1387 - Current practices in the diagnosis and treatment of varicella infections in the United States

Background: The Advisory Committee on Immunization Practices recommended a 1 dose varicella immunization program in 1996, expanding this to include 2 doses in 2006.  As a result, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections have become uncommon, the response of health care providers (HCPs) to patients presenting with varicella symptoms may result in misdiagnosis and/ mistreatment. This study investigated the diagnostic and treatment strategies used by HCPs for managing varicella infections in US children.

Methods: An online cross-sectional survey of licensed HCPs was conducted, after an Institution review board approval and HCP consent. 8 clinical vignettes with information on patients with varying varicella symptoms (representing uncomplicated and complicated cases) were presented. For each vignette, HCPs selected a diagnosis and appropriate intervention(s) from pre-determined lists. Descriptive analyses were performed.

Results: A total of 153 HCPs (50 nurses, 103 doctors) completed the survey.  Mean age was 44 years, 62% were female, and 82% were licensed after 1995. Varicella infection was correctly diagnosed 79% of the time.  HCPs were able to recognize uncomplicated cases of varicella 85% of the time and complicated cases 61% of the time.   HCPs recommended the correct intervention 43% of the time for uncomplicated cases and 25% of the time for complicated cases. For example, HCPs recommended antibiotics 17% of the time and/or antivirals 18% of the time (Table 1), of which 25% and 69% (respectively) were not appropriate per the American Academy of Pediatrics guidelines respectively. Antibiotics were incorrectly recommended 6% of the time for uncomplicated cases of varicella.Table 1. Additional Diagnosis & Treatment Results


Conclusion: Given the low incidence of varicella infections in the US, complicated cases of varicella may be under-recognized or inappropriately treated by some HCPs. Additional training may help HCPs better recognize/ treat cases of varicella. Further, ensuring high rates of varicella vaccination is important to avoid vaccine preventable conditions and to minimize unnecessary exposure to antimicrobial and antiviral therapies.