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Prevention and Control of Varicella-Zoster Infections in Healthcare Facilities

Published online by Cambridge University Press:  02 January 2015

David J. Weber ,
William A. Rutala  and
Holli Hamilton
David J. Weber*
Affiliation:
Division of Infectious Disease, University of North Carolina School of Medicine Department of Epidemiology, University of North Carolina School of Public Health Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
William A. Rutala
Affiliation:
Division of Infectious Disease, University of North Carolina School of Medicine Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
Holli Hamilton
Affiliation:
Division of Infectious Disease, University of North Carolina School of Medicine Department of Epidemiology, University of North Carolina School of Public Health
*
547 Burnett-Womack, CB #7030, Division of Infectious Diseases, UNC at Chapel Hill, Chapel Hill, NC 27599-7030
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Abstract

Varicella-zoster virus (VZV) is the causative agent of two diseases: varicella (chickenpox) and zoster (shingles). Although varicella generally is a mild disease in children, serious morbidity and mortality are common if infection occurs in neonates, pregnant women, adults, or immunocompromised patients. For this reason, the Centers for Disease Control and Prevention recommends that all the hospitals institute control measures. Healthcare workers should be screened for VZV immunity and, if susceptible, should receive the recently licensed Oka/Merck vaccine (unless contraindicated). This article reviews nosocomial outbreaks associated with VZV and provides detailed algorithms for preexposure immunization and postexposure management of healthcare workers exposed to VZV.

Type
Topics in Occupational Medicine
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 10 , October 1996 , pp. 694 - 705
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

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References

1. Plotkin, SA. Clinical and pathogenetic aspects of varicella-zoster. Postgrad Med J 1985;61(suppl 4):7–14.Google ScholarPubMed
2. Straus, SE, Ostrove, JM, Inchauspe, G, et al. National Institute of Health conference. Varicella-zoster virus infections: biology, natural history, treatment, and prevention. Ann Intern Med 1988;108:221–237. Published erratum appears in Ann Intern Med 1988;109:438-439.CrossRefGoogle ScholarPubMed
3. Brunell, PA. Varicella-zoster infections. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases. 3rd ed. Philadelphia, PA: WB Saunders Co; 1992:1587–1591.Google Scholar
4. Drwal-Klein, LA, O'Donovan, CA. Varicella in pediatric patients. Ann Pharmacother 1993;27:938–949.CrossRefGoogle ScholarPubMed
5. Whitley, RJ. Varicella-zoster virus. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:1345–1351.Google Scholar
6. Williams, WW. Centers for Disease Control guideline for infection control in hospital personnel. Infect Control 1983;4:326–349.Google ScholarPubMed
7. Garner, JS. Centers for Disease Control guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
8. 1994 Red Book: Report of the Committee on Infectious Diseases. 23rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 1994.Google Scholar
9. Brunell, PA. Contagion and varicella-zoster virus. Pediatr Infect Dis J 1982;1:304–307.Google ScholarPubMed
10. Brawley, RL, Wenzel, RP. An algorithm for chickenpox exposure. Pediatr Infect Dis J 1984;3:502–504.CrossRefGoogle ScholarPubMed
11. Weitekamp, MR, Schan, P, Aber, RC. An algorithm for the control of nosocomial varicella-zoster virus infection. Am J Infect Control 1985;13:193–198.CrossRefGoogle ScholarPubMed
12. Sayre, MR, Lucid, EJ. Management of varicella-zoster virusexposed hospital employees. Ann Emerg Med 1987;16:421–424.CrossRefGoogle ScholarPubMed
13. Weber, DJ, Rutala, WA, Parham, C. Impact and costs of varicella prevention in a University Hospital. Am J Public Health 1988;78:19–23.CrossRefGoogle ScholarPubMed
14. Preblud, SR, D'Angelo, LJ. Chickenpox in the United States, 1972-1977. J Infect Dis 1979;140:257–260.CrossRefGoogle ScholarPubMed
15. Guess, HA, Broughton, DD, Melton, LJ, Kurland, LT. Population-based studies of varicella complications. Pediatrics 1986;78(suppl):723–727.CrossRefGoogle ScholarPubMed
16. Wharton, M, Fehrs, LJ, Cochi, SL, Stroup, NE. The health impact of varicella in the 1980s. In: Program and Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy, American Society of Microbiology; October 21-24, 1990; Atlanta, GA. Abstract 1138. Washington, DC: American Society for Microbiology, 1990:276.Google Scholar
17. Kelley, PW, Petruccelli, BP, Stehr-Green, P, Erickson, RL, Mason, CJ. The susceptibility of young adult Americans to vaccine-preventable infections: a national serosurvey of US Army recruits. JAMA 1991;266:2724–2729.CrossRefGoogle ScholarPubMed
18. Struewing, JP, Hyams, KC, Tueller, JE, Gray, GC. The risk of measles, mumps, and varicella among young adults: a sero-survey of US Navy and Marine Corps recruits. Am J Public Health 1993;83:1717–1720.CrossRefGoogle Scholar
19. Guess, HA, Broughton, DD, Melton, LJ, Kurland, LT. Chickenpox hospitalizations among residents of Olmstead County, Minnesota, 1962 through 1981. Am J Dis Child 1984;138:1055–1057.CrossRefGoogle Scholar
20. Gray, GC, Palinkas, LA, Kelley, PW. Increasing incidence of varicella hospitalizations in United States Army and Navy personnel: are today's teenagers more susceptible? Should recruits be vaccinated? Pediatrics 1990;86:867–873.CrossRefGoogle ScholarPubMed
21. Choo, PW, Donahue, JG, Manson, JE, Platt, R. The epidemiology of varicella and its complications. J Infect Dis 1995;172:706–712.CrossRefGoogle ScholarPubMed
22. Miller, E, Vurdien, J, Farrington, P. Shift in age in chickenpox. Lancet 1993;341:308–309.CrossRefGoogle ScholarPubMed
23. Simpson, REH. Infectiousness of communicable diseases in the household (measles, chickenpox, and mumps). Lancet 1952;2:549–554.CrossRefGoogle Scholar
24. Ross, AH. Modification of chickenpox in family contacts by administration of gamma globulin. N Engl J Med 1962;267:369–376.CrossRefGoogle ScholarPubMed
25. Josephson, A, Karanfil, L, Gombert, ME. Strategies for the management of varicella-susceptible healthcare workers after a known exposure. Infect Control Hosp Epidemiol 1990;11:309–313.CrossRefGoogle ScholarPubMed
26. Sinna, DP. Chickenpox-a disease predominantly affecting adults in rural West Bengal, India. Int J Epidemiol 1976;5:367–374.CrossRefGoogle Scholar
27. Miller, E, Marshall, R, Vurdien, J. Epidemiology, outcome and control of varicella-zoster infection. Rev Med Microbiol 1993;4:222–230.CrossRefGoogle Scholar
