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European Journal of Pediatrics

, Volume 178, Issue 5, pp 641–648 | Cite as

Epidemiological and clinical characteristics and the approach to infant chickenpox in primary care

  • Yessica Rodriguez-SantanaEmail author
  • Elena Sanchez-Almeida
  • Cesar Garcia-Vera
  • Maria Garcia-Ventura
  • Laura Martinez-Espligares
  • PAPenRED
Original Article

Abstract

Chickenpox is not common in the first year of life (infant varicella) and there is a lack of data on its presentation, especially in primary care. A year-long observational study (July 2015–2016) carried out by a research network of primary care pediatricians throughout Spain.Two hundred and sixty-four pediatricians gathered data from 358 cases of clinically diagnosed chickenpox in infants. The illness was considered mild in 78% of infants < 7 months compared to 65% in those aged 7 to 12 months (p = 0.0144). Fever (46%) was present in 35% of children ≤ 6 months compared to 55% in older children (p = 0.0005). The number of skin lesions was > 50 in 35% of children ≤ 6 months old compared to 47% in > 7 months (p = 0.0273). From the 2% of hospitalized children 86% were younger than 7 months. Oral antiviral treatment was given in 33% of cases ≤ 6 months compared to 18% in older patients (p = 0.0023). Doubts about administering the chickenpox vaccine at a later date were expressed by 18% of pediatricians.

Conclusion: Chickenpox is considered benign, having a mild effect on most infants. There is less clinical effect in infants ≤ 6 months although this age group is hospitalized more and is prescribed more antiviral treatment. There are doubts among pediatricians about the subsequent need for vaccination.

What is Known:

Chickenpox is uncommon and of uncertain evolution in the first year of life

Hospital admissions for chickenpox are more frequent in the first year of life

What is New:

• The course of chickenpox in the first year of life is mild, especially in infants younger than 7 months despite the fact they are hospitalized more and are treated more frequently with antivirals. Antivirals are prescribed to 1 in 4 children with chickenpox under 12 months of age.

Almost 50% of pediatricians recommend a subsequent vaccination against chickenpox especially if it occurs in the first 6 months of life.

Keywords

Chickenpox Infant Primary care Acyclovir Chickenpox complications 

Abbreviations

PC

Primary care

AR

Autonomous region

SD

Standard deviation

CI

Confidence interval

OR

Odds ratio

PAPenRed

Pediatric Epidemiological Surveillance Network of Spanish Primary Care Pediatrics Association

