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Sun X, Wang Y, Zhang L, Liu Y, Xu LX, Chen Q, Sun H, Wang F, Wang Z, Wang W. Explore the optimal timing for administering the second dose of the varicella vaccine in China. J Med Virol 2023; 95:e29119. [PMID: 37737678 DOI: 10.1002/jmv.29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
The prevalence of varicella in China has been increasing annually, with a relatively high incidence rate of breakthrough cases. Administering two doses of the varicella vaccine (Varv) proves to be the most effective measure. The objective of this study is to assess the immunogenicity of two doses of the Varv at varying intervals and explore the optimal timing for administering the second dose of the Varv. Utilizing a prospective cohort study design, the quantification of varicella immunoglobulin G (IgG) antibodies' geometric mean concentrations (GMC) is conducted through glycoprotein-based enzyme-linked immunosorbent assay (gpELISA). A total of 903 infants were included in the per-protocol population. After completing the first dose of the Varv, the GMC of antibody after 1 month (Group A) was 463.8 (447.6-480.1) mIU/mL. There was a statistically significant difference in GMC and seroconversion rates among the groups (B/C/D) that received the second dose of the Varv (p < 0.05). Multiple comparisons revealed that the group with a 3-year interval between the two vaccine doses had a higher GMC of 665.2 (622.6-707.8) mIU/mL compared to the group with a 1-year interval of 611.1 (577.1-645.3) mIU/mL and the group with a 5-year interval of 564.7 (540.1-589.4) mIU/mL. To effectively prevent and control the varicella epidemic in Jiangsu Province, two dose Varv vaccination is recommended, the optimal time point for the second dose Varv is 3 years after the first vaccination.
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Affiliation(s)
- Xiang Sun
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yong Wang
- Scientific Research Department, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Lei Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yuanbao Liu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ling-Xiao Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Qiang Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hui Sun
- Medical Department, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Fangfang Wang
- Department of Hematology, Yangzhou University Clinical Medical College, Yangzhou, Jiangsu, China
| | - Zhiguo Wang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Wen Wang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
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Chen D, Li Y, Wu Q. Effectiveness of varicella vaccine as post-exposure prophylaxis: a meta-analysis. Hum Vaccin Immunother 2021; 17:5316-5324. [PMID: 34893015 DOI: 10.1080/21645515.2021.2009729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of varicella vaccine (VarV) as post-exposure prophylaxis (PEP) among children during varicella outbreaks. MATERIAL AND METHODS A comprehensive literature search was performed in PubMed, Embase, Web of Science, SinoMed, Wanfang and CNKI. Relevant outcomes included the incidence of varicella. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies. RESULTS A total of 15 studies with 7,474 children that received one or two dosages of VarV as PEP and 183,827 children who received no VarV were included in the meta-analysis. In total, one-dose and two-dose VarV as PEP had 43% (95% confidence interval (CI):27%, 55%) and 60% (95%CI: 35%, 75%) efficacy, respectively. When PEP was applied within 3 days, the pooled VarV as PEP for prevention of varicella was 80% (95%CI: 68%, 88%); when PEP was administered beyond 3 days, the pooled VarV as PEP for the prevention of varicella was 50% (95%CI: 11%, 72%). If the PEP was implemented with a coverage of more than 80%, the VarV could prevent 82% of varicella cases from occurring (95%CI: 15%, 96%); if the PEP covered a maximum of 80% of the susceptible cases, the VarV could prevent 65% of varicella cases from occurring (95%CI: 50%, 76%). CONCLUSION The two-dose VarV had better efficacy than one-dose VarV in the control of varicella outbreaks, especially if PEP was applied within 3 days of an outbreak and in conjunction with a high coverage rate ≥80%.
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Affiliation(s)
- Daoyong Chen
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Yue Li
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Qiangsong Wu
- Department of Immunization Program, Xuhui District Center for Disease Control and Prevention, Shanghai, China
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Wang Y, Zhang L, Sun X, Cao Y, Wang Z, Liu L, Xu Y, Zhou M, Liu Y. Effectiveness and failure rate of the varicella vaccine in an outbreak in Jiangsu, China: a 1:2 matched case-control study. Hum Vaccin Immunother 2020; 16:506-512. [PMID: 31526231 DOI: 10.1080/21645515.2019.1665959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: The varicella vaccine is not included in the national childhood immunization schedules in China, although one-dose varicella vaccine has been suggested for susceptible children aged 1-12 years in Jiangsu Province. However, varicella epidemics and outbreaks are frequently reported. We investigated a varicella outbreak in an elementary school to explore the risk factors for varicella transmission and vaccine failure.Methods: A 1:2 matched case-control study was carried out. Participant data were collected with standardized questionnaires. For each case, we enrolled two controls: a subject with high exposure in the same classroom as the case and a subject with low exposure in a different classroom. Data regarding vaccination status and medical and exposure histories were analyzed.Results: Fifty-one cases were reported during the outbreak; 26 cases (51%) were breakthrough varicella. Varicella vaccine immunization history (P < .001, OR = 0.19, 95% CI = 0.08-0.45) and the presence of siblings (P = .037, OR = 0.45, 95% CI = 0.21-0.95) were protective factors in preventing varicella infection. Contact with varicella patients increased the risk of varicella infection (P = .028, OR = 3.39, 95% CI = 1.14-10.09). Breakthrough varicella cases tended to present a milder rash (P = .049), fewer complications (P = .02), fewer rash sites (P = .02) and a shorter duration of active lesions (P = .001). One pneumonia case and one encephalitis case were reported in breakthrough cases. Age <15 months at the time of vaccination increased the risk of breakthrough varicella (P = .012). The adjusted vaccine effectiveness was 81%.Conclusions: One-dose varicella vaccine is effective at alleviating clinical manifestations. The moderate coverage provided by one dose cannot prevent varicella outbreaks, and vaccination after 15 months of age should be considered in the immunization schedule; a two-dose strategy is highly recommended.
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Affiliation(s)
- Yong Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lei Zhang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiang Sun
- Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Yang Cao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhiguo Wang
- Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Li Liu
- Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Yan Xu
- Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Minghao Zhou
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China.,Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Yuanbao Liu
- Department of Expanded Programme on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
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Qin W, Xu XK, Wang Y, Meng XM, Yang CW, Xia F, Su H. Clinical characteristics and risk factors associated with breakthrough varicella during varicella outbreaks. Hum Vaccin Immunother 2020; 16:1851-1856. [PMID: 32118512 DOI: 10.1080/21645515.2019.1704574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although a varicella vaccine has been available in China since 1998 in the private sector, varicella outbreaks and breakthrough varicella (BV) still occur. In 2018, four varicella outbreaks with high BV rate sequentially occurred in four schools in Lu'an, sparking local public health authority's concerns on the varicella vaccine. Therefore, we conducted this investigation to evaluate varicella vaccine effectiveness (VE), characterize BV, and detect potential risk factors associated with BV. METHODS This was a three-stage study. First, a retrospective cohort study was done in each school to estimate the VEs of varicella vaccine during outbreaks. Second, a descriptive epidemiological method was used to describe the characteristics of the four outbreaks and to compare the clinical characteristics between the BV cases and unvaccinated varicella cases. To identify the risk factors associated with BV, we conducted an unmatched case-control study in the third stage of the study. RESULTS A total of 199 cases were identified among four outbreaks, and the overall attack rate was 14%. Of 1203 students with available vaccination information, 822 (68%) were vaccinated at least once. The overall VEs among four outbreaks ranged from 19% to 69%, whereas the VE against moderate or severe varicella ranged from 74% to 90%. Compared with unvaccinated varicella cases, the moderate or severe varicella (p < .001) and fever (p = .029) in the BV group were less common. Besides, BV cases had a shorter duration of disease (p = .007). Children vaccinated more than six years before the outbreak had a higher risk of developing BV compared with those vaccinated within the past six years (OR = 2.4, 95% CI: 1.2-4.8). The risk of developing BV differed by the exposure intensity. Compared with the presence of three or fewer varicella cases in the same class, the OR was 7.8 (95% CI: 3.6-16.9) for four to nine cases in the same class and 25.2 (95% CI: 13.5 -47.2) for that of 10 or more cases. CONCLUSIONS The overall VE was insufficient to protect varicella infection, and the VE for moderate or severe varicella was only moderate. The manifestations of BV cases were generally milder than those seen in natural varicella infection. The time since vaccination and the intensity of exposure are risk factors for developing BV during an outbreak.
