title: Knowledge, attitudes, and practices for diagnosing breakthrough varicella in the outpatient setting.
abstract: OBJECTIVE
  We assessed provider knowledge, attitudes, and practices for the management of breakthrough varicella and identified barriers to implementation of laboratory testing and reporting.
  
  
  METHODS
  We surveyed 145 health-care providers (HCPs) from 30 pediatric practices in Philadelphia who did not have a history of laboratory testing for breakthrough varicella. The self-administered survey instrument collected information on clinicians' practices for management of children presenting with rash, infection-control strategies, reporting to public health agencies, and laboratory testing.
  
  
  RESULTS
  Among the 144 HCPs who completed the survey, 73 (51%) had practiced for more than 10 years. While 115 HCPs (80%) would elect to evaluate a child with rash in the office, only 19 (13%) would submit diagnostics. When patients had a known recent exposure to varicella, 84 HCPs (58%) would use laboratory tests: 40% would use direct fluorescent antibody staining on a specimen from a cutaneous lesion, 24% would use polymerase chain reaction on a lesion specimen, 21% would use acute and convalescent serology, and 10% would use other tests. While waiting for test results, 82 HCPs (57%) would advise that the child be kept at home, 39 (27%) would notify the local health department, and 33 (23%) would inform the school nurse.
  
  
  CONCLUSIONS
  As varicella becomes increasingly uncommon, laboratory confirmation becomes more critical for appropriate diagnosis, similar to poliomyelitis and measles. Our findings suggest that HCPs need further education regarding laboratory confirmation, containment, and reporting of breakthrough varicella.
authors.affiliation: Philadelphia Department of Public Health, Division of Disease Control, Philadelphia, PA, USA. daskalaki.i@gmail.com
authors.forename: Irini
authors.initials: I
authors.lastname: Daskalaki
authors.forename: Kendra M
authors.initials: KM
authors.lastname: Viner
authors.forename: Dana
authors.initials: D
authors.lastname: Perella
authors.forename: E Claire
authors.initials: EC
authors.lastname: Newbern
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Johnson
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Watson
mesh_terms: D000554:Ambulatory Care Facilities; D002644:Chickenpox / Q000175:diagnosis* / Q000628:therapy; D003140:Communicable Disease Control / Q000379:methods*; D018563:Disease Notification / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D015143:Philadelphia