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PEPtalk: post-exposure prophylaxis against varicella in children with cancer
Lookup NU author(s)
Dr Paula Heath
Professor Roderick Skinner
Dr Sheila Patel
Dr Pamela Kearns
Professor Sophie Hambleton
Bate J, Chisholm J, Heath P, Breuer J, Skinner R, Manley S, Patel S, Wheatley K, Ramsay M, Kearns P, Hambleton S
Archives of Disease in Childhood
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Objectives: To describe post-exposure prophylaxis (PEP) against varicellazoster virus (VZV) in children being treated for malignancy in the UK and Eire:the population at risk, frequency of exposure, clinical practice and attitudesamong healthcare providers.Design: An observational study in three parts: (1) a retrospective survey ofserostatus at diagnosis of malignancy, (2) collation of varicella zoster immuneglobulin (VZIG) dispensing data for children with malignancy in England andWales over a 3-year period, and (3) an online survey of paediatric oncologists’clinical practice and beliefs in relation to VZV disease and its prevention.Setting: UK and EireParticipants: Children aged under 15 years and diagnosed with malignancy inthe calendar year 2009 (for serostatus survey) or receiving VZIG between April2006 and March 2009 (for VZIG dispensing study). Paediatric oncologists andhaematologists working in the tertiary paediatric oncology centres and theirrelated shared care units in the UK and Eire participated in the physician survey.Results: Of the 1500 children diagnosed with malignancy each year, at least24% are VZV-seronegative. Few centres make efforts to prevent householdexposure by identifying and vaccinating VZV-susceptible family members.Exposures to VZV result in the administration of PEP to approximately 250children with cancer annually: half receive an intramuscular injection of VZIGwhile the remainder receive a course of oral aciclovir. The choice of PEP is madeby doctors. There is no consensus among paediatric oncologists as to which isthe better option, reflecting the lack of a secure evidence base.Conclusions: A randomised controlled trial to compare the effectiveness andacceptability of VZIG and aciclovir as PEP against VZV is both desirable andfeasible.
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