28. Feldman, S. Hughes, WT, Daniel, CB. Varicella in children with cancer: seventy-seven cases. Pediatrics 1975;56:388–397.CrossRefGoogle ScholarPubMed
29. Feldhoff, CM, Balfour, HH, Simmons, RL, Nagarian, JS, Mauer, SM. Varicella in children with renal transplants. J Pediatr 1981;98:25–31.CrossRefGoogle ScholarPubMed
30. Locksley, RM, Flournoy, N, Sullivan, KM, Meyers, JD. Infection with varicella-zoster virus after marrow transplantation. J Infect Dis 1985;152:1172–1181.CrossRefGoogle ScholarPubMed
31. Meyers, JD, MacQuarrie, MB, Merigan, TC, Jennison, MH. Part 1: Nosocomial varicella: outbreak in oncology patients at a children's hospital. West J Med 1979;130:196–199.Google Scholar
32. Morgan, ER, Smalley, LA. Varicella in immunocompromised children. Am J Dis Child 1983;137:883–885.CrossRefGoogle ScholarPubMed
33. Whitley, R, Hilty, M, Haynes, R, et al. Vidarabine therapy of varicella in immunosuppressed patients. J Pediatr 1982;101:125–131.Google ScholarPubMed
34. Laforet, EG, Lynch, CL. Multiple congenital defects following maternal varicella. N Engl J Med 1947;236:534–537.CrossRefGoogle ScholarPubMed
35. Enders, G, Miller, E, Cradock-Watson, J, Bolley, I, Ridehalgh, M. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet 1994;343:1547–1550.CrossRefGoogle ScholarPubMed
36. Gershon, AA. Varicella-zoster virus: prospects for control. Adv Pediatr Infect Dis 1995;10:93–124.Google ScholarPubMed
37. Pastuszak, AL, Levy, M, Schick, B, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 1994;330:901–905.CrossRefGoogle ScholarPubMed
38. Meyers, JD. Congenital varicella in term infants: risk reconsidered. J Infect Dis 1974;129:215–217.CrossRefGoogle ScholarPubMed
39. Miller, E, Cradock-Watson, JE, Ridehalgh, MK. Outcome in newborn babies given anti-varicella-zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus. Lancet 1989;2:371–373.CrossRefGoogle ScholarPubMed
40. Sterner, G, Forsgren, M, Enocksson, E, Grandien, M, Granstrom, G. Varicella-zoster infections in late pregnancy. Scand J Infect Dis 1990;71(suppl):30–35.Google ScholarPubMed
41. Guess, HA, Broughton, DD, Melton, LJ, Kurland, LT. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics 1985;76:512–517.CrossRefGoogle ScholarPubMed
42. Hardy, IRB, Gershon, AA. Prospects for use of a varicella vaccine in adults. Infect Dis Clin North Am 1990;4:159–173.CrossRefGoogle ScholarPubMed
43. Gershon, AA, LaRussa, P, Hardy, I, Steinberg, S, Silverstein, S. Varicella vaccine: the American experience. J Infect Dis 1992;166(suppl 1):63S–68S.CrossRefGoogle ScholarPubMed
44. Takahashi, M, Otsuka, T, Okuno, Y, Asano, Y, Yazaki, T, Isomura, S. Live vaccine used to prevent the spread of varicella in children in hospital. Lancet 1974;2:1288–1290.CrossRefGoogle ScholarPubMed
45. Gershon, AA. Varicella vaccine: its past, present and future. Pediatr Infect Dis J 1995;14:742–744.CrossRefGoogle ScholarPubMed
46. Committee on Infectious Diseases. Recommendations for the use of live attenuated varicella vaccine. Pediatrics 1995;95:791–796.Google Scholar
47. Anonymous. Varicella vaccine. Med Lett 1995;37:55–57.Google Scholar
48. Gardner, P, Eickoff, T, Poland, GA, et al. Adult immunizations. Ann Intern Med 1996;124:35–40.CrossRefGoogle ScholarPubMed
49. Preblud, SR, Orenstein, WA, Koplan, JP, Bart, KJ, Hinman, AR. A benefit-cost analysis of a childhood varicella vaccination programme. Postgrad Med J 1985;61(suppl 4):17–22.Google ScholarPubMed
