Screening Healthcare Workers for Varicella-Zoster Virus: Can We Trust the History?

2004 ◽  
Vol 25 (7) ◽  
pp. 595-598 ◽  
Author(s):  
Maha Almuneef ◽  
Ziad A. Memish ◽  
Mostafa F. Abbas ◽  
Hanan H. Balkhy
Keyword(s):  
Varicella Zoster Virus ◽  
Predictive Value ◽  
Healthcare Workers ◽  
Middle Eastern ◽  
Enzyme Linked Immunosorbent Assay ◽  
New Employees ◽  
Varicella Zoster ◽  
History Of ◽  
Serologic Screening ◽  
New Recruits

AbstractObjective:To determine the relationship between immunity and a history of chickenpox based on a self-administered questionnaire.Methods:We investigated immunity to varicella-zoster virus in a cohort of newly recruited employees with different job categories and different nationalities using enzyme-linked immunosorbent assay IgG.Results:There were 1,058 new recruits. Of these, 890 (84%) were immune and 168 (16%) were susceptible. The susceptibility rate was 23% (n = 77) for Asian, 15% (n = 14) for South African, 13% (n = 66) for Middle Eastern, and 9% (n = 11) for Western employees. Physicians were more likely to be immune (93%) than were nurses (85%), medical technicians (75%), or administrative clerks (84%). Seropositivity was not affected by age or gender. The positive predictive value of a history of chickenpox for the seropositivity was 89% (511 of 574); the negative predictive value was 22% (105 of 484). History of chickenpox had a sensitivity of 57% (511 of 890) and a specificity of 63% (105 of 168).Conclusions:The varicella-zoster virus seroprevalence among new employees was low, posing an important risk to existing employees and patients. Positive or negative history of chickenpox was an unreliable indicator of susceptibility among healthcare workers of different nationalities. Serologic screening of all employees and vaccination of those susceptible was recommended.

scholarly journals Long -Term Persistence of Antibodies Against Varicella in Fully Immunized Healthcare Workers: An Italian Retrospective Cohort Study

2021 ◽  
Author(s):  
Francesco Bianchi ◽  
Silvio Tafuri ◽  
Angela Larocca ◽  
Cinzia Germinario ◽  
Pasquale Stefanizzi
Keyword(s):  
Varicella Zoster Virus ◽  
Healthcare Workers ◽  
Varicella Vaccine ◽  
Serious Adverse Events ◽  
Biological Risk ◽  
Varicella Zoster ◽  
Vaccine Booster ◽  
History Of ◽  
Study Population

Abstract Background. Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs). Methods. The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined. Results. The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI=27.2–41.4%), with serosusceptibility more common among males than females (p<0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded. Conclusions. One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.

scholarly journals Long -term persistence of antibodies against varicella in fully immunized healthcare workers: an Italian retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesco Paolo Bianchi ◽  
Silvio Tafuri ◽  
Angela Maria Vittoria Larocca ◽  
Cinzia Annatea Germinario ◽  
Pasquale Stefanizzi
Keyword(s):  
Varicella Zoster Virus ◽  
Healthcare Workers ◽  
Varicella Vaccine ◽  
Serious Adverse Events ◽  
Biological Risk ◽  
Varicella Zoster ◽  
Vaccine Booster ◽  
History Of ◽  
Study Population

Abstract Background Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs). Methods The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined. Results The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI = 27.2–41.4%), with serosusceptibility more common among males than females (p < 0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded. Conclusions One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.

A Cluster of Primary Varicella Cases Among Healthcare Workers With False-Positive Varicella Zoster Virus Titers

2003 ◽  
Vol 24 (3) ◽  
pp. 202-206 ◽  
Author(s):  
Amy Behrman ◽  
D. Scott Schmid ◽  
Anne Crivaro ◽  
Barbara Watson
Keyword(s):  
Varicella Zoster Virus ◽  
False Positive ◽  
Healthcare Workers ◽  
Screening Program ◽  
Varicella Vaccine ◽  
Varicella Zoster ◽  
Control And Prevention ◽  
Serologic Screening ◽  
Positive Results

