Seroconversion rates in healthcare workers using a latex agglutination assay after varicella virus vaccination

Postexposure Prophylaxis Against Varicella-Zoster Virus Infection Among Recipients of Hematopoietic Stem Cell Transplant: Unresolved Issues

Recent guidelines for the prevention of opportunistic infections have addressed a variety of issues germane to recipients of hematopoietic stem cell transplant. However, there are several issues regarding postexposure prophylaxis against varicella-zoster virus that remain unresolved. We address these questions and offer several consensus recommendations.

Measles, mumps, rubella, and varicella immunization status of first responders--a policy proposal

The responsibility of occupational health nursing often extends to the communities that workers serve. This is especially true for first responders (i.e., firefighters, paramedics, and emergency medical technicians) and their measles, mumps, rubella, and varicella status.

Prevalence of childhood exanthematic disease antibodies in paramedical students: need of vaccination

The immunity to common childhood exanthematic diseases such as varicella, rubella, mumps and measles was evaluated in 1024 students of the degree courses of health professions at Padua University Medical School. Subjects were subdivided according to gender and age (25 years old or less, and older than 25 years). Results showed that the prevalence of positive antibodies (IgG) to varicella and rubella (94.1 and 94.5%, respectively) was significantly higher (p<0.001) than mumps (78.6%) and measles (86.3%). In addition, measles showed a significant higher prevalence than mumps (p<0.001). Prevalence of positive antibodies to rubella in females (97.4%) was significantly higher (p<0.001) than males (87.5%), but only if aged 25 years or less. Furthermore, males older than 25 years were significantly more immune (p<0.001) to measles (93.0%) than younger ones (84.3%). A vaccination strategy was applied but compliance was less than 50%; in addition, about 40.0% of vaccinated subjects eluded control after vaccination. Seroconversion after vaccine appeared high for rubella, mumps and measles (92.3, 88.9 and 88.1%, respectively), but low for varicella (43.8%).

Management of varicella-vaccinated patients and employees exposed to varicella in the healthcare setting

Varicella exposures from patients, visitors, and staff continue to occur in healthcare facilities. In a recent report from the National Surveillance System for Health Care Workers, 9 participating hospitals reported 72 varicella exposures from 1996 to 1999, involving 1,111 health-care workers. Depending on the patient and employee demographics for any particular healthcare institution, the number of these exposures can vary. Many healthcare facilities follow the guidelines of the Hospital Infection Control Practices Advisory Committee for non-immune employees exposed to varicella. These guidelines recommend that such employees be excluded from duty from 8 to 21 days after exposure to varicella. There is no standard definition of what constitutes exposure to varicella, which can result in employees' being excluded from duty on one or more occasions without having contracted chickenpox. We previously reported our experience of allowing non-immune employees exposed to varicella to work while wearing masks, checking daily for prodromal symptoms, and excluding these employees from duty only if such symptoms occurred. Since our original report from 1994, we have continued this practice without adverse consequences.

A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000

BACKGROUND

Nosocomial infections (NIs) are a serious patient safety issue. Infection control personnel are responsible for implementing interventions to reduce this risk. The purpose of this systematic review was to audit the published economic evidence of the attributable cost of NIs and interventions conducted by infection control professionals and to evaluate the methods used. Economic evaluation methodology and recommendations for standardization are reviewed.

METHODS

A search of MEDLINE and HealthSTAR with medical subject headings or text words "nosocomial infections," "infection control," or "hospital acquired infections" cross-referenced with "costs," "cost analysis," "economics," or "cost-effectiveness analysis" was conducted. Published review articles were also searched. Inclusion criteria included articles published between 1990 and 2000 that contained an abstract and original cost estimate and were written in English. Results were standardized into a common currency.

RESULTS

Fifty-five studies were eligible. Approximately one quarter examined NIs in intensive care patients (n = 13). Most studies were conducted from the hospital perspective (n = 48). The costs attributable to bloodstream (mean = $38,703) and methicillin-resistant Staphylococcus aureus infections (mean = $35,367) were the largest.

CONCLUSIONS

Increased standardization and rigor are needed. Clinicians should partner with economists and policy analysts to expand and improve the economic evidence available to reduce hospital complications such as NI and other adverse patient/staff outcomes.

Live-attenuated varicella vaccine

This article reviews the history and development of live attenuated varicella vaccine from its early days in Japan to its widespread use throughout the world. The vaccine has proven extremely safe after immunization of as many as 10 million healthy children and adults in the United States alone. The vaccine is also highly immunogenic and offers close to 100% protection from severe chickenpox and 90% protection from illness. It is expected to have a major impact on the epidemiology of varicella and zoster in countries with high vaccine uptake.