Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-05T08:50:31.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Report of the Council on Scientific Affairs American Medical Association: Immunization of Healthcare Workers With Varicella Vaccine

Published online by Cambridge University Press:  02 January 2015

James M. Lyznicki ,
Rebecca J. Bezman ,
Myron Genel  and
Council on Scientific Affairs, American Medical Association
James M. Lyznicki
Affiliation:
Council on Scientific Affairs (CSA) of the American Medical Association, Chicago, Illinois
Rebecca J. Bezman
Affiliation:
Council on Scientific Affairs (CSA) of the American Medical Association, Chicago, Illinois
Myron Genel
Affiliation:
Council on Scientific Affairs (CSA) of the American Medical Association, Chicago, Illinois
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE: In June 1996, a resolution was introduced to the House of Delegates of the American Medical Association (AMA) asking the AMA to advocate that healthcare workers be given the informed option of receiving the varicella vaccine. The AMA Council on Scientific Affairs studied this issue and presented this report to the House of Delegates in June 1997.

METHODS:Information for the report was derived from published literature and from personal communications with medical and public health experts and the vaccine manufacturer.

FINDINGS: Nosocomial outbreaks of varicella-zoster virus (VZV) can result in serious morbidity and mortality. Sero-logical testing of healthcare workers and immunization of nonimmune individuals is recommended by infection control and infectious disease experts to prevent nosocomial transmission of VZV. While current data indicate that the vaccine is safe and poses minimal risks to both adults and children, ongoing research should address various concerns about the long-term safety, efficacy, and epidemiological impact of more widespread use of the vaccine.

CONCLUSION:Unless contraindicated, all susceptible healthcare workers should receive the varicella vaccine. Whereas individuals with a definite history of VZV infection can be considered immune, those with a negative or uncertain history should undergo serological testing and, if seronegative, should be immunized

