Identification of potential candidates for varicella vaccination by history: questionnaire and seroprevalence study
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《英国医生杂志》
1 Department of Infection, Guy's and St Thomas' Hospital NHS Trust, London SE1 7EH, 2 Occupational Health Department, Guy's and St Thomas' Hospital NHS Trust, 3 Occupational Health Department, Guy's, King's, and St Thomas' School of Medicine, London SE1 9RT
Correspondence to: E MacMahon eithne.macmahon@gstt.sthames.nhs.uk
Introduction
Candidates for varicella vaccination (seronegative staff) will inevitably be missed if a blanket policy of screening by history alone is implemented. As shown here, their number will increase considerably if groups with a significantly higher false positive rate account for a substantial proportion of the workforce.
The overall seroprevalence and positive predictive value are lower than figures usually quoted for healthcare workers in Europe, but the distribution of geographical origins largely explains the discrepancy. It is a weakness of this study that some of the countries defined as temperate in the questionnaire—for example, India—also contain regions with tropical climates. Serological testing of recruits from these areas should also be considered. Individuals born or raised in tropical climates should have serological screening regardless of a history of chickenpox.
What is already known on this topic
A history of chickenpox is a reliable indicator of past infection in temperate climates
What this study adds
Seronegative candidates for varicella vaccination will be missed if a blanket policy of screening by history alone is applied to people born or raised in tropical climates
This article was posted on bmj.com on 23 July 2004: http://bmj.com/cgi/doi/10.1136/bmj.38170.691956.AE
We thank the Guy's and St Thomas' Hospital NHS Trust's occupational health nurses for conducting the questionnaire, its department of infection staff for laboratory work and secretarial help, and Sue Chinn for help with statistical analysis.
Contributors: EMacM and DP designed the study, wrote the paper and did the statistical analysis. LJB did data entry, manipulation, and analysis. SB coordinated data collection and entered the data. DCS contributed throughout the study. EMacM is the guarantor.
Funding: None.
Competing interests: In the past five years, EMacM has received sponsorship from Launch Diagnostics Biokit, GlaxoWellcome, SmithKlineBeecham Pharmaceuticals, and Aventis Pasteur MSD towards the cost of attending conferences. DP has been funded by GlaxoSmithKline to give a talk on a subject unrelated to this study.
Ethical approval: St Thomas' Research Ethics Committee.
References
Department of Health. www.dh.gov.uk/policyandguidance/healthandsocialcaretopics/greenbook (See new chapter 34) (accessed 16 July 2004).
Vandersmissen G, Moens G, Vranckx R, de Schryer A, Jacques P. Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study. Occup Environ Med 2000;57: 621-6.
Garnett GP, Cox MJ, Bundy DAP, Didier JM, St Catharine J. The age of infection with varicella-zoster virus in St Lucia, West Indies. Epidemiol Infect 1993;110: 361-72.
Buchanan J, Edwards N. Nursing numbers in Britain: the argument for workforce planning. BMJ 2000; 1067-70.
Rogers J. Recruiting in hard times. BMJ 1997;315(suppl):S2. (http://bmj.bmjjournals.com/cgi/content/full/315/7122/S2-7122)(Eithne MacMahon, consulta)
Correspondence to: E MacMahon eithne.macmahon@gstt.sthames.nhs.uk
Introduction
Candidates for varicella vaccination (seronegative staff) will inevitably be missed if a blanket policy of screening by history alone is implemented. As shown here, their number will increase considerably if groups with a significantly higher false positive rate account for a substantial proportion of the workforce.
The overall seroprevalence and positive predictive value are lower than figures usually quoted for healthcare workers in Europe, but the distribution of geographical origins largely explains the discrepancy. It is a weakness of this study that some of the countries defined as temperate in the questionnaire—for example, India—also contain regions with tropical climates. Serological testing of recruits from these areas should also be considered. Individuals born or raised in tropical climates should have serological screening regardless of a history of chickenpox.
What is already known on this topic
A history of chickenpox is a reliable indicator of past infection in temperate climates
What this study adds
Seronegative candidates for varicella vaccination will be missed if a blanket policy of screening by history alone is applied to people born or raised in tropical climates
This article was posted on bmj.com on 23 July 2004: http://bmj.com/cgi/doi/10.1136/bmj.38170.691956.AE
We thank the Guy's and St Thomas' Hospital NHS Trust's occupational health nurses for conducting the questionnaire, its department of infection staff for laboratory work and secretarial help, and Sue Chinn for help with statistical analysis.
Contributors: EMacM and DP designed the study, wrote the paper and did the statistical analysis. LJB did data entry, manipulation, and analysis. SB coordinated data collection and entered the data. DCS contributed throughout the study. EMacM is the guarantor.
Funding: None.
Competing interests: In the past five years, EMacM has received sponsorship from Launch Diagnostics Biokit, GlaxoWellcome, SmithKlineBeecham Pharmaceuticals, and Aventis Pasteur MSD towards the cost of attending conferences. DP has been funded by GlaxoSmithKline to give a talk on a subject unrelated to this study.
Ethical approval: St Thomas' Research Ethics Committee.
References
Department of Health. www.dh.gov.uk/policyandguidance/healthandsocialcaretopics/greenbook (See new chapter 34) (accessed 16 July 2004).
Vandersmissen G, Moens G, Vranckx R, de Schryer A, Jacques P. Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study. Occup Environ Med 2000;57: 621-6.
Garnett GP, Cox MJ, Bundy DAP, Didier JM, St Catharine J. The age of infection with varicella-zoster virus in St Lucia, West Indies. Epidemiol Infect 1993;110: 361-72.
Buchanan J, Edwards N. Nursing numbers in Britain: the argument for workforce planning. BMJ 2000; 1067-70.
Rogers J. Recruiting in hard times. BMJ 1997;315(suppl):S2. (http://bmj.bmjjournals.com/cgi/content/full/315/7122/S2-7122)(Eithne MacMahon, consulta)