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Li Y, Xu F, Liu M, Teng S, Liang F, Wang F. Effectiveness of two-dose vs. one-dose varicella vaccine in children in Shanghai, China: a prospective cohort study. Front Public Health 2024; 12:1320407. [PMID: 38894987 PMCID: PMC11183296 DOI: 10.3389/fpubh.2024.1320407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Objective Varicella, a highly contagious viral disease caused by the varicella-zoster virus (VZV), affects millions globally, with a higher prevalence among children. After the initial infection, VZV lies dormant in sensory ganglia and has the potential to reactivate much later, causing herpes zoster (HZ). Vaccination is one of the most effective methods to prevent varicella, and the two-dose varicella vaccine (VarV) regimen is widely used around the world. In China, the VarV has been included in the national immunization programme with a recommended single-dose regimen. This study aimed to compare the effectiveness of the two-dose vs. one-dose VarV regimen in children in Shanghai, China. Materials and methods A prospective cohort study was conducted in Shanghai, China, from September 2018 to December 2022. The study enrolled children aged 3-18 years who had received either the one-dose, two-dose, or 0-dose VarV regimen. Vaccination history, varicella infection status, and relevant variables, including demographic information (name, date of birth and sex) and medical history (clinical features of varicella and illness duration) were collected through medical record review and parental interviews. Results A total of 3,838 children were included in the study, with 407 in the 0-dose regimen group, 2,107 in the one-dose regimen group and 1,324 in the two-dose regimen group. The corresponding incidence density in these groups was 0.13, 0.05 and 0.03 cases per 1,000 person-days, respectively. The adjusted vaccine effectiveness (VE) was 81.7% (95%CI: 59.3-91.8%) for the two-dose regimen and 60.3% (95%CI: 29.3-77.7%) for the one-dose regimen, compared to the 0-dose regimen. The two-dose VarV regimen showed a protective effectiveness of 47.6% (95%CI: 2.5-71.9%) compared to the one-dose VarV regimen. Conclusion This study provides evidence supporting the greater effectiveness of the two-dose VarV regimen in preventing varicella infection compared to the one-dose regimen.
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Affiliation(s)
- Yue Li
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Fang Xu
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Meiling Liu
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Sashuang Teng
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Fan Liang
- Department of Immunization Program, Hongkou District Center for Disease Control and Prevention, Shanghai, China
| | - Fei Wang
- Hongkou District Center for Disease Control and Prevention, Shanghai, China
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Welby S, Feng Y, Tang H, Ye C, Cohet C. A feasibility assessment of real-world data capabilities for monitoring vaccine safety and effectiveness in China: Human papillomavirus vaccination in the Yinzhou district as a use case. Pharmacoepidemiol Drug Saf 2023; 32:1131-1141. [PMID: 37228132 DOI: 10.1002/pds.5644] [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: 10/24/2022] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Real-world data (RWD) are increasingly used to generate real-world evidence (RWE) of vaccine safety and effectiveness for regulatory purposes. Assessing feasibility of using RWD sources prior to implementing observational studies is recommended. As a use case, we described the process and findings of a feasibility assessment to identify reliable and relevant data sources for monitoring the safety and effectiveness of the AS04-HPV-16/18 human papillomavirus (HPV) vaccine in China. METHODS Iterative multi-step process: (1) targeted literature review and data source mapping; (2) expert opinion from national RWD experts; (3) survey to evaluate the identified data source operational infrastructure; and (4) continuous appraisal of published studies using the identified data source. RESULTS The Yinzhou Regional Health Information Platform (YRHIP) was identified as a data source of main interest, based on its large population coverage, high cervical cancer screening rates, and availability of adult electronic immunization records. Field meetings with national RWD experts confirmed its suitability for post-authorization vaccine studies. Survey results showed that exposure data and relevant safety and effectiveness endpoints were recorded and linkable at the individual level across the platform. Iterative appraisal of emerging evidence from the literature corroborated these findings. CONCLUSIONS This feasibility assessment indicates that the YRHIP has the capacity to capture demographic, exposure, outcome and other data required to generate RWE on HPV vaccine safety and effectiveness in China. Studies using the YRHIP to monitor the AS04-HPV-16/18 vaccine in routine use building on this feasibility assessment are ongoing.
