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Bozzola E, Marchesani S, Ficari A, Brusco C, Spina G, Marchili MR, Guolo S. Assessing the use of antibiotics in pediatric patients hospitalized for varicella. Ital J Pediatr 2022; 48:196. [PMID: 36503563 PMCID: PMC9743721 DOI: 10.1186/s13052-022-01393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella. METHODS Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1st of November 2005 to the 1st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered. RESULTS According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures. CONCLUSION Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
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Affiliation(s)
- Elena Bozzola
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Silvio Marchesani
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Ficari
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carla Brusco
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Spina
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Guolo
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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Liu X, Li Q, Du X, Zhao X, Yin Z. Vaccine Coverage and Effectiveness in a School-Based Varicella Outbreak in Jinan Prefecture, Shandong Province. Vaccines (Basel) 2022; 10:vaccines10081225. [PMID: 36016113 PMCID: PMC9416244 DOI: 10.3390/vaccines10081225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Licheng District of Jinan Prefecture reported a school-based varicella outbreak. We conducted an investigation to analyze the epidemiology and scope of the outbreak, determine varicella vaccine coverage on the school campus, and estimate varicella vaccine effectiveness (VE). Methods: In the epidemiological investigation, we determined the attack rate, the clinical manifestations of varicella cases, and histories of prior varicella disease and varicella vaccination. We tested students for presence of serum IgM antibodies, and we attempted to isolate the varicella virus from vesicular fluid samples. We used chi-square to compare incidences between classes and floors. VE was estimated using a retrospective cohort study. Results: There were 13 varicella cases in the outbreak. All were among fourth grade students - twelve in Class 7 and one in Class 6. The attack rate in the two classrooms was 14.3% (13/91). Clinical symptoms were rash (100%) and fever (46.15%). All cases were reported within one average incubation period, and the epidemic curve suggested common exposure. Six of the 13 cases previously received one dose of varicella vaccine with a median time between vaccination and infection of 9 years; the other seven cases had not been vaccinated. Varicella vaccine coverage with one or more doses was 81.31%; 2-dose coverage was 38.15%. The median age of receipt of dose 1 was 1.18 years, and median age for receiving dose 2 was 5.12 years. One-dose varicella VE was 73.2% (95% confidence interval: 37.0%, 88.6%), and two-dose VE was 100%. Conclusions: Varicella vaccine coverage has been gradually increasing in recent years, as ≥1-dose and 2-dose coverage rates are higher in younger children than older children. High one-dose vaccination coverage limited the outbreak scope and led to the breakthrough cases being mild. Mild cases were difficult to detect in a timely manner. Varicella vaccine was highly effective, with 1-dose VE of 73% nine years after vaccination and 2-dose VE of 100%. We strongly recommended that all school students receive two doses of varicella vaccine.
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Affiliation(s)
- Xiaoxue Liu
- Jinan Municipal Center for Disease Control and Prevention, No.2 Weiliu Road, Huaiyin District, Jinan 250021, China;
| | - Quanxia Li
- Licheng District Center for Disease Control and Prevention, Licheng District, Jinan 250199, China; (Q.L.); (X.D.)
| | - Xu Du
- Licheng District Center for Disease Control and Prevention, Licheng District, Jinan 250199, China; (Q.L.); (X.D.)
| | - Xiaodong Zhao
- Jinan Municipal Center for Disease Control and Prevention, No.2 Weiliu Road, Huaiyin District, Jinan 250021, China;
- Correspondence: (X.Z.); (Z.Y.)
| | - Zundong Yin
- Chinese Center for Disease Control and Prevention, No.27 Nanwei Road, Xicheng District, Beijing 100050, China
- Correspondence: (X.Z.); (Z.Y.)
