Evaluation of Hospitalizations among Children with Varicella Between 2012 and 2017 at an University Hospital

Yıl 2020, Cilt: 14 Sayı: 2, 102 - 107, 18.03.2020

Zeliha Haytoğlu

https://doi.org/10.12956/tjpd.2018.383

Öz

Objective: Varicella is common in childhood in countries where a routine vaccination program is not implemented. The disease can cause serious morbidity and even mortality, especially with increasing age. In our country, the varicella vaccine was included in the national vaccination program on 1 January 2013. The aim of this study was to investigate the hospitalized children with varicella after the administration of varicella vaccine in the national vaccination program. 

Material and Methods: Pediatric patients who were admitted to our tertiary research hospital between January 1, 2012 and December 31, 2017 with a diagnosis of varicella were evaluated retrospectively. The patient demographics, clinical characteristics, underlying diseases, duration of hospitalization, hospitalization costs, and complications were analyzed. 

Results: A total of 104 cases consisting of 66 (63.5%) males and 38 (36.5%) females were included. Of these cases, 40 (38.4%) were aged under 24 months, 36 (34.6%) between 25 and 72 months, and 28 (27%) over 73 months. There were no underlying diseases in 45 (43.3%) cases. The causes of admission were pulmonary infection in 21 (20.2% ) cases, bacterial skin superinfections in 21 (20.2%) cases, cerebellitis in 7 (6.7%) cases, disseminated rash in 6 (5.8%) cases, hepatitis in 4 (3.8%) cases, febrile convulsions in 4 (3.8%) cases, severe thrombocytopenia in 3 (2.9%) cases, meningoencephalitis in 3 (2.9%) cases, and bronchiolitis in 1(1%) case of all admissions, 24% were in 2012, 10.6% in 2016, and 5.8% in 2017. The median hospital cost per hospital stay was not different in patients without an underlying disease compared to patients with an underlying disease. The median duration of hospitalization was 7 (3-42) days in patients without an underlying disease. 

Conclusion: These findings indicate that chickenpox can cause a serious problem even in healthy children without underlying diseases. Following the inclusion of varicella vaccine in the national vaccination program, a critical decrease was observed in the frequency of cases requiring hospitalization. 

Anahtar Kelimeler

Complication, Varicella, Vaccination

2012-2017 Yılları Arasında Üniversite Hastanemizde Suçiçeği Nedeni ile Yatış Gerektiren Çocuk Olguların Değerlendirilmesi

Öz

 Amaç: Rutin aşılama programı uygulanmayan ülkelerde suçiçeği çocukluk çağında yaygın olarak görülür. Bu hastalık özellikle artan yaşla birlikte ciddi mortalite ve morbiditeye yol açabilir. Ülkemizde suçiçeği aşısı 1 Ocak 2013 tarihinde ulusal aşı takvimine alınmıştır. Bu çalışmada suçiçeği aşısının ulusal aşılama programına dahil edilmesinden sonraki dönemde suçiçeği nedeniyle yatırılan çocuk hastaların yatış nedenlerinin değerlendirilmesi amaçlanmıştır. 

Gereç ve Yöntemler: Üçüncü basamak araştırma hastanemizde 1 Ocak 2012 ve 31 Aralık 2017 tarihleri arasında, suçiçeği tanısı ile yatırılan çocuk hastalar geriye dönük olarak incelendi. Hastaların demografik, klinik özellikleri, altta yatan hastalıkları, yatış nedenleri, yatış süreleri, yatış maliyetleri, komplikasyonları ve fatura bilgileri geriye dönük olarak incelendi. 

