Risk factors for invasive group A streptococcal infections in children with varicella

A case-control study

Carol L. Peterson, Duc J. Vugia, Hildy B. Meyers, Shin Margaret Chao, Jacqueline Vogt, Judith Lanson, Philip A. Brunell, Kwang Sik Kim, Laurene Mascola

Research output: Contribution to journalArticle

Abstract

Objective. To identify characteristic clinical manifestations and potential risk factors for invasive group A streptococcal (GAS) disease in children with varicella. Design and participants. A case-control study was conducted in Los Angeles and Orange Counties, CA. Cases were children with varicella who developed invasive GAS disease between January 1 and May 3, 1994 (n = 25). Controls were acquaintance, neighborhood or schoolmate children with uncomplicated varicella during the study period (n = 62). Cases were compared with controls with regard to underlying illness, child care practices, parental home health practices, health care-seeking behaviors, sociodemographic characteristics and clinical characteristics. Results. Controlling for age we found that cases were more likely than controls: (1) to be cared for in the home vs. out-of-home child care (odds ratio (OR), 4.4 (95% confidence interval (95% CI), 1.1 to 17)); (2) to report having asthma (OR, 6.2 (95% CI, 1.2 to 41.0)) and to be taking albuterol (OR, 11.6 ((95% CI, 1.0 to 581)); (3) to be secondary varicella cases within a household (OR, 7.3 (95% CI, 2.2 to 25)); (4) to report fever after Day 2 of varicella; and (5) to have contacted their health care provider later than controls (Day 3.8 rather than Day 1.7, P <0.001). Conclusions. To our knowledge this is the first case-control study exploring potential risk factors for invasive GAS disease in children with varicella. Both previously healthy children with varicella and those with underlying medical problems, including asthma, may be at increased risk for GAS complications. Interventions should be targeted to parents and health care providers to increase awareness of early signs and symptoms of invasive GAS disease in children with varicella. Additional studies are needed to confirm the associations suggested by this study between GAS complications of varicella and asthma, in-home child care, secondary vs. primary varicella household cases and delayed contact with medical care providers.

Original languageEnglish (US)
Pages (from-to)151-156
Number of pages6
JournalPediatric Infectious Disease Journal
Volume15
Issue number2
DOIs
StatePublished - 1996
Externally publishedYes

Fingerprint

Streptococcal Infections
Chickenpox
Case-Control Studies
Child Care
Odds Ratio
Confidence Intervals
Asthma
Home Care Services
Health Personnel
Patient Acceptance of Health Care
Los Angeles
Albuterol
Signs and Symptoms
Fever
Parents

Keywords

  • Invasive group A streptococcal infections
  • risk factors
  • varicella

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)

Cite this

Risk factors for invasive group A streptococcal infections in children with varicella : A case-control study. / Peterson, Carol L.; Vugia, Duc J.; Meyers, Hildy B.; Chao, Shin Margaret; Vogt, Jacqueline; Lanson, Judith; Brunell, Philip A.; Kim, Kwang Sik; Mascola, Laurene.

In: Pediatric Infectious Disease Journal, Vol. 15, No. 2, 1996, p. 151-156.

Research output: Contribution to journalArticle

Peterson, Carol L. ; Vugia, Duc J. ; Meyers, Hildy B. ; Chao, Shin Margaret ; Vogt, Jacqueline ; Lanson, Judith ; Brunell, Philip A. ; Kim, Kwang Sik ; Mascola, Laurene. / Risk factors for invasive group A streptococcal infections in children with varicella : A case-control study. In: Pediatric Infectious Disease Journal. 1996 ; Vol. 15, No. 2. pp. 151-156.
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abstract = "Objective. To identify characteristic clinical manifestations and potential risk factors for invasive group A streptococcal (GAS) disease in children with varicella. Design and participants. A case-control study was conducted in Los Angeles and Orange Counties, CA. Cases were children with varicella who developed invasive GAS disease between January 1 and May 3, 1994 (n = 25). Controls were acquaintance, neighborhood or schoolmate children with uncomplicated varicella during the study period (n = 62). Cases were compared with controls with regard to underlying illness, child care practices, parental home health practices, health care-seeking behaviors, sociodemographic characteristics and clinical characteristics. Results. Controlling for age we found that cases were more likely than controls: (1) to be cared for in the home vs. out-of-home child care (odds ratio (OR), 4.4 (95{\%} confidence interval (95{\%} CI), 1.1 to 17)); (2) to report having asthma (OR, 6.2 (95{\%} CI, 1.2 to 41.0)) and to be taking albuterol (OR, 11.6 ((95{\%} CI, 1.0 to 581)); (3) to be secondary varicella cases within a household (OR, 7.3 (95{\%} CI, 2.2 to 25)); (4) to report fever after Day 2 of varicella; and (5) to have contacted their health care provider later than controls (Day 3.8 rather than Day 1.7, P <0.001). Conclusions. To our knowledge this is the first case-control study exploring potential risk factors for invasive GAS disease in children with varicella. Both previously healthy children with varicella and those with underlying medical problems, including asthma, may be at increased risk for GAS complications. Interventions should be targeted to parents and health care providers to increase awareness of early signs and symptoms of invasive GAS disease in children with varicella. Additional studies are needed to confirm the associations suggested by this study between GAS complications of varicella and asthma, in-home child care, secondary vs. primary varicella household cases and delayed contact with medical care providers.",
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AU - Chao, Shin Margaret

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AU - Brunell, Philip A.

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AU - Mascola, Laurene

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N2 - Objective. To identify characteristic clinical manifestations and potential risk factors for invasive group A streptococcal (GAS) disease in children with varicella. Design and participants. A case-control study was conducted in Los Angeles and Orange Counties, CA. Cases were children with varicella who developed invasive GAS disease between January 1 and May 3, 1994 (n = 25). Controls were acquaintance, neighborhood or schoolmate children with uncomplicated varicella during the study period (n = 62). Cases were compared with controls with regard to underlying illness, child care practices, parental home health practices, health care-seeking behaviors, sociodemographic characteristics and clinical characteristics. Results. Controlling for age we found that cases were more likely than controls: (1) to be cared for in the home vs. out-of-home child care (odds ratio (OR), 4.4 (95% confidence interval (95% CI), 1.1 to 17)); (2) to report having asthma (OR, 6.2 (95% CI, 1.2 to 41.0)) and to be taking albuterol (OR, 11.6 ((95% CI, 1.0 to 581)); (3) to be secondary varicella cases within a household (OR, 7.3 (95% CI, 2.2 to 25)); (4) to report fever after Day 2 of varicella; and (5) to have contacted their health care provider later than controls (Day 3.8 rather than Day 1.7, P <0.001). Conclusions. To our knowledge this is the first case-control study exploring potential risk factors for invasive GAS disease in children with varicella. Both previously healthy children with varicella and those with underlying medical problems, including asthma, may be at increased risk for GAS complications. Interventions should be targeted to parents and health care providers to increase awareness of early signs and symptoms of invasive GAS disease in children with varicella. Additional studies are needed to confirm the associations suggested by this study between GAS complications of varicella and asthma, in-home child care, secondary vs. primary varicella household cases and delayed contact with medical care providers.

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