I. Clinical Question * How do outbreaks of vaccine-preventable disease occur?

* What is the rate of vaccination and vaccine effectiveness and risk factors associated with breakthrough disease? II. Title of the Article Chickenpox Outbreak in a Highly Vaccinated School Population

III. Study Characteristics A. Population 422 students of Oregon Elementary School B. Intervention compared Immunologic boosting, which may occur through exposure to wild-type virus, may decrease as the rate of vaccination increases. Immunologic boosting through a second dose of varicella vaccination for children deserves additional consideration. Watson et al, demonstrated that a second dose of varicella vaccine in children induced stronger humoral and cell-mediated immune responses than did a single dose. A second vaccination should decrease the rates of both primary and secondary vaccine failure, if present.

C. Outcome Monitored If the interval between vaccination and exposure is significantly associated with breakthrough disease in future outbreak investigations, routine booster vaccination for children might be warranted. Studies regarding the effectiveness and cost-benefit of such a strategy would still be needed. Since this outbreak, they have received reports of several other chickenpox outbreaks in Oregon schools. They have initiated limited school surveillance for outbreaks of chickenpox to follow its changing epidemiology in the vaccine era.

D. The study did really focus on a significant problem in clinical practice. Yes because this study really focuses on students who doesnt received any varicella vaccination and those who had no history of chickenpox before October 30, 2001. This study only tests the outbreak of chickenpox in Oregon Elementary School.

IV. Methodology/Design A. Methodology They reviewed varicella vaccination records and history of prior chickenpox, and they calculated vaccine effectiveness. They evaluated the effects of age, gender, age at vaccination, and time since vaccination on risk of breakthrough disease (ie, chickenpox occurring >42 days after vaccination).

B. Setting The study was conducted in Oregon elementary school

C. Data Sources Sources are taken from immunization records collected by the school district, questionnaire (survey A) to each students parents to determine whether the student had a history of chickenpox or varicella vaccination before the outbreak and the dates of these events, and a questionnaire (survey B) about chickenpox occurrence during the 2-week winter break and the week after the break was sent to each childs parents. D. Subject Selection a. Inclusion Criteria Inclusion of only affected classrooms in the calculation of vaccine effectiveness may have led to an underestimate if the vaccine was more protective in the unaffected classrooms. However, we chose to include only affected classrooms in our calculation of vaccine effectiveness because we could not be certain that exposure to the virus had taken place outside of those classrooms. Because there were no susceptible students in unaffected classrooms in this outbreak, had we included all classrooms in our analysis, susceptible students would have had a higher likelihood of exposure relative to vaccinated students, and thus vaccine efficacy would have been overestimated.

b. Exclusion Criteria Students were excluded from the analysis if they were vaccinated during the outbreak, because their immune status could not be classified reliability. E. Has the original study been replicated? No because this study focuses on a certain problem and its about the outbreak of chickenpox in Oregon Elementary School. F. What were the risks and benefits of the nursing action/intervention tested in the study? The risk factors for breakthrough chickenpox is that among students who had no prior history of chickenpox in affected classrooms, attack rates were dramatically increased among students vaccinated >5 years before the start of the outbreak. Therefore, they chose this 5-year point for additional comparison. Early age at vaccination was not associated with the development of chickenpox. V. Results of the study Of 422 students, 218 had no prior chickenpox. Of these, 211 had been vaccinated before the outbreak. Twenty-one cases occurred in 9 of 16 classrooms. In these 9 classrooms, 18 of 152 vaccinated students developed chickenpox, compared with 3 of 7 unvaccinated students. Vaccine effectiveness was 72%. Students vaccinated >5 years before the outbreak were 6.7 times. VI. Authors Conclusions/Recommendations A chickenpox outbreak occurred in a school in which 97% of students without a prior history of chickenpox were vaccinated. Students vaccinated >5 years before the outbreak were at risk for breakthrough disease. Booster vaccination may deserve additional consideration. 1. What contribution intervention make? to client health status does the nursing action /

It will prevent the occurrence of chickenpox especially to those students who doesnt have vaccination before.

2. What overall contribution to nursing knowledge does the study make? The overall contribution of this study is that how do outbreaks of vaccinepreventable disease occur and what are the vaccine effects and the risk factors of this outbreak. VII. Applicability 1. Does the study provide a direct enough answer to your clinical question in terms of type of patients, intervention and outcome? Yes, my clinical questions were answered by this article and this study specifically discussed what population should be included and it also discussed the interventions need to be done and what is the outcome of those interventions. 2. Is it feasible to carry out the nursing action in the real world? Yes it is because this study causes no harm to patients, they have just conducted the outbreak of chickenpox and they find out how many students are susceptible to chickenpox. And specially, nursing actions mentioned in this study would greatly help those students to prevent the occurrence of chickenpox.

VIII. Reviewers Conclusion / Commentary The outbreak of chickenpox in Oregon Elementary school was too high. Researchers did a very good study because they really found out how do outbreaks of vaccinepreventable occur and they found out who needs to be vaccinated. They used different methods to determine who among the students of Oregon are susceptible and need to be vaccinated. They also discussed how to prevent the occurrence of chickenpox. This study helped me a lot, I do more understand what chickenpox is and how to prevent this one.

Far Eastern University Institute of Nursing

EBN About Chickenpox

Submitted by: Tagoon, Glaizalyn F. BSN406 Group 24B Submitted to: Professor Sta. Maria, Rn, MAN, PHD