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Qiu L, Liu S, Zhang M, Zhong G, Peng S, Quan J, Lin H, Hu X, Zhu K, Huang X, Peng J, Huang Y, Huang S, Wu T, Xu J, Dong Z, Liang Q, Wang W, Su Y, Zhang J, Xia N. The epidemiology of varicella and effectiveness of varicella vaccine in Ganyu, China: a long-term community surveillance study. BMC Public Health 2023; 23:1875. [PMID: 37770829 PMCID: PMC10537126 DOI: 10.1186/s12889-023-16304-4] [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: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The real-world data of long-term protection under moderate vaccination coverage is limited. This study aimed to evaluate varicella epidemiology and the long-term effectiveness under moderate coverage levels in Ganyu District, Lianyungang City, Jiangsu Province. METHODS This was a population-based, retrospective birth cohort study based on the immunization information system (IIS) and the National Notifiable Disease Surveillance System (NNDSS) in Ganyu District. Varicella cases reported from 2009 to 2020 were included to describe the epidemiology of varicella, and eleven-year consecutive birth cohorts (2008-2018) were included to estimate the vaccine effectiveness (VE) of varicella by Cox regression analysis. RESULTS A total of 155,232 native children and 3,251 varicella cases were included. The vaccination coverage was moderate with 37.1%, correspondingly, the annual incidence of varicella infection increased 4.4-fold from 2009 to 2020. A shift of the varicella cases to older age groups was observed, with the peak proportion of cases shifting from 5-6 year-old to 7-8 year-old. The adjusted effectiveness of one dose of vaccine waned over time, and the adjusted VE decreased from 72.9% to 41.8% in the one-dose group. CONCLUSIONS The insufficient vaccination coverage (37.1%) may have contributed in part to the rising annual incidence of varicella infection, and a shift of varicella cases to older age groups occurred. The effectiveness of one dose of varicella vaccine was moderate and waned over time. It is urgent to increase varicella vaccine coverage to 80% to reduce the incidence of varicella and prevent any potential shift in the age at infection in China.
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Affiliation(s)
- Lingxian Qiu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Sheng Liu
- Ganyu County Center for Disease Control and Prevention, Ganyu County, Lianyungang, Jiangsu, China
| | - Minglei Zhang
- Ganyu County Center for Disease Control and Prevention, Ganyu County, Lianyungang, Jiangsu, China
| | - Guohua Zhong
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Siying Peng
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Jiali Quan
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Hongyan Lin
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Xiaowen Hu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Kongxin Zhu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Xingcheng Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Junchao Peng
- Information Technology and Laboratory Management Center, Wuyi University, Wuyishan, Fujian, China
| | - Yue Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Shoujie Huang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Ting Wu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Jinbo Xu
- Ganyu County Center for Disease Control and Prevention, Ganyu County, Lianyungang, Jiangsu, China
| | - Zifang Dong
- Ganyu County Center for Disease Control and Prevention, Ganyu County, Lianyungang, Jiangsu, China
| | - Qi Liang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu , China.
| | - Wei Wang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China.
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China.
| | - Yingying Su
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China.
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China.
| | - Jun Zhang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
| | - Ningshao Xia
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Collaborative Innovation Center of Biologic Products, National Innovation Platform for Industry-Education Integration in Vaccine Research, NMPA Key Laboratory for Research and Evaluation of Infectious Disease Diagnostic Technology, the Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, Fujian, China
- The Research Aff of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen, China
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Xiu S, Wang X, Wang Q, Jin H, Shen Y. Impact of implementing a free varicella vaccination policy on incidence in Wuxi City, China: an interrupted time series analysis. Epidemiol Infect 2023; 151:e125. [PMID: 37469289 PMCID: PMC10540171 DOI: 10.1017/s0950268823001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/08/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
Varicella vaccination is optional and requires self-payment. On 1 December 2018, Wuxi City launched a free varicella vaccination program for children. This study aimed to evaluate the changes in varicella incidence before and after the implementation of the policy. The data were obtained from official information systems and statistical yearbooks. We divided the period into chargeable (January 2017 to November 2018) and free (December 2018 to December 2021) periods. Interrupt time series analysis was used to conduct a generalised least-squares regression analysis for the two periods. A total of 51,071 varicella cases were reported between January 2017 and December 2021. After the implementation of the policy, there was a statistically significant decrease in the incidence of varicella (β2 = -0.140, P = 0.017), and the slope of the incidence also decreased by 0.012 (P = 0.015). Following policy implementation, the incidence decreased in all age groups, with the largest decline observed among children aged 8-14 years (β2 = -1.109, P = 0.009), followed by children aged ≤7 years (β2 = -0.894, P = 0.013). Our study found a significant reduction in the incidence of varicella in the total population after the introduction of free varicella vaccination in Wuxi City.