Notes

Acknowledgements

This work is the result of a joint effort of collaborating pediatricians and coordinators of the nationwide PAPenRED network, to whom we thank for their selfless efforts in the interests of primary care research. The following is the list of network collaborators for this study: Abad-Balaguer B, Acitores-Suz E, Aguilera-López L, Aizpurua-Galdeano MA, Albaladejo-Beltrán S, Alcaraz-Quiñonero M, Alonso-Bernardo LM, Álvarez-Bueno E, Álvarez de Laviada-Mulero T, Aparicio-Rodrigo M, Arana Cañedo-Argüelles C, Arnal-Alonso JM, Arranz-Sanjuan R, Arroyo-Úbeda R, Asensi-Monzo MT, Astiz-Blanco MI, Ayechu-Díaz A, Balaguer-Martínez JV, Barea-García JJ, Barral-Mena E, Barrios-González EM, Batalla-Fadó L, Bayona-Ferrer I, Bejarano-López MA, Belda-García MT, Benítez-Rubio MR, Bercedo-Sanz A, Bernabé-Moyano MA, Bernad-Usoz JV, Biosca-Pàmies M, Blanco-González J, Blesa-Baviera LC, Bombín-Granado JM, Bonet-Garrosa A, Botana del Arco IM, Botella-Serrano B, Boullosa M, Bravo-Acuña J, Bretón-Peña AI, Burgaleta-Sagaseta AM, Caballero-Morales MA, Cairó-Corominas S, Calavia-Moreno C, Callejas-Pozo JE, Calvo-Lorenzo MT, Canadell-Villaret D, Cantarero-Vallejo MD, Capell-Redondo G, Carballal-Mariño M, Carmona-Cedrés N, Caro-Gómez A, Carrera-Polanco M, Carretero L, Casado-Sánchez ML, Casares-Alonso I, Cascón-Criado E, Casellas de-Asprer A, Casquet-Barceló A, Caubet-Busquet I, Cayuela-Guerrero C, Cerezo del-Olmo Y, Chinarro-Martínez P, Coello-Torres Z, Coto-Fuente MM, de Frutos Gallego E, De la Fuente García MA, De La Fuente Romero DM, De las Heras Díaz-Varela C, Del Castillo Aguas G, Del Toro Calero C, Diaz-Cirujano AI, Díaz-Sánchez A, Diaz-Zaera O, Domínguez-Aurrecoechea B, Duelo-Marcos M, Elorza-Beitia C, Escanciano-Garcia Y, Escribano-Romero MJ, Esparza-Olcina MJ, Espín-Quirante C, Espinazo-Ramos O, Esquivel-Ojeda JN, Fabregat-Ferrer E, Fernández-León A, Fernández-Pastor F, Fernández-Cuesta-Valcarce MA, Ferrándiz-Cerdá B, Flores-Erro U, Fontalva-Ballesteros MB, Galán-Rico J, Galardi-Andonegui MS, Gallego-Iborra A, Garach-Gómez A, Garcés-Sánchez M, García-Mérida MJ, García-Pérez R, García-Rebollar CA, García-Rodríguez AI, García-Santiago M, García-Onieva- Artázcoz M, García-Teresa García E, Garrido-Redondo M, Gil-Alexandres I, Gil-Camarero E, Giménez San Andrés M, Giribet-Folch M, Gómez-Maraver M, Gómez-Sorrigueta P, González-Cortés MV, González-Herrero M, González-Rodríguez MP, González-Valdés S, Gracia-Alfonso MA, Grau-García AI, Gros-Esteban D, Guillot-Roselló B, Gutiérrez-Abad C, Gutiérrez-Blasco J, Gutiérrez-Sigler MD, Heras-Galindo JA, Hernández-Encinas MA, Hernández-Guillén R, Hernández-Ortiz MY, Hernando-Helguero P, Hernando-Zarate Z, Iofrío De Arce A, Iribarren-Udobro I, Iturrioz-Mata A, Jaldo-Jiménez MR, Jaramillo-Hidalgo D, Jiménez-Alés R, Jiménez-Hereza JM, Jové-Naval J, Juanes de Toledo B, Juliá-Benito JC, Labordena-Barceló C, Laso-Murillo P, Ledesma-Albarrán JM, Lobelle-González C, Lobera-Navaz P, López-Alonso R, Lorente-García S, Lorente-García-Mauriño AM, Losa-Frías V, Lupiani-Castellanos P, Marco-Puche A, Marfil-Olink S, Márquez-Moreno MD, Martin-Carballo G, Martin-Delgado MI, Martín LM, Martin-Rial S, Martínez-Moral N, Martínez-Rubio MV, Martínez-Rubio A, Martos-Lozano C, Méndez-Gallego S, Menéndez-BADA T, Menéndez-González N, Mengual-Gil J, Mínguez-Verdejo R, Miranda-Berrioategortúa I, Moneo-Hernández I, Montañés-Sánchez AM, Montes-Peña M, Muñoz-Hiraldo ME, Murcia-García J, Mustieles-Moreno C, Navarro-Cabañas G, Navarro-Quesada FJ, Navas-Heredia CM, Novo-Rodríguez AI, Nuño-Martín F, Ordoñez-Alonso A, Ortells-Ramón I, Padilla-Esteban ML, Padilla-Sánchez MC, Palomares-Gimeno MJ, Palomino-Urda N, Panizo-Santos MB, Parejo-Carranza R, Pavo-Garcia MR, Peix-Sambola MA, Pena-Nieto MJ, Peñarroja-Peirats S, Pérez-Candas JI, Pérez de Saracho Taramona M, Pérez-García I, Pérez-Gavilán J, Pérez-Serrano MJ, Pérez-Tomás RM, Pérez-Vidal MT, Pinilla-Fuentes JA, Polo-Mellado MC, Prado-Muñoz S, Pulido-Bosch MR, Pumarola-Batlle M, Quintanilla-Sánchez M, Ramírez-Gavira RM, Ramos-Zugasti M, Rey del Castillo C, Ribera-Sirvent C, Rico-Marí E, Ripoll-Lozano A, Rivas-Abraldes N, Riveros-Huckstadt MP, Robles-García J, Rodríguez-Delgado J, Rodríguez-Fernández MM, Rodríguez-Fernández-Oliva CR, Rodríguez-Lombardía CA, Rodríguez-Mur P, Rodriguez-Varela A, Rodríguez-López-Márquez GA, Rodríguez-Moldes-Vázquez B, Rodríguez-Salinas-Pérez E, Romero-Reyes C, Ruiz-Chércoles E, Ruiz-Sánchez JF, Ruiz-Canela-Cáceres J, Ruiz-Cuevas-Garcias P, Saenz de Urturi-Sánchez A, Sáez De Lafuente-Arriazu A, Salvá-Siquier A, Sanantonio-Valdearcos F, Sánchez-Andrada RM, Sánchez-Calderón M, Sánchez-Cordero N, Sánchez-Diaz MD, Sánchez-Echenique M, Sánchez-Fuentes V, Sánchez-García Monge MC, Sánchez-González B, Sánchez-Jiménez MC, Sánchez-Pina C, Sánchez-Precioso S, Sancho-Madrid B, Satrústegui-Gamboa F, Segovia-Ferrera C, Seijas-Vázquez L, Serna-Saugar MC, Serrano-Gómez ML, Servera-Ginard CI, Somoza-Martín M, Soriano-Faura J, Suárez-Vicent E, Surribas-Murillo C, Torres Álvarez de Arcaya ML, Úbeda-Sansano I, Valdivia-Jiménez C, Valls-Durán T, Vaquerizo-Pollino MJ, Vega-Pérez MS, Velasco-Guijarro O, Vera-Domínguez MI, Viar-Urieta M, Vigueras-Abellán JJ, Vila-Alonso M, Vila-Buch G, Vílchez-Pérez JS, Villafruela-Álvarez C, Villaizán-Pérez C, Villar-Fernández MD, Viudes de Velasco A, and Viver-Gómez S.

