Skip to main content
Top
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Hospitalizations for varicella in children and adolescents in a referral hospital in Hong Kong, 2004 to 2008: A time series study

Authors: Johnny YC Chan, Linwei Tian, YW Kwan, WM Chan, CW Leung

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

Varicella accounts for significant morbidities and remains a public health issue worldwide. Climatic factors have been shown to associate with the incidence and transmission of various infectious diseases. We describe the epidemiology of varicella in paediatric patients hospitalized at a tertiary referral hospital in Hong Kong from 2004 to 2008, and to explore the possible association between the occurrence of varicella infection and various climatic factors.

Methods

The hospital discharge database of Princess Margaret Hospital was retrospectively analyzed for admissions associated with varicella from 2004 to 2008. Meteorological data were obtained from the monthly meteorological reports from the Hong Kong Observatory website. Time series analysis was performed with Poisson regression using a Generalized Estimating Equation (GEE) approach.

Results

During the study period, 598 children were hospitalized for varicella. The mean age on admission was 57.6 months, and the mean duration of hospitalization was 3.7 days. The overall complication rate was 47%. The mean monthly relative humidity, especially in cool seasons, was inversely correlated with the monthly varicella cases of the same month.

Conclusions

Varicella can lead to serious complications and prolonged hospitalization, even in previously healthy children. Lower relative humidity in cool seasons is associated with higher number of paediatric varicella hospital admissions. These findings are useful for a better understanding of the pattern of paediatric varicella hospitalization in Hong Kong.
Appendix
Available only for authorised users
Literature
1.
go back to reference Boelle PY, Hanslik T: Varicella in non-immune persons: incidence, hospitalization and mortality rates. Epidemiol Infect. 2002, 129: 599-606. 10.1017/S0950268802007720.CrossRefPubMedPubMedCentral Boelle PY, Hanslik T: Varicella in non-immune persons: incidence, hospitalization and mortality rates. Epidemiol Infect. 2002, 129: 599-606. 10.1017/S0950268802007720.CrossRefPubMedPubMedCentral
2.
go back to reference Marchetto S, de Benedictis FM, de Martino M, Versace A, Chiappini E, Bertaine C, Osimani P, Cordiali R, Gabiano C, Galli L: Epidemiology of hospital admissions for chickenpox in children: an Italian multicentre study in the pre-vaccine era. Acta Paediatrica. 2007, 96: 1490-3. 10.1111/j.1651-2227.2007.00465.x.CrossRefPubMed Marchetto S, de Benedictis FM, de Martino M, Versace A, Chiappini E, Bertaine C, Osimani P, Cordiali R, Gabiano C, Galli L: Epidemiology of hospital admissions for chickenpox in children: an Italian multicentre study in the pre-vaccine era. Acta Paediatrica. 2007, 96: 1490-3. 10.1111/j.1651-2227.2007.00465.x.CrossRefPubMed
3.
go back to reference Galil K, Brown C, Lin F, Seward J: Hospitalizations for varicella in the United States, 1988 to 1999. Pediatr Infect Dis J. 2002, 21: 931-5. 10.1097/00006454-200210000-00009.CrossRefPubMed Galil K, Brown C, Lin F, Seward J: Hospitalizations for varicella in the United States, 1988 to 1999. Pediatr Infect Dis J. 2002, 21: 931-5. 10.1097/00006454-200210000-00009.CrossRefPubMed
4.
