Varicella Complications in Unvaccinated Children and Delay in Hospital Admission

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We have read the report by Popescu et al,1 recently published. The authors reported on 1302 hospitalizations for varicella in patients younger than 30 years with 20.3% respiratory complications and 4.6% neurologic complications.
We retrospectively reviewed 404 medical records of children hospitalized for varicella from January 2004 to November 2011 at Bambino Gesù Children Hospital, Roma, Italy. Neurologic complications occurred in 21.7%. The pooled prevalence of neurologic complications resulting from a systematic review of the literature from January 1990 to January 2012 identified the likelihood of pediatric neurologic complications in the 13.9%–20.4%.2
We speculate that the different incidences in neurologic complications may be due to the age of patients included in the study, to a different sociodemographic structure of the population or to different hospitalization policies.
Finally, the authors show the highest rate of hospitalizations in years 2011 to 2013 resulting from varicella complications. They speculate that this should be the consequence of the economic crisis, “with long working hours for parents limiting early presentation for care.”1
We speculate that the delay in hospital admission can be due to a public perception of varicella infection as a harmless childhood affliction. In fact, media are known to be able to influence the population even on health decisions. In particular, the use of the internet to search for medical and health-related information is increasing. Unfortunately, it is associated with concerns about both the quality and the safety of immunization policy and of medical treatment.3 Finally, pediatricians may have underestimated the potential risk of varicella, considering it a benign acute disease, possibly contributing to the delay of primary care.
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