Hospitalizaciones por complicaciones de la varicela en niños menores de 15 años

doi:10.1016/S1695-4033(03)78170-3

Anales de Pediatría

Volume 59, Issue 3, 2003, Pages 229-233

https://doi.org/10.1016/S1695-4033(03)78170-3 Get rights and content

Antecedentes

Las complicaciones por varicela se consideran una de las indicaciones que apoyan la cobertura vacunal universal

Objetivo

Describir las complicaciones por varicela que han precisado hospitalización en una población definida (Guipuzkoa, España) y comparar la incidencia de hospitalizaciones con otras series

Material y métodos

Estudio multicéntrico, retrospectivo, observacional, por revisión de historias clínicas, codificadas como varicela (CMBD, CIE-9, códigos 052.0–052.9) desde 1 de enero de 1993 a 31 de diciembre de 2002, y cálculo de las tasas de hospitalización en base a las urgencias asistidas y a los datos poblacionales

Población infantil de Guipuzkoa (España) asistida en el ámbito geográfico de los servicios de pediatría de los hospitales de agudos de Osakidetza-Servicio Vasco de Salud de Hondarribia, Mendaro, San Sebastián y Zumárraga, con una cobertura poblacional media de 54.999 niños menores de 15 años por año

Todos los niños y niñas de 0 a 15 años de edad, hospitalizados más de 24 h con el diagnóstico de varicela complicada

Se estudiaron las siguientes variables: edad, sexo, antecedentes personales, vacuna antivaricela, estado inmunológico, fiebre, radiografía de tórax, exámenes complementarios, duración del ingreso, tratamiento, diagnósticos de alta, evolución, complicaciones y secuelas al alta

Resultados

Ingresaron 71 niños no vacunados frente al virus varicela- zoster, 80% menores de 5 años de edad, 68 inmunocompetentes y 3 no inmunocompetentes. Han predominado las sobreinfecciones bacterianas (56 %) y destacan 7 casos con enfermedad invasiva. La estancia media ha sido de 6,50 ± 5,15 día, sin mortalidad y sin secuelas

Conclusiones

La incidencia anual de ingresos hospitalarios por varicela complicada superiores a 24 h ha sido 12,90 casos por cada 100.000 menores de 15 años, lo cual representa el 0,31 % de los ingresos anuales hospitalarios en ese grupo

Background

The complications of varicella are one of the arguments in favor of universal vaccination programs in children

Objective

To describe the complications of varicella requiring hospital admission in a well-defined population (Gipuzkoa, Spain) and to compare the incidence of hospitalization with that reported in other series

Material and methods

Observational, retrospective, multicenter study of admissions for varicella. The medical histories codified as varicella (minimum data set, CIE-0, codes 952.0–052.9) from 1 January 1993 to 31 December 2002 were reviewed. Calculation of hospitalization rates was based on emergency department visits and population data

The pediatric population of Gipuzkoa seeking medical attention at one of the four Basque Country Health Service hospitals in the area: Hondarribia, Mendaro, San Sebastian and Zumarraga. The mean coverage in Gipuzkoa is 54,999 children aged less than 15 years/year. All the children aged 0–15 years old admitted for more than 24 h with a discharge diagnosis of varicella complications

The variables studied are: age, gender, personal history, varicella immunization, immune status, fever, chest X-ray, complementary investigations, length of hospital stay, treatment, discharge diagnosis, clinical course, complications and sequelae at discharge

Results

Seventy-one children were hospitalized. None had been vaccinated against the varicella-zoster virus. Eighty percent were aged less than 5 years and three were immunocompromised. Fifty-six percent had bacterial superinfection and invasive forms were found in seven patients. The mean length of admission was 6.5 days ± 5.1. No deaths or sequelae were reported

Conclusions

The annual incidence rate of admissions longer than 24 hours due to varicella complications was 12.9 cases per 100 000 children aged less than 15 years, representing 0.31 % of all annual admissions in this age group

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Cited by (25)

