Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-28T00:16:06.987Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Amy Behrman ,
D. Scott Schmid ,
Anne Crivaro  and
Barbara Watson
Amy Behrman*
Affiliation:
Hospital of the University of Pennsylvania, Division of Occupational Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
D. Scott Schmid
Affiliation:
Centers for Disease Control and Prevention, National VZV Laboratory, Viral Immunology Section, Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Anne Crivaro
Affiliation:
Hospital of the University of Pennsylvania, Immunology Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
Barbara Watson*
Affiliation:
City of Philadelphia Department of Public Health, Division of Disease Control, Philadelphia, Pennsylvania
*
Occupational Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
Occupational Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

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.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 3 , March 2003 , pp. 202 - 206
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gallagher, J, Quaid, B, Cryan, B. Susceptibility to varicella zoster virus infection in health care workers. Occup Med 1996;46:289–292.Google Scholar
2.Weber, DJ, Rutala, WA, Hamilton, H. Prevention and control of varicella-zoster infections in healthcare facilities. Infect Control Hosp Epidemiol 1996;17:694–705.Google Scholar
3.Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(RR-11):1–36.Google Scholar
4.Garner, JS. Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.Google Scholar
5.Josephson, A, Karanfil, L, Gombert, ME. Strategies for the management of varicella-susceptible healthcare workers after a known exposure. Infect Control Hosp Epidemiol 1990;11:309–313.CrossRefGoogle ScholarPubMed
6.Lyznicki, JM, Bezman, RJ, Genel, M. Report of the Council on Scientific Affairs, American Medical Association: immunization of healthcare workers with varicella vaccine. Infect Control Hosp Epidemiol 1998;19:348–353.CrossRefGoogle ScholarPubMed
7.Tennenberg, AM, Brassard, JE, Van Lieu, J, Drusin, LM. Varicella vaccination for healthcare workers at a university hospital: an analysis of costs and benefits. Infect Control Hosp Epidemiol 1997;18:405–411.Google Scholar
8.Nettleman, MD, Schmid, M. Controlling varicella in the healthcare setting: the cost effectiveness of using varicella vaccine in healthcare workers. Infect Control Hosp Epidemiol 1997;18:504–508.Google Scholar
9.Weinberg, A, Hayward, AR, Masters, HB, Ogu, IA, Levin, MJ. Comparison of two methods for detecting varicella-zoster virus antibody with varicella-zoster virus cell-mediated immunity. J Clin Microbiol 1996:34:445–446.Google Scholar
10.Steinberg, SP, Gershon, AA. Measurement of antibodies to varicella-zoster virus by using a latex agglutination test. J Clin Microbiol 1991;29:1527–1529.CrossRefGoogle ScholarPubMed
11.Landry, ML, Ferguson, D. Comparison of latex agglutination test with enzyme-linked immunosorbent assay for detection of antibody to varicella-zoster virus. J Clin Microbiol 1993;31:3031–3033.CrossRefGoogle ScholarPubMed
12.Hall, S, Macuta, T, Seward, J, et al.Second varicella infections: are they more common than previously thought? Pediatrics 2002;109:1068–1073.CrossRefGoogle ScholarPubMed