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Severe complications of chickenpox in hospitalised children in the UK and Ireland
  1. Claire Cameron (claire.cameron{at}hps.scot.nhs.uk)
  1. Health Protection Scotland, United Kingdom
    1. Geraldine Allan (gallan{at}fsmail.net)
    1. Health Protection Scotland, United Kingdom
      1. Fiona Johnston (fiona.johnston{at}hps.scot.nhs.uk)
      1. Health Protection Scotland, United Kingdom
        1. Adam Finn (adam.finn{at}bristol.ac.uk)
        1. University of Bristol, United Kingdom
          1. Paul Heath (pheath{at}sghms.ac.uk)
          1. University of London, United Kingdom
            1. Robert Booy (robertb2{at}chw.edu.au)
            1. National Centre for Immunisation research and surveillance, Australia

              Abstract

              Aims: To estimate the annual incidence of hospitalisations due to severe complications of varicella, describe the complications and estimate annual mortality.

              Methods: Active surveillance throughout the UK and Republic of Ireland for 13 months, by paediatricians notifying cases to the British Paediatric Surveillance Unit and completing a questionnaire. The case definition was any child aged <16 years hospitalised with complicated varicella, as defined by a list of conditions, or admitted to ICU/HDU with varicella.

              Results: 188 cases were notified for the surveillance period, of which 112 (0.82/100,000 children/year) met the case definition and were not duplicates. Confirmed cases had a median age of 3 years (range 0-14). The complications were: bacteraemia/septic shock (n=30), pneumonia (n=30), encephalitis (n=26), ataxia (n=25), toxic shock syndrome/toxin-mediated disease (n=14), necrotising fasciitis (n=7), purpura fulminans/disseminated coagulopathy (n=5), fulminant varicella (n=5), neonatal varicella (n=3). Fifty-seven cases (51%) had additional bacterial or viral infections. There were six deaths, due, or possibly due to varicella, including one intrauterine death. Four of the other five deaths (ages 2-14 years) had a pre-existing medical condition. Sequelae on discharge were positively reported for 41 cases (40%), most frequently ataxia or skin scarring. The median length of hospital stay was 7 days (range 1-68).

              Conclusions: This study provides a minimum estimate of severe complications and death that occur as a result of varicella in children in the UK and Ireland. The majority of complications, part from deaths, occur in otherwise healthy children and thus would be preventable only through a universal childhood immunisation programme.

              • Chickenpox
              • Chickenpox vaccine
              • Death
              • Hospitalization

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