Institutional Chickenpox Prevention Programme (ICPP) in a tertiary care hospital in Singapore: Lessons from epidemiology and contact tracing. Mittal, C., Sridhar, R., Chan, H. C., Hou, Y., Sng, J. G. K., Lin, R., Tambyah, P. A., Fisher, D., & Venkatachalam, I. International Journal of Infectious Diseases, 45(SUPPL. 1):283, 2016.
Institutional Chickenpox Prevention Programme (ICPP) in a tertiary care hospital in Singapore: Lessons from epidemiology and contact tracing [link]Paper  doi  abstract   bibtex   
Background: Chickenpox vaccination in Singapore is not mandatory. At the National University Hospital (NUH), nosocomial transmission has led to a sentinel event and secondary cases. To prevent future transmissions, we studied the impact of Institutional Chickenpox Prevention Program at NUH. Methods & Materials: NUHis a 1000 bedded tertiary care hospital in Singapore, with negative pressure isolation capability in 179 rooms and staff strength of approximately 7300. A retrospective audit of contact tracing data was done from January 2010 to June 2014, with probabilistic modeling to predict costs and number of future varicella infections. Data was obtained from clinical records, hospital information systems and the human resource department. Result(s): There were 51 cases of chickenpox including 15 staff (Average 11.3 cases per year in total, 3.3 per year among staff). One index resulted in secondary transmission. The median number of staff contacts per index case was 4 (IQR 2- 13) with 0 (IQR 0-2) being non-immune staff contacts . Direct costs and man hours lost in high risk areas (obstetrics and oncology), were significantly higher. Current vaccination strategy A, where staff with negative or uncertain history of prior chickenpox, are screened with serum Varicella zoster virus immunoglobulin (VZV IgG) levels was compared with two scenarios B and C using probabilistic modeling, (B: VZV IgG for all existing and new staff; C: VZV IgG for existing staff with negative history and all new staff). After 10 years, expected number of chickenpox infections per year are 3, 1, and 2 under Strategies A, B and C respectively. Number of susceptible healthcare workers is 744.6 for A, 109.5 for B and 355.5 for C. Cumulative costs for Strategies B (599048 SGD) and C (496752 SGD) are 65% and 37% higher as compared to Strategy A. Conclusion(s): Chickenpox adds significant burden in terms of costs and man hours lost. Current strategy relies on history and contact tracing, to keep the number of infections at 3 per year. Wider screening strategies incur greater cost, but targeted interventions such as laboratory screening for international staff and those working in high risk wards may be more cost effective. (Figure Presented).
@article{mittal_institutional_2016,
	title = {Institutional {Chickenpox} {Prevention} {Programme} ({ICPP}) in a tertiary care hospital in {Singapore}: {Lessons} from epidemiology and contact tracing},
	volume = {45},
	issn = {1201-9712},
	url = {http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed17&NEWS=N&AN=72245578},
	doi = {10.1016/j.ijid.2016.02.625},
	abstract = {Background: Chickenpox vaccination in Singapore is not mandatory. At the National University Hospital (NUH), nosocomial transmission has led to a sentinel event and secondary cases. To prevent future transmissions, we studied the impact of Institutional Chickenpox Prevention Program at NUH. Methods \& Materials: NUHis a 1000 bedded tertiary care hospital in Singapore, with negative pressure isolation capability in 179 rooms and staff strength of approximately 7300. A retrospective audit of contact tracing data was done from January 2010 to June 2014, with probabilistic modeling to predict costs and number of future varicella infections. Data was obtained from clinical records, hospital information systems and the human resource department. Result(s): There were 51 cases of chickenpox including 15 staff (Average 11.3 cases per year in total, 3.3 per year among staff). One index resulted in secondary transmission. The median number of staff contacts per index case was 4 (IQR 2- 13) with 0 (IQR 0-2) being non-immune staff contacts . Direct costs and man hours lost in high risk areas (obstetrics and oncology), were significantly higher. Current vaccination strategy A, where staff with negative or uncertain history of prior chickenpox, are screened with serum Varicella zoster virus immunoglobulin (VZV IgG) levels was compared with two scenarios B and C using probabilistic modeling, (B: VZV IgG for all existing and new staff; C: VZV IgG for existing staff with negative history and all new staff). After 10 years, expected number of chickenpox infections per year are 3, 1, and 2 under Strategies A, B and C respectively. Number of susceptible healthcare workers is 744.6 for A, 109.5 for B and 355.5 for C. Cumulative costs for Strategies B (599048 SGD) and C (496752 SGD) are 65\% and 37\% higher as compared to Strategy A. Conclusion(s): Chickenpox adds significant burden in terms of costs and man hours lost. Current strategy relies on history and contact tracing, to keep the number of infections at 3 per year. Wider screening strategies incur greater cost, but targeted interventions such as laboratory screening for international staff and those working in high risk wards may be more cost effective. (Figure Presented).},
	language = {English},
	number = {SUPPL. 1},
	journal = {International Journal of Infectious Diseases},
	author = {Mittal, C. and Sridhar, R. and Chan, H. C. and Hou, Y. and Sng, J. G. K. and Lin, R. and Tambyah, P. A. and Fisher, D. and Venkatachalam, I.},
	year = {2016},
	keywords = {*Singapore, *chickenpox, *contact examination, *epidemiology, *infection, *prevention, *tertiary care center, Varicella zoster virus, health care personnel, hospital information system, human, immunoglobulin, immunoglobulin G, laboratory, male, medical audit, model, obstetrics, oncology, risk, screening, sentinel event, serum, university hospital, vaccination, ward},
	pages = {283}
}
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