KEYWORDS:
Community Awareness, Epidemiology, Vaccination, Vaccine-Preventable Disease, Varicella

BACKGROUND:
In June 2002, the Uinta County Public Health Nursing Services (UC-PHN) received a report of an increased incidence of physician diagnosed varicella cases from a pediatric clinic. A varicella outbreak was suspected, and the Wyoming Department of Health (WDH) and UC-PHN collaborated on an investigation.

OBJECTIVE:
To obtain laboratory confirmation of the etiologic agent, to determine the magnitude of the outbreak, to enhance rash-illness surveillance through educational awareness in the community, to identify high-risk populations, and to prevent further morbidity through targeted immunization.

METHOD:
The case definition was an acute papulovesicular rash (without other apparent cause) occurring in a Uinta County resident from February through July 2002. A structured questionnaire, based on CDC’s varicella questionnaire, was administered to the parents of identified cases. Laboratory testing was performed on both serum and swabs. Active case finding was achieved by placing calls to pediatric clinics.

RESULT:
Twenty-eight cases were identified: 21 were physician diagnosed varicella cases and 7 were shingles cases. Laboratory testing of six serum and swab samples were positive for varicella virus. A case attended a community event and potentially exposed 133 adults and 235 children. Upon follow-up, 13 adults and 42 children were susceptible to varicella. To prevent further morbidity, 62% of the susceptible adults and 50% of the susceptible children were vaccinated by UC-PHN.

CONCLUSION:
Varicella outbreaks indicate minimal vaccination coverage in a community; hence coordination between state and local public health and laboratory entities are essential to control outbreaks, as is community awareness and involvement. The importance of appropriate laboratory collection for testing proved to be significant.

LEARNING OBJECTIVES:
In a bioterrorism era where the etiologies of rash-like illnesses need to be identified in a timely manner, multi-agency coordination and appropriate laboratory testing are essential.