Outbreak of varicella-zoster virus infection among Thai Healthcare workers
Outbreak of varicella-zoster virus infection among Thai Healthcare workers
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DOI：
10.1086/512639
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发表时间：
2007-04-01
影响因子：
4.5
通讯作者：
Mundy, Linda M.
中科院分区：
文献类型：
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作者：
Apisarnthanarak, Anucha;Kitphati, Rungrueng;Mundy, Linda M.
Objective.评价泰国卫生工作者（HCWs）水痘感染暴发中水痘既往史的自我报告与水痘带状疱疹病毒（VZV）免疫球蛋白（IG）G血清学检测结果之间的相关性，并对建立常规VZV免疫接种作为职业卫生项目的一部分进行成本效益分析。所有暴露患者均接受预防性治疗，并对我们3个重症监护室（ICU）的HCW进行前瞻性评价。评估HCW的病史和VZV IgG的血清学证据。进行成本效益分析。在140名HCW和18名ICU患者暴露于VZV后，10名（7%）活动性VZV感染的HCW被解除工作，直到皮肤病变结痂。无环鸟苷（ACV）处方的所有10个HCW与活动性疾病，和所有18个暴露患者接受预防与ACV。在140名HCW中，100名同意纵向随访。23名（100%）报告有水痘病史的HCW也有VZV IgG阳性的血清学检测结果，相比之下，77名HCW中有30名（39%）报告没有水痘病史，但VZV IgG阳性的检测结果。水痘病史报告的敏感性为43%，特异性为100%，阳性预测值为100%，阴性预测值为61%。本次疫情调查的总费用估计为23，087美元。HCW报告的水痘病史是免疫力的可靠预测因素;没有水痘病史的报告是不可靠的。我们的成本效益分析表明，一个职业健康计划，包括VZV监测和免疫接种的未来323 HCW的成本将大约等于额外的成本17,227美元的无环鸟苷治疗，HCW休假，和员工加班与此爆发。
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 HCW's 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.