AbstractBackground:Five cases of primary varicella zoster virus (VZV) were diagnosed among hospital healthcare workers (HCWs). All had complied with a pre-employment VZV screening program and had been considered immune.Objectives:To summarize the investigation of VZV among un-immunized HCWs and to provide recommendations for avoiding false-positive serologic tests.Design:Risk of transmission of VZV to susceptible HCWs is minimized through serologic screening. Varicella vaccine is recommended for susceptible HCWs. A commercially available latex bead agglutination assay (LA) is widely used because it is rapid and easy to perform. LA was compared with the whole-cell varicella ELISA standardized in the Centers for Disease Control and Prevention (CDC) National Herpes Laboratory.Setting/Population:Large inner-city, tertiarycare hospital with a diverse employee population.Results:In a year, 5 HCWs presented with laboratory-confirmed primary varicella infection. Four had VZV exposures 2 weeks prior to presentation. All had documented positive VZV titers by LA performed at hire. None were offered VZV vaccination. The original LAs were judged false-positives.Intervention/Follow-Up Investigation:Fifty-three consecutive VZV LA samples from the hospital laboratory were retested at the CDC. Forty-four samples concurred. Of the remaining 9, 4 were positive by hospital LA but negative by CDC IgG ELISA. Four were equivocal by hospital LA but negative by CDC IgG ELISA and LA. One was positive by hospital LA but negative by LA and equivocal by ELISA at the CDC.Conclusion:LA may be prone to false-positive results and inappropriate for screening hospital HCWs.

Hospital Experience with Varicella-Zoster Virus

1986 ◽  
Vol 7 (6) ◽  
pp. 312-316 ◽  
Author(s):  
Keith Krasinski ◽  
Robert S. Holzman ◽  
Rita LaCouture ◽  
Alfred Florman
Keyword(s):  
Infection Control ◽  
Varicella Zoster Virus ◽  
Hospital Staff ◽  
Control Measures ◽  
Varicella Zoster ◽  
Staff Members ◽  
Infection Control Measures ◽  
Serologic Testing ◽  
Care Workers ◽  
History Of

AbstractVaricella-zoster virus (VZV), one of the most common highly communicable agents of disease, stimulates aggressive infection control measures. In a 1-year period, at one hospital, at least 93 inpatients (82 adult patients, 11 pediatric patients) and 2 hospital staff with active varicella-zoster infections served as potential sources of nosocomial infection. Six incidents of exposure to the virus that occurred without the protection of standard infection control precautions were investigated by the infection control surveillance team. One hundred fifty-six patients and 353 hospital staff were exposed. Fifty-one patients had no history of varicella-zoster infection, but only five were susceptible by serologic testing. One hundred one staff members had no history of varicella-zoster, but only 11 were susceptible by serologic testing. These exposures resulted in three secondary varicella-zoster infections, six courses of varicella-zoster immune globulin prophylaxis and furlough of 13 staff members. Epidemiologic investigation consumed approximately 356 hours of staff time, and management of exposed persons cost approximately $41,500. Prospective knowledge of the immune status of health care workers would vastly decrease the time and effort required to control hospital VZV exposures.

Avoiding a lumbar puncture may be a rash decision: a case report of varicella-zoster virus-associated radiculopathy in advanced HIV infection

2019 ◽  
Vol 30 (10) ◽  
pp. 1031-1033
Author(s):  
Emma Wallis ◽  
Bahij Al-Hakim ◽  
Paul Holmes ◽  
Sam Douthwaite ◽  
Ranjababu Kulasegaram
Keyword(s):  
Varicella Zoster Virus ◽  
Lumbar Puncture ◽  
Case Reports ◽  
Response To Treatment ◽  
High Dose ◽  
Serum Samples ◽  
Cd4 Cell Count ◽  
Varicella Zoster ◽  
Intravenous Acyclovir ◽  
History Of

A 34-year-old man recently diagnosed with advanced human immunodeficiency virus infection (CD4 cell count of 139 cells/mm3), not yet started on antiretroviral medications, presented to hospital with a ten-day history of left leg weakness and difficulty walking. He described a childhood history of chickenpox with previous shingles over his buttock over three years ago. Examination revealed reduced power in the left hip and knee flexors and absent knee and adductor reflexes. Lumbar punctures were performed and polymerase chain reaction (PCR) detected varicella-zoster virus (VZV) DNA. Concurrent serum samples for VZV PCR were negative. The patient was diagnosed with VZV radiculopathy and treated with high-dose intravenous acyclovir. Within two days, neurological signs improved. Previous case reports define VZV radiculopathy by a temporal and geographical relationship with a zoster rash. Our diagnosis was based on a clinical picture of radiculopathy with virological evidence in CSF and confirmed by a dramatic clinical response to treatment. We propose that lumbar puncture and detection of VZV DNA by PCR in the cerebrospinal fluid (CSF) is an invaluable investigation that should be considered in the workup of immunosuppressed patients presenting with a radiculopathy.

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