Hospital admissions due to varicella in a tertiary hospital
2014, Anales de Pediatria
La varicela puede generar hospitalizaciones y complicaciones graves. Varios países han incluido la vacuna antivaricelosa en sus calendarios vacunales.
Estudio descriptivo retrospectivo de los pacientes ingresados por varicela y sus complicaciones en un centro de referencia entre 2005 y 2011.
Consultaron por varicela en urgencias 1.192 niños, 99 (8,5%) precisaron ingreso. Incidencia anual de ingresos por varicela y varicela complicada: 19,4 y 15,3 casos por 100.000 menores de 14 años. Las complicaciones fueron más frecuentes en menores de 5 años (79,5%) y sin enfermedad de base (78,2%). La infección de piel y partes blandas fue la complicación más frecuente (62%). La estancia hospitalaria media ± desviación estándar fue de 4,5 ± 4 días.
La varicela produce una elevada morbilidad; esta es más frecuente en términos absolutos en niños sanos menores de 5 años. Por este motivo, la vacunación sistemática recomendada por el Comité Asesor de Vacunas debería ser mandatoria.
Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules.
A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011.
A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4).
Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory.
Neurological complications of varicella in childhood: Case series and a systematic review of the literature
2012, Vaccine
Citation Excerpt :
We examined a total of 1008 manuscripts resulting from our MEDLINE search or from additional references found during review. Out of them, 29 studies were eligible for inclusion in the meta-analysis and were analyzed to estimate a pooled rate of neurological complications in pediatric age [1–4,6,7,10,11,14,16–39]. We excluded 979 articles for the following reasons: (1) they did not report the exact number of neurological complications in varicella in a well defined study period study (855); (2) they were limited to immunocompromised children or to children affected by underlying diseases (12); (3) they were case reports (71); (4) the study population was limited to adults (7); (5) they reported data on both adults and children, not analyzable separately (6); (6) they included both hospitalized and not hospitalized children (3); (7) they focused only on a specific neurological complication (23); (8) their inclusion criteria were too strict (2) (one report included only neonates and one only children younger than one year).
Although varicella has usually an uncomplicated course in early childhood, several neurological complications may occur. We conducted a study to review the type and the rate of varicella neurological complications in a case series of hospitalized immunologically healthy children over nearly a 8 year period. We also systematically reviewed data from the literature to estimate the rate of varicella neurological complications. In our case reports, the proportion of neurological complications among all those hospitalized for varicella was of 21.7% (CI 17.9–26%). The pooled prevalence of neurological complications resulting from the systematic review of the literature identifies the likelihood of such complications in the range of 13.9–20.4%. Although neurological complications of chickenpox do not frequently result in permanent sequelae, they represent significant determinants of prolonged hospital stay and of other indirect costs. The obtained results may be useful for estimating costs associated with hospitalization from varicella in cost–benefit analysis for immunization.
Septic arthritis of the knee in a patient with chicken pox
2012, Anales de Pediatria
Recommendations of the Committee of Experts on usage of two doses schedule of the varicella vaccination
2010, Pediatria Polska
Citation Excerpt :
na rok [14–18]. W Polsce zapadalność na ospę wietrzną wynosi 340 do 420/100 tysięcy (odpowiednio w 2008 i 2007 roku), czyli rocznie zgłoszono od 130 do 160 tysięcy nowych zachorowań [19]. Współczynnik hospitalizacji z powodu ospy wietrznej i powikłań w omawianym okresie wynosił 0,67–0,68/100 tys.
Postvaricella cerebellar ataxia in children in Costa Rica
2008, Anales de Pediatria
La ataxia cerebelosa aguda posvaricela (ACAPV) y la meningoencefalitis son las complicaciones neurológicas agudas más comunes de la varicela. El objetivo del estudio es describir la presentación clínica, el tratamiento médico y el pronóstico de la ACAPV en niños costarricenses hospitalizados en el único hospital pediátrico de nuestro país, donde la vacunación contra la varicela aún no es sistemática.
Estudio descriptivo retrospectivo; se incluyeron pacientes de entre 1 y 12 años de edad, egresados del Hospital de Nacional Niños de Costa Rica entre enero de 1997 y junio de 2004, con el diagnóstico de ACAPV.
De los 441 pacientes inmunocompetentes que fueron hospitalizados por presentar complicaciones asociadas a virus varicela zóster durante este período, 37 pacientes (8,4 %) tuvieron ACAPV, y 24/37 (64,9 %) fueron varones. La edad media (rango) fue de 5 años (1-10 años). La media (rango) de aparición de la ataxia tras el inicio del brote fue de 2 días (1-30). El análisis del líquido cefalorraquídeo (LCR) se realizó en 22 pacientes (59,5 %) y en todos fue normal. La tomografía computarizada (TC) mostró edema cerebral en 6/18 pacientes (33,3 %). Un total 23 niños de 37 recibieron aciclovir intravenoso, aunque no se observaron diferencias significativas (p > 0,05) entre ambos grupos en cuanto a beneficio con la terapia. La duración media (rango) de la ataxia fue de 4 días (1-10) y 7 pacientes (19 %) fueron dados de alta atáxicos. La estancia hospitalaria media (rango) fue de 4,4 días (2-11). Se documentaron secuelas menores en 13/24 pacientes (54,2 %) durante las visitas de seguimiento y contactos telefónicos.
