title: Serotesting versus presumptive varicella vaccination of adolescents with a negative or uncertain history of chickenpox.
abstract: OBJECTIVE
  To review the current practice of adolescent health care providers when an adolescent reports a negative or uncertain history of chickenpox in order to provide information for future practice.
  
  
  METHODS
  Retrospective chart review of a sample of patients seen in a hospital-based adolescent primary care clinic between 1996 and 1999.
  
  
  RESULTS
  Among adolescents who reported a positive history of chickenpox (190 patients, aged 15 +/- 1 years), varicella occurred before age 5 years in 30%, between 5 and 10 years in 56%, and at older than age 10 years in 14% of the patients. When adolescents reported a negative or uncertain history of varicella (55 patients, aged 15 +/- 1 years), serotesting was ordered for the majority (73%) of cases, while only 16% were presumptively vaccinated with varicella vaccine. In six patients no intervention was noted in the charts, and these patients were contacted. In 80% of the patients who were serotested, varicella IgG titers of > or = 1:32 indicated a previous unnoticed infection and lifelong immunity to varicella. In only 20% of the patients sera were negative for varicella IgG titer, requiring varicella vaccination. There was no statistical difference between the number of siblings of patients with a positive serologic test (3 +/- 1) and the number of siblings of seronegative patients (2 +/- 1, p = 0.41). Seven of the eight seronegative patients consented to varicella vaccination and were vaccinated within 10 months of serotesting.
  
  
  CONCLUSIONS
  These data support the practice of serotesting for a previously unnoticed varicella infection rather than presumptive vaccination in the adolescent age group. A follow-up vaccination of seronegative adolescents should be scheduled as close to serotesting as possible.
authors.affiliation: Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island 02903, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Harel
authors.forename: L
authors.initials: L
authors.lastname: Ipp
authors.forename: S
authors.initials: S
authors.lastname: Riggs
authors.forename: R
authors.initials: R
authors.lastname: Vaz
authors.forename: P
authors.initials: P
authors.lastname: Flanagan
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000276:immunology; D002644:Chickenpox / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000276:immunology*; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008487:Medical History Taking / Q000706:statistics & numerical data; D012698:Serologic Tests / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000914:Antibodies, Viral; D019433:Chickenpox Vaccine; D007074:Immunoglobulin G