go back to reference Lin F, Hadler JL: Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. J Infect Dis. 2000, 181: 1897-905. 10.1086/315492.CrossRefPubMed Lin F, Hadler JL: Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. J Infect Dis. 2000, 181: 1897-905. 10.1086/315492.CrossRefPubMed
5.
go back to reference Carapetis JR, Russell DM, Curtis N: The burden and cost of hospitalised varicella and zoster in Australian children. Vaccine. 2004, 23: 755-61. 10.1016/j.vaccine.2004.07.025.CrossRefPubMed Carapetis JR, Russell DM, Curtis N: The burden and cost of hospitalised varicella and zoster in Australian children. Vaccine. 2004, 23: 755-61. 10.1016/j.vaccine.2004.07.025.CrossRefPubMed
6.
go back to reference Tseng HF, Tan HF, Chang CK, Wang LY, Yang SE, Liau MY, Pan MJ, Chen CY, Huang SP: A seroepidemiology study of varicella among children aged 0-12 years in Taiwan. Southeast Asian Journal of Tropical Medicine and Public Health. 2005, 36: 1201-7.PubMed Tseng HF, Tan HF, Chang CK, Wang LY, Yang SE, Liau MY, Pan MJ, Chen CY, Huang SP: A seroepidemiology study of varicella among children aged 0-12 years in Taiwan. Southeast Asian Journal of Tropical Medicine and Public Health. 2005, 36: 1201-7.PubMed
7.
8.
go back to reference Nguyen HQ, Jumaan AO, Seward JF: Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. 2005, 352: 450-8. 10.1056/NEJMoa042271.CrossRefPubMed Nguyen HQ, Jumaan AO, Seward JF: Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. 2005, 352: 450-8. 10.1056/NEJMoa042271.CrossRefPubMed
9.
go back to reference Fairley CK, Miller E: Varicella-zoster virus epidemiology: a changing scene?. J Infect Dis. 1996, 174 (Suppl 3): S314-9.CrossRefPubMed Fairley CK, Miller E: Varicella-zoster virus epidemiology: a changing scene?. J Infect Dis. 1996, 174 (Suppl 3): S314-9.CrossRefPubMed
10.
go back to reference Yawn B, Yawn R, Lydick E: Community impact of childhood varicella infection. J Pediatr. 1997, 130: 759-65. 10.1016/S0022-3476(97)80019-4.CrossRefPubMed Yawn B, Yawn R, Lydick E: Community impact of childhood varicella infection. J Pediatr. 1997, 130: 759-65. 10.1016/S0022-3476(97)80019-4.CrossRefPubMed
11.
go back to reference Gershon AA, Takahashi M, White CJ: Varicella vaccine. Vaccines. Edited by: Plotkin SA, Orenstein WA. 1999, Philadephia: Saunders, 475-507. Gershon AA, Takahashi M, White CJ: Varicella vaccine. Vaccines. Edited by: Plotkin SA, Orenstein WA. 1999, Philadephia: Saunders, 475-507.
12.
go back to reference Wu PY, Li YC, Wu HD: Risk factors for chickenpox incidence in Taiwan from a large-scale computerized database. International J of Dermat. 2007, 46: 362-366. 10.1111/j.1365-4632.2006.03050.x.CrossRef Wu PY, Li YC, Wu HD: Risk factors for chickenpox incidence in Taiwan from a large-scale computerized database. International J of Dermat. 2007, 46: 362-366. 10.1111/j.1365-4632.2006.03050.x.CrossRef
13.
go back to reference Kokaze A, Yoshida M, Sekine Y, Ishikawa M, Kurokochi T, Uchida Y, Matsunaga N, Takashima Y: The magnitude of variation in temperature within a year has an effect on the seasonal variations of chickenpox incidence in Japan. Epidemiol Infect. 2001, 126: 269-277.CrossRefPubMedPubMedCentral Kokaze A, Yoshida M, Sekine Y, Ishikawa M, Kurokochi T, Uchida Y, Matsunaga N, Takashima Y: The magnitude of variation in temperature within a year has an effect on the seasonal variations of chickenpox incidence in Japan. Epidemiol Infect. 2001, 126: 269-277.CrossRefPubMedPubMedCentral
