title: Management and outcome of a varicella exposure in a neonatal intensive care unit: lessons for the vaccine era.
abstract: BACKGROUND
  Varicella exposure in health care settings poses a threat to susceptible, immunocompromised hosts. We describe the management and outcome of a varicella exposure in a neonatal intensive care unit.
  
  
  METHODS
  We reviewed the history of the index case, determination of the exposed cohort, medical management of exposed neonates, and assignment of health care workers based on exposure and immune status. We present the results of serologic testing of health care workers related to their history of varicella disease.
  
  
  RESULTS
  Of 427 health care workers assessed at the time of the exposure, 13.1% were seronegative for varicella. Among 180 employees recorded as having a previous history of varicella, 9 were seronegative. A total of 34 infants received prophylaxis with intravenous immune globulin; acyclovir prophylaxis was added for those born at <28 weeks gestational age. The exposed cohort was isolated. No secondary cases of varicella occurred among patients or health care workers.
  
  
  CONCLUSIONS
  Nosocomial varicella exposures require rapid assessment and response, which can be guided by a checklist of actions. Varicella immunity in health care workers cannot be assumed even among those born before 1980; institutional policies should adhere to the 2007 Centers for Disease Control and Prevention's definition of immunity to varicella for health care workers.
authors: Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. skellie@salud.unm.edu
authors: Susan M
authors: SM
authors: Kellie
authors: Monear
authors: M
authors: Makvandi
authors: Martha L
authors: ML
authors: Muller