Bulgular: Çalışma süresince 66’sı erkek (%63.5), 38’i kız (% 36.5) toplam 104 hasta incelenmiştir. Olguların 40‘ı (%38.4) 24 ay ve altında, 36’sı (%34.6) 25 – 72 ay arasında, 28’i (%27) 73 ay ve üzerindeydi. 45 olguda (%43.3) altta yatan hastalık yoktu. 21 olgu (%20.2) pnömoni, 21 olgu (%20.2) sekonder bakteriyel cilt enfeksiyonu, 7 olgu (%6.7) serebellit, 6 olgu (%5.8) yaygın cilt döküntüsü, 4 olgu (%3.8) hepatit, 4 olgu (%3.8) febril konvülziyon, 3 olgu(%2.9) menigoensefalit, 3 olgu(%2.9) kanamaya yol açan trombositopeni, 1(%1) olgu bronşiolit nedeniyle yatırılmştı. Tüm yatışların 25’i (%24) 2012 yılında iken, 11’i (%10.6) 2016 yılında, 6’sı (%5.8) ise 2017 yılındaydı. Altta yatan hastalığı olmayan 45 olgunun yatış maliyetinin ortanca değeri, altta yatan hastalığı olan 59 olguyla kıyaslandığında ortanca değerleri arasında istatistiksel fark saptanmadı. Altta yatan hastalığı olmayan olgularda yatış süresinin ortanca değeri 7 (3-42) gündü. 

Sonuç: Bulgularımız suçiçeğinin günümüzde kronik hastalığı olmayan sağlıklı çocuklarda bile ciddi sorunlar oluşturabildiğini göstermiştir. Suçiçeği aşısının ulusal aşılama programına alınmasından sonra, yıllar içinde yatış gerektiren olguların sıklığında anlamlı düzeyde azalma olduğu gözlenmiştir. 

