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Outbreak of Varicella-Zoster Virus Infection Among Thai Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak ,
Rungrueng Kitphati ,
Pranee Tawatsupha ,
Kanokporn Thongphubeth ,
Piyaporn Apisarnthanarak  and
Linda M. Mundy
Anucha Apisarnthanarak*
Affiliation:
Infectious Diseases Division, Thammasart University Hospital, Pratumthani
Rungrueng Kitphati
Affiliation:
Department of Medical Science, National Institute of Health, Nonthaburi
Pranee Tawatsupha
Affiliation:
Department of Medical Science, National Institute of Health, Nonthaburi
Kanokporn Thongphubeth
Affiliation:
Infection Control Unit, Faculty of Medicine, Thammasart University Hospital, Pratumthani
Piyaporn Apisarnthanarak
Affiliation:
Department of Radiology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
Linda M. Mundy
Affiliation:
Saint Louis University School of Public Health, St. Louis, Missouri
*
Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pratumthani, Thailand, 12120 ([email protected])
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Abstract

Objective.

To evaluate the correlation between self-report of a prior history of chickenpox and results of varicella-zoster virus (VZV) immunoglobulin (Ig) G serologic test results in an outbreak of VZV infection among Thai healthcare workers (HCWs) and to conduct a cost-benefit analysis of establishing routine VZV immunization as part of an occupational health program on the basis of the outbreak data.

Methods.

All exposed patients received prophylaxis and the HCWs in our 3 intensive care units (ICUs) were prospectively evaluated. HCWs were assessed for disease history and serologic evidence of VZV IgG. A cost-benefit analysis was performed.

Results.

After 140 HCWs and 18 ICU patients were exposed to VZV, 10 HCWs (7%) with active VZV infection were relieved from work until skin lesions were crusted. Acyclovir (ACV) was prescribed to all 10 HCWs with active disease, and all 18 exposed patients received prophylaxis with ACV. Of 140 HCWs, 100 consented to longitudinal follow-up. Twenty-three (100%) of the HCWs who reported a history of chickenpox also had serologic test results that were postive for VZV IgG, compared with 30 (39%) of 77 HCWs who reported no prior history of chickenpox, yet had test results that were positive for VZV IgG. Reported history of chickenpox had a sensitivity of 43%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 61% with respect to VZV infection immunity. The total cost estimate for this outbreak investigation was $23,087.

Conclusions.

An HCWs reported history of chickenpox was a reliable predictor of immunity; a report of no prior history of chickenpox was unreliable. Our cost-benefit analysis suggests that the costs of an occupational health program that included VZV surveillance and immunization for the next 323 HCWs would be approximately equal to the excess costs of $17,227 for the ACV therapy, HCW furloughs, and staff overtime associated with this outbreak.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 430 - 434
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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