Breakthrough varicella occurred in 11 patients, with simple clinical course in all cases; in 8/47 (17%) episodes when PEP was guideline-compliant versus 3/5 (60%) when not.
Discussion:
Recommendations have been respected and are efficient. PEP needs to be standardized and a study carried out to define the optimal approach. Anti-VZV immunization of seronegative family members should be encouraged.
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