title: PEPtalk: postexposure prophylaxis against varicella in children with cancer.
abstract: OBJECTIVE
  To describe postexposure prophylaxis (PEP) against varicella zoster virus (VZV) in children being treated for malignancy in the UK and Ireland: the population at risk, frequency of exposure, clinical practice and attitudes among healthcare providers.
  
  
  METHODS
  An observational study in three parts: (1) a retrospective survey of serostatus at diagnosis of malignancy, (2) collation of varicella zoster immune globulin (VZIG) dispensing data over a 3-year period and (3) an online survey of paediatric oncologists' clinical practice and beliefs in relation to VZV disease and its prevention.
  
  
  METHODS
  UK and Ireland.
  
  
  METHODS
  Children diagnosed with malignancy in 2009 (serostatus survey) or receiving VZIG between April 2006 and March 2009 (VZIG dispensing study). Paediatric oncologists and haematologists working in tertiary paediatric oncology centres and related shared care units in the UK and Ireland (physician survey).
  
  
  RESULTS
  Of 1500 children diagnosed with malignancy each year, at least 24% are VZV seronegative. Few centres make efforts to prevent household exposure by vaccinating VZV-susceptible family members. Exposures to VZV result in the administration of PEP to approximately 250 children with cancer annually: half receive an intramuscular injection of VZIG while the remainder receive a course of oral aciclovir. The choice of PEP is made by doctors. There is no consensus among paediatric oncologists as to which is the better option, reflecting the lack of a secure evidence base.
  
  
  CONCLUSIONS
  A randomised controlled trial to compare the effectiveness and acceptability of VZIG and aciclovir as PEP against varicella is both desirable and feasible.
authors.affiliation: Division of Clinical Sciences, St George's, University of London, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bate
authors.forename: Julia
authors.initials: J
authors.lastname: Chisholm
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
authors.forename: Judith
authors.initials: J
authors.lastname: Breuer
authors.forename: Rod
authors.initials: R
authors.lastname: Skinner
authors.forename: Sue
authors.initials: S
authors.lastname: Manley
authors.forename: Soonie
authors.initials: S
authors.lastname: Patel
authors.forename: Keith
authors.initials: K
authors.lastname: Wheatley
authors.forename: Mary
authors.initials: M
authors.lastname: Ramsay
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Kearns
authors.forename: Sophie
authors.initials: S
authors.lastname: Hambleton
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002644:Chickenpox / Q000150:complications / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007106:Immune Sera / Q000008:administration & dosage*; D009369:Neoplasms / Q000150:complications*; D009894:Opportunistic Infections / Q000150:complications / Q000517:prevention & control*; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D011364:Professional Practice / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D007106:Immune Sera; C030799:varicella-zoster immune globulin; D000212:Acyclovir