Nosocomial transmission of chickenpox and varicella zoster virus seroprevalence rate amongst healthcare workers in a teaching hospital in China.
Adolescent
Adult
Antibodies, Viral
/ blood
Chickenpox
/ epidemiology
China
/ epidemiology
Cross Infection
/ epidemiology
Cross-Sectional Studies
Disease Outbreaks
Disease Susceptibility
Enzyme-Linked Immunosorbent Assay
Female
Health Personnel
/ statistics & numerical data
Herpesvirus 3, Human
/ immunology
Hospitals, Teaching
/ statistics & numerical data
Humans
Infection Control
Male
Middle Aged
Retrospective Studies
Seroepidemiologic Studies
Students, Medical
/ statistics & numerical data
Varicella Zoster Virus Infection
/ epidemiology
Chickenpox
China
Healthcare worker
Outbreak
Seroprevalence
Varicella zoster virus
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
05 Jul 2019
05 Jul 2019
Historique:
received:
16
01
2019
accepted:
26
06
2019
entrez:
7
7
2019
pubmed:
7
7
2019
medline:
24
9
2019
Statut:
epublish
Résumé
Varicella zoster virus (VZV) is a highly contagious herpesvirus with potential for nosocomial transmission. However, the importance of nosocomial chickenpox outbreak in China has often been ignored. With the increasing immunocompromised population in China, a thorough review of issues related to nosocomial transmission and the seroprevalence rate of VZV among healthcare workers is necessary. Retrospective case finding for nosocomial transmission of chickenpox was conducted between January 1, 2013 and December 31, 2017. Cases were identified based on clinical features compatible with chickenpox. A cross-sectional study on the seroprevalence rate of VZV among healthcare workers (HCWs) was conducted between January 1, 2014 and December 31, 2017. The serum VZV antibodies of 1804 HCWs were measured by enzyme-linked immunosorbent assay (ELISA). The seroprevalence rate of VZV antibodies, the positive predictive value and negative predictive value of self-reported history of varicella were analyzed. The economic impact associated with nosocomial transmission of VZV was also assessed. A total of 8 cases of chickenpox were identified in three nosocomial transmissions, including 4 HCWs who were infected nosocomially. The overall seroprevalence rate of VZV was 88.4%, which significantly increased with age (P < 0.01). The seroprevalence rates of HCWs with different genders and occupations showed no statistically significant differences. The positive and negative predictive values of a self-reported history of varicella were 80.8 and 10.6% respectively. An estimation of 163.3 person-days of work were lost in each nosocomial transmission and 86.7 infection control unit person-hours were required for each outbreak investigation. The cost of VZV IgG ELISA screening was estimated to be 83 USD per nosocomial transmission. Nosocomial transmission of VZV occurred repeatedly in the hospital setting. An alarming 11.6% of HCWs were seronegative for VZV, which might increase the risk of nosocomial infection and outbreak for other susceptible co-workers and patients. This is especially important in the setting of a teaching hospital where many immunocompromised patients were managed. Furthermore, the positive predictive value of self-reported varicella on seroprevalence rate in our study was lower than those reported in other countries, therefore serological testing of VZV antibodies with subsequent vaccination for all non-immune HCWs should be considered.
Sections du résumé
BACKGROUND
BACKGROUND
Varicella zoster virus (VZV) is a highly contagious herpesvirus with potential for nosocomial transmission. However, the importance of nosocomial chickenpox outbreak in China has often been ignored. With the increasing immunocompromised population in China, a thorough review of issues related to nosocomial transmission and the seroprevalence rate of VZV among healthcare workers is necessary.
METHODS
METHODS
Retrospective case finding for nosocomial transmission of chickenpox was conducted between January 1, 2013 and December 31, 2017. Cases were identified based on clinical features compatible with chickenpox. A cross-sectional study on the seroprevalence rate of VZV among healthcare workers (HCWs) was conducted between January 1, 2014 and December 31, 2017. The serum VZV antibodies of 1804 HCWs were measured by enzyme-linked immunosorbent assay (ELISA). The seroprevalence rate of VZV antibodies, the positive predictive value and negative predictive value of self-reported history of varicella were analyzed. The economic impact associated with nosocomial transmission of VZV was also assessed.
RESULTS
RESULTS
A total of 8 cases of chickenpox were identified in three nosocomial transmissions, including 4 HCWs who were infected nosocomially. The overall seroprevalence rate of VZV was 88.4%, which significantly increased with age (P < 0.01). The seroprevalence rates of HCWs with different genders and occupations showed no statistically significant differences. The positive and negative predictive values of a self-reported history of varicella were 80.8 and 10.6% respectively. An estimation of 163.3 person-days of work were lost in each nosocomial transmission and 86.7 infection control unit person-hours were required for each outbreak investigation. The cost of VZV IgG ELISA screening was estimated to be 83 USD per nosocomial transmission.
CONCLUSIONS
CONCLUSIONS
Nosocomial transmission of VZV occurred repeatedly in the hospital setting. An alarming 11.6% of HCWs were seronegative for VZV, which might increase the risk of nosocomial infection and outbreak for other susceptible co-workers and patients. This is especially important in the setting of a teaching hospital where many immunocompromised patients were managed. Furthermore, the positive predictive value of self-reported varicella on seroprevalence rate in our study was lower than those reported in other countries, therefore serological testing of VZV antibodies with subsequent vaccination for all non-immune HCWs should be considered.
Identifiants
pubmed: 31277589
doi: 10.1186/s12879-019-4222-x
pii: 10.1186/s12879-019-4222-x
pmc: PMC6612143
doi:
Substances chimiques
Antibodies, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
582Subventions
Organisme : Guangdong Province
ID : Not applicable
Organisme : Sanming Project of Medicine in Shenzhen (CN)
ID : Not applicable
Références
Vaccine. 2005 Feb 10;23(12):1434-6
pubmed: 15670877
Enferm Infecc Microbiol Clin. 1991 Jun-Jul;9(6):357-60
pubmed: 1657207
Lancet. 2006 Oct 14;368(9544):1365-76
pubmed: 17046469
MMWR Recomm Rep. 2007 Jun 22;56(RR-4):1-40
pubmed: 17585291
Med Princ Pract. 2007;16(5):399-401
pubmed: 17709931
J Infect Dis. 2008 Mar 1;197(5):646-53
pubmed: 18260757
Scand J Infect Dis. 2010 Aug;42(8):620-2
pubmed: 20429711
Asian Pac J Cancer Prev. 2010;11(2):289-92
pubmed: 20843103
Am J Infect Control. 2010 Oct;38(8):669-70
pubmed: 20868936
Am J Infect Control. 2011 Dec;39(10):844-8
pubmed: 21600672
J Hosp Infect. 2012 Feb;80(2):162-7
pubmed: 22188630
J Infect Dis. 2012 May 1;205(9):1336-41
pubmed: 22454467
J Infect Dis. 2012 May 1;205(9):1331-3
pubmed: 22454471
J Clin Diagn Res. 2013 Oct;7(10):2294-5
pubmed: 24298507
J Infect Chemother. 2014 Mar;20(3):194-8
pubmed: 24462433
J Hosp Infect. 2014 May;87(1):11-24
pubmed: 24767811
Wkly Epidemiol Rec. 2014 Jun 20;89(25):265-87
pubmed: 24983077
Am J Infect Control. 2014 Aug;42(8):885-7
pubmed: 25087140
J Infect Chemother. 2014 Dec;20(12):774-7
pubmed: 25179391
J Pathol. 2015 Jan;235(2):298-311
pubmed: 25255989
Minerva Pediatr. 2016 Jun;68(3):213-25
pubmed: 27125440
Nat Rev Dis Primers. 2015 Jul 02;1:15016
pubmed: 27188665
Ann Intern Med. 1988 Feb;108(2):221-37
pubmed: 2829675
New Microbiol. 2018 Apr;41(2):95-105
pubmed: 29498740
Pediatrics. 1982 Oct;70(4):550-6
pubmed: 6289235
N Engl J Med. 1980 Feb 21;302(8):450-3
pubmed: 7351951