14.
go back to reference Gnann JW: Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis. 2002, 186 (Suppl 1): S91-8.CrossRefPubMed Gnann JW: Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis. 2002, 186 (Suppl 1): S91-8.CrossRefPubMed
16.
go back to reference Pan W: Akaike's information criterion in generalized estimating equations. Biometrics. 2001, 57: 120-125. 10.1111/j.0006-341X.2001.00120.x.CrossRefPubMed Pan W: Akaike's information criterion in generalized estimating equations. Biometrics. 2001, 57: 120-125. 10.1111/j.0006-341X.2001.00120.x.CrossRefPubMed
18.
go back to reference Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ: Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001, 108: e79-10.1542/peds.108.1.79.CrossRefPubMed Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ: Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001, 108: e79-10.1542/peds.108.1.79.CrossRefPubMed
19.
go back to reference Lu L, Lin H, Tian L, Yang W, Sun J, Liu Q: Time series analysis of dengue fever and weather in Guangzhou, China. BMC Public Health. 2009, 9: 395-10.1186/1471-2458-9-395.CrossRefPubMedPubMedCentral Lu L, Lin H, Tian L, Yang W, Sun J, Liu Q: Time series analysis of dengue fever and weather in Guangzhou, China. BMC Public Health. 2009, 9: 395-10.1186/1471-2458-9-395.CrossRefPubMedPubMedCentral
20.
go back to reference Luz PM, Mendes BVM, Codeco CT, Struchiner CJ, Galvani AP: Time Series Analysis of Dengue Incidence in Rio de Janeiro, Brazil. Am J Trop Med Hyg. 2008, 79: 933-939.PubMed Luz PM, Mendes BVM, Codeco CT, Struchiner CJ, Galvani AP: Time Series Analysis of Dengue Incidence in Rio de Janeiro, Brazil. Am J Trop Med Hyg. 2008, 79: 933-939.PubMed
21.
go back to reference Tian LW, Bi Y, Ho SC, Liu WJ, Liang S, Goggins WB, Chan EYY, Zhou S, Sung JJY: One-year delayed effect of fog on malaria transmission: a time-series analysis in the rain forest area of Mengla County, south-west China. Malar J. 2008, 7: 110-10.1186/1475-2875-7-110.CrossRefPubMedPubMedCentral Tian LW, Bi Y, Ho SC, Liu WJ, Liang S, Goggins WB, Chan EYY, Zhou S, Sung JJY: One-year delayed effect of fog on malaria transmission: a time-series analysis in the rain forest area of Mengla County, south-west China. Malar J. 2008, 7: 110-10.1186/1475-2875-7-110.CrossRefPubMedPubMedCentral
22.
go back to reference Tong S, Hu W: Climate variation and incidence of Ross river virus in Cairns, Australia: a time-series analysis. Environ Health Perspect. 2001, 109 (12): 1271-1273. 10.1289/ehp.011091271.CrossRefPubMedPubMedCentral Tong S, Hu W: Climate variation and incidence of Ross river virus in Cairns, Australia: a time-series analysis. Environ Health Perspect. 2001, 109 (12): 1271-1273. 10.1289/ehp.011091271.CrossRefPubMedPubMedCentral
23.
go back to reference Hu W, Tong S, Mengersen K, Connell D: Weather variability and the incidence of cryptosporidiosis: comparison of time series poisson regression and SARIMA models. Ann Epidemiol. 2007, 17: 679-688. 10.1016/j.annepidem.2007.03.020.CrossRefPubMed Hu W, Tong S, Mengersen K, Connell D: Weather variability and the incidence of cryptosporidiosis: comparison of time series poisson regression and SARIMA models. Ann Epidemiol. 2007, 17: 679-688. 10.1016/j.annepidem.2007.03.020.CrossRefPubMed
24.
