1216. Safety and Efficacy of Postexposure Prophylaxis with High-dose Valacyclovir Against Varicella Exposures in Pediatric Wards
Session: Poster Abstract Session: Pediatric CMV and Other Herpes Infections
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Although most children with varicella recover from the disease uneventfully, varicella infection can cause high morbidity and mortality in immunocompromised patients. As postexposure prophylaxis (PEP) in the inpatient setting, the administration of intravenous acyclovir and immunoglobulin (IVIG) has been used to prevent secondary varicella in immunocompromized patients; however, the usefulness of oral valacyclovir as a PEP in this specific population has not been well documented.

Methods: We experienced six varicella outbreaks between April 2009 and July 2010 in pediatric wards at the largest pediatric tertiary care hospital in Japan. We used either oral high-dose valacyclovir (90mg/kg/day q8h, max dose: 3g/day) or intravenous acyclovir (30mg/kg/day q8h) as a PEP with or without IVIG (400mg/kg/dose). The therapy was immediately started after the exposure and the duration of therapy was 14 days.  Post-exposure vaccination was also provided when indicated.

Results: There were 154 patients exposed to varicella during the study period. The mean age of the patients was 2.7 years (range: 2 months-17 years). PEP was administered to 35 (23%) patients, and the majority of the patients (n = 31, 89%) were immnocompromised. High-dose valacyclovir and intravenous acyclovir were used in 84% (26/31) and 16% (5/31) of the patients, respectively. Ninety percent (28/31) of the immnocompromised patients also received concomitant IVIG. There were no cases of secondary varicella among the patients who received a PEP, and no adverse events were reported in patients who received valacyclovir. Furthermore, 15(48%) patients were able to be discharged from the hospital during the PEP.

Conclusion: The use of oral high-dose valacyclovir as PEP for immnocompromised children was found to be safe and effective. The PEP also decreased the duration of the hospital stay.  A larger study is necessary in the future to validate these findings.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Tomohiro Katsuta, MD, PhD1, Kensuke Shoji, MD2, Chikara Ogimi, MD3 and Akihiko Saitoh, MD, PhD2, (1)pediatrics, kawasaki municipal tama hospital, kawasaki, kanagawa, Japan, (2)National Center for Child Health and Development, Tokyo, Japan, (3)United States Naval Hospital Yokosuka, Yokosuka, Japan


T. Katsuta, None

K. Shoji, None

C. Ogimi, None

A. Saitoh, None

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