Anahtar Kelimeler

Komplikasyon, Suçiçeği, Suçiçeği aşısı

Kaynakça

• 1. Heininger U, Seward JF. Varicella. Lancet 2006;368:1365-76.
• 2. Centers for Disease Control and Prevention. Varicella. In Hamborsky J, Kroger A, Wolfe S (eds). Epidemiology and Prevention of Vaccine- Preventable Diseases. The Pink Book: Course Textbook, 13th ed, Washington, DC: Public Health Foundation, 2015. http://www.cdc. gov/vaccines/pubs/pinkbook/index.html (Accessed on Apr, 2018).
• 3. American Academy of Pediatrics. Varicella-zoster virus infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS (eds). RedBook. 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village: IL 2015:846-56.
• 4. Dinleyici EC, Kurugol, Z, Turel O, Hatipoglu N, Devrim I, Agin, H, et al. The epidemiology and economic impact of varicella-related hospitalizations in Turkey from 2008 to 2010: A nation wide survey during the pre-vaccine era (VARICOMP study). Eur J Pediatr 2012;171:817-25.
• 5. Chaves SS, Lopez AS, Watson TL, Civen R, Watson B, Mascola L, et al. Varicella in infants after implementation of the US varicella vaccination program. Pediatrics 2011;128:1071-7.
• 6. Tan B, Bettinger J, McConnell A, Scheifele D, Halperin S, Vaudry W, et al; Members of the Canadian Immunization Monitoring Program, Active (IMPACT). The effect of funded varicella immunization programs on varicella-related hospitalizations in IMPACT centers, Canada, 2000–2008. Pediatr Infect Dis J 2012;31:956–63.
• 7. Siedler A, Arndt U. Impact of the routine varicella vaccination programme on varicella epidemiology in Germany. Euro Surveill 2010;15(13):pii19530.
• 8. Pezzotti P, Bellino S, Prestinaci F, Iacchini S, Lucaroni F, Camoni L, et al. The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900–2015. Vaccine 2018;11:1435- 48.
• 9. Garcia Cenoz M, Castilla J, Chamorro J, Martinez-Baz I, Martinez Artola V, Irisarri F, et al. Impact of universal two-dose vaccination on varicella epidemiology in Navarre, Spain, 2006 to 2012. Euro Surveill 2013;18:20552.
• 10. Heywood AE, Wang H, Macartney KK, McIntyre P. Varicella and herpes zoster hospitalizations before and after implementation of one-dose varicella vaccination in Australia: An ecological study. Bull World Health Organ 2014;92:593–604.
• 11. Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al: NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med 1988; 108:221-37.
• 12. Pnomoni tanı ve tedavi uzlaşı raporu 2009. Türk Toraks Derneği. 13. Vankatesan A, Tunkel AR, Bluch KC, Lauring AS, Sejyar J, Bitnun A, et al. Case definitions, diagnostic algorithms and priorities in encephalitis: Consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114-28.
• 14. Bozzola E, Tozzi AE, Bozzola M, Krzysztofiak A, Valentini D, Grandin A, et al. Neurological complications of varicella in childhood: Case series and a systematic review of the literature. Vaccine 2012;30:5785–90.
• 15. Felek S. Karaciğer ve safra yolları infeksiyonları. İçinde: Sistemik İnfeksiyon Hastalıkları. 1. baskı, İstanbul: Nobel Tıp Kitabevi, 2000:195-212.
• 16. Lusher JM. Clinical and laboratory approach to the patient with bleeding. In: Nathan DG, Orkin SH, Ginsburg D, Look AT (eds). Nathan and Oski’s Hematology of Infancy and Childhood. 6th ed. Philadelphia: Saunders, 2003:1515-20.
• 17. Koturoglu G, Kurugöl Z, Cetin N, Hizarcioglu M, Vardar F, Helvaci M, et al. Complications of varicella in healthy children in Izmir, Turkey. Pediatr Int 2005;47:296-99.
• 18. Ozdemir H, Candir, MO, Karbuz A, Belet N, Tapisiz A, Ciftci E, et al. Chickenpox complications, incidence and financial burden in previously healthy children and those with an underlying disease in Ankara in the pre-vaccination period. Turk J Pediatr 2011;53:614- 25. 19. Bonsignori F, Chiappini E, Frenos S, Peraldo M, Galli L, de Martino M. Hospitalization rates for complicated and uncomplicated chickenpox in a poorly vaccinated pediatric population. Infection 2007;35:444–50.
• 20. Theodoridou M, Laina I, Hadjichristodoulou C, Syriopoulou V. Varicella-related complications and hospitalisations in a tertiary pediatric medical center before vaccine introduction. Eur J Pediatr 2006;165:273–74.
• 21. Sauerbrei A. Review of varicella-zoster virus infections in pregnant women and neonates. Health 2010;2:143-52.
• 22. Freij BJ, Sever JL. Viral and protozoal infections. In: Mhairi MG, Mullett MD, Seshia MM (eds). Avery’s Neonatology: Pathophysiology and Management of the Newborn. 6th ed. Philadelphia: Lippincott Williams Wilkins, 2005:1274-356.
• 23. Centers for Disease Control and Prevention (CDC). A new product (VariZIG) for postexposure prophylaxis of varicella available under an investigational new drug application expanded access protocol. MMWR Morb Mortal Wkly Rep 2006;55:209-10.
• 24. Gershon AA. Chickenpox, measles, and mumps. In: Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA (eds). Infectious Disease of the Fetus and Newborn Infant. 7th ed. Philadelphia: Elsevier Saunders, 2011:899-904.
• 25. Liese JG, Grote V, Rosenfeld E, Fischer R, Belohradsky BH, Kries R, et al. The burden of varicella complications before the introduction of routine varicella vaccination in Germany. Pediatr Infect Dis J 2008;27:119–24.
• 26. Marchetto S, de Benedictis FM, de Martino M, Versace A, Chiappini E, Bertaine C, et al. Epidemiology of hospital admissions for chickenpox in children: An Italian multicentre study in the prevaccine era. Acta Paediatr 2007;96:1490–93.
• 27. Bonhoeffer J, Baer G, Muehleisen B, Aebi C, Nadal D, Schaad UB, et al. Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents. Eur J Pediatr 2005;164:366–70.
• 28. Kulcu N, Say A,Guven F, Sezer RG, Degirmenci S, Sahin E. Bir eğitim hastanesinde suçiçeği ve komplikasyonları sebebiyle yatırılan hastaların değerlendirilmesi. J Pediatr Inf 2012;6:12-7.
• 29. Davis MM, Patel MS, Gebremariam A. Decline in varicella related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States. Pediatrics 2004;114:786-92.
• 30. Lopez AS, Zhang J, Brown C, Bialek S. Varicella-related hospitalizations in the United States, 2000-2006: The 1-dose varicella vaccination era. Pediatrics 2011;127:238-45.