Post-Exposure Prophylaxis for Varicella-Zoster Virus Exposure in High-Risk Children
Emily Shteynberg1,2, Shan Sun1, Ravi Jhaveri1,3
1Division of Pediatric Infectious Disease, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA.
Insights
Post-exposure prophylaxis (PEP) for varicella in high-risk children showed varied prescribing practices. Acyclovir use was linked to a higher incidence of subsequent varicella disease compared to other PEP options.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Epidemiology
Background:
- Post-exposure prophylaxis (PEP) for varicella is recommended for high-risk children to prevent complications.
- Providers often opt for alternatives like acyclovir or intravenous immunoglobulin (IVIG) instead of varicella immunoglobulin.
Purpose of the Study:
- To analyze the patterns of varicella PEP use in high-risk children across multiple institutions.
- To compare the effectiveness of different PEP regimens in preventing subsequent varicella disease.
Main Methods:
- A retrospective cohort study analyzed data from 47 children's hospitals (2009-2019).
- Included were 1704 children with varicella exposure, examining PEP choices and subsequent varicella disease incidence.
- Regimen choice was analyzed based on underlying conditions and hospital practices.
Main Results:
- Of 1704 children, 509 received PEP; 65 developed varicella disease.
- Acyclovir was the most frequent PEP (38.3%), followed by varicella immunoglobulin (28.7%) and IVIG (22.6%).
- Acyclovir use was associated with the highest rate of subsequent varicella disease (15.4%) compared to varicella immunoglobulin (3.4%) and IVIG (0%).
Conclusions:
- Varicella PEP prescribing practices for high-risk children vary significantly among children's hospitals.
- Acyclovir use demonstrated a higher rate of subsequent varicella disease encounters in this cohort.
Background:
Post-exposure prophylaxis (PEP) with varicella immunoglobulin is recommended to minimize risk of varicella complications for high-risk children. However, providers frequently use alternatives like acyclovir or intravenous immunoglobulin.
Methods:
A retrospective cohort study was conducted of PEP for varicella in children from January 2009 to December 2019. Data were provided by 47 children's hospitals who participate in the Pediatric Health Information Systems database. Patients with clinical encounters for varicella exposure were reviewed. Choice of varicella PEP regimens, including differences by underlying condition and institution, and incidence of varicella disease were determined.
Results:
A total of 1704 patients with first clinical encounters for varicella met inclusion criteria. Of these patients, 509 (29.9%) were prescribed PEP after varicella exposure, and 65 (3.8%) ultimately had a subsequent encounter for varicella disease. Of 509 patients who received PEP, acyclovir was most frequently prescribed (n = 195, 38.3%), followed by varicella immunoglobulin (n = 146, 28.7%), IVIG (n = 115, 22.6%), and combination therapy (n = 53, 10.4%). The highest proportion of varicella immunoglobulin use (10/20, 50%) was amongst children with diagnoses of rheumatological/gastrointestinal conditions. The highest proportion of acyclovir use (29/684, 4.2%) was amongst children with diagnoses of oncology/stem cell transplant conditions. The proportion of patients who subsequently had clinical encounters for varicella disease was highest for Acyclovir (30/195, 15.4%) followed by varicella immunoglobulin (5/146, 3.4%), combination therapy (2/53, 3.8%), and intravenous immunoglobulin alone (0/115) (P < .0001).
Conclusions:
Varicella PEP in high-risk children was highly varied among children's hospitals. In our dataset, use of acyclovir was associated with a higher rate of subsequent encounters for Varicella disease.
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