go back to reference Garnett GP, Cox MJ, Bundy DAP, Didier JM, Catherine St J: The age of infection with varicella-zoster virus in St Lucia, West Indies. Epidemiol Infect. 1993, 110: 361-372. 10.1017/S0950268800068308.CrossRefPubMedPubMedCentral Garnett GP, Cox MJ, Bundy DAP, Didier JM, Catherine St J: The age of infection with varicella-zoster virus in St Lucia, West Indies. Epidemiol Infect. 1993, 110: 361-372. 10.1017/S0950268800068308.CrossRefPubMedPubMedCentral
25.
go back to reference Lee BW: Review of varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health. 1998, 3: 886-890. 10.1046/j.1365-3156.1998.00316.x.CrossRefPubMed Lee BW: Review of varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health. 1998, 3: 886-890. 10.1046/j.1365-3156.1998.00316.x.CrossRefPubMed
26.
go back to reference White E: Chickenpox in Kerala. Indian Journal of Public Health. 1978, 22: 141-151.PubMed White E: Chickenpox in Kerala. Indian Journal of Public Health. 1978, 22: 141-151.PubMed
27.
go back to reference Basu RN, Jezek Z, Ward NA: The eradication of smallpox from India. 1979, World Health Organization, New Delhi, 255-270. Basu RN, Jezek Z, Ward NA: The eradication of smallpox from India. 1979, World Health Organization, New Delhi, 255-270.
28.
go back to reference Venkitaraman AR, John TJ: The epidemiology of varicella in staff and students of a hospital in the tropics. International Journal of Epidemiology. 1984, 13: 502-505. 10.1093/ije/13.4.502.CrossRefPubMed Venkitaraman AR, John TJ: The epidemiology of varicella in staff and students of a hospital in the tropics. International Journal of Epidemiology. 1984, 13: 502-505. 10.1093/ije/13.4.502.CrossRefPubMed
29.
go back to reference Lee BW: Review of varicella zoster seroepidemiology in India and South-east Asia. Tropical Medicine and Internation Health. 1998, 3 (11): 886-890. 10.1046/j.1365-3156.1998.00316.x.CrossRef Lee BW: Review of varicella zoster seroepidemiology in India and South-east Asia. Tropical Medicine and Internation Health. 1998, 3 (11): 886-890. 10.1046/j.1365-3156.1998.00316.x.CrossRef
30.
go back to reference Maretic Z, Cooray MPM: Comparisons between chickenpox in a tropical and a European country. Journal of Tropical Medicine and Hygiene. 1963, 66: 311-315.PubMed Maretic Z, Cooray MPM: Comparisons between chickenpox in a tropical and a European country. Journal of Tropical Medicine and Hygiene. 1963, 66: 311-315.PubMed
31.
go back to reference Lolekha S, Tanthiphabha W, Sornchai P, Kosuwan P, Sutra S, Warachit B, Chupupprakarn S, Hutagalung Y, Weil J, Bock HL: Effect of climatic factors and population density on varicella. Am J Trop Med Hyg. 2001, 64 (3, 4): 131-136.PubMed Lolekha S, Tanthiphabha W, Sornchai P, Kosuwan P, Sutra S, Warachit B, Chupupprakarn S, Hutagalung Y, Weil J, Bock HL: Effect of climatic factors and population density on varicella. Am J Trop Med Hyg. 2001, 64 (3, 4): 131-136.PubMed
32.
go back to reference Suzuki K, Yoshikawa T, Ihira M, Ohashi M, Suga S, Asano Y: Spread of varicellazoster virus DNA to the environment from varicella patients who were treated with oral acyclovir. Pediatr Int. 2003, 45 (4): 458-60. 10.1046/j.1442-200X.2003.01746.x.CrossRefPubMed Suzuki K, Yoshikawa T, Ihira M, Ohashi M, Suga S, Asano Y: Spread of varicellazoster virus DNA to the environment from varicella patients who were treated with oral acyclovir. Pediatr Int. 2003, 45 (4): 458-60. 10.1046/j.1442-200X.2003.01746.x.CrossRefPubMed
33.