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Development of a skin- and neuro-attenuated live vaccine for varicella. Nat Commun 2022; 13:824. [PMID: 35149692 PMCID: PMC8837607 DOI: 10.1038/s41467-022-28329-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
Varicella caused by the primary infection of varicella-zoster virus (VZV) exerts a considerable disease burden globally. Current varicella vaccines consisting of the live-attenuated vOka strain of VZV are generally safe and effective. However, vOka retains full neurovirulence and can establish latency and reactivate to cause herpes zoster in vaccine recipients, raising safety concerns. Here, we rationally design a live-attenuated varicella vaccine candidate, v7D. This virus replicates like wild-type virus in MRC-5 fibroblasts and human PBMCs, the carrier for VZV dissemination, but is severely impaired for infection of human skin and neuronal cells. Meanwhile, v7D shows immunogenicity comparable to vOka both in vitro and in multiple small animal species. Finally, v7D is proven well-tolerated and immunogenic in nonhuman primates. Our preclinical data suggest that v7D is a promising candidate as a safer live varicella vaccine with reduced risk of vaccine-related complications, and could inform the design of other herpes virus vaccines. Current varicella vaccines retain neurovirulence and can establish latency and reactivate. Here, the authors present preclinical results of a rationally-designed, skin- and neuro-attenuated varicella vaccine candidate, v7D, showing its attenuation in human skin and neuronal cells and its immunogenicity in small animal models and nonhuman primates
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Chen D, Li Y, Wu Q. Effectiveness of varicella vaccine as post-exposure prophylaxis: a meta-analysis. Hum Vaccin Immunother 2021; 17:5316-5324. [PMID: 34893015 DOI: 10.1080/21645515.2021.2009729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of varicella vaccine (VarV) as post-exposure prophylaxis (PEP) among children during varicella outbreaks. MATERIAL AND METHODS A comprehensive literature search was performed in PubMed, Embase, Web of Science, SinoMed, Wanfang and CNKI. Relevant outcomes included the incidence of varicella. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies. RESULTS A total of 15 studies with 7,474 children that received one or two dosages of VarV as PEP and 183,827 children who received no VarV were included in the meta-analysis. In total, one-dose and two-dose VarV as PEP had 43% (95% confidence interval (CI):27%, 55%) and 60% (95%CI: 35%, 75%) efficacy, respectively. When PEP was applied within 3 days, the pooled VarV as PEP for prevention of varicella was 80% (95%CI: 68%, 88%); when PEP was administered beyond 3 days, the pooled VarV as PEP for the prevention of varicella was 50% (95%CI: 11%, 72%). If the PEP was implemented with a coverage of more than 80%, the VarV could prevent 82% of varicella cases from occurring (95%CI: 15%, 96%); if the PEP covered a maximum of 80% of the susceptible cases, the VarV could prevent 65% of varicella cases from occurring (95%CI: 50%, 76%). CONCLUSION The two-dose VarV had better efficacy than one-dose VarV in the control of varicella outbreaks, especially if PEP was applied within 3 days of an outbreak and in conjunction with a high coverage rate ≥80%.
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Affiliation(s)
- Daoyong Chen
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Yue Li
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Qiangsong Wu
- Department of Immunization Program, Xuhui District Center for Disease Control and Prevention, Shanghai, China
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Bozzola E, Spina G, Marchili MR, Brusco C, Guolo S, Rossetti C, Logrieco G, Pignatelli F, Raponi M, Villani A. Pediatric Hospitalization for Varicella in an Italian Pediatric Hospital: How Much Does It Cost? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212053. [PMID: 34831809 PMCID: PMC8617963 DOI: 10.3390/ijerph182212053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Varicella is a common pediatric infection. Even if it generally has a benign course, it may complicate and require hospitalization. The aim of our study was to estimate the acute hospitalization cost (AHC) for varicella in the acute phase in a pediatric population. METHODS We calculated the AHC of pediatric patients admitted for varicella at Bambino Gesù Children Hospital, Rome, Italy, from 1 November 2005 to 1 November 2020. RESULTS In the study period, 825 pediatric patients affected by varicella were hospitalized. The mean hospitalization cost was EUR 4015.35 (range from EUR 558.44 to EUR 42,608.00). Among patients, 55% were unvaccinable due to either their age or their immunosuppression status. They would benefit from herd immunity, reducing the overall AHC by EUR 182,196,506. Since the introduction of the compulsory vaccination against varicella in Italy, we observed a significant reduction in AHC cost of 60.6% in 2019 and of 93.5% in 2020. Finally, from the beginning of the COVID-19 pandemic, we documented a decline of 81.2% and 76.9% in varicella hospitalization, compared to 2018 and 2019, respectively. CONCLUSIONS Varicella AHC is an important economic and health assessment point and can be useful for improving preventive strategies.
