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Abstract
Varicella is a common vaccine-preventable disease that usually presents as a mild disorder but can lead to severe complications. Before the implementation of universal varicella vaccination (UVV) in some European countries, the burden of varicella disease was broadly similar across the region. Despite this, countries adopted heterogeneous varicella vaccination strategies. UVV is currently recommended in 12 European countries. Known barriers to UVV implementation in Europe include (1) a perceived low disease burden and low public health priority; (2) cost-effectiveness and funding availability; (3) concerns related to a shift in varicella disease and incidence of herpes zoster and (4) safety concerns related to measles, mumps, rubella and varicella-associated febrile seizures after the first dose. Countries that implemented UVV experienced decreases in varicella incidence, hospitalizations and complications, showing overall beneficial impact. Alternative strategies targeting susceptible individuals at higher risk of complications have been less effective. This article discusses ways to overcome the barriers to move varicella forward as a truly vaccine preventable disease.
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Zoch-Lesniak B, Tolksdorf K, Siedler A. Trends in herpes zoster epidemiology in Germany based on primary care sentinel surveillance data, 2005-2016. Hum Vaccin Immunother 2018; 14:1807-1814. [PMID: 29498894 PMCID: PMC6067859 DOI: 10.1080/21645515.2018.1446718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/07/2018] [Accepted: 02/25/2018] [Indexed: 11/07/2022] Open
Abstract
Herpes zoster (HZ) is caused by reactivation of the varicella-zoster-virus (VZV). Childhood varicella vaccination, as recommended in Germany in 2004, may reduce the risk of HZ in vaccinated children but also virus circulation and thus the booster possibility of latent infected persons. In this context we analyzed age-specific trends in HZ epidemiology in Germany using data on HZ-associated outpatient consultations in participating sentinel sites and HZ-associated cases in all hospitals since 2005. We analyzed two separate time periods that differed in sentinel management and data integrity. For the period 2005-2010, we found a decrease in HZ-associated outpatient consultations in 1- to 4-year-olds (IRR = 0.72, 95%CI 0.63-0.81, p<0.001). For the period 2013-2016, we observed a decrease in HZ-associated outpatient consultations in 10- to 14-year-olds (IRR = 0.85, 95%CI 0.78-0.93, p<0.01). Moreover, we detected an increase in the age groups 20 years and older except for the group 30-39 years. HZ-associated hospitalizations showed similar trends for the second time period (here 2012-2015). The decrease in HZ-associated outpatient consultations and hospitalizations in children started and continued over cohorts eligible for varicella vaccination and could be a result of their reduced HZ-risk. Whether the observed steady increasing HZ incidences for adults are associated with the varicella vaccination in children remains unclear and could not be investigated with our data.
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Affiliation(s)
- Beate Zoch-Lesniak
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Immunization Unit, Berlin, Germany
| | - Kristin Tolksdorf
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
| | - Anette Siedler
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Immunization Unit, Berlin, Germany
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Hu Y, Chen Y, Wang Y, Liang H. Evaluation of potentially achievable vaccination coverage of the second dose of measles containing vaccine with simultaneous administration and risk factors for missed opportunities among children in Zhejiang province, east China. Hum Vaccin Immunother 2018; 14:875-880. [PMID: 29252094 DOI: 10.1080/21645515.2017.1419111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the potential achievable coverage of the second dose of measles containing vaccine (MCV2) when the protocol of simultaneous administration of childhood vaccines was fully implemented. Risk factors for missed opportunity (MO) for simultaneous administration of MCV2 were also investigated. METHODS Children born from 1 January 2005 to 31 December 2014 and registered in Zhejiang provincial immunization information system were enrolled in this study. The MO of simultaneous administration of MCV2, the actual age-appropriate coverage (AAC) of MCV2 and the potentially achievable coverage (PAC) of MCV2 were evaluated and compared across different birth cohorts, by different socio-demographic variables. For the 2014 birth cohort, logistic regression model was used to detect the risk factors of MOs, from both socio-demographic and vaccination service providing aspects. RESULTS Compared to the AAC, the PAC of MCV2 increased significantly from 2005 birth cohort to 2014 birth cohort (p<0.001), with a median of 12.7 percentage points. Higher birth order of children, resident children, higher maternal education background, higher socio-economic development level of resident areas, less frequent vaccination service, and shorter vaccination service time were significant risk factors of MO for simultaneous administration of MCV2, with all p-value < 0.05. CONCLUSION The findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible vaccine doses at the same vaccination visit is critical for achieving the coverage target of 95% for MCV2. Future interventions focusing on the group with risk factors observed could substantially eliminate MOs for simultaneous administration of MCV2, further to improve the coverage of fully immunization of MCV, and finally achieve the goal of eliminating measles.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
| | - Hui Liang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , Zhejiang , China
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Ouwens MJNM, Littlewood KJ, Sauboin C, Téhard B, Denis F, Boëlle PY, Alain S. The impact of 2-dose routine measles, mumps, rubella, and varicella vaccination in France on the epidemiology of varicella and zoster using a dynamic model with an empirical contact matrix. Clin Ther 2015; 37:816-829.e10. [PMID: 25726457 DOI: 10.1016/j.clinthera.2014.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/08/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Varicella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization. The objective of this analysis was to assess the impact of routine varicella vaccination, with MMRV in place of MMR, on the incidence of varicella and zoster diseases in France and to assess the impact of exogenous boosting of zoster incidence, age shift in varicella cases, and other possible indirect effects. METHODS A dynamic transmission population-based model was developed using epidemiological data for France to determine the force of infection, as well as an empirically derived contact matrix to reduce assumptions underlying these key drivers of dynamic models. Scenario analyses tested assumptions regarding exogenous boosting, vaccine waning, vaccination coverage, risk of complications, and contact matrices. FINDINGS The model provides a good estimate of the incidence before varicella vaccination implementation in France. When routine varicella vaccination is introduced with French current coverage levels, varicella incidence is predicted to decrease by 57%, and related complications are expected to decrease by 76% over time. After vaccination, it is observed that exogenous boosting is the main driver of change in zoster incidence. When exogenous boosting is assumed, there is a temporary increase in zoster incidence before it gradually decreases, whereas without exogenous boosting, varicella vaccination leads to a gradual decrease in zoster incidence. Changing vaccine efficacy waning levels and coverage assumptions are still predicted to result in overall benefits with varicella vaccination. IMPLICATIONS In conclusion, the model predicted that MMRV vaccination can significantly reduce varicella incidence. With suboptimal coverage, a limited age shift of varicella cases is predicted to occur post-vaccination with MMRV. However, it does not result in an increase in the number of complications. GSK study identifier: HO-12-6924.
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Affiliation(s)
| | | | | | - Bertrand Téhard
- Pharmaco Epidemiology Unit, GSK France, Marly-le-Roi, France
| | - François Denis
- CHU de Limoges, Service de Bactériologie Virologie-Hygiène, Limoges, France
| | - Pierre-Yves Boëlle
- Université Pierre et Marie Curie, Service de Biostatistique - INSERM U707, Paris, France
| | - Sophie Alain
- CHU de Limoges, Service de Bactériologie Virologie-Hygiène, Limoges, France; Université de Limoges, Faculté de Médecine, Service de Bactériologie, INSERM UMR 1092, Limoges, France
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Littlewood KJ, Ouwens MJNM, Sauboin C, Tehard B, Alain S, Denis F. Cost-effectiveness of routine varicella vaccination using the measles, mumps, rubella and varicella vaccine in France: an economic analysis based on a dynamic transmission model for varicella and herpes zoster. Clin Ther 2015; 37:830-841.e7. [PMID: 25721380 DOI: 10.1016/j.clinthera.2015.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/11/2014] [Accepted: 01/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Each year in France, varicella and zoster affect large numbers of children and adults, resulting in medical visits, hospitalizations for varicella- and zoster-related complications, and societal costs. Disease prevention by varicella vaccination is feasible, wherein a plausible option involves replacing the combined measles, mumps, and rubella (MMR) vaccine with the combined MMR and varicella (MMRV) vaccine. This study aimed to: (1) assess the cost-effectiveness of adding routine varicella vaccination through MMRV, using different vaccination strategies in France; and (2) address key uncertainties, such as the economic consequences of breakthrough varicella cases, the waning of vaccine-conferred protection, vaccination coverage, and indirect costs. METHODS Based on the outputs of a dynamic transmission model that used data on epidemiology and costs from France, a cost-effectiveness model was built. A conservative approach was taken regarding the impact of varicella vaccination on zoster incidence by assuming the validity of the hypothesis of an age-specific boosting of immunity against varicella. FINDINGS The model determined that routine MMRV vaccination is expected to be a cost-effective option, considering a cost-effectiveness threshold of €20,000 per quality-adjusted life-year saved; routine vaccination was cost-saving from the societal perspective. Results were driven by a large decrease in varicella incidence despite a temporary initial increase in the number of zoster cases due to the assumption of exogenous boosting. In the scenario analyses, despite moderate changes in assumptions about incidence and costs, varicella vaccination remained a cost-effective option for France. IMPLICATIONS Routine vaccination with MMRV was associated with high gains in quality-adjusted life-years, substantial reduction in the occurrences of varicella- and zoster-related complications, and few deaths due to varicella. Routine MMRV vaccination is also expected to provide reductions in costs related to hospitalizations, medication use, and general-practitioner visits, as well as indirect costs, and it is expected to be a cost-effective intervention in France (GSK study identifier: HO-12-6924).
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Affiliation(s)
| | | | | | - Bertrand Tehard
- Pharmaco Epidemiology Unit, GSK France, Marly-le-Roi, France
| | - Sophie Alain
- University of Limoges, Faculty of Medicine, Bacteriology-Virology Service, Limoges, France
| | - François Denis
- CHU of Limoges, Bacteriology-Virology Hygiene Service, Limoges, France
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Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW. Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis 2013; 13:170. [PMID: 23574765 PMCID: PMC3637114 DOI: 10.1186/1471-2334-13-170] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years. The forthcoming European launch of a vaccine against HZ (Zostavax®) prompts the need for a better understanding of the epidemiology of HZ in Europe. Therefore the aim of this systematic review was to summarize the available data on HZ incidence in Europe and to describe age-specific incidence. Methods The Medline database of the National Library of Medicine was used to conduct a comprehensive literature search of population-based studies of HZ incidence published between 1960 and 2010 carried out in the 27 member countries of the European Union, Iceland, Norway and Switzerland. The identified articles were reviewed and scored according to a reading grid including various quality criteria, and HZ incidence data were extracted and presented by country. Results The search identified 21 studies, and revealed a similar annual HZ incidence throughout Europe, varying by country from 2.0 to 4.6/1 000 person-years with no clearly observed geographic trend. Despite the fact that age groups differed from one study to another, age-specific HZ incidence rates seemed to hold steady during the review period, at around 1/1 000 children <10 years, around 2/1 000 adults aged <40 years, and around 1–4/1 000 adults aged 40–50 years. They then increased rapidly after age 50 years to around 7–8/1 000, up to 10/1 000 after 80 years of age. Our review confirms that in Europe HZ incidence increases with age, and quite drastically after 50 years of age. In all of the 21 studies included in the present review, incidence rates were higher among women than men, and this difference increased with age. This review also highlights the need to identify standardized surveillance methods to improve the comparability of data within European Union Member States and to monitor the impact of VZV immunization on the epidemiology of HZ. Conclusions Available data in Europe have shortcomings which make an accurate assessment of HZ incidence and change over time impossible. However, data are indicative that HZ incidence is comparable, and increases with age in the same proportion across Europe.
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Affiliation(s)
- Sybil Pinchinat
- Epidemiology Department, Sanofi Pasteur MSD, 8 rue Jonas Salk, Lyon, 69007, France
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Gaillat J, Gajdos V, Launay O, Malvy D, Demoures B, Lewden L, Pinchinat S, Derrough T, Sana C, Caulin E, Soubeyrand B. Does monastic life predispose to the risk of Saint Anthony's fire (herpes zoster)? Clin Infect Dis 2012; 53:405-10. [PMID: 21844022 DOI: 10.1093/cid/cir436] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The consequences of the epidemiology of varicella for zoster epidemiology are still debated. We therefore compared the frequency of herpes zoster in an adult population with virtually no varicella zoster virus (VZV) exposure with that in the general population (GP). METHODS We performed a national, multicenter, observational, exposed versus nonexposed, comparative study. The nonexposed population consisted of members of contemplative monastic orders (CMO) of the Roman Catholic Church living in 40 isolated monasteries in France. The exposed population consisted of a sample of the GP representative of the French population in terms of age group, sex, socio-occupational categories, and regions. RESULTS The primary analysis population comprised 920 members of CMO (41.5% nuns; mean age, 64.2 years) and 1533 members of the GP (51.9% women; mean age, 64.6 years). The reported frequency of zoster was 16.2% among CMO and 15.1% in the GP (P = .27, adjusted for sex and age). The reported mean age of onset of zoster was 54.8 and 48.6 years, respectively (P = .06). CONCLUSIONS This study failed to demonstrate an increased risk or earlier onset of zoster in members of CMO not exposed to VZV, compared with that in the GP. Although adults highly exposed to VZV could have a reduced risk of zoster, compared with the GP, our results suggest that the opposite is not true: adults not exposed to VZV are not at increased risk of zoster when compared with the GP, challenging the relevance of the assumptions and forecasts of current epidemiological models.