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Affiliation(s)
- Wei Qin
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an, Anhui, China
| | - Xiao-Kang Xu
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an, Anhui, China
| | - Yao Wang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an, Anhui, China
| | - Xiang-Mei Meng
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an, Anhui, China
| | - Cheng-Wu Yang
- Department of Expanded Program on Immunization, Huoshan County Center for Disease Control and Prevention , Lu'an, Anhui, China
| | - Feng Xia
- Department of Expanded Program on Immunization, Huoqiu County Center for Disease Control and Prevention , Lu'an, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University , Hefei, Anhui, China
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Wu QS, Wang X, Liu JY, Chen YF, Zhou Q, Wang Y, Sha JD, Xuan ZL, Zhang LW, Yan L, Hu Y. Varicella outbreak trends in school settings during the voluntary single-dose vaccine era from 2006 to 2017 in Shanghai, China. Int J Infect Dis 2019; 89:72-78. [DOI: 10.1016/j.ijid.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022] Open
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Chisholm H, Howe A, Best E, Petousis-Harris H. Pertussis Vaccination Failure in the New Zealand Pediatric Population: Study Protocol. Vaccines (Basel) 2019; 7:vaccines7030065. [PMID: 31315274 PMCID: PMC6789883 DOI: 10.3390/vaccines7030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Pertussis vaccines have been effective at reducing pertussis-associated morbidity and mortality. However, they have a complex array of limitations, particularly associated with the duration of protection against clinical disease and imperfect immunity (carriage and transmission). Little is known about risk factors for pertussis vaccination failure. Understanding pertussis vaccination failure risk is most important in the paediatric population. This study aims to investigate risk factors for pertussis vaccination failure in (1) infants between birth and six weeks of age born to mothers who received pertussis booster vaccinations during pregnancy and (2) infants after the completion of the primary series (approximately five months old) to four years old. This will be achieved in a two-step process for each study group. Pertussis vaccination failure cases will first be described using a case series study design, relevant case characteristics will be sourced from six national administrative datasets. The case series study results will help select candidate risk factors (hypothesis generating step) to be tested in the retrospective cohort study (hypothesis testing step. Pattern analysis will be used to investigate risk factor patterns in the cohort study. The identification of higher risk groups enables targeting strategies, such as additional doses, to better prevent pertussis disease.
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Affiliation(s)
- Hannah Chisholm
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
| | - Anna Howe
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
| | - Emma Best
- Department of Paediatrics, Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
| | - Helen Petousis-Harris
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
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Povey M, Henry O, Riise Bergsaker MA, Chlibek R, Esposito S, Flodmark CE, Gothefors L, Man S, Silfverdal SA, Štefkovičová M, Usonis V, Wysocki J, Gillard P, Prymula R. Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine or one dose of monovalent varicella vaccine: 10-year follow-up of a phase 3 multicentre, observer-blind, randomised, controlled trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:287-297. [PMID: 30765242 DOI: 10.1016/s1473-3099(18)30716-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/14/2018] [Accepted: 11/09/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The duration of protection provided by varicella vaccines is unclear. We assessed the 10-year vaccine efficacy of two doses of a combined measles-mumps-rubella-varicella vaccine (MMRV), one live attenuated varicella vaccine (V) dose given after one measles-mumps-rubella vaccine (MMR) dose (MMR + V), versus two MMR doses (control vaccine) for the prevention of confirmed varicella. METHODS This was a phase 3b follow-up of an observer-blinded, randomised, controlled trial. In phase a, children aged 12-22 months (at first vaccination) from Czech Republic (Czechia), Greece, Italy, Lithuania, Norway, Poland, Romania, Russia, Slovakia, and Sweden were randomly assigned by computer-generated randomisation list (3:3:1) to receive two doses of MMRV, one dose of MMR and one dose of varicella vaccine, or two doses of MMR, 42 days apart. Varicella cases were confirmed by detection of viral DNA, or epidemiological link and clinical assessment, by an independent data monitoring committee; disease severity was based on a modified Vázquez scale. Hazard ratios for MMRV and MMR + V versus MMR estimated in the per-protocol cohort using a Cox proportional hazards regression model were used to calculate vaccine efficacy and 95% CI. Serious adverse events were recorded throughout the study in all vaccinated children. Study objectives were secondary and descriptive. The trial is registered at ClinicalTrials.gov, number NCT00226499. FINDINGS Between Sept 1, 2005, and May 10, 2006, 5803 children (mean age 14·2 months, SD 2·5) were vaccinated. The per-protocol cohort included 2279 children from the MMRV group, 2266 from the MMR + V group, and 744 from the MMR group. From baseline to a median follow-up of 9·8 years, 76 (3%) children in the MMRV group, 469 (21%) in the MMR + V group, and 352 (47%) in the MMR group had varicella. Vaccine efficacy against all varicella was 95·4% (95% CI 94·0-96·4) for MMRV and 67·2% (62·3-71·5) for MMR + V; vaccine efficacy against moderate or severe varicella was 99·1% (97·9-99·6) for MMRV and 89·5% (86·1-92·1) for MMR + V. During phase b, serious adverse events were reported by 290 (15%) of 1961 children in the MMRV group, 317 (16%) of 1978 in the MMR + V group, and 93 (15%) of 641 in the MMR group. There were no treatment-related deaths. INTERPRETATION The 10-years vaccine efficacy observed, suggests that a two-dose schedule of varicella vaccine provided optimum long-term protection for the prevention of varicella by offering individual protection against all severities of disease and leading to a potential reduction in transmission, as observed in the US experience with universal mass vaccination. FUNDING GlaxoSmithKline Biologicals.
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Affiliation(s)
| | | | - Marianne A Riise Bergsaker
- Division of Health Services, Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Roman Chlibek
- University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | | | - Leif Gothefors
- The Public Health Agency of Sweden and Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Sorin Man
- 3rd Pediatric Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Mária Štefkovičová
- Faculty of Health Care, Alexander Dubček University of Trenčín, Trenčín, Slovakia
| | - Vytautas Usonis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jacek Wysocki
- Department of Preventive Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Roman Prymula
- University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic; Charles University, Faculty of Medicine in Hradec Kralove, Department of Social Medicine, Hradec Kralove, Czech Republic
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Varicella breakthrough infection and effectiveness of 2-dose varicella vaccine in China. Vaccine 2018; 36:5665-5670. [DOI: 10.1016/j.vaccine.2018.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/18/2018] [Accepted: 05/04/2018] [Indexed: 11/20/2022]
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Zhang X, Yu Y, Zhang J, Kwan EP, Huang S, Wang Z, Zhang J, Peng X, Yan Y, Zhang L, Luo Y, Han S, Han X, Liu G, Liu F, Zhao J, He Y. One-dose vaccination associated with attenuated disease severity of adolescent and adult varicella cases in Beijing's Fengtai District. Hum Vaccin Immunother 2015; 10:2417-20. [PMID: 25424949 DOI: 10.4161/hv.29140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In recent years, the number of varicella cases in adults has significantly increased in Beijing. However, the effect of the vaccination on varicella-related characteristics among adults has not been studied. METHODS AND RESULTS Using data from the Infectious Disease Reporting System and the Immunization Information System, we compared the epidemiology and disease severity in breakthrough and unvaccinated varicella cases in adolescents and adults (≥ 15 year-old) from 2008 to 2011 in Beijing's Fengtai district, China. The results showed that the age (P = 0.003),contact history (90% vs. 73%, P = 0.019) and outbreak cases (10% vs. 1%, P < 0.0001) were significantly differently distributed between the two groups and that both the incidence of moderate-to-severe cases (26% vs. 45%, P = 0.035, OR = 0.446) and varicella-associated fever (49% vs. 66%, P = 0.068, OR = 0.534) were either significantly lower or trended to be lower in the breakthrough group than in the unvaccinated group. Additionally,vaccine effectiveness against moderate-to-severe cases of varicella was 55.4%. CONCLUSION Altogether, these results indicate that vaccination against varicella among adolescents and adults affected the epidemiology and attenuated the disease severity of the cases. The Results from this study will provide useful information for the prevention of varicella in adolescents and adults.
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Affiliation(s)
- Xue Zhang
- Department of Epidemiology and Biostatistics; School of Public Health; Capital Medical University; 2. Fengtai Center for Disease Control and Prevention; Beijing, China
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Zhang X, Yu Y, Zhang J, Huang S, Wang Z, Zhang J, Yan Y, Liu F, Zhao J, He Y. The epidemiology of varicella cases among children in Beijing's Fengtai District from 2008 to 2012. Vaccine 2014; 32:3569-72. [PMID: 24791731 DOI: 10.1016/j.vaccine.2014.04.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 03/24/2014] [Accepted: 04/22/2014] [Indexed: 11/26/2022]
Abstract
In recent years, the number of breakthrough cases of varicella (onset >42 days after vaccination) increased each year, and varicella outbreaks continue to occur in Beijing. Data from the Immunization Information System and the Infectious Disease Reporting System demonstrated that in Beijing's Fengtai District, the varicella breakthrough rate increased from 0.7% in 2008 to 2.5% in 2012 and showed an increased trend (P<0.001). Among the varicella cases in children (age of 3-15 years), the number of breakthrough cases increased from 167 in 2008 to 622 in 2012, which was 45.2% (n=1735) of the total child cases (n=3842). From 2008 to 2012, a total of 62 outbreaks occurred; among the 787 affected child outbreak cases, 61% were vaccinated. Altogether, the results from this study indicated that 1-dose vaccination cannot sufficiently prevent the occurrence of breakthrough cases of varicella or control varicella outbreaks in Beijing's Fengtai District.
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Affiliation(s)
- Xue Zhang
- Fengtai Center for Disease Control and Prevention, Beijing 100071, China
| | - Yuncui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Jie Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Shengtian Huang
- Fengtai Center for Disease Control and Prevention, Beijing 100071, China
| | - Zhongzhan Wang
- Fengtai Center for Disease Control and Prevention, Beijing 100071, China
| | - Jianjun Zhang
- Fengtai Center for Disease Control and Prevention, Beijing 100071, China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Fen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Jianzhong Zhao
- Fengtai Center for Disease Control and Prevention, Beijing 100071, China.
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing 100069, China; Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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Tafuri S, Guerra R, Cappelli MG, Martinelli D, Prato R, Germinario C. Determinants of varicella breakthrough: results of a 2012 case control study. Hum Vaccin Immunother 2014; 10:667-70. [PMID: 24398423 DOI: 10.4161/hv.27382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study aims to evaluate the determinants of breakthrough infection after one dose of varicella vaccine. We designed a retrospective case-control study. Breakthrough cases were children, aged 1-15, who presented varicella symptoms ≥ 42 days after the first dose of varicella vaccine (breakthrough). Controls were children, aged 1-15 years, who attended the same class (in a school or in a kindergarten) than the cases in the year of the breakthrough onset; they received a dose of varicella vaccine ≥ 42 days before the case rash onset and they did not develop varicella symptoms. We enrolled 45 cases and 135 controls. 40% of cases (n = 18; 95% CI = 25.4-54.6) presented at least one risk factor; this proportion was 39.2% (95% CI = 30.9-47.6) among the controls (chi-square = 0.0078; P = 0.93). Time between vaccination and virus exposure was longer among cases. Logistic regression showed that breakthrough disease was associated with duration of time from vaccination.
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Affiliation(s)
- Silvio Tafuri
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
| | - Rocco Guerra
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
| | - Maria Giovanna Cappelli
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
| | - Domenico Martinelli
- Department of Medical and Surgical Science; University of Foggia; Foggia, Italy
| | - Rosa Prato
- Department of Medical and Surgical Science; University of Foggia; Foggia, Italy
| | - Cinzia Germinario
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
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