Type
Special Report
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 5 , May 1998 , pp. 348 - 353
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Whitley, RJ. Varicella-zoster virus. In: Mandell, GR, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:1345–1351.Google Scholar
2. Benenson, AS. Control of Communicable Diseases Manual. 16th ed. Washington, DC: American Public Health Association; 1995.Google Scholar
3. Arvin, AM. Varicella-zoster virus. Clin Microbiol Rev 1996;9:361–381.CrossRefGoogle ScholarPubMed
4. Wharton, M. The epidemiology of varicella-zoster infections. Infect Dis Clin North Am 1996;10:571–581.CrossRefGoogle Scholar
5. Centers of Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices. MMWR 1996;45(RR-11):1–36.Google Scholar
6. Choo, PW, Donahue, JG, Manson, JE. The epidemiology of varicella and its complications. J Infect Dis 1995;172:706–712.CrossRefGoogle ScholarPubMed
7. Fairley, CK, Miller, E. Varicella-zoster epidemiology—a changing scene? J Infect Dis 1996;174(suppl 3):S314–S319.CrossRefGoogle ScholarPubMed
8. Preblud, SR. Varicella: complications and costs. Pediatrics 1986;78: 728–735.CrossRefGoogle ScholarPubMed
9. Plotkin, SA. Varicella vaccine. Pediatrics 1996;97:251–253.CrossRefGoogle ScholarPubMed
10. Katz, VL, Kuller, JA, McMahon, MJ, Warren, MA, Wells, SR. Varicella during pregnancy: maternal and fetal effects. West J Med 1995;163:446–450.Google ScholarPubMed
11. Seidman, DS, Stevenson, DK, Arvin, AM. Varicella vaccine in pregnancy. BMJ 1996;313:701–702.CrossRefGoogle ScholarPubMed
12. Pastuszak, AL, Levy, M, Schick, B, Zuber, C, Feldkamp, M, Gladstone, J, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 1994;330:901–905.CrossRefGoogle ScholarPubMed
13. 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;343:1548–1551.CrossRefGoogle ScholarPubMed
14. 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
15. Merck Vaccine Division. Varivax. Manufacturer's Package Insert. West Point, PA: Merck & Co, Inc; 1995.Google Scholar
16. Committee on Infectious Diseases, American Academy of Pediatrics. Recommendations for the use of live attenuated varicella vaccine. Pediatrics 1995;95:791–796.Google Scholar
17. Weibel, RE, Neff, BJ, Kuter, BJ, Guess, HA, Rothenberger, CA, Fitzgerald, AJ, et al. Live attenuated varicella virus vaccine: efficacy trial in healthy children. N Engl J Med 1984;310:1409–1415.CrossRefGoogle ScholarPubMed
18. White, CJ, Kuter, BJ, Hildebrand, CS, Isgantis, KL, Matthews, H, Miller, WJ, et al. Varicella vaccine (VARIVAX) in healthy children and adolescents: results from clinical trials, 1987 to 1989. Pediatrics 1991;87:604–610.Google ScholarPubMed
19. Gershon, AA, Steinberg, SP, LaRussa, P, Ferrara, A, Hammerschlag, M, Gelb, L, NIAID Collaborative Varicella Vaccine Study Group. Immunization of healthy adults with live attenuated varicella vaccine. J Infect Dis 1988;158:132–137.CrossRefGoogle Scholar
20. Kuter, BJ, Ngai, A, Patterson, CM, Staehle, BO, Cho, I, Matthews, H, et al. Safety, tolerability, and immunogenicity of two regimens of Oka/Merck varicella vaccine (Varivax) in healthy adolescents and adults. Vaccine 1995;13:967–972.CrossRefGoogle ScholarPubMed
21. Gershon, AA. Varicella-zoster virus: prospects for control. Adv Pediatr Infect Dis 1995;10:93–124.Google ScholarPubMed
22. Krause, PR, Klinman, DM. Efficacy, immunogenicity, safety, and use of live attenuated chickenpox vaccine. J Pediatr 1995;127:518–525.CrossRefGoogle ScholarPubMed
23. Watson, BM, Piercy, SA, Plotkin, SA, Starr, SE. Modified chickenpox in children immunized with the Oka/Merck varicella vaccine. Pediatrics 1993;91:17–22.CrossRefGoogle ScholarPubMed
24. Henderson, DK. Nosocomial herpesvirus infections. In: Mandell, GR, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:2656–2666.Google Scholar
25. Weber, DJ, Rutala, WA, Hamilton, H. Prevention and control of varicella-zoster infections in healthcare facilities. Infect Control Hosp Epidemiol 1996;17:694–705.CrossRefGoogle ScholarPubMed
26. Meyers, JD, MacQuarrie, MB, Merigan, TC, Jennison, MH. Nosocomial varicella, part 1: outbreak in oncology patients at a children's hospital. West J Med 1979;130:196–199.Google Scholar
27. Leclair, JM, Zaia, JA, Levine, MJ, Congdon, RG, Goldmann, DA. Airborne transmission of chickenpox in a hospital. N Engl J Med 1980;302:450–453.CrossRefGoogle ScholarPubMed
