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Varicella in a Paediatric Intensive Care Unit: 10-year review from Starship Children's Hospital, New Zealand

Authors

  • Sophie Chien-Hui Wen,

    Corresponding author
    1. Department of Paediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand
    Current affiliation:
    1. Department of Microbiology, Canterbury Health Laboratories, PO Box 151, Christchurch, New Zealand
    • Correspondence: Dr Sophie Chien-Hui Wen, Department of Microbiology, Canterbury Health Laboratories, PO Box 151, Christchurch 8011, New Zealand. Fax: +64 3 3640238; email: Sophie.Wen@cdhb.health.nz

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  • Fiona Miles,

    1. Department of Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
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  • Brent McSharry,

    1. Department of Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
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  • Elizabeth Wilson

    1. Department of Paediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand
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  • Conflict of interest: None declared.
  • Funding: None.

Abstract

Aims

Varicella is now a vaccine-preventable disease but is generally considered benign, making it a low priority for a funded universal immunisation scheme. We aimed to increase the knowledge of the severity, morbidity and mortality caused by varicella, by a review of cases requiring paediatric intensive care in New Zealand where vaccine is available but not funded.

Methods

This is a retrospective chart review of children admitted to the paediatric intensive care unit (PICU) over a 10-year period (July 2001–July 2011) identified from the PICU database with a primary or secondary code for varicella.

Results

Thirty-four cases were identified and 26 cases were included. Of the 26 cases, 84.6% were Maori or Pacific Island ethnicity, 54% had no preceding medical condition and 23% were immunocompromised. Main PICU admission reasons were neurologic (38.5%), secondary bacterial sepsis or shock (26.9%), respiratory (15.4%), disseminated varicella (11.5%), or other causes (7.7%). Fifty per cent of children required inotropic support and 81% invasive ventilation. Four children died (15%), three of whom were immunocompromised. A further eight children (31%) had ongoing disability at hospital discharge.

Conclusion

Varicella, or its secondary complications, requiring paediatric intensive care, carries high mortality, particularly for immunocompromised patients, and long-term morbidities, mostly affecting previously healthy children.

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