Medical Students and Community Physicians Also Susceptible to Varicella-Zoster Virus

Abstract

To the Editor: I read with great interest the article by Alter and colleagues 1 concerning an approach to the evaluation of immune status to varicella-zoster virus (VZV) in health care providers. This was a tremendous undertaking and has provided a valuable data base. I am concerned, however, about several issues. First, no mention is made of the medical students who may have performed rotations at this institution during 1984. Were student physicians included in the study? If not, were data available on their immune status from their medical schools? My colleagues and I have found at our institution that over the last 4 years 1.9% to 4.7% of entering medical students each year lacked detectable antibody to VZV. 2 As of 1983, however, only 18.8% of medical schools responding to our nationwide survey 3 were evaluating students' immune status to VZV. Second, I am concerned about not surveying t h e c o m m u n i t y-b a s e d attending physicians. Was there a reason to suspect that they were 100% immune? It is possible that as many as 43 (using percentages of susceptible individuals on page 451) of these 853 p h y s i c i a n s may lack i m m u n i t y. Depending on their attendance and patient-care activities at the institution, they could, just as easily as e m p l o y e e s , s e r v e as v e c t o r s of nosocomial infection. This problem is not just true of VZV, but may also be true for rubella or measles virus. It depicts, to some extent, a "double standard," one set of requirements (screening) for employees, and a second set for physicians on staff. In my experience, this situation is more likely the rule rather than the exception in hospitals today. Hospital-based screening programs have not been successful in attracting physician participation in the past. 4-5 1 would be curious to know how many of the 167 who elected not to participate in this study were physicians. I believe that part of the solution to this problem begins with better screening and preventive health programs in the medical schools along with beginning to dismantle the "double standard" practices by hospital administrations.