Incidence and consequences of varicella in children treated for cancer in Guatemala
| Autor: | Mario Melgar, Myron J. Levin, Edwin J. Asturias, Federico Antillon-Klussmann, Amy E. Caruso Brown, Pamela Mettler |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent Databases Factual Varicella vaccine viruses medicine.medical_treatment Acyclovir Antineoplastic Agents Comorbidity Malignancy Risk Assessment 03 medical and health sciences Age Distribution Chickenpox 0302 clinical medicine Maintenance therapy Neoplasms 030225 pediatrics Pediatric surgery medicine Humans 030212 general & internal medicine Sex Distribution Child Infusions Intravenous Developing Countries Retrospective Studies Chemotherapy business.industry Incidence Incidence (epidemiology) Infant virus diseases Cancer Guatemala medicine.disease Survival Rate Clinical trial Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Immunology Female business Needs Assessment Follow-Up Studies |
| Zdroj: | World Journal of Pediatrics. 12:320-326 |
| ISSN: | 1867-0687 1708-8569 |
| DOI: | 10.1007/s12519-016-0025-y |
| Popis: | Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children, despite treatment with antiviral agents. Universal varicella vaccine programs have significantly decreased this risk in many highincome countries, but in most low-income and middleincome countries, the burden of varicella in children treated for malignancy is poorly defined. We retrospectively reviewed records of children at the National Unit of Pediatric Oncology (UNOP) in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity, mortality, treatment interruption, and cost. Fifty-nine cases of varicella were identified. Incidence was 23.4 cases per 1000 person-years (p-y). 66.1% of cases occurred in children with leukemia (median age 5.2 years; interquantile range 3.4-7 years) and 41.0% of these occurred during maintenance therapy. Source of exposure was identified for 14/59 (23.7%) children. Most were hospitalized (71.2%) and given intravenous acyclovir (64.4%). Eight (13.6%) children required critical care, and two (3.4%) died from disseminated varicella with multiorgan failure. Chemotherapy was delayed or omitted due to varicella in 50%. No significant differences in outcomes based on nutritional and immunologic status were detected. The minimum average cost of treatment per episode was 598.75 USD. Varicella is a significant problem in children treated for cancer in Guatemala, where effective post-exposure prophylaxis is limited. In the absence of universal varicella vaccination, strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden. |
| Databáze: | OpenAIRE |
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