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Affiliation(s)
- Elena Bozzola
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
- Correspondence: ; Tel.: +39-06-6859-2744
| | - Giulia Spina
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Maria Rosaria Marchili
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Carla Brusco
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Chiara Rossetti
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Giuseppe Logrieco
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Francesca Pignatelli
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
| | - Massimiliano Raponi
- Sanitary Direction, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (C.B.); (S.G.); (M.R.)
| | - Alberto Villani
- Pediatric Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00100 Roma, Italy; (G.S.); (M.R.M.); (C.R.); (G.L.); (F.P.); (A.V.)
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Peredelskaya EA, Safyanova TV, Druchanov MM. Clinical and epidemiological characteristics of chickenpox in children aged 0–17 in Barnaul. JOURNAL INFECTOLOGY 2021. [DOI: 10.22625/2072-6732-2021-13-1-66-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction. Chickenpox is one of the most common infectious diseases in childhood. It is considered a benign disease, but both children and adults can lead to the development of serious complications.Purpose: to study the epidemiological and clinical features of chickenpox in children aged 0–17 years, hospitalized in the Krai government-owned publicy funded health care institution “City clinical hospital No. 11, Barnaul”, for the period 2008–2018.Materials and methods. The materials of the study were data from statistical reporting forms No. 2 of the Federal state statistical observation “Information on infectious and parasitic diseases” in Barnaul for 2008–2018, and medical archive documentation of the children’s infectious diseases Department of the Krai government-owned publicy funded health care institution “City clinical hospital No. 11, Barnaul” for the same period. Data processing was performed using calculation of intensive and extensive indicators, calculation of the arithmetic mean (X) and standard error of the average (m). Calculations were made using the STATISTICA-10 program.Results. The incidence of chickenpox is consistently high, and children aged 3 to 6 years dominated the structure of hospitalized patients with the diagnosis of «chickenpox». All patients were not vaccinated against this infection. Patients developed complications due to the layering of secondary bacterial flora. Summary. Chickenpox is an infectious disease that can be severe, especially in patients with a heavy premorbid background. There is a tendency to” grow up” the infection, which emphasizes the need to discuss specific prevention of the disease.
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Bonanni P, Zanobini P. Universal and targeted varicella vaccination. THE LANCET. INFECTIOUS DISEASES 2021; 21:11-12. [PMID: 32711691 DOI: 10.1016/s1473-3099(20)30358-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, 48-50134 Florence, Italy.
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, 48-50134 Florence, Italy
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Near-atomic cryo-electron microscopy structures of varicella-zoster virus capsids. Nat Microbiol 2020; 5:1542-1552. [PMID: 32895526 DOI: 10.1038/s41564-020-0785-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/03/2020] [Indexed: 12/18/2022]
Abstract
Varicella-zoster virus (VZV) is a medically important human herpesvirus that causes chickenpox and shingles, but its cell-associated nature has hindered structure studies. Here we report the cryo-electron microscopy structures of purified VZV A-capsid and C-capsid, as well as of the DNA-containing capsid inside the virion. Atomic models derived from these structures show that, despite enclosing a genome that is substantially smaller than those of other human herpesviruses, VZV has a similarly sized capsid, consisting of 955 major capsid protein (MCP), 900 small capsid protein (SCP), 640 triplex dimer (Tri2) and 320 triplex monomer (Tri1) subunits. The VZV capsid has high thermal stability, although with relatively fewer intra- and inter-capsid protein interactions and less stably associated tegument proteins compared with other human herpesviruses. Analysis with antibodies targeting the N and C termini of the VZV SCP indicates that the hexon-capping SCP-the largest among human herpesviruses-uses its N-terminal half to bridge hexon MCP subunits and possesses a C-terminal flexible half emanating from the inner rim of the upper hexon channel into the tegument layer. Correlation of these structural features and functional observations provide insights into VZV assembly and pathogenesis and should help efforts to engineer gene delivery and anticancer vectors based on the currently available VZV vaccine.
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Menéndez Del Castro M, Coca-Pelaz A, Menéndez S, Vivanco-Allende A, Pedregal-Mallo D, García-Cabo P, Fernández-Vañes L, Llorente JL. Retropharyngeal abscess and mediastinitis as an uncommon complication of varicella infection. Int J Pediatr Otorhinolaryngol 2020; 132:109904. [PMID: 32018164 DOI: 10.1016/j.ijporl.2020.109904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
Varicella infection is one of the most common and contagious infection in children and could course with severe complications. We report the case of a 4-year-old patient derived to our hospital for suspicion of suppurative complication in the context of a varicella infection. A computerized tomographic scanning was performed, showing a large retropharyngeal abscess with mediastinitis. Complications of varicella are up to 2% of patients, but this is the first report of a retropharyngeal and mediastinal abscess in this context. In the face of clinical suspicion, early intervention is important through imaging, intravenous antibiotics and surgical drainage in necessary cases.
