Varicella Vaccine Decreases Hospitalization in Varicella-Related Group A Strep Infections

Abstract

Critical Care| May 01 2004 Varicella Vaccine Decreases Hospitalization in Varicella-Related Group A Strep Infections AAP Grand Rounds (2004) 11 (5): 50–51. https://doi.org/10.1542/gr.11-5-50 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Varicella Vaccine Decreases Hospitalization in Varicella-Related Group A Strep Infections. AAP Grand Rounds May 2004; 11 (5): 50–51. https://doi.org/10.1542/gr.11-5-50 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: chickenpox, chickenpox vaccine, streptococcal infections, group a Source: Patel RA, Binns HJ, Shulman ST. Reduction in pediatric hospitalizations for varicella-related invasive group A streptococcal infections in the varicella vaccine era. J Pediatr. 2004;144:68–74. Varicella infection has been shown to play an antecedent role in children with invasive group A streptococcal (IGAS) disease.1 The authors from Northwestern University, Evanston, Ill, reviewed all hospitalized patients who had group A streptococcus (GAS) isolated from a normally sterile site from 1993–2001. When varicella vaccine was introduced in 1995, demographic data, clinical features, and microbiological data were collected. The presence of streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) were noted. Annual hospitalization rates were calculated as cases of IGAS per total hospital admissions annually. There were 144 cases, 11 (8%) with STSS or NF. There was no significant change over the study period in the annual hospitalization rates for IGAS. Over 50% of cases had skin or soft issue infections and 5% had NF. Nineteen percent had either retropharyngeal abscess or peritonsillar abscess, while 9% had bacteremia, 6% had pneumonia, and 6% had osteomyelitis. Ninety percent of patients were less than 10 years of age. Children over 5 years of age were significantly more likely to have either STSS or NF (13% versus 3%, P=.02). Twenty-three (16%) children had varicella, 19 (13%) had a laceration, and 12 (8%) had trauma prior to development of IGAS disease. Eighteen (13%) children were immunosuppressed from a malignancy, medications, or HIV. Among children with varicella, 17% developed either STSS or NF compared to 6% of those who did not have varicella (P=.08). From 1993–1995, 27% of IGAS cases had varicella infections, which decreased to 16% from 1996–1998. From 1999–2001, only 2% of cases were associated with varicella infection. The authors concluded that a decline in varicella-related GAS infection was temporally related to utilization of the varicella vaccine. Varicella is an important antecedent to IGAS disease and one proposed benefit of the vaccine was to decrease such life-threatening infections. Other studies have shown either a decrease in the number of cases of varicella or a decrease in varicella-related hospitalizations during similar time periods.2,3 The limited and retrospective nature of this review of 1 hospital’s data leaves some fundamental questions unanswered. The authors do not comment on the lack of change in the total incidence of IGAS disease despite the decline in varicella, which is the most important predisposing condition (15–30% in most studies). The small numbers in this study also did not permit any conclusions about the incidence of STSS or NF even though the rate of varicella association in these patients was high (36%). Approximately 83% of the varicella-related IGAS cases occurred in patients greater than 1 year of age. As the authors state, this represents the minimum number of potentially preventable cases, but additional cases of children younger than 1 year of age may be preventable by immunization of older children. The findings suggest an important benefit of varicella vaccination and... You do not currently have access to this content.