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Affiliation(s)
- Shixin Xiu
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Xuwen Wang
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Yuan Shen
- Department of Immunization, Wuxi Center for Disease Control and Prevention, Wuxi, China
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Wang Z, He J, Jin B, Zhang L, Han C, Wang M, Wang H, An S, Zhao M, Zhen Q, Tiejun S, Zhang X. Using Baidu Index Data to Improve Chickenpox Surveillance in Yunnan, China: Infodemiology Study. J Med Internet Res 2023; 25:e44186. [PMID: 37191983 DOI: 10.2196/44186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/21/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Chickenpox is an old but easily neglected infectious disease. Although chickenpox is preventable by vaccines, vaccine breakthroughs often occur, and the chickenpox epidemic is on the rise. Chickenpox is not included in the list of regulated communicable diseases that must be reported and controlled by public and health departments; therefore, it is crucial to rapidly identify and report varicella outbreaks during the early stages. The Baidu index (BDI) can supplement the traditional surveillance system for infectious diseases, such as brucellosis and dengue, in China. The number of reported chickenpox cases and internet search data also showed a similar trend. BDI can be a useful tool to display the outbreak of infectious diseases. OBJECTIVE This study aimed to develop an efficient disease surveillance method that uses BDI to assist in traditional surveillance. METHODS Chickenpox incidence data (weekly from January 2017 to June 2021) reported by the Yunnan Province Center for Disease Control and Prevention were obtained to evaluate the relationship between the incidence of chickenpox and BDI. We applied a support vector machine regression (SVR) model and a multiple regression prediction model with BDI to predict the incidence of chickenpox. In addition, we used the SVR model to predict the number of chickenpox cases from June 2021 to the first week of April 2022. RESULTS The analysis showed that there was a close correlation between the weekly number of newly diagnosed cases and the BDI. In the search terms we collected, the highest Spearman correlation coefficient was 0.747. Most BDI search terms, such as "chickenpox," "chickenpox treatment," "treatment of chickenpox," "chickenpox symptoms," and "chickenpox virus," trend consistently. Some BDI search terms, such as "chickenpox pictures," "symptoms of chickenpox," "chickenpox vaccine," and "is chickenpox vaccine necessary," appeared earlier than the trend of "chickenpox virus." The 2 models were compared, the SVR model performed better in all the applied measurements: fitting effect, R2=0.9108, root mean square error (RMSE)=96.2995, and mean absolute error (MAE)=73.3988; and prediction effect, R2=0.548, RMSE=189.1807, and MAE=147.5412. In addition, we applied the SVR model to predict the number of reported cases weekly in Yunnan from June 2021 to April 2022 using the same period of the BDI. The results showed that the fluctuation of the time series from July 2021 to April 2022 was similar to that of the last year and a half with no change in the level of prevention and control. CONCLUSIONS These findings indicated that the BDI in Yunnan Province can predict the incidence of chickenpox in the same period. Thus, the BDI is a useful tool for monitoring the chickenpox epidemic and for complementing traditional monitoring systems.
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Affiliation(s)
- Zhaohan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Jun He
- Yunnan Center for Disease Control and Prevention, Yunnan, China
| | - Bolin Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Lizhi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Chenyu Han
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Meiqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Hao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Shuqi An
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Meifang Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Qing Zhen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Shui Tiejun
- Yunnan Center for Disease Control and Prevention, Yunnan, China
| | - Xinyao Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
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Lee YH, Choe YJ, Hong K, Yoon Y, Kim YK. The Protective Effectiveness of 2-Dose Varicella Vaccination in Children in Korea: A Case-Control Study. Pediatr Infect Dis J 2023:00006454-990000000-00438. [PMID: 37171976 DOI: 10.1097/inf.0000000000003958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND A 2-dose vaccination against varicella has been adopted in many places; however, it has not been widely introduced in Korea. This study aimed to assess 1-dose and 2-+dose vaccine effectiveness (VE) against laboratory-confirmed varicella in Korea to provide a scientific basis for developing an immunization strategy. METHODS We constructed a national cohort using national surveillance data and the national immunization registry. From the cohort, we conducted a 1:2 matched nested case-control study to estimate and compare the VE of the 1-dose and 2-dose of varicella vaccination using exact conditional logistic regression. VE was calculated as [1 - matched odds ratio (OR) × 100%]. RESULTS From January 1, 2011 to December 31, 2020, a total of 205,173 varicella cases were reported to the notifiable diseases surveillance system. Of these, we included 4,387 laboratory-confirmed varicella cases and 8,774 controls for the analyses. The VE of 1-dose vaccination was 16.8% (95% CI: -9.0% to 36.5%), whereas the VE of 2-doses of the vaccination was 98.6% (95% CI: 96.0%-99.5%). CONCLUSION These findings suggest that the 2-dose vaccination strategy can be an effective strategy to prevent varicella.