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Affiliation(s)
| | - Andrés Coca-Pelaz
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturia, IUOPA, Oviedo, Spain
| | - Sergio Menéndez
- Pediatric Intensive Care Unit, Department of Pediatrics. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana Vivanco-Allende
- Pediatric Intensive Care Unit, Department of Pediatrics. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Pedregal-Mallo
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Patricia García-Cabo
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Laura Fernández-Vañes
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José Luis Llorente
- Department of Otolaryngology. Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturia, IUOPA, Oviedo, Spain
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Diniz LMO, Maia MMM, Oliveira YVD, Mourão MSF, Couto AV, Mota VC, Versiani CM, Silveira PODC, Romanelli RMC. Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment. Hosp Pediatr 2019; 8:419-425. [PMID: 29921616 DOI: 10.1542/hpeds.2017-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Varicella is a disease with potentially severe complications. We aimed to investigate characteristics of hospitalized children with varicella in Brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. METHODS A prospective cohort study was conducted from May 2011 to April 2014. Patients up to 13 years of age with varicella diagnosis were included. Information was collected through interview and review of medical records. Logistic regression analysis was performed. RESULTS A total of 669 patients were admitted. The median age of subjects was 2.7 years (range 0-14 years) with a predominance of boys (56.6%). The main causes of hospitalization were bacterial complications (77.7%), viral complications (11.4%), and at-risk patients (10.9%). Main bacterial complications were skin infection and pneumonia. Main viral complications were herpes zoster, cerebellitis, and encephalitis. Most at-risk patients used corticosteroids or had a diagnosis of leukemia. At-risk patients were hospitalized earlier (P < .01) and remained hospitalized for longer periods (P = .03). A total of 44 patients (6.6%) were admitted to the ICU, and 5 (0.8%) died of septic shock. Thrombocytopenia was associated with more severe illness in patients with bacterial infections (P = .001). The long-time interval between onset of infection and admission was associated with the need for intensive care in all groups (P = .007). CONCLUSIONS Secondary bacterial infection is the main cause of hospitalization, and thrombocytopenia in these patients leads to worse outcomes. Difficulties of access to the health system and delay in medical care are determining factors of greater severity in this population.
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Affiliation(s)
| | | | | | | | - Amanda Vieira Couto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vânia Carneiro Mota
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Hagemann C, Krämer A, Grote V, Liese JG, Streng A. Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany). Infect Dis Ther 2019; 8:597-611. [PMID: 31674000 PMCID: PMC6856245 DOI: 10.1007/s40121-019-00273-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Universal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a significant overall decline of varicella-related hospitalizations (VRHs). We investigated the incidence of specific types of varicella-related complications (VRCs) in hospitalized children and the impact of UVV on VRCs during the first 7 years of UVV. METHODS Children < 17 years of age hospitalized with an ICD-10-based (International Classification of Diseases, 10th Revision) discharge diagnosis of varicella were identified as VRH in pediatric hospitals in Bavaria by annual standardized data queries of the hospital databases (2005-2011). For each VRH, the hospitals reported basic demographic data, duration of hospital stay, all diagnostic and procedural codes, and outcome. VRCs were reported overall, per year, and by immune status. Complication rates were calculated as mean number per complication category per hospital and per year; VRC trends over time were assessed by linear regression. RESULTS Between 78% (2005) and 61% (2011) of Bavarian hospitals participated and reported a total of 1263 VRHs. Specific VRCs were reported in 954 (76%) children. Complication rates per hospital and year decreased from 6.7 [95% confidence interval (CI): 5.1-8.3] in 2005 to 1.5 (95% CI: 0.8-2.3) in 2011, with the strongest reduction of 90% in children < 5 years of age from 5.3 (95% CI: 4.0-6.6) in 2005 to 0.5 (95% CI: 0.1-0.9) in 2011. Significant decreases were observed for children with upper respiratory tract (URT, by 97%), lower respiratory tract (LRT, by 90%), skin (by 81%), gastrointestinal (by 78%), and neurologic (by 65%) VRCs. Forty-eight children with VRCs were immunocompromised; their annual rate decreased by 87%. DISCUSSION Corresponding to increasing varicella vaccination coverage in the population, the incidence of VRC decreased by 77% from 2005 to 2011, with the most substantial decrease in the target group for UVV. CONCLUSION Within 7 years, UVV in Germany led to a decrease of about 77% of all types of VRCs, with the highest reductions observed for VRCs of the respiratory tract.