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Affiliation(s)
- Jacques Gaillat
- Department of Infectious and Tropical Diseases, Annecy General Hospital, Pringy, France.
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Pozza F, Piovesan C, Russo F, Bella A, Pezzotti P, Emberti Gialloreti L. Impact of universal vaccination on the epidemiology of varicella in Veneto, Italy. Vaccine 2011; 29:9480-7. [PMID: 22015389 DOI: 10.1016/j.vaccine.2011.10.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/07/2011] [Accepted: 10/09/2011] [Indexed: 11/29/2022]
Abstract
In 2005, universal varicella vaccination was introduced in the Veneto region, Italy. We examined trends in varicella incidence and hospitalization rates before and after vaccine introduction, and applied statistical models to assess vaccine effectiveness. Varicella incidence rates for 2000-2008 were calculated from the mandatory regional surveillance data and from a special surveillance system based on reports from a sample of family pediatricians that during the study period followed more than 40,000 children. To evaluate hospital admission rates, we analyzed the regional hospital discharge registry. The vaccine coverage rate was 6.8% in the 2004 birth-cohort and 78.6% in the 2008 cohort. Varicella incidence in 0-14 year-olds was 6136.8/100,000 person-years in 2000 and 4004.8 in 2008; hospitalization rates were 18.7 and 8.4. Incidence rates significantly decreased 2.5 years after beginning the universal vaccination, while hospitalization rates showed a significant decrease one year earlier. There was a remarkable decline of both varicella incidence and hospitalizations especially in 1-4 year-old children. This study confirms the positive impact of universal vaccination.
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Bilcke J, Beutels P, Brisson M, Jit M. Accounting for Methodological, Structural, and Parameter Uncertainty in Decision-Analytic Models. Med Decis Making 2011; 31:675-92. [DOI: 10.1177/0272989x11409240] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Accounting for uncertainty is now a standard part of decision-analytic modeling and is recommended by many health technology agencies and published guidelines. However, the scope of such analyses is often limited, even though techniques have been developed for presenting the effects of methodological, structural, and parameter uncertainty on model results. To help bring these techniques into mainstream use, the authors present a step-by-step guide that offers an integrated approach to account for different kinds of uncertainty in the same model, along with a checklist for assessing the way in which uncertainty has been incorporated. The guide also addresses special situations such as when a source of uncertainty is difficult to parameterize, resources are limited for an ideal exploration of uncertainty, or evidence to inform the model is not available or not reliable. Methods for identifying the sources of uncertainty that influence results most are also described. Besides guiding analysts, the guide and checklist may be useful to decision makers who need to assess how well uncertainty has been accounted for in a decision-analytic model before using the results to make a decision.
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Affiliation(s)
- Joke Bilcke
- Center for Health Economic Research and Modeling for Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (Vaxinfectio), Antwerp University, Antwerp, Belgium (JB, PB)
- Département de Médecine sociale et préventive, Université Laval, Québec, Canada (MB)
- URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Québec, Canada (MB)
- Modelling and Economics Unit, Health Protection Agency, London, United Kingdom (MJ)
| | - Philippe Beutels
- Center for Health Economic Research and Modeling for Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (Vaxinfectio), Antwerp University, Antwerp, Belgium (JB, PB)
- Département de Médecine sociale et préventive, Université Laval, Québec, Canada (MB)
- URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Québec, Canada (MB)
- Modelling and Economics Unit, Health Protection Agency, London, United Kingdom (MJ)
| | - Marc Brisson
- Center for Health Economic Research and Modeling for Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (Vaxinfectio), Antwerp University, Antwerp, Belgium (JB, PB)
- Département de Médecine sociale et préventive, Université Laval, Québec, Canada (MB)
- URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Québec, Canada (MB)
- Modelling and Economics Unit, Health Protection Agency, London, United Kingdom (MJ)
| | - Mark Jit
- Center for Health Economic Research and Modeling for Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (Vaxinfectio), Antwerp University, Antwerp, Belgium (JB, PB)
- Département de Médecine sociale et préventive, Université Laval, Québec, Canada (MB)
- URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Québec, Canada (MB)
- Modelling and Economics Unit, Health Protection Agency, London, United Kingdom (MJ)
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Current world literature. Refractive surgery. Corneal and external disorders. Curr Opin Ophthalmol 2010; 21:322-6. [PMID: 20548165 DOI: 10.1097/icu.0b013e32833bb58c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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