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Affiliation(s)
- Young Hwa Lee
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine
| | - Yoonsun Yoon
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea; and
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University Ansan Hospital and Korea University College of Medicine, Seoul, Korea
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Sun X, Dai C, Wang K, Liu Y, Jin X, Wang C, Yin Y, Ding Z, Lu Z, Wang W, Wang Z, Tang F, Wang K, Peng Z. A Dynamic Compartmental Model to Explore the Optimal Strategy of Varicella Vaccination: An Epidemiological Study in Jiangsu Province, China. Trop Med Infect Dis 2022; 8:tropicalmed8010017. [PMID: 36668924 PMCID: PMC9861499 DOI: 10.3390/tropicalmed8010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/11/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Varicella (chickenpox) is highly contagious among children and frequently breaks out in schools. In this study, we developed a dynamic compartment model to explore the optimal schedule for varicella vaccination in Jiangsu Province, China. A susceptible-infected-recovered (SIR) model was proposed to simulate the transmission of varicella in different age groups. The basic reproduction number was computed by the kinetic model, and the impact of three prevention factors was assessed through the global sensitivity analysis. Finally, the effect of various vaccination scenarios was qualitatively evaluated by numerical simulation. The estimated basic reproduction number was 1.831 ± 0.078, and the greatest contributor was the 5-10 year-old group (0.747 ± 0.042, 40.80%). Sensitivity analysis indicated that there was a strong negative correlation between the second dose vaccination coverage rate and basic reproduction number. In addition, we qualitatively found that the incidence would significantly decrease as the second dose vaccine coverage expands. The results suggest that two-dose varicella vaccination should be mandatory, and the optimal age of second dose vaccination is the 5-10 year-old group. Optimal vaccination time, wide vaccine coverage along with other measures, could enhance the effectiveness of prevention and control of varicella in China.
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Affiliation(s)
- Xiang Sun
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Chenxi Dai
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, China
| | - Kai Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yuanbao Liu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Xinye Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Congyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yi Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhongxing Ding
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhenzhen Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Weiming Wang
- Department of Mathematics and Statistics, Huaiyin Normal University, Huaian 223300, China
| | - Zhiguo Wang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Fenyang Tang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
- Correspondence: (F.T.); (K.W.); (Z.P.); Tel.: +86-25-83759423 (F.T.); +86-23-68771726 (K.W.); +86-25-86868244 (Z.P.)
| | - Kaifa Wang
- Department of Mathematics and Statistics, Southwest University, Chongqing 400715, China
- Correspondence: (F.T.); (K.W.); (Z.P.); Tel.: +86-25-83759423 (F.T.); +86-23-68771726 (K.W.); +86-25-86868244 (Z.P.)
| | - Zhihang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Correspondence: (F.T.); (K.W.); (Z.P.); Tel.: +86-25-83759423 (F.T.); +86-23-68771726 (K.W.); +86-25-86868244 (Z.P.)
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8
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Seroprevalence of Varicella-Zoster Virus and Measles among Healthcare Workers in a Tertiary Medical Center in Korea. Vaccines (Basel) 2022; 10:vaccines10111956. [PMID: 36423051 PMCID: PMC9697537 DOI: 10.3390/vaccines10111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Measles and varicella still occur in the general population despite the widespread vaccination against them, and healthcare workers (HCWs) are still at risk of exposure to these diseases. Here, we evaluated the seroprevalence of measles and varicella-zoster virus (VZV) in HCWs and the trend of seroprevalence according to age, birth year, and occupational group. The serostatuses of measles and VZV of HCWs during new employee medical examinations between October 2015 and October 2021 were included. Thereafter, the trends of seroprevalence according to age, birth year, and occupational groups were evaluated. Overall, 2070 and 1827 HCWs were evaluated for VZV and measles serostatus, respectively. The seroprevalences of VZV and measles were 91% (1884/2070) and 70% (1284/1827), respectively. Younger HCWs had a significantly lower seroprevalence of measles (p = 0.02, age) and VZV (p = 0.003, birth year and p < 0.001, age). The seroprevalence of measles and VZV was significantly higher among doctors and nursing assistants than among nurses and other HCWs (p < 0.001 in both). In conclusion, the seroprevalence of measles and VZV significantly decreased in younger HCWs. Additionally, monitoring the serostatus of measles and VZV and the immunization of susceptible HCWs are required to prepare and control infectious diseases in healthcare facilities.