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Affiliation(s)
- Christine Hagemann
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Alexander Krämer
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | - Veit Grote
- Dr. von Haunersches Children's Hospital, University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
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Infarctus cérébral secondaire à une artériopathie post-varicelle chez l’enfant. Presse Med 2019; 48:198-201. [DOI: 10.1016/j.lpm.2018.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/30/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
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13
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Wutzler P, Bonanni P, Burgess M, Gershon A, Sáfadi MA, Casabona G. Varicella vaccination - the global experience. Expert Rev Vaccines 2017. [PMID: 28644696 DOI: 10.1080/14760584.2017.1343669] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Varicella, although a frequently benign childhood disease, nevertheless represents a considerable health burden. WHO recommends including varicella vaccines in universal routine vaccination programs, and maintaining coverage >80%. Many countries have successfully introduced varicella vaccination and have benefited from lower disease burden, but many others have not adopted the vaccine. Reasons include cost commitment for a 'mild childhood disease' or concerns that vaccination will shift varicella to older age groups or increase herpes zoster incidence. Areas covered: This literature review summarizes the effectiveness and epidemiological impact of varicella immunization programs. Expert commentary: Varicella vaccines are immunogenic with acceptable safety profiles. One and two dose schedules are highly effective against varicella and large reductions in disease incidence, particularly moderate-severe disease, have been widely reported. There is currently no evidence to suggest that the introduction of varicella vaccination results in a shift of varicella disease burden to older age groups. Although epidemiological studies have shown an increased incidence of herpes zoster since the vaccines were launched, there are many other contributing factors, and indeed, this secular trend was evident before their introduction. In conclusion, varicella vaccination easily fits into existing immunization programs and significantly reduces the often underestimated burden of varicella.
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Affiliation(s)
- Peter Wutzler
- a Institute of Virology and Antiviral Therapy , Friedrich Schiller University , Jena , Germany
| | - Paolo Bonanni
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Margaret Burgess
- c The Discipline of Paediatrics and Adolescent Health , University of Sydney , Sydney , Australia
| | - Anne Gershon
- d Division of Infectious Disease , Columbia University , New York , NY , USA
| | - Marco Aurélio Sáfadi
- e Department of Pediatrics , Santa Casa de Sao Paulo School of Medical Sciences , Sao Paulo , Brazil
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Bozzola E, Gattinara GC, Bozzola M, Mirante N, Masci M, Rossetti C, Krzystofiak A, Nicolosi L, Cutrera R, Lancella L, Tozzi AE, Villani A. Varicella associated pneumoniae in a pediatric population. Ital J Pediatr 2017; 43:49. [PMID: 28558810 PMCID: PMC5450302 DOI: 10.1186/s13052-017-0366-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Varicella pneumonia has been studied extensively in adults; it may also affect children and may require hospitalization. METHODS We examined pneumonia complications in children hospitalized for varicella, over a 13 year period. RESULTS Pneumonia occurred in 8.2% of children hospitalized for varicella. The median length of hospitalization was 6 days. No statistically significant difference in length of stay was detected between immunodepressed children and previously healthy children. The hospitalization was on average shorter in patients who started antiviral therapy within 24 h of varicella onset. None of the included patients had been previously immunized for varicella. CONCLUSIONS Our results support the need for increased awareness of current varicella prevention recommendations among both immunocompetent and immunodepressed individuals. In children affected by varicella, prompt antiviral therapy may be indicated to reduce the number of days of hospitalization.
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Affiliation(s)
- Elena Bozzola
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Guido Castelli Gattinara
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, Pediatrics and Adolescentology Unit, University of Pavia, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Nadia Mirante
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Masci
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Rossetti
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrzej Krzystofiak
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luciana Nicolosi
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- University/hospital Department of Pediatrics, Pulmonology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- Sanitary Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Alberto Villani
- University/hospital Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Varicella Susceptibility in Iran Military Conscripts: A Study Among Military Garrisons. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2016. [DOI: 10.5812/archcid.30600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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