28. Josephson, A, Gombert, ME. Airborne transmission of nosocomial varicella from localized zoster. J Infect Dis 1988;158:238–241.CrossRefGoogle ScholarPubMed
29. 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
30. Ng, PC, Lyon, DJ, Wong, MY, Fok, TF, Wong, W, Cheung, KL, et al. Varicella exposure in a neonatal intensive care unit: emergency management and control measures. J Hosp Infect 1996;32:229–236.CrossRefGoogle Scholar
31. Preblud, SR. Nosocomial varicella: worth preventing, but how? Am J Public Health 1988;78:13–15.CrossRefGoogle Scholar
32. Centers for Disease Control. Guideline for infection control in hospital personnel. MMWR 1983;4(suppl):1–24.Google Scholar
33. Haiduven, DJ, Hench, CP, Stevens, DA. Postexposure varicella management of nonimmune personnel: an alternative approach. Infect Control Hosp Epidemiol 1994;15:329–334.CrossRefGoogle ScholarPubMed
34. Faoagali, JL, Darcy, DD. 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
35. 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
36. 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
37. McKinney, WP, Horowitz, MM, Battlola, RJ. Susceptibility of hospitalbased health care personnel to varicella-zoster virus infections. Am J Infect Control 1989;17:26–30.CrossRefGoogle ScholarPubMed
38. Gardner, P, Eickhoff, T, Poland, GA, Gross, P, Griffin, M, LaForce, M, et al. Adult immunization. Ann Intern Med 1996;12(1 pt 1):35–40.CrossRefGoogle Scholar
39. US Preventive Services Task Force. Adult immunizations. In: Guide to Clinical Preventive Services. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996:791–814.Google Scholar
40. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 4th ed. Washington, DC: American College of Obstetricians and Gynecologists; 1997.Google Scholar
41. Tsolia, M, Gershon, AA, Steinberh, SP, Gelb, L, NIAID Varicella Vaccine Collaborative Study Group. Live, attenuated varicella vaccine: evidence that the virus is attenuated and the importance of skin lesions in transmission of the varicella-zoster virus. J Pediatr 1990;116:184–189.CrossRefGoogle Scholar
42. Diaz, PS, Au, D, Smith, S, Amylon, M, Link, M, Smith, S, et al. Lack of transmission of the live attenuated varicella vaccine virus to immunocompro-mised children after immunization of their siblings. Pediatrics 1991;87:166–170.Google Scholar
43. Hughes, P, LaRussa, P, Pearce, JM, Lepow, M, Steinberg, S, Gershon, A. Transmission of varicella-zoster virus from a vaccinee with leukemia, demonstrated by polymerase chain reaction. J Pediatr 1994;124:932–935.CrossRefGoogle ScholarPubMed
44. Watson, B, Gupta, R, Randall, T, Starr, S. Persistence of cell-mediated and humoral immune responses in healthy children immunized with live attenuated varicella vaccine. J Infect Dis 1994;169:197–199.CrossRefGoogle ScholarPubMed
45. Asano, Y, Suga, S, Yoshikawa, T, Kobayashi, I, Yazaki, T, Shibata, M, et al. Experience and reason: twenty-year follow-up of protective immunity of the Oka strain live varicella vaccine. Pediatrics 1994;94:524–526.CrossRefGoogle ScholarPubMed
46. Brunell, PA, Taylor-Wiedeman, J, Geiser, CF, Frierson, L, Lydick, E. Risk of herpes zoster in children with leukemia: varicella vaccine compared with history of chickenpox. Pediatrics 1986;77:53–56.CrossRefGoogle ScholarPubMed
47. Lawrence, R, Gershon, AA, Holzman, R, Steinberg, SP, NIAID Varicella Vaccine Collaborative Study Group. The risk of zoster after varicella vaccination in children with leukemia. N Engl J Med 1988;318:543–548.CrossRefGoogle Scholar
48. Hardy, I, Gershon, AA, Steinberg, SP, LaRussa, P, NIAID Varicella Vaccine Collaborative Study Group. The incidence of zoster after immunization with live attenuated varicella vaccine: a study in children with leukemia. N Engl J Med 1991;325:1545–1550.CrossRefGoogle Scholar
49. Tennenberg, AM, Brassard, JE, Van Lieu, J, Drusin, LM. Varicella vaccination for healthcare workers at a university hospital: an analysis of costs and benefits. Infect Control Hosp Epidemiol 1997;18:405–411.CrossRefGoogle Scholar
50. Nettleman, MD, Schmid, M. Controlling varicella in the healthcare setting: the cost-effectiveness of using varicella vaccine in healthcare workers. Infect Control Hosp Epidemiol 1997;18:504–508.CrossRefGoogle ScholarPubMed