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Lessons From an Outbreak of Varicella Infection in Pediatric Hemato-oncology Patients

Manistarski, Michal, MD*; Levin, Dror, MD*; Dvir, Rina, MD*; Berger-Achituv, Sivan, MD*; Rosenfeld Keidar, Hila, MD*; Grisaru-Soen, Galia, MD; Carmeli, Yehuda, MD; Elhasid, Ronit, MD*

The Pediatric Infectious Disease Journal: July 2018 - Volume 37 - Issue 7 - p 649–653
doi: 10.1097/INF.0000000000001920
Original Studies

Background: Immunocompromised patients exposed to varicella may experience significant morbidity and a 7% mortality rate. Management and outcome of an outbreak of varicella infection among hospitalized pediatric hemato-oncology patients using the guidelines of the American Academy of Pediatrics Committee on Infectious Diseases are presented.

Methods: This retrospective study describes an outbreak of varicella infection between February 2011 and June 2011. Data were retrieved from the patients’ files. Positive polymerase chain reaction results for varicella zoster virus from vesicular skin lesions were used for the diagnosis of varicella infection.

Results: Twelve pediatric hemato-oncology patients experienced 13 episodes of varicella infection, 11 underwent 1 episode each and 1 patient had 2 episodes. All exposed patients without immunity received varicella zoster immune globulins or intravenous immunoglobulin and were isolated as recommended by the guidelines. Infected patients received intravenous acyclovir. One patient with acute lymphoblastic leukemia at induction chemotherapy died. All the other patients survived.

Conclusions: Our experience in the management of hospitalized immunocompromised patients exposed to varicella was that a positive IgG serology did not confer protection after exposure to varicella infection and thus can not serve as a marker for immunity. Unlike the isolation period sufficient for immunocompetent patients, crusted lesions can be contagious and thus require extended isolation for immunocompromised patients. Patients receiving rituximab are at greater risk of having persistent or recurrent disease. Studies with a larger sample size should be performed to better assess the management of immunocompromized patients exposed to varicella.

From the *Pediatric Hemato-Oncology Department

Pediatric Infectious Diseases Unit

Department of Epidemiology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Accepted for publication October 17, 2017.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Ronit Elhasid, MD, Department of Pediatric Hemato-Oncology, Dana Children’s Hospital, Tel Aviv Medical Center, 6 Weizmann St. Tel Aviv 6423906, Israel. E-mail:

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