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APHA Scientific Session and Event Listing

Pat Tormey, RN, MPH, Venus Gray, RN, MSN, Barbara Butwinick, RN, BA, BSN, and Kate Matthews, RN, BA. Communicable Disease Control Division, Boston Public Health Commission, 1010 Massachusetts Ave, 2nd Floor, Boston, MA 02118, 617 534-5611, ptormey@bphc.org

Children attending daycare through grade twelve in Massachusetts are required to have proof of immunity to chickenpox. However, breakthough disease after vaccination and disease in unvaccinated adults and some children have resulted in school outbreaks. The number of schools (kindergarten through grade 12) with chickenpox exposures reported to the Boston Public Health Commission (BPHC) increased from three in 2003 to sixteen in 2005. Management of a reported chickenpox exposure in a school requires a significant amount of time from school and public health nurses. Goals are to protect high risk contacts in which chickenpox is more likely to cause severe illness and to limit the number of secondary cases. A 2005 outbreak with fifteen cases in eight classrooms in one school over a five week period will be presented. High risk susceptible contacts included an immunocompromised student and three staff; three additional cases occurred in infant siblings. Interventions included verification of diagnosis, identification of susceptible contacts, referrals for vaccination or for Varicella Zoster Immune Globulin (for high risk contacts), exclusion of susceptibles, and enhanced surveillance. Barriers to control include difficulty in diagnosing breakthrough disease, delayed reporting, limited personnel able to identify susceptible persons, requirement to exclude susceptibles (resulting in problems for parents and staff shortages), and a misperception that “chickenpox is a normal childhood disease.” Interventions by public health and school nurses can control the extent of a varicella outbreak, but are very resource intensive. Partnerships among the nurses, parents and healthcare providers are key for limiting secondary cases.

Learning Objectives: