Wen Sophie Chien-Hui, Miles Fiona, McSharry Brent, Wilson Elizabeth
Department of Paediatric Infectious Disease, Starship Children's Hospital, Auckland, New Zealand.
J Paediatr Child Health. 2014 Apr;50(4):280-5. doi: 10.1111/jpc.12473. Epub 2013 Dec 23.
Varicella is now a vaccine-preventable disease but is generally considered benign, making it a low priority for a funded universal immunisation scheme. We aimed to increase the knowledge of the severity, morbidity and mortality caused by varicella, by a review of cases requiring paediatric intensive care in New Zealand where vaccine is available but not funded.
This is a retrospective chart review of children admitted to the paediatric intensive care unit (PICU) over a 10-year period (July 2001-July 2011) identified from the PICU database with a primary or secondary code for varicella.
Thirty-four cases were identified and 26 cases were included. Of the 26 cases, 84.6% were Maori or Pacific Island ethnicity, 54% had no preceding medical condition and 23% were immunocompromised. Main PICU admission reasons were neurologic (38.5%), secondary bacterial sepsis or shock (26.9%), respiratory (15.4%), disseminated varicella (11.5%), or other causes (7.7%). Fifty per cent of children required inotropic support and 81% invasive ventilation. Four children died (15%), three of whom were immunocompromised. A further eight children (31%) had ongoing disability at hospital discharge.
Varicella, or its secondary complications, requiring paediatric intensive care, carries high mortality, particularly for immunocompromised patients, and long-term morbidities, mostly affecting previously healthy children.
水痘现在是一种可用疫苗预防的疾病，但通常被认为是良性的，这使得它在有资金支持的全民免疫计划中优先级较低。我们旨在通过回顾新西兰有疫苗但无资金支持情况下需要儿科重症监护的病例，来增加对水痘所致严重程度、发病率和死亡率的了解。
这是一项回顾性图表审查，研究对象为从儿科重症监护病房（PICU）数据库中识别出的在10年期间（2001年7月至2011年7月）因水痘主要或次要编码而入住PICU的儿童。
共识别出34例病例，纳入26例。在这26例病例中，84.6%为毛利族或太平洋岛民种族，54%之前无基础疾病，23%为免疫功能低下者。入住PICU的主要原因是神经系统问题（38.5%）、继发性细菌性败血症或休克（26.9%）、呼吸系统问题（15.4%）、播散性水痘（11.5%）或其他原因（7.7%）。50%的儿童需要使用血管活性药物支持，81%需要有创通气。4名儿童死亡（15%），其中3名是免疫功能低下者。另有8名儿童（31%）出院时仍有持续残疾。
需要儿科重症监护的水痘或其继发性并发症具有高死亡率，尤其是对免疫功能低下的患者，以及长期发病率，主要影响既往健康的儿童。
