Incidence and case-fatality of varicella-zoster virus infection among pediatric cancer patients in developing countries.

UNLABELLED: Limited evidence is available about varicella-zoster virus (VZV) infection among pediatric cancer patients in developing countries, which raises questions about the generalizability of VZV vaccine recommendations for pediatric cancer patients (derived from developed countries) to these settings. We assessed the incidence and case-fatality of VZV infection at three institutions in developing countries (Argentina, Mexico, and Nicaragua). Individuals eligible for our study were aged <20 years and actively receiving cancer-directed therapy. We estimated a summary incidence rate (IR) and case-fatality risk with corresponding 95 % confidence limits (CL) of VZV infection across sites using random-effects models. Our study population comprised 511 pediatric cancer patients, of whom 64 % were aged <10 years, 58 % were male, and 58 % were diagnosed with leukemia. We observed a total of 10 infections during 44,401 person-days of follow-up across the 3 sites (IR = 2.3, 95 % CL 1.2, 4.2). The summary case-fatality risk was 10 % (95 % CL 1.4, 47 %) based on one death. CONCLUSION: Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. VZV vaccine recommendations for pediatric cancer patients in developed countries may be generalizable to developing countries. WHAT IS KNOWN: • Current recommendations, based on evidence from pediatric cancer patients in developed countries, contraindicate varicella-zoster virus (VZV) vaccination until completion of cancer-directed therapy and recovery of immune function. • The generalizability of these VZV vaccine recommendations to pediatric cancer patients in developing countries is unknown because of limited information about the incidence and case-fatality of VZV in these settings. What is New: • Our results suggest low incidence and case-fatality of VZV infections among pediatric cancer patients in three developing countries. • VZV vaccine recommendations based on evidence from pediatric cancer patients in developed countries may be generalizable to pediatric cancer patients in developing countries.

Understanding hand hygiene behavior in a pediatric oncology unit in a low- to mid-income country.

BACKGROUND/OBJECTIVE: A qualitative method study identified perceived barriers and motivations for hand hygiene (HH) practice in a pediatric oncology unit in Guatemala. METHODS: Data collection included focus groups with participants grouped by job type. Focus group responses were assessed using content analysis. Participants included nurse supervisors, registered nurses, auxiliary nurses, physicians, and auxiliary and support staff and volunteers (n=55). RESULTS: Themes emerged from participant responses, providing a framework to develop and implement targeted interventions to improve HH. Perceived barriers to HH included the following themes: inconsistent HH supplies, time pressures related to workload, lack of HH training for some healthcare workers and patients' families; negative social reactions after reminding others to practice HH; and cultural traditions shaping patients' families' hygiene. Motivations for HH practice included two themes: patient protection and self-protection. Some of these themes were unique to this culture and clinical setting. Recommendations included a preference for visual aids rather than verbal reminders (e.g. HH promotion signage, demonstrations of HH), and disclosure of compliance rates. CONCLUSIONS: The research team concluded that the main barriers and motivations for HH, including culturally-unique and site-specific factors, were identified and used for subsequent HH compliance improvement such as education. Intervention post focus group concentrated in HH education of healthcare providers using e-learning methodology.

Economic analysis of a pediatric ventilator-associated pneumonia prevention initiative in nicaragua.

We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP) prevalence in pediatric intensive care units (PICUs) at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale.