title: Incidence and consequences of varicella in children treated for cancer in Guatemala.
abstract: BACKGROUND
  Varicella-zoster virus infection is associated with significant morbidity and mortality in immune-compromised children, despite treatment with antiviral agents. Universal varicella vaccine programs have significantly decreased this risk in many highincome countries, but in most low-income and middleincome countries, the burden of varicella in children treated for malignancy is poorly defined.
  
  
  METHODS
  We retrospectively reviewed records of children at the National Unit of Pediatric Oncology (UNOP) in Guatemala diagnosed with varicella between January 2009 and March 2013 in order to calculate incidence of varicella and evaluate morbidity, mortality, treatment interruption, and cost.
  
  
  RESULTS
  Fifty-nine cases of varicella were identified. Incidence was 23.4 cases per 1000 person-years (p-y). 66.1% of cases occurred in children with leukemia (median age 5.2 years; interquantile range 3.4-7 years) and 41.0% of these occurred during maintenance therapy. Source of exposure was identified for 14/59 (23.7%) children. Most were hospitalized (71.2%) and given intravenous acyclovir (64.4%). Eight (13.6%) children required critical care, and two (3.4%) died from disseminated varicella with multiorgan failure. Chemotherapy was delayed or omitted due to varicella in 50%. No significant differences in outcomes based on nutritional and immunologic status were detected. The minimum average cost of treatment per episode was 598.75 USD.
  
  
  CONCLUSIONS
  Varicella is a significant problem in children treated for cancer in Guatemala, where effective post-exposure prophylaxis is limited. In the absence of universal varicella vaccination, strategies to improve recognition of exposure and the future use of novel inactivated vaccines currently under investigation in clinical trials could mitigate this burden.
authors.affiliation: Center for Bioethics and Humanities and Department of Pediatrics, SUNY Upstate Medical University, Syracuse, USA. brownamy@upstate.edu.
authors.forename: Amy E Caruso
authors.initials: AEC
authors.lastname: Brown
authors.affiliation: Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA.
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Asturias
authors.affiliation: National Unit of Pediatric Oncology, Guatemala City, Guatemala.
authors.forename: Mario
authors.initials: M
authors.lastname: Melgar
authors.affiliation: National Unit of Pediatric Oncology, Guatemala City, Guatemala.
authors.forename: Federico A
authors.initials: FA
authors.lastname: Antillon-Klussmann
authors.affiliation: Department of Biostatistics and Informatics, Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Mettler
authors.affiliation: Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Levin
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D017677:Age Distribution; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002644:Chickenpox / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D020380:Needs Assessment; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000212:Acyclovir
keywords: cancer; developing countries; immunocompromised host; oncology; varicella