50. Lieu, TA, Cochi, SL, Black, SB, et al. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994;271:375–381.CrossRefGoogle ScholarPubMed
51. Weibel, RE, Neff, BJ, Kuter, BJ, et al. Live attenuated varicella vaccine. Efficacy trial in healthy children. N Engl J Med 1984;310:1409–1415.CrossRefGoogle ScholarPubMed
52. Arbeter, AM, Starr, DE, Preblud, SR, et al. Varicella vaccine trials in healthy children: a summary of comparative and follow-up studies. Am J Dis Child 1984;138:434–438.CrossRefGoogle ScholarPubMed
53. Weibel, RE, Kuter, BJ, Neff, BJ, et al. Live Oka/Merck varicella vaccine in healthy children: further clinical and laboratory assessment. JAMA 1985;254:2435–2439.CrossRefGoogle ScholarPubMed
54. Arbeter, AM, Starr, SE, Plotkin, SA. Varicella vaccine studies in healthy children and adults. Pediatrics 1986;78(suppl):748–756.Google ScholarPubMed
55. Johnson, CE, Shurin, PA, Fattlar, D, Rome, LP, Kumar, ML. Live attenuated varicella vaccine in healthy 12- to 24-month-old children. Pediatrics 1988;81:512–518.CrossRefGoogle ScholarPubMed
56. Gershon, AA, Steinberg, SP, LaRussa, P, et al. Immunization of healthy adults with live attenuated varicella vaccine. J Infect Dis 1988;158:132–137.CrossRefGoogle ScholarPubMed
57. Kuter, BJ, Wiebel, RE, Guess, HA, et al. Oka/Merck varicella vaccine in healthy children: final report of a 2-year efficacy study and 7-year follow-up studies. Vaccine 1991;9:643–647.CrossRefGoogle ScholarPubMed
58. White, CJ, Kuter, B, Hildebrand, CS, et al. Varicella vaccine (Varivax) in healthy children and adolescents: results from clinical trials, 1987 to 1989. Pediatrics 1991;87:604–610.Google ScholarPubMed
59. Varivax. Package Insert. Merck & Co, Inc. 1996.Google Scholar
60. Black, S, Shinefield, H, Ray, P, et al. Safety of varicella vaccine: results of post-marketing surveillance in 32,947 recipients of Varivax (MSD). In: Program and Abstracts of the Society for Pediatric Research; May 10-11, 1996; Washington, DC. Google Scholar
61. Diaz, PS, Au, D, Smith, S, et al. Lack of transmission of the live attenuated varicella vaccine virus to immunocompromised children after immunization of their siblings. Pediatrics 1991;87:166–170.Google ScholarPubMed
62. Myers, MG, Rasley, DA, Hierholzer, WJ. Hospital infection control for varicellazoster virus infection. Pediatrics 1982;70:199–201.CrossRefGoogle Scholar
63. Steele, RW, Coleman, MA, Fiser, M, Bradsher, RW. Varicella-zoster in hospital personnel: skin test reactivity to monitor susceptibility. Pediatrics 1982;70:604–608.CrossRefGoogle ScholarPubMed
64. Hyams, PJ, Stuewe, MCS, Heitzer, V. Herpes zoster causing varicella (chickenpox) in hospital employees: cost of a casual attitude. Am J Infect Control 1984;12:2–5.CrossRefGoogle ScholarPubMed
65. Alter, SJ, Hammond, JA, McVey, CJ, Myers, MG. Susceptibility to varicella-zoster virus among adults at high risk for exposure. Infect Control 1986;7:448–451.CrossRefGoogle ScholarPubMed
66. Krasinski, K, Holzman, RS, LaCouture, R, Florman, A. Hospital experience with varicella-zoster virus. Infect Control 1986;7:312–316.CrossRefGoogle ScholarPubMed
67. Haiduven-Griffiths, D, Fecko, H. Varicella in hospital personnel: a challenge for the infection control practitioner. Am J Infect Control 1987;15:207–211.CrossRefGoogle ScholarPubMed
