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Children hospitalized for varicella: a prevaccine review
C L Peterson1, L Mascola, S M Chao
1Division of Acute Communicable Disease Control, County of Los Angeles Department of Health Services, California 90012, USA.
Insights
Varicella (chickenpox) complications in hospitalized children, particularly skin infections and those caused by group A beta-hemolytic streptococcus, have increased. Vaccination is expected to reduce these varicella-related hospitalizations.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology of Viral Illnesses
- Public Health Surveillance
Background:
- Varicella (chickenpox) can lead to serious complications requiring hospitalization in children.
- Understanding the types and trends of these complications is crucial for public health interventions.
Purpose of the Study:
- To describe varicella complications in hospitalized children, differentiating between healthy and previously ill individuals.
- To investigate trends in group A beta-hemolytic streptococcus (GABHS) related varicella complications.
Main Methods:
- Retrospective review of medical records for children hospitalized with varicella.
- Data collected from nine acute care hospitals in Los Angeles County between 1990 and 1994.
- Analysis of complication types, patient health status, and trends over time.
Main Results:
- 574 children were hospitalized for varicella; 74% for complications.
- Skin/soft tissue infections were most common (45%), followed by neurologic (18%) and respiratory (14%).
- Previously healthy children had more skin/soft tissue and neurologic issues, while previously ill children had more respiratory complications. Hospitalizations for skin/soft tissue infections and GABHS complications increased during the study period.
Conclusions:
- A child's prior health status predicts the type of varicella complication.
- An increasing trend in skin/soft tissue complications and GABHS-related varicella complications was observed.
- Widespread varicella vaccination is anticipated to reverse these trends and decrease overall varicella impact.
Objectives:
To describe varicella complications in healthy and previously ill children hospitalized for varicella and to explore trends in group A beta-hemolytic streptococcus complications of varicella.
Methods:
A retrospective record review of children hospitalized for varicella between January 1, 1990, and March 31, 1994, was conducted in nine large acute care hospitals in Los Angeles County, California.
Results:
We identified 574 children hospitalized for varicella in study hospitals during the 4.25-year study period (estimated risk of hospitalization, approximately 1 in 550 cases of varicella); 53% of the children were healthy before the onset of varicella and 47% were previously ill with underlying cancers or other chronic illnesses. Children were hospitalized for treatment of complications (n = 427, 74%) or for prophylactic antiviral therapy or observation (n = 147, 26%). Systems involved in complications included skin/soft tissue (45%), neurologic (18%), respiratory (14%), gastrointestinal (10%), and hematologic, renal, or hepatic (8% or less). The mean age of children with skin/soft tissue infections was 2.7 years (range < 1 to 16 years) compared with 4.7 years (< 1 to 18 years) for other complications. Children with skin/soft tissue and neurologic complications were more often previously healthy (p < 0.05), whereas those with respiratory complications were more often previously ill (p < 0.001). Hospitalizations for skin/soft tissue infections increased during the study period. The proportion of complications as a result of group A beta-hemolytic streptococcus infection increased from 4.7% before 1993 to 12.2% for the remainder of the study period (p = 0.02).
Conclusions:
Prior health status was predictive of the type of complications experienced by children with varicella requiring hospitalization. Our data suggest a recent increase in skin/soft tissue complications of varicella requiring hospitalization and an increase in the proportion of complications related to group A beta-hemolytic streptococcus. Wide-scale vaccine use should reverse this trend and reduce the overall impact of varicella on both healthy and previously ill children.