go back to reference Asano Y, Yoshikawa T, Ihira M, Furukawa H, Suzuki K, Suga S: Spread of varicellazoster virus DNA to family members and environments from siblings with varicella in a household. Pediatrics. 1999, 103 (5): e61-10.1542/peds.103.5.e61.CrossRefPubMed Asano Y, Yoshikawa T, Ihira M, Furukawa H, Suzuki K, Suga S: Spread of varicellazoster virus DNA to family members and environments from siblings with varicella in a household. Pediatrics. 1999, 103 (5): e61-10.1542/peds.103.5.e61.CrossRefPubMed
34.
go back to reference Shinefield H, Black S, Williams WR, Marchant C, Reisinger K, Stewart T, Meissner HC, Guerrero J, Klopfer SO, Xu J, Schodel F, Kuter BJ: Dose Selection Study Group for Proquad. Dose-response study of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J. 2005, 24: 670-5. 10.1097/01.inf.0000172901.29621.e9.CrossRefPubMed Shinefield H, Black S, Williams WR, Marchant C, Reisinger K, Stewart T, Meissner HC, Guerrero J, Klopfer SO, Xu J, Schodel F, Kuter BJ: Dose Selection Study Group for Proquad. Dose-response study of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J. 2005, 24: 670-5. 10.1097/01.inf.0000172901.29621.e9.CrossRefPubMed
35.
go back to reference Heininger U, Desgrandchamps D, Schaad UB: Seroprevalence of varicella-zoster virus IgG antibodies in Swiss children during the first 16 months of age. Vaccine. 2006, 24: 3258-60. 10.1016/j.vaccine.2006.01.026.CrossRefPubMed Heininger U, Desgrandchamps D, Schaad UB: Seroprevalence of varicella-zoster virus IgG antibodies in Swiss children during the first 16 months of age. Vaccine. 2006, 24: 3258-60. 10.1016/j.vaccine.2006.01.026.CrossRefPubMed
36.
go back to reference Wise RP, Salive ME, Braun MM, Mootrey GT, Seward JF, Rider LG, Krause PR: Postlicensure safety surveillance for varicella vaccine. JAMA. 2000, 284: 1271-9. 10.1001/jama.284.10.1271.CrossRefPubMed Wise RP, Salive ME, Braun MM, Mootrey GT, Seward JF, Rider LG, Krause PR: Postlicensure safety surveillance for varicella vaccine. JAMA. 2000, 284: 1271-9. 10.1001/jama.284.10.1271.CrossRefPubMed
37.
go back to reference Nelson WE, Behrman RE, Kliegman RM: Streptococcal infections. Textbook of Pediatrics. Edited by: James Todd. 1996, Philadelphia, PA: W.B. Saunders, 750-751. 15 Nelson WE, Behrman RE, Kliegman RM: Streptococcal infections. Textbook of Pediatrics. Edited by: James Todd. 1996, Philadelphia, PA: W.B. Saunders, 750-751. 15
38.
go back to reference Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, Roos L, De Serres G: Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect. 2001, 127: 305-314.CrossRefPubMedPubMedCentral Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, Roos L, De Serres G: Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect. 2001, 127: 305-314.CrossRefPubMedPubMedCentral
39.
go back to reference O'Grady KA, Merianos A, Patel M, Gilbert L: High seroprevalence of antibodies to varicella zoster virus in adult women in a tropical climate. Tropical Medicine and International health. 2000, 5 (10): 732-736. 10.1046/j.1365-3156.2000.00622.x.CrossRefPubMed O'Grady KA, Merianos A, Patel M, Gilbert L: High seroprevalence of antibodies to varicella zoster virus in adult women in a tropical climate. Tropical Medicine and International health. 2000, 5 (10): 732-736. 10.1046/j.1365-3156.2000.00622.x.CrossRefPubMed
Metadata
Title
Hospitalizations for varicella in children and adolescents in a referral hospital in Hong Kong, 2004 to 2008: A time series study
Authors
Johnny YC Chan
Linwei Tian
YW Kwan
WM Chan
CW Leung
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-366

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue