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Sherman SM, Lingley-Heath N, Lai J, Sim J, Bedford H. Parental acceptance of and preferences for administration of routine varicella vaccination in the UK: A study to inform policy. Vaccine 2023; 41:1438-1446. [PMID: 36796935 DOI: 10.1016/j.vaccine.2023.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To explore acceptability of and preferences for the introduction of varicella vaccination to the UK childhood immunisation schedule. DESIGN We conducted an online cross-sectional survey exploring parental attitudes towards vaccines in general, and varicella vaccine specifically, and their preferences for how the vaccine should be administered. PARTICIPANTS 596 parents (76.3% female, 23.3% male, 0.4% other; mean age 33.4 years) whose youngest child was aged 0-5 years. MAIN OUTCOME MEASURES Willingness to accept the vaccine for their child and preferences for how the vaccine should be administered (in combination with the MMR vaccine [MMRV], on the same day as the MMR vaccine but as a separate injection [MMR + V], on a separate additional visit). RESULTS 74.0% of parents (95% CI 70.2% to 77.5%) were extremely/somewhat likely to accept a varicella vaccine for their child if one became available, 18.3% (95% CI 15.3% to 21.8%) were extremely/somewhat unlikely to accept it and 7.7% (95% CI 5.7% to 10.2%) were neither likely nor unlikely. Reasons provided by parents likely to accept the vaccine included protection from complications of chickenpox, trust in the vaccine/healthcare professionals, and wanting their child to avoid their personal experience of chickenpox. Reasons provided by parents who were unlikely included chickenpox not being a serious illness, concern about side effects, and believing it is preferable to catch chickenpox as a child rather than as an adult. A combined MMRV vaccination or additional visit to the surgery were preferred over an additional injection at the same visit. CONCLUSIONS Most parents would accept a varicella vaccination. These findings highlight parents' preferences for varicella vaccine administration, information needed to inform vaccine policy and practice and development of a communication strategy.
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Affiliation(s)
| | | | - Jasmine Lai
- Division of Biosciences, University College London, London WC1E 6DE, UK
| | - Julius Sim
- School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Helen Bedford
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.
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Widgren K, Persson Berg L, Mörner A, Lindquist L, Tegnell A, Giesecke J, Studahl M. Severe chickenpox disease and seroprevalence in Sweden - implications for general vaccination. Int J Infect Dis 2021; 111:92-98. [PMID: 34380088 DOI: 10.1016/j.ijid.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To describe the current panorama of severe chickenpox disease and seroprevalence in Sweden, as a basis for the approaching decision on universal vaccination. METHODS We included patients discharged with an International Classification of Diseases, 10th revision-code for chickenpox (B01.1-9) in eight pediatric and infectious diseases departments in Stockholm and Gothenburg in 2012-2014 and reviewed their medical charts. Further, residual serum samples collected from 16 laboratories across Sweden were analyzed for varicella zoster IgG-antibodies to investigate the age-specific seroprevalences. RESULTS In all, 218 children and 46 adults were included in the hospital-based study, 87.2% of children and 63.0% of adults had complications. An underlying condition was not associated with an increased risk for complication. In children dehydration (31.7%), bacterial skin infections (29.8%) and neurological involvement (20.6%) were most frequent complications. Among adult cases, 63 % were born abroad. The seroepidemiological analysis included 957 patient samples. Seroprevalence was 66.7% at 5 years and 91.5% at 12 years. Infants and adolescents/adults were overrepresented among admitted patients compared to seroprevalence data. CONCLUSIONS Half of all complications in hospitalized chickenpox cases was seen in previously healthy children, which supports universal childhood vaccination. Adult migrants was a risk group for chickenpox hospitalization. Age-specific seroprevalence was similar to neighboring countries.
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Affiliation(s)
- K Widgren
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden; Department of Public Health Analysis and Data Management, the Public Health Agency of Sweden, Solna, Sweden.
| | - L Persson Berg
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Mörner
- Department of Microbiology, the Public Health Agency of Sweden,Solna, Sweden
| | - L Lindquist
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - A Tegnell
- Department of Public Health Analysis and Data Management, the Public Health Agency of Sweden, Solna, Sweden
| | - J Giesecke
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - M Studahl
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cates M, Donati M, Gillet S, Ustianowski A, Galloway J. Managing varicella zoster virus contact and infection in patients on anti-rheumatic therapy. Rheumatology (Oxford) 2018; 57:596-605. [PMID: 28575315 DOI: 10.1093/rheumatology/kex189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 12/30/2022] Open
Abstract
Chickenpox and shingles can be more severe and occasionally life threatening in immunosuppressed patients. As such, some groups warrant a more detailed history, serological testing and consideration of prophylaxis following contact with the virus. Active disease may also require more aggressive treatment with antivirals. Guidance for the use of varicella zoster immunoglobulin has recently been updated by Public Health England with important implications for rheumatology patients.
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Affiliation(s)
- Matthew Cates
- Department of Rheumatology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK
| | - Matthew Donati
- Department of Virology, Public Health England, Bristol, UK
| | - Sophie Gillet
- Department of Virology, United Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Andrew Ustianowski
- Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - James Galloway
- Department of Rheumatology, King's College London, London, UK
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Pembrey L, Waiblinger D, Griffiths P, Patel M, Azad R, Wright J. Cytomegalovirus, Epstein-Barr virus and varicella zoster virus infection in the first two years of life: a cohort study in Bradford, UK. BMC Infect Dis 2017; 17:220. [PMID: 28320319 PMCID: PMC5360071 DOI: 10.1186/s12879-017-2319-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Cytomegalovirus (CMV), Epstein Barr virus (EBV) and varicella-zoster virus (VZV) are common herpesviruses frequently acquired in childhood, which establish persistent, latent infection and are likely to impact the developing immune system. Little is known about the epidemiology of CMV and EBV infections in contemporary UK paediatric populations, particularly whether age at infection differs by ethnic group. Methods Children enrolled in the Born in Bradford Allergy and Infection Study had a blood sample taken and a questionnaire completed at 12 and 24 months of age. Ordered logistic regression quantified associations between ethnicity and other risk factors and age at CMV/EBV/VZV infection (<12 months, 12–24 months, uninfected at 24 months). Results Pakistani children (n = 472) were more likely to be infected with CMV and EBV at a younger age than White British children (n = 391) (CMV: adjusted odds ratio (OR) 2.53, 95% confidence interval (CI) 1.47–4.33; EBV: adjusted OR 2.16, 95% CI 1.43–3.26). Conversely, Pakistani children had lower odds of being VZV infected in the second year than White British children (adjusted OR 0.57, 95% CI 0.33–0.97). There was a strong association between increasing birth order and later CMV infection in Pakistani children. Conclusions We report large differences in CMV and EBV incidence in the first 2 years between Pakistani and White British children born in Bradford, which cannot be explained by differences in risk factors for infection. Our data will inform the optimum schedule for future CMV and EBV vaccination programmes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2319-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lucy Pembrey
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Paul Griffiths
- Centre for Virology, University College London Medical School, London, UK
| | - Mauli Patel
- Virology Department, Royal Free Hospital, London, UK
| | - Rafaq Azad
- Department of Biochemistry, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford, UK
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MAPLE PAC, HAEDICKE J, QUINLIVAN M, STEINBERG SP, GERSHON AA, BROWN KE, BREUER J. The differences in short- and long-term varicella-zoster virus (VZV) immunoglobulin G levels following varicella vaccination of healthcare workers measured by VZV fluorescent-antibody-to-membrane-antigen assay (FAMA), VZV time-resolved fluorescence immunoassay and a VZV purified glycoprotein enzyme immunoassay. Epidemiol Infect 2016; 144:2345-53. [PMID: 27018820 PMCID: PMC5726866 DOI: 10.1017/s0950268816000595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/04/2016] [Accepted: 03/02/2016] [Indexed: 01/31/2023] Open