68. McKinney, WP, Horowitz, MM, Battiola, RJ. Susceptibility of hospital-based health care personnel to varicella-zoster virus infections. Am J Infect Control 1989;17:26–30.CrossRefGoogle ScholarPubMed
69. Stover, BH, Cost, KM, Hamm, C, Adams, G, Cook, LN. Varicella exposure in a neonatal intensive care unit: case report and control measures. Am J Infect Control 1988;16:167–172.CrossRefGoogle Scholar
70. Shehab, ZM, Brunell, PA. Susceptibility of hospital personnel to varicella-zoster virus. J Infect Dis 1984;150:786.CrossRefGoogle ScholarPubMed
71. Haiduven, DJ, Hench, CP, Stevens, DA. Postexposure varicella management of nonimmmune personnel: an alternative approach. Infect Control Hosp Epidemiol 1994;15:329–334.CrossRefGoogle Scholar
72. Gustafson, TL, Shehab, Z, Brunell, PA. Outbreak of varicella in a newborn intensive care nursery. Am J Dis Child 1984;138:548–550.Google Scholar
73. Evans, P An epidemic of chickenpox. Lancet 1940;2:339–340.CrossRefGoogle Scholar
74. McKendrick, GDW, Emond, RTD. Investigation of cross-infection in isolation wards of different designs. J Hyg (Camb) 1976:76:23–31.CrossRefGoogle Scholar
75. Morens, DM, Bregman, DJ, West, CM, et al. An outbreak of varicella-zoster virus infection among cancer patients. Ann Intern Med 1980;93:414–419.CrossRefGoogle ScholarPubMed
76. Leclair, JM, Zaia, JA, Levin, MJ, Congdon, RG, Goldmann, DA. Airborne transmission of chickenpox in a hospital. N Engl J Med 1980;302:450–453.CrossRefGoogle ScholarPubMed
77. Scheifele, D, Bonner, M. Airborne transmission of chicken-pox. N Engl J Med 1980;303:281–282. Letter.Google Scholar
78. Asano, Y, Iwayama, S, Miyata, T, et al. Spread of varicella in hospitalized children having no direct contact with an indicator zoster case and its prevention by a live vaccine. Biken J 1980;23:157–161.Google ScholarPubMed
79. Faizallah, R, Green, HT, Krasner, N, Walker, RJ. Outbreak of chickenpox from a patient with immunosuppressed herpes zoster in hospital. Br Med J 1982;285:1022–1023.CrossRefGoogle ScholarPubMed
80. Gustafson, TL, Lavely, GB, Brawner, ER, Hutcheson, RH, Wright, PF, Schaffner, W. An outbreak of airborne nosocomial varicella. Pediatrics 1982;70:550–556.CrossRefGoogle ScholarPubMed
81. Tsujino, G, Sako, M, Takahashi, M. Varicella infection in a children's hospital: prevention by vaccine and an episode of airborne transmission. Biken J 1984;27:129–132.Google Scholar
82. Anderson, JD, Bonner, M, Schiefele, DW, Schneider, BC. Lack of nosocomial spread of varicella in a pediatric hospital with negative pressure ventilated patient rooms. Infect Control 1985;6:120–121.CrossRefGoogle Scholar
83. Josephson, A, Gombert, M. Airborne transmission of nosocomial varicella from localized zoster. J Infect Dis 1988;158:238–241.CrossRefGoogle ScholarPubMed
84. Morgan-Capner, P, Wilson, M, Wright, J, Hutchinson, DN. Varicella and zoster in hospitals. Lancet 1990;335:1460.CrossRefGoogle Scholar
85. Friedman, CA, Temple, DM, Robbins, KK, Rawson, JE, Wilson, JP, Feldman, S. Outbreak and control of varicella in a neonatal intensive care unit. Pediatr Infect Dis J 1994;13:152–153.Google Scholar
86. Faoagali, JL, Darcy, D. Chickenpox outbreak among the staff of a large, urban adult hospital: costs of monitoring and control. Am J Infect Control 1995;23:247–250.CrossRefGoogle ScholarPubMed
87. Sawyer, MH, Chamberlin, CJ, Wu, YN, Aintablian, N, Wallace, MR. Detection of varicella-zoster virus DNA in air samples from hospital rooms. J Infect Dis 1994;169:91–94.CrossRefGoogle ScholarPubMed