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9
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Shu M, Zhang D, Ma R, Yang T, Pan X. Long-term vaccine efficacy of a 2-dose varicella vaccine in China from 2011 to 2021: A retrospective observational study. Front Public Health 2022; 10:1039537. [PMID: 36424959 PMCID: PMC9679788 DOI: 10.3389/fpubh.2022.1039537] [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: 09/08/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
Objective A 2-dose varicella vaccine immunization strategy has been implemented in many cities in China, but there is few evidence on a long-term evaluation of the efficacy of the 2-dose varicella vaccine from China. This study aims to assess the long-term vaccine efficacy of the two doses varicella vaccine and analysis of its influencing factors. Methods A retrospective study was carried out in 837,144 children born between 2011 and 2017 in Ningbo, Easten China. The logistic regression was performed to estimate varicella vaccine effectiveness (VE). Results The overall VE of 2 doses of varicella vaccine compared without the vaccine was 90.31% (89.24-91.26%), and the overall incremental VE of 2 doses of varicella vaccine compared to the 1-dose was 64.71% (59.92-68.93%). Moreover, the varicella vaccination age of the second dose and the interval between 2 doses were both associated with VE. The VE compared to that without the vaccine in children vaccinated at <4 years old was 91.22% (95%CI: 90.16-92.17%) which was higher than in children vaccinated at ≥4 years old (VE: 86.79%; 95%CI: 84.52-88.73). And the effectiveness of the vaccine was 93.60% (95%CI: 92.19-94.75%) in children with the interval of the 2 doses ≤ 24 months significantly higher than in children with the interval of ≥36 months (VE: 85.62%, 95%CI: 82.89-87.91%). Conclusions This study provides evidence for long-term VE of the 2-dose varicella vaccine and the better age for 2-dose vaccination and the interval between 2 doses of the vaccine in China.
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Affiliation(s)
- Mingming Shu
- Ningbo Women and Children's Hospital, Ningbo, China
| | - Dandan Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Rui Ma
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Tianchi Yang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Xingqiang Pan
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China,*Correspondence: Xingqiang Pan
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10
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Hu P, Yang F, Li X, Wang Y, Xiao T, Li H, Wang W, Guan J, Li S. Effectiveness of one-dose versus two-dose varicella vaccine in children in Qingdao, China: a matched case-control study. Hum Vaccin Immunother 2021; 17:5311-5315. [PMID: 34623220 DOI: 10.1080/21645515.2021.1982281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
To evaluate whether two-dose of varicella vaccine would provide a better protection to children from varicella than one-dose, we conducted a 1:3 matched case-control study in children in Qingdao, China. A total of 509 varicella cases aged 6-11 y were collected from the China Information System for Disease Control and Prevention (CISDCP). And 1,527 controls, who did not suffer from varicella, were selected and matched with cases by age and class. The varicella vaccine effectiveness (VE) and corresponding 95% confidence interval (95% CI) were calculated. The vaccination coverage rate of one-dose varicella vaccine in the cases was 52.9%, while for the controls was 59.1%. And the two-dose vaccination rate in the cases and controls were 4.3% and 14.5%, respectively. A statistically significant difference was found in the immunization history between the cases and controls (P < .001).The overall varicella VE was 56.1% (95% CI: 45.0%-64.9%), and the VE of two-dose vaccination (81.6%, 95% CI: 70.5%-88.4%) was substantially higher than that of one-dose vaccination (44.7%, 95% CI: 31.6%-55.4%). For less than 2 y, 2-4 y, 4-6 y, and more than 6 y after only one-dose vaccination, the varicella VE were 96.6% (95% CI: 75.0%-99.5%), 81.2% (95% CI: 55.6%-92.0%), 60.8% (95% CI: 46.8%-70.2%), and 18.0% (95% CI: 4.3%-35.6%), respectively. The varicella VE gradually decreased over time (P for trend < 0.001). It is recommended that the coverage of varicella vaccine should be increased and two-dose of varicella vaccine should be included in the National Immunization Program of China.
