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Controlling Varicella in the Healthcare Setting: The Cost Effectiveness of Using Varicella Vaccine in Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Mary D. Nettleman  and
Marlene Schmid
Mary D. Nettleman*
Affiliation:
Division of General Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond Virginia
Marlene Schmid
Affiliation:
University of Wisconsin–Madison, Madison, Wisconsin. At the time of this writing, Dr. Nettleman was affiliated with the University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
Division of General Medicine, Department of Internal Medicine, Medical College of Virginia, 207 West Hospital, PO Box 980102, Richmond, VA 23298-0102
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Abstract

Objective:

To determine if varicella vaccination of healthcare workers would result in a net cost savings.

Design:

A Markov-based decision analysis.

Setting:

The analysis was based on a hypothetical population of healthcare workers. Data were obtained from exposure records of a tertiary-care hospital and from the literature. Workers were considered potentially susceptible if they had no past history of varicella.

Results:

Vaccination of potentially susceptible workers would result in a net cost savings of $59 per person. Serological testing prior to vaccination resulted in smaller net savings. The results were robust across a wide range of assumptions. Importantly, however, the result was very dependent on infection control policy regarding work restrictions for vaccine recipients. If more than 3% of vaccinees were removed from work due to vaccine-associated rash, vaccination no longer would result in a net cost savings.

Conclusion:

Varicella vaccination of potentially susceptible healthcare workers can reduce costs and decrease morbidity. Infection control policy regarding work restrictions for vaccine recipients will play a key role in the feasibility of vaccination.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 7 , July 1997 , pp. 504 - 508
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Ford-Jones, EL. The special problems of nosocomial infection in the pediatric patient. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Baltimore, MD: Williams & Wilkins; 1993:812–896.Google Scholar
2. Preblud, SR. Nosocomial varicella: worth preventing, but how? Am J Public Health 1988;78:13–15.Google Scholar
3. Weber, DJ, Rutala, WA, Parham, C. Impact and costs of varicella prevention in a university hospital. Am J Public Health 1988;78:19–23.Google Scholar
4. Hyams, PJ, Stuewe, MCS, Heitzer, V. Herpes zoster causing varicella in hospital employees: cost of a casual attitude. Am J Infect Control 1984;12:2–5.CrossRefGoogle ScholarPubMed
5. Lewis, DA, Jenks, P, Gent, AEM, Side, L, Breuer, J. Varicella-zoster vaccination for healthcare workers. Lancet 1994;343:1362–1363.Google Scholar
6. Haiduven, DJ, Hench, CP, Stevens, DA. Postexposure varicella management of nonimmune personnel: an alternative approach. Infect Control Hosp Epidemiol 1994;15:329–334.Google Scholar
7. White, CJ, Kuter, BJ, 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
8. Asano, Y, Suga, S, Yoshikawa, T, et al. Experience and reason: twenty-year follow-up of protective immunity of the Oka strain live varicella vaccine. Pediatrics 1994;94(4 Pt 1):524–526.Google Scholar
9. Lieu, TA, Cochi, SL, Black, SB, et al. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994;271:375–381.Google Scholar
10. Huse, DM, Meissner, HC, Lacey, MJ, Oster, G. Childhood vaccination against chicken pox: an analysis of benefits and costs. J Pediatr 1994;124:869–874.CrossRefGoogle ScholarPubMed
11. Sonnenberg, FA, Beck, JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993;13:322–328.Google Scholar
12. Beck, JR, Pauker, SG. The Markov process in medical prognosis. Med Decis Making 1983;3:419–458.Google Scholar
13. Gershon, AA, Steinberg, S, LaRussa, P, Hammerschlag, M, Ferrara, A, the NIAID Collaborative Varicella Vaccine Study Group. Immunization of healthy adults with live attenuated varicella vaccine. J Infect Dis 1988;158:132–137.Google Scholar
14. Gershon, AA, LaRussa, P, Steinberg, S. Live attenuated varicella vaccine: current status and future uses. Semin Pediatr Infect Dis 1991;2:171–178.Google Scholar
15. Gershon, AA, LaRussa, P, Hardy, I, Steinberg, S, Silverstein, S. Varicella vaccine: the American experience. J Infect Dis 1992;166(suppl 1):63S–68S.Google Scholar
16. Weibel, RE, Neff, BJ, Kuter, BJ, et al. Live attenuated varicella virus vaccine: efficacy trial in healthy children. N Engl J Med 1984;310:1409–1415.Google Scholar
17. Medical Letter. Varicella vaccine. Medical Letter 1995;37:55–57.Google Scholar
18. Tsolia, M, Gershon, AA, Steinberg, SP, et al. Live attenuated varicella vaccine: evidence that the virus is attenuated and the importance of skin lesions in transmission of varicella-zoster virus. J Pediatr 1990;116:184–189.Google Scholar
19. Preblud, SR. Varicella: complications and costs. Pediatrics 1986;78(suppl):728–735.Google Scholar
20. Choo, PW, Donahue, JG, Manson, JE, Platt, R. The epidemiology of varicella and its complications. J Infect Dis 1995;172:706–712.Google Scholar
21. Lieu, TA, Finkler, LJ, Sorel, ME, Black, SB, Shinefield, HR. Cost-effectiveness of varicella serotesting versus presumptive vaccination of school-age children and adolescents. Pediatrics 1995;95:632–638.Google Scholar
22. Centers for Disease Control. Guideline for infection control in hospital personnel. MMWR 1983;4(suppl):1–24.Google Scholar
23. Merck & Co. Varivax (Varicella Virus Vaccine Live [Oka/Merck]). Product literature and insert, 1995.Google Scholar
24. Bernstein, HH, Rothstein, EP, Pennridge Pediatric Associates, et al. Clinical survey of natural varicella compared with breakthrough varicella after immunization with live attenuated Oka/Merck varicella vaccine. Pediatrics 1993;92:833–837.Google Scholar
25. Nelson, KE, Sullivan-Bolyai, JZ. Preventing teratogenic viral infections in hospital employees: the cases of rubella, cytomegalovirus, and varicella-zoster virus. Occup Med 1987;2:471–498.Google ScholarPubMed
26. Balducci, J, Rodis, JF, Rosengren, S, Vintzileos, AM, Spivey, G, Vosseller, C. Pregnancy outcome following first-trimester varicella infection. Obstet Gynecol 1992;79:5–6.Google Scholar
27. Brunell, PA. Varicella in pregnancy, the fetus, and the newborn: problems in management. J Infect Dis 1992;166(suppl 1):42S–47S.Google Scholar
28. Hardy, I, Gershon, AA, Steinberg, SP, LaRussa, P, the 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.Google Scholar
29. Centers for Disease Control and Prevention. Prevention of varicella. MMWR 1996;45(RR-11):2–6.Google Scholar
30. Gurevich, I, Jensen, L, Kalter, R, Cunha, BA. Chicken pox in apparently ‘immune’ hospital workers. Infect Control Hosp Epidemiol 1990;11:510–512. Letter.Google Scholar
31. 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