88. Nettleman, MD, Schmid, M. Cost-effectiveness of varicella vaccination in hospital employees. In: Program and Abstracts of the 6th Annual Meeting of Society for Healthcare Epidemiology of America; April 21-23, 1996; Washington, DC. Abstract 70.Google Scholar
89. Hamilton, HA. A Cost Minimization Analysis of Varicella Vaccine in Healthcare Workers. Chapel Hill, NC: University of North Carolina School of Public Health; 1996. Thesis.Google Scholar
90. Asano, Y, Yoshikawa, T, Suga, S, et al. Postexposure prophylaxis of varicella in family contact by oral acyclovir. Pediatrics 1993;92:219–222.CrossRefGoogle ScholarPubMed
91. Suga, S, Yoshikawa, T, Ozaki, T, Asano, Y. Effect of oral acyclovir against primary and secondary viremia in incubation period of varicella. Arch Dis Child 1993;69:639–642.CrossRefGoogle ScholarPubMed
92. Abe, C, Bradley, J. Varicella in a pediatric convalescent hospital: controlling clinical disease following widespread exposure. In: Program and Abstracts of the 5th Annual Meeting of Society of Healthcare Epidemiology of America; April 2-4, 1995; San Diego, CA. Abstract S32.Google Scholar
93. Asano, Y, Nakayama, H, Yazaki, T, Ito, S, Isomura, S, Takahasi, M. Protective efficacy of vaccination in children in four episodes of natural varicella and zoster in the ward. Pediatrics 1977;59:8–12.Google ScholarPubMed
94. Udeda, K, Yamada, I, Goto, M, et al. Use of a live varicella vaccine to prevent the spread of varicella in handicapped or immunosuppressed children including MSLC (muco-cuta-neous lymph node syndrome) patients in hospitals. Biken J 1977;20:117–123.Google Scholar
95. Katsushima, N, Yazaki, N, Sakamoto, M, et al. Application of a live varicella vaccine to hospitalized children and its follow-up study. Biken J 1982;25:29–42.Google ScholarPubMed
96. Asano, Y, Hirose, S, Iwayama, S, Miyata, T, Yazaki, T, Takahashi, M. Protective effect of immediate inoculation of a live varicella vaccine in household contacts in relation to the viral dose and interval between exposure and vaccination. Biken J 1982;25:43–45.Google Scholar
97. Katsushima, N, Yazaki, N, Sakamoto, M. Effect and follow-up study of varicella vaccine. Biken J 1984;27:51–58.Google ScholarPubMed
98. Sugino, H, Tsukino, R, Miyashiro, E, et al. Live varicella vaccine: prevention of nosocomial infection and protection of high risk infants from varicella infection. Biken J 1984;27:63–65.Google ScholarPubMed
99. Naganuma, Y, Osawa, S, Takahashi, R. Clinical application of a live varicella vaccine (Oka strain) in a hospital. Biken J 1984;27:59–61.Google ScholarPubMed
100. Boda, D, Bartyik, K, Szuts, P Turi, S. Active immunization of children exposed to varicella infection in a hospital ward using live attenuated varicella vaccine given subcutaneously or intracuta-neously. Acta Paeditrica Hungarica 1986;27:247–252.Google Scholar
101. Advisory Committee on Immunization Practices (ACIP). Varicella-zoster immune globulin for the prevention of chick-enpox. MMWR 1984;33:84–90,95-96,99-100.Google Scholar
102. Balfour, HH. Current management of varicella zoster virus infections. J Med Virol 1993;(suppl 1):74–81.CrossRefGoogle ScholarPubMed
103. Anonymous. Val acyclovir. Med Lett 1996;38:3–4.Google Scholar
104. Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(RR-11):1–36.Google Scholar