Also, we thank an anonymous referee for comments that help in improving the understanding of the results put forward in this work.

Authors’ contributions

Y. Rodríguez Santana and E. Sánchez Almeida contributed to the data compilation, interpretation of the findings, writing and reviewing the article, and the final approval of the presented version. C. García Vera contributed to the conception, design and coordination of the study, data analysis, interpretation of the findings, a critical review of the article, and the final approval of the presented version. M. García Ventura contributed to data processing and analysis and the final approval of the submitted version. L Martínez Espligares contributed to the conception, design, data analysis, and interpretation, and had ultimate responsibility for the final manuscript and its approval as presented.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical considerations

The PAPenRED project as a whole has obtained the approval of the Aragon Ethics and Scientific Research Committee (Favorable Ruling, Act No. 19/2013, C.P.-C.I. PI13 / 00154). An information sheet was provided for the parents/legal guardians of the children participating in the study and informed consent was signed for the use of data. To ensure the appropriate patient anonymity, the data was codified so that only the patient’s own pediatrician could know their identity.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Primary health care El CaleroServicio Canario de SaludLas PalmasSpain
  2. 2.Primary health care La Guancha-San Juan de la RamblaServicio Canario de SaludSanta Cruz de TenerifeSpain
  3. 3.Primary health care José Ramón Muñoz FernándezServicio Aragonés de SaludZaragozaSpain
  4. 4.Hospital Universitario Infantil Miguel ServetZaragozaSpain
  5. 5.Primary health care MiralbuenoServicio Aragonés de SaludZaragozaSpain
  6. 6.Pediatric Epidemiological Surveillance Network of Spanish Primary Care Pediatrics AssociationZaragozaSpain

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