title: Varicella outbreak in a pediatric oncology ward: the Manado experience.
abstract: BACKGROUND
  Varicella is highly contagious and dangerous disease, especially in immunocompromised patients. Children with cancer are at increased risk of severe illness and fatal cases occur.
  
  
  OBJECTIVE
  To describe an outbreak of varicella among in-patient cancer children, family members and staff. Estella Children Cancer Center in Manado, Indonesia with 14 beds and a 15 bed capacity guest house for family members.
  
  
  METHODS
  A retrospective study of patients, family members and staff who were diagnosed with varicella based on clinical appearance was performed. Follow up was until 28 days from the last patient diagnosis' date.
  
  
  RESULTS
  From late February to early May 2009, varicella was affecting 4 among 8 children with leukemia, 1 family member and 1 housekeeping staff. Measurers taken after the index case were oral acyclovir both for patients and contacts, patient isolation, ward disinfection and some chemotherapy interruption. Nevertheless, a second and third wave of varicella occurred. The index case died due to encephalitis. Other patients were non-severe and cured, but one child was lost to follow up.
  
  
  CONCLUSIONS
  This outbreak highlights the importance of proper prevention and prompt management of varicella in immunocompromised patients. Simple and locally applicable guidelines are needed.
authors.affiliation: Estella Children Cancer Center, RD Kandou General Hospital, Manado, Indonesia. stefledi2000@yahoo.com
authors.forename: Stefanus
authors.initials: S
authors.lastname: Gunawan
authors.forename: Paulus
authors.initials: P
authors.lastname: Linardi
authors.forename: Konda
authors.initials: K
authors.lastname: Tawaluyan
authors.forename: Max F J
authors.initials: MF
authors.lastname: Mantik
authors.forename: A J P
authors.initials: AJ
authors.lastname: Veerman
mesh_terms: D002644:Chickenpox / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D014645:Herpesvirus 3, Human / Q000472:pathogenicity*; D006761:Hospitals; D006801:Humans; D016867:Immunocompromised Host; D007214:Indonesia; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies