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Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US

BACKGROUND: In 1995, the CDC recommended one-dose routine varicella immunization for children <12 years of age, expanding its recommendation to two doses in 2006. Today, with widespread varicella vaccination coverage, an estimated 3.5 million cases of varicella, 9,000 hospitalizations, and 100 de...

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Autores principales: Fergie, Jaime, Pawaskar, Manjiri, Veeranki, Phani, Samant, Salome, Harley, Carolyn, MacEwan, Joanna, Schwartz, Taylor T., Surati, Shikha, Conway, James H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231738/
https://www.ncbi.nlm.nih.gov/pubmed/35749342
http://dx.doi.org/10.1371/journal.pone.0269596
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author Fergie, Jaime
Pawaskar, Manjiri
Veeranki, Phani
Samant, Salome
Harley, Carolyn
MacEwan, Joanna
Schwartz, Taylor T.
Surati, Shikha
Conway, James H.
author_facet Fergie, Jaime
Pawaskar, Manjiri
Veeranki, Phani
Samant, Salome
Harley, Carolyn
MacEwan, Joanna
Schwartz, Taylor T.
Surati, Shikha
Conway, James H.
author_sort Fergie, Jaime
collection PubMed
description BACKGROUND: In 1995, the CDC recommended one-dose routine varicella immunization for children <12 years of age, expanding its recommendation to two doses in 2006. Today, with widespread varicella vaccination coverage, an estimated 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections are now uncommon, health care providers (HCPs) may not recognize varicella infections and may prescribe inappropriate treatment. METHODS: An online survey of HCPs was conducted to assess recognition and management of varicella infections. Responses to eight varicella vignettes describing patients with varying varicella symptoms were analyzed and descriptive analyses performed. Stratified analysis comparing responses of those licensed before and in/after 1996 was also performed. RESULTS: 153 HCPs (50 nurse practitioners, 103 doctors) completed the survey. Mean age of respondents was 44 years. 62% were female, and 82% were licensed before 1996. Varicella infection was correctly diagnosed 79% of the time. HCPs correctly recognized uncomplicated varicella vignettes 85% of the time versus 61% of the time for complicated varicella vignettes. Antibiotics were recommended 17% of the time and antivirals 18% of the time, of which 25% and 69% (respectively) were not appropriate per guidelines. HCPs licensed before 1996 were better able to recognize varicella compared to those licensed later, but prescribed more antimicrobials medications to treat varicella. CONCLUSIONS: Although most HCPs recognized varicella infection, a sizable proportion could not recognize cases with complications, and some of the varicella cases were inappropriately treated with antibiotics and/or antivirals. Additional HCP training and high vaccination coverage are important strategies to avoid inaccurate diagnoses and minimize unnecessary exposure to antimicrobial/antiviral therapies.
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spelling pubmed-92317382022-06-25 Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US Fergie, Jaime Pawaskar, Manjiri Veeranki, Phani Samant, Salome Harley, Carolyn MacEwan, Joanna Schwartz, Taylor T. Surati, Shikha Conway, James H. PLoS One Research Article BACKGROUND: In 1995, the CDC recommended one-dose routine varicella immunization for children <12 years of age, expanding its recommendation to two doses in 2006. Today, with widespread varicella vaccination coverage, an estimated 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections are now uncommon, health care providers (HCPs) may not recognize varicella infections and may prescribe inappropriate treatment. METHODS: An online survey of HCPs was conducted to assess recognition and management of varicella infections. Responses to eight varicella vignettes describing patients with varying varicella symptoms were analyzed and descriptive analyses performed. Stratified analysis comparing responses of those licensed before and in/after 1996 was also performed. RESULTS: 153 HCPs (50 nurse practitioners, 103 doctors) completed the survey. Mean age of respondents was 44 years. 62% were female, and 82% were licensed before 1996. Varicella infection was correctly diagnosed 79% of the time. HCPs correctly recognized uncomplicated varicella vignettes 85% of the time versus 61% of the time for complicated varicella vignettes. Antibiotics were recommended 17% of the time and antivirals 18% of the time, of which 25% and 69% (respectively) were not appropriate per guidelines. HCPs licensed before 1996 were better able to recognize varicella compared to those licensed later, but prescribed more antimicrobials medications to treat varicella. CONCLUSIONS: Although most HCPs recognized varicella infection, a sizable proportion could not recognize cases with complications, and some of the varicella cases were inappropriately treated with antibiotics and/or antivirals. Additional HCP training and high vaccination coverage are important strategies to avoid inaccurate diagnoses and minimize unnecessary exposure to antimicrobial/antiviral therapies. Public Library of Science 2022-06-24 /pmc/articles/PMC9231738/ /pubmed/35749342 http://dx.doi.org/10.1371/journal.pone.0269596 Text en © 2022 Fergie et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Fergie, Jaime
Pawaskar, Manjiri
Veeranki, Phani
Samant, Salome
Harley, Carolyn
MacEwan, Joanna
Schwartz, Taylor T.
Surati, Shikha
Conway, James H.
Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US
title Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US
title_full Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US
title_fullStr Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US
title_full_unstemmed Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US
title_short Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US
title_sort recognition & management of varicella infections and accuracy of antimicrobial recommendations: case vignettes study in the us
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231738/
https://www.ncbi.nlm.nih.gov/pubmed/35749342
http://dx.doi.org/10.1371/journal.pone.0269596
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