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Adults living in residential settings should be screened for varicella immunity
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ATLANTA — After an outbreak of varicella disease among adults living in a residential community, investigators suggested that immunity should not be assumed in this population, and routine screening of residents and staff should be conducted, according to data presented at the 44th National Immunization Conference.
In December 2008, a varicella outbreak occurred at a residential facility for adults with disabilities. The facility is run by the Department of Developmental Services in Connecticut. The outbreak prompted investigation by the Connecticut Department of Public Health and the CDC.
“The researchers’ objectives were documenting the extent of the outbreak among staff and residents of the facility, determining risk factors for disease and identifying the origin of the outbreak,” Jessica Leung, MPH, of the CDC, said during the presentation.
The researchers defined cases as generalized maculopapular with or without vesicles or without other apparent cause that developed after Nov. 1, 2008, according to Leung.
Serologic specimens underwent immunoglobulin M and G testing, and clinical lesion specimens were collected for polymerase chain reaction testing and genotyping. Environmental specimen collection results indicated that 71 specimens were found in January 2009 and 25 specimens were found in March 2009. Isolates were found in beds, belongings, common areas, transportation vehicles and spaces where day program activities took place.
The researchers analyzed distribution of varicella cases across the three buildings in the facility. Results indicated that there were eight cases in people living in Building 1 and three cases in people living in Building 3. Leung said residents in Building 2 were more autonomous than residents living in Buildings 1 and 3.
The age range of infected individuals was 32 to 49 years. Two patients had a history of disease, and none were vaccinated before the outbreak. One nurse and one caregiver working at the facility also were infected, Leung said.
A 41-year-old man with shingles living in Building 1 was identified as a possible source of the outbreak. He developed a localized vesicular rash on his right arm 18 days before the first case.
Control measures during the outbreak included confining cases to rooms, covering lesions and vaccinating noncases. Leung said, however, that such strategies were not optimal in a residential facility for adults with disabilities due to the close contact and constant care required by residents.
“Adults born in the U.S. who have lived in residential facilities may not have general exposure or immunity,” she said. “As a result of the outbreak, lab testing of clinical and environmental specimens are important tools for investigation and control of outbreaks and assessing immunity.
“The outbreak also showed the need to adhere to ACIP guidelines that suggest screening for varicella and other vaccine-preventable diseases for staff and residents,” Leung said. – by Melissa Foster
This study describing an adult outbreak illustrates the ongoing questions regarding varicella immunity that continue to be pressing medical needs.
– David W. Kimberlin, MD
Co-director,
division of pediatric infectious diseases at The University of Alabama
Birmingham –
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