Abstract
BackgroundVaricella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur.ObjectivesThe objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits.MethodsThe study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period.Results3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP.ConclusionsThis study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.
Highlights
The Varicella zoster virus (VZV) is a highly contagious virus [1]
This study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use
The study was a retrospective observational study using data extracted from the IQVIA Longitudinal Patient Database (LPD), a database that has been widely used in previous drug utilization and epidemiological studies and represents a robust source of information on primary care in Belgium [21,22,23]
Summary
The Varicella zoster virus (VZV) is a highly contagious virus [1]. A primary infection with the virus causes varicella (chickenpox). In most countries without UVV, the decision not to introduce a UVV program has been primarily based on varicella being considered as mild disease from a clinical and economic perspective, associated with a low disease burden [4] Another argument against UVV is the potential shift in the incidence of varicella disease in older ages, which might result in increased morbidity and mortality in adults, despite a reduction in the number of paediatric varicella cases [4]. The theory of exogenous boosting hypothesizes that re-exposure to wild circulating varicella virus can boost the cellmediated immunity, and, as a result, could prevent the development of HZ later in life This would imply that UVV could lead to an increase of the HZ incidence. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur
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