La ACAPV usualmente se asocia con un pronóstico favorable; sin embargo, pueden producirse secuelas neurológicas. La utilidad real del aciclovir y de realizar estudios de imágenes cerebrales en estos niños es controvertida.
Postvaricella cerebellar ataxia (PVCA) and meningoencephalitis are the most common acute neurological complications of chickenpox. The objective of this study was to describe the clinical presentation, management, and outcome of children hospitalized with PVCA in the only pediatric hospital of this developing country, where routine varicella immunization is not yet available.
We performed a retrospective chart review of children aged 1-12 years old admitted to the National Children's Hospital of Costa Rica from January 1997 to June 2004 with a diagnosis of PVCA.
Among the 441 immunocompetent patients admitted for varicella zoster virus-associated complications during this period, 37 (8.4 %) had PVCA. Twenty-four of the 37 (64.9 %) patients were boys. The mean (range) age was 5 (1-10) years. The median (range) interval from rash onset to admission was 2 (1-3) days. Cerebrospinal fluid analysis was available in 22 (59.5 %) patients and was normal in all. Head computed tomography showed cerebral edema in six out of 18 patients (33.3 %). Intravenous acyclovir was administered to 23 patients but no significant differences in clinical manifestations or outcomes were observed in treated versus untreated patients. The mean (range) length of ataxia was 4 (1-10) days, and seven (19 %) patients were still ataxic on discharge. The mean (range) length of hospital stay was 4.4 (2-11) days. Minor sequelae were documented in 13 out of 24 (54.2 %) patients during follow-up visits and telephone contacts.
PVCA is usually associated with a favorable prognosis; however, neurological sequelae can occur. The real utility of acyclovir treatment and brain imaging studies in these children remains controversial.
Causes of hospitalization of patients with ongoing varicella in a French children hospital: evolution between 1990 and 2001
2006, Archives de Pediatrie
Décrire les caractéristiques cliniques des patients hospitalisés pour varicelle à partir des urgences de l'hôpital Armand-Trousseau et l'évolution des motifs d'hospitalisation sur une période de 11 ans.
Étude longitudinale rétrospective dans un service parisien d'urgences pédiatriques de mars 1990 à février 2001.
Cent huit enfants atteints de varicelle ont été hospitalisés en 11 ans (principalement en unité d'hospitalisation de courte durée : 107). Soixante pour cent étaient âgés de moins de 2 ans. Seulement 4,7 % avaient un terrain à risque reconnu. Le principal motif d'hospitalisation était l'existence de 1 ou plusieurs complications (83,3 %) cutanées (34 %), digestives (19,8 %), pulmonaires (17,6 %), neurologiques (15,3 %) et ORL (8,8 %). Sur la période d'observation considérée, le taux global de complications est resté stable alors que l'on a observé une augmentation importante du nombre d'admissions pour varicelle liée à une augmentation significative des surinfections cutanées.
Ces données confirment la gravité potentielle de la varicelle et l'émergence des surinfections cutanées parmi les complications. D'autres études apparaissent nécessaires pour comprendre les causes de ce phénomène et envisager les meilleures méthodes de prévention.
To describe the characteristics of paediatric varicella in patients admitted through the emergency department (ED) of the Armand-Trousseau Children hospital in Paris and the evolution of the causes of admission during the study period.
Retrospective longitudinal cohort study from March 1990 to February 2001.
One hundred and eight children were hospitalized for varicella during these 11 years. Sixty per cent were under 2 years of age and all but one were immunocompetent. The first cause of admission was the presence of at least 1 complication (83,3%) classified as: cutaneous (34%), digestive (19,8,%), respiratory (17,6%), neurological (15,3%) and ENT complications (8,8%). Over 11 years, the rate of overall complications remained stable but there was an important increase in varicella cases admitted through the ED mainly due to increase in cutaneous superinfections.
These data confirm the potential severity of varicella and underline the emerging problem of increasing cutaneous complications. Additional studies are necessary to address this phenomenon and to determine optimal prophylactic measures.

View all citing articles on Scopus

^*: Conflicto de intereses: E.G. Pérez-Yarza ha recibido durante los 3 últimos años becas y ayudas económicas por parte de GSK España S.A., para realizar proyectos de investigación y participar en reuniones científicas

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Hospitalizaciones por complicaciones de la varicela en niños menores de 15 añosHospital Admissions For Varicella Complications In Children Aged Less Than 15 Years Old

Antecedentes

Objetivo

Material y métodos

Resultados

Conclusiones

Background

Objective

Material and methods

Results

Conclusions

J Pediatr

Vaccine

Vacunas Invest Pract

Age-specific risks of varicella complications

Pediatrics

Varicella-zoster virus epidemiology: A changing scene?

J Infect Dis

Chickenpox hospitalizations among residents of Olmsted County, Minnesota, 1962 through 1981: A population-based study

Am J Dis Child

Deaths from chickenpox in England and Wales 1995–7: Analysis of routine mortality data

Bmj

Calendario vacunal de la Asociación Española de Pediatría 2003

An Esp Pediatr

Resumen de las enfermedades infecciosas

Virus de la varicela-zoster