Epidemiological investigation of a nosocomial varicella outbreak triggered by a herpes zoster case
LUO Xiulan1, ZHENG Yongtao1, NI Mengjiao1, LU Chao1, XU Tingyan1, WENG Jiyan2, LAI Fenhua1
1. Xiaoshan District Center for Disease Control and Prevention, Hangzhou, Zhejiang 311203, China; 2. Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
Abstract：On August 24 2024, Xiaoshan District Center for Disease Control and Prevention, Hangzhou City, received a report of two cases of varicella infection among staff in the intensive care unit (ICU) of a hospital in its jurisdiction. The center immediately organized personnel to conduct an epidemiological investigation of the cases and their close contacts. The index case was a patient admitted to the ICU who had large areas of red rash and pustules on the chest, back, and right axilla. This case was diagnosed with herpes zoster by a dermatology consultation within the hospital. The other nine secondary cases were all nursing staff in the ICU, who were clinically diagnosed with varicella between August 21 and September 1, with an attack rate of 14.06%. All secondary varicella cases had a history of contact with the herpes zoster case and no history of varicella infection. Their varicella vaccination history was unknown. Based on the results of the on-site epidemiological and sanitary investigations, it was determined that this was an outbreak of varicella in the hospital caused by a herpes zoster case. After the last case was diagnosed, no new cases were reported within the longest incubation period (21 days), and the outbreak was declared over on September 21. Close contact with the herpes zoster case was likely the main cause of the outbreak. This highlights the need for early identification and isolation of suspected herpes zoster cases in hospitals in the future, as well as enhanced protective measures to prevent nosocomial infections.
[1] 国家卫生健康委员会,国家中医药管理局.水痘诊疗方案(2023年版)[J].国际流行病学传染病学杂志,2024,51(1):4-6. National Health Commission of the People's Republic of China,State Administration of Traditional Chinese Medicine.Diagnosis and treatment plan for varicella(2023 edition)[J].Inter J Epidemiol Infect Dis,2024,51(1):4-6.(in Chinese) [2] 张玉萍,徐文阁.对带状疱疹传染性的认识[J].中华医院感染学杂志,2009,19(17):2281. ZHANG Y P,XU W G.Understanding the infectiousness of herpes zoster[J].Chin J Nosocomio,2009,19(17):2281.(in Chinese) [3] 中华人民共和国国家卫生和计划生育委员会.经空气传播疾病医院感染预防与控制规范:WS/T 511—2016[S].北京:中国标准出版社,2016. National Health and Family Planning Commission of the People's Republic of China.Regulation for prevention and control of healthcare associated infection of airborne transmission diseases in healthcare facilities:WS/T 511—2016[S].Beijing:Standards Press of China,2016.(in Chinese) [4] 刘冰,曹洋,王丽,等.医务人员分级防护的政策依据与临床实践[J].中国消毒学杂志,2023,40(4):315-318. LIU B,CAO Y,WANG L,et al.Policy basis and clinical practice of hierarchical protection for medical staff[J].Chin J Disinfect,2023,40(4):315-318.(in Chinese) [5] 中华人民共和国卫生部,国家中医药管理局.卫生部国家中医药管理局关于印发《医院感染暴发报告及处置管理规范》的通知[J].中华人民共和国卫生部公报,2009(9):37-39. [6] 韩麦,徐潜.带状疱疹引起的院内聚集性水痘疫情调查分析[J].中日友好医院学报,2017,31(4):226-227,230. HAN M,XU Q.Investigation and analysis of a hospital cluster varicella outbreak caused by herpes zoster[J].J China-Japan Friendship Hosp,2017,31(4):226-227,230.(in Chinese) [7] 许玉洋,许二萍,刘艳,等.一起ICU疑似护理带状疱疹病例引起的水痘聚集性疫情调查[J].预防医学,2016,28(10):1047-1048,1051. XU Y Y,XU E P,LIU Y,et al.Investigation of a cluster varicella outbreak caused by a suspected herpes zoster case in an ICU nurse[J].China Prev Med J,2016,28(10):1047-1048,1051.(in Chinese) [8] KENDRA V,DANA P,ADRIANA L,et al.Transmission of varicella zoster virus from individuals with herpes zoster or varicella in school and day care settings[J].J Infec Dis,2012,205(9):1336-1341. [9] 殷大鹏,卢莉,刘燕敏.水痘疫苗预防接种专家共识[J].首都公共卫生,2023,17(5):257-266. YIN D P,LU L,LIU Y M.Expert consensus of varicella vaccine immunization in China[J].Cap J Public Health,2023,17(5):257-266.(in Chinese) [10] 中国医疗保健国际交流促进会皮肤科分会,中华医学会皮肤性病学分会老年性皮肤病研究中心.带状疱疹疫苗预防接种专家共识[J].中华医学杂志,2022,102(8):538-543. Dermatology Branch of China International Exchange and Promotion Association for Medical and Health Care,Research Center for Geriatric Dermatology of Chinese Medical Association.Expert consensus on herpes zoster vaccine prevention and immunization[J]. Natl Med J China,2022,102(8):538-543.(in Chinese) [11] 蒋静凤,王旭雯.水痘疫苗保护效果的病例对照研究[J].现代预防医学,2020,47(9):1684-1687. JIANG J F,WANG X W.Case-control study on the protective effect of varicella vaccine[J].Mod Prev Med,2020,47(9):1684-1687.(in Chinese) [12] 蔡一飙,李萍萍,赵凤敏,等.宁波市学校水痘暴发疫情及疫苗接种效果调查[J].预防医学,2016,28(2):174-175. CAI Y B,LI P P,ZHAO F M,et al.Varicella outbreak in Ningbo City schools and evaluation of vaccine effectiveness[J].China Prev Med J,2016,28(2):174-175.(in Chinese)
