Journal Review
Journal Review
Weinstock DM, Rogers M, Lim S, et al. Serocon version rates in healthcare workers using a latex agglutination assay after varicella virus vaccination. Infect Control Hosp Epidemiol 1999; 20:504-507.Though finding a considerably lower rate of varicella vaccine-induced seroconversion at their hospital compared to that of the published literature, the authors still report that universal vaccination is "an extremely cost-effective alternative to the furloughing of exposed, seronegative health care workers." They projected hospital savings in excess of $53,000 in the first year after vaccination alone.
The Centers for Disease Control and Preven tion recommends that all health care workers should ensure that they are immune to varicella (chickenpox). The authors tried to determine the seroconversion rate after varicella immunization of health care workers and the effect of seroconversion rate on current cost-based recommendations for universal vaccination. A voluntary vaccination program for health care workers was performed at a tertiary-care cancer center in New York City. A commercial latex agglutination assay was used to test post-vaccination antibody response. Costs for vaccination and post-vaccination serological testing were compared to potential costs of post-exposure employee furloughs.
Of 263 seronegative workers, 96 (36.5%) began the vaccine program. Thirty-nine workers received only one dose of vaccine. Seven returned for follow-up antibody testing, of whom four were sero positive. Of the 57 workers who received two doses, 38 returned for follow-up serology. Thirty-one (81.6%) were positive for varicella antibodies, and seven (18.4%) remained negative.
At a cost of $80 per two-dose series of the vaccine, immunization for all 263 susceptible workers would cost $21,040, the authors calculated. Post-vaccination testing using the LA assay to confirm the presence of antibodies in vaccinated workers would cost $7,890. An 18.4% seronegative rate after vaccination implies an annual expense of $18,584 for the furlough of exposed, vaccinated workers who failed to seroconvert. Therefore, the total cost of a universal vaccination program for the first year would be $47,514.
"Universal varicella vaccination offers the health care industry an attractive alternative to the financial burden of varicella-susceptible workers," the authors conclude. "Our data indicate that, despite the lower seroconversion rates found in our study population using the LA assay, universal vaccination remained a cost-effective strategy."
With expenses totaling $47,514 for universal vaccination and projected expenses of $101,000 in furloughs without vaccination, potential savings exceed $53,000 in the first year alone. Only 36.5% of the susceptible health care workers at the institution participated in voluntary vaccination, reinforcing the potential need for mandatory, universal vaccination, the authors emphasize. Universal vaccination remains a cost-effective proposition as long as the average salary of furloughed workers is above $21,000. With an average salary of $60,000, seroconversion rates of as low as 30% still support universal vaccination, they conclude.
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