Abstract
Healthcare workers (HCWs) reporting no history of varicella frequently receive varicella vaccination (vOka) if they test varicella-zoster virus (VZV) immunoglobulin G (IgG) negative. In this study, the utilities of VZV-IgG time-resolved fluorescence immunoassay (VZV-TRFIA) and a commercial VZV-IgG purified glycoprotein enzyme immunoassay (gpEIA) currently used in England for confirming VZV immunity have been compared to the fluorescent-antibody-to-membrane-antigen assay (FAMA). A total of 110 HCWs received two doses of vOka vaccine spaced 6 weeks apart and sera collected pre-vaccination (n = 100), at 6 weeks post-completion of vaccination (n = 86) and at 12-18 months follow-up (n = 73) were analysed. Pre-vaccination, by FAMA, 61·0% sera were VZV IgG negative, and compared to FAMA the sensitivities of VZV-TRFIA and gpEIA were 74·4% [95% confidence interval (CI) 57·9-87·0] and 46·2% (95% CI 30·1-62·8), respectively. Post-completion of vaccination the seroconversion rate by FAMA was 93·7% compared to rates of 95·8% and 70·8% determined by VZV-TRFIA and gpEIA, respectively. At 12-18 months follow-up seropositivity rates by FAMA, VZV-TRFIA and gpEIA were 78·1%, 74·0% and 47·9%, respectively. Compared to FAMA the sensitivities of VZV-TRFIA and gpEIA for measuring VZV IgG following vaccination were 96·4% (95% CI 91·7-98·8) and 74·6% (95% CI 66·5-81·6), respectively. Using both FAMA and VZV-TRFIA to identify healthy adult VZV susceptibles and measure seroconversion showed that vOka vaccination of HCWs is highly immunogenic.
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Affiliation(s)
- P. A. C. MAPLE
- Virus Reference Department, Public Health England, Reference Microbiology Services, Colindale, London, UK
- East Yorkshire Microbiology, York Science Park, Heslington, York, UK
| | - J. HAEDICKE
- Department of Infection, The Cruciform Building, University College London, London, UK
| | - M. QUINLIVAN
- Department of Infection, The Cruciform Building, University College London, London, UK
| | - S. P. STEINBERG
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA
| | - A. A. GERSHON
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA
| | - K. E. BROWN
- Virus Reference Department, Public Health England, Reference Microbiology Services, Colindale, London, UK
| | - J. BREUER
- Department of Infection, The Cruciform Building, University College London, London, UK
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Amirthalingam G, Ramsay M. Should the UK introduce a universal childhood varicella vaccination programme? Arch Dis Child 2016; 101:2-3. [PMID: 26342095 DOI: 10.1136/archdischild-2015-308730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK Correspondence to Dr Gayatri Amirthalingam, Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| | - Mary Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK Correspondence to Dr Gayatri Amirthalingam, Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
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Maple PAC. Application of Oral Fluid Assays in Support of Mumps, Rubella and Varicella Control Programs. Vaccines (Basel) 2015; 3:988-1003. [PMID: 26690230 PMCID: PMC4693228 DOI: 10.3390/vaccines3040988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/19/2015] [Accepted: 12/02/2015] [Indexed: 02/01/2023] Open
Abstract
Detection of specific viral antibody or nucleic acid produced by infection or immunization, using oral fluid samples, offers increased potential for wider population uptake compared to blood sampling. This methodology is well established for the control of HIV and measles infections, but can also be applied to the control of other vaccine preventable infections, and this review describes the application of oral fluid assays in support of mumps, rubella and varicella national immunization programs. In England and Wales individuals with suspected mumps or rubella, based on clinical presentation, can have an oral fluid swab sample taken for case confirmation. Universal varicella immunization of children has led to a drastic reduction of chickenpox in those countries where it is used; however, in England and Wales such a policy has not been instigated. Consequently, in England and Wales most children have had chickenpox by age 10 years; however, small, but significant, numbers of adults remain susceptible. Targeted varicella zoster virus (VZV) immunization of susceptible adolescents offers the potential to reduce the pool of susceptible adults and oral fluid determination of VZV immunity in adolescents is a potential means of identifying susceptible individuals in need of VZV vaccination. The main application of oral fluid testing is in those circumstances where blood sampling is deemed not necessary, or is undesirable, and when the documented sensitivity and specificity of the oral fluid assay methodology to be used is considered sufficient for the purpose intended.
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Affiliation(s)
- Peter A C Maple
- East Yorkshire Microbiology, Innovation Centre, York Science Park, York YO10 5DG, UK.
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Shackleton N, Hale D, Viner RM. Trends and socioeconomic disparities in preadolescent's health in the UK: evidence from two birth cohorts 32 years apart. J Epidemiol Community Health 2015; 70:140-6. [PMID: 26359506 DOI: 10.1136/jech-2015-205603] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/21/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to children and adults, little is known about changes in adolescent health over time. This study profiles the health of preadolescents in two distinct time periods, 1980 and 2012. METHODS Secondary analysis of the British Cohort Study and the Millennium Cohort Study for preadolescents mostly aged between 10 and 11.5 years (range 9.75-13 years). The prevalence/average of, and socioeconomic gradients in, the following were compared between 1980 and 2012; general health problems, anthropometrics, allergic conditions, infectious diseases, health service use, smoking and parental smoking behaviour and maternal adiposity. Socioeconomic status was measured by familial income (3 groups). RESULTS There were decreases in the proportion of hospital admissions (Δ=-0.10(-0.09:-0.11)) smoking (Δ=-0.12(-0.11:-0.13)), parental smoking (mother: (Δ=-0.19(-0.18:-0.21)) father: (Δ=-0.35(-0.34:-0.37), infectious diseases (measles: (Δ=-0.46(-0.45:-0.47)) whooping cough: (Δ=-0.07(-0.06:-0.07)) and hearing problems (Δ=-0.04(-0.03:-0.05)). There were no changes in limiting long-standing illness (Δ=0.00 (-0.00:0.00)), or the proportion of children having two or more accidents requiring medical attention (Δ=-0.02(-0.00:-0.02)). There were increases in the proportion overweight (Δ=0.18(0.17:0.19)), maternal overweight(Δ=0.22(0.21:0.23)) and obesity(Δ=0.12(0.11:0.13)), height for age(Δ=0.47(0.44:0.49)), weight for age (Δ=0.68(0.65:0.71)), proportion reporting chicken pox (Δ=0.28(0.27:0.29)), allergic conditions (eczema Δ=0.19(0.18:0.20)), asthma Δ=0.12(0.11:0.13), hay fever Δ=0.15(0.14:0.16)) and wearing glasses (Δ=0.08(0.07:0.09)). There were increases in socioeconomic gradients for limiting long-standing illness, smoking, overweight, weight for age, height for age, wearing glasses, asthma and the onset of puberty. CONCLUSIONS There have been reductions in infectious diseases and tobacco exposure among British preadolescents, but overweight and allergic conditions have risen dramatically. Children from deprived families have benefitted least from improvements in health status, and have experienced the largest increases in health risks.
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Affiliation(s)
- Nichola Shackleton
- Department of General and Adolescent Paediatrics, Population, Policy & Practice Programme, Institute Of Child Health, University College London, London, UK
| | - Daniel Hale
- Department of General and Adolescent Paediatrics, Population, Policy & Practice Programme, Institute Of Child Health, University College London, London, UK
| | - Russell M Viner
- Department of General and Adolescent Paediatrics, Population, Policy & Practice Programme, Institute Of Child Health, University College London, London, UK
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Preventing varicella in children with malignancies: what is the evidence? Curr Opin Infect Dis 2011; 24:203-11. [PMID: 21455062 DOI: 10.1097/qco.0b013e328345d666] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The prevention of varicella in children with cancer is generally agreed to be an important goal, because of their elevated risk of varicella zoster virus (VZV)-associated morbidity and mortality. However, there is a lack of consensus on the best means of achieving this. Here, we review the existing evidence in relation to postexposure prophylaxis against varicella in this group and summarize data regarding the role of active vaccination. RECENT FINDINGS Death from varicella during treatment for cancer is now rare, but VZV disease and its prevention remain significant problems in paediatric oncology practice. Measures to reduce VZV exposure amongst seronegative individuals are often neglected. When exposure is known to have occurred, early administration of varicella zoster immune globulin (VZIG) is generally protective against severe and complicated varicella. However, many centres in the UK and Japan use an oral antiviral agent, aciclovir, in place of VZIG. Published evidence for the efficacy of aciclovir as postexposure prophylaxis (PEP) relates mostly to healthy children, with no controlled studies in the immunocompromised. SUMMARY Good evidence already supports the administration of varicella vaccine to healthy susceptible family contacts of children with malignancy, but not to patients themselves. Further data are urgently needed to inform the choice of PEP against VZV in the immunocompromised.
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