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Affiliation(s)
- Ping Hu
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Feng Yang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Xiaofan Li
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Yang Wang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Tingting Xiao
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Han Li
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Wencheng Wang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Jing Guan
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
| | - Shanpeng Li
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Preventive Medicine, Qingdao, China
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11
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Hong K, Sohn S, Choe YJ, Rhie K, Lee JK, Han MS, Chun BC, Choi EH. Waning Effectiveness of One-dose Universal Varicella Vaccination in Korea, 2011-2018: a Propensity Score Matched National Population Cohort. J Korean Med Sci 2021; 36:e222. [PMID: 34519184 PMCID: PMC8438188 DOI: 10.3346/jkms.2021.36.e222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite high coverage (~98%) of universal varicella vaccination (UVV) in the Republic of Korea since 2005, reduction in the incidence rate of varicella is not obvious. The study aimed to evaluate the vaccine effectiveness (VE) of one-dose UVV by timeline and severity of the disease. METHODS All children born in Korea in 2011 were included for this retrospective cohort study that analyzed insurance claims data from 2011-2018 and the varicella vaccination records in the immunization registry. Adjusted hazard ratios by Cox proportional hazard models were used to estimate the VE through propensity score matching by the month of birth, sex, healthcare utilization rate, and region. RESULTS Of the total 421,070 newborns in the 2011 birth cohort, 13,360 were matched for age, sex, healthcare utilization rate, and region by the propensity score matching method. A total of 55,940 (13.29%) children were diagnosed with varicella, with the incidence rate 24.2 per 1000 person-year; 13.4% of vaccinated children and 10.4% of unvaccinated children. The VE of one-dose UVV against any varicella was 86.1% (95% confidence interval [CI], 81.4-89.5) during the first year after vaccination and 49.9% (95% CI, 43.3-55.7) during the 6-year follow-up period since vaccination, resulting in a 7.2% annual decrease of VE. The overall VE for severe varicella was 66.3%. The VE of two-dose compared to one-dose was 73.4% (95% CI, 72.2-74.6). CONCLUSION We found lower long-term VE in one-dose vaccination and waning of effectiveness over time. Longer follow ups of the vaccinated children as well as appropriately designed studies are needed to establish the optimal strategy in preventing varicella in Korea.
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Affiliation(s)
- Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sangho Sohn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Kyuyol Rhie
- Department of Pediatrics, Incheon Sejong Hospital, Incheon, Korea
| | - Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
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12
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Li Z, Yao Y, Lu X, Liu J, Huang Z, Sun X, Lu Y. Impact of a two-dose varicella immunization program on the incidence of varicella: a multi-year observational study in Shanghai, China. Expert Rev Vaccines 2021; 20:1177-1183. [PMID: 34343035 DOI: 10.1080/14760584.2021.1963236] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND It remains hesitant to include a two-dose varicella vaccine (VarV) in a national routine immunization program in China. We aimed to quantify the impact of the two-dose VarV on varicella incidence in Shanghai. RESEARCH DESIGN AND METHODS We directly extracted the data of varicella cases and VarV doses in 2013-2020 in Shanghai, and then estimated the effects of two-dose VarV using a Serfling model. RESULTS A two-dose VarV immunization program has been extensively implemented since October 2017 and become free since August 2018 in Shanghai. Before and after this program, varicella cases significantly declined in children (P < 0.01), whereas did not in adults aged >18 years (P = 0.22). Compared to the predicted number of varicella cases, actual number was significantly lower by 8% in 2018 and 28% in 2019. Among children aged 4-6 years, the reduction in varicella cases was largest. Moreover, there was a significant reduction in varicella cases throughout 2020 (P < 0.001), in which the decrease due to social distancing for the COVID-19 was 54%. CONCLUSIONS A two-dose VarV immunization program may further reduce approximately one-third of varicella cases in Shanghai. Children <4 years and adults benefit less in this program, which warrants enhancing the immunization.
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Affiliation(s)
- Zhi Li
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Ye Yao
- Department Of Biostatistics, Ministry Of Education Key Laboratory Of Public Health Safety, School Of Public Health, Fudan University, Shanghai, China
| | - Xinyue Lu
- Department Of Epidemiology, Ministry Of Education Key Laboratory Of Public Health Safety, School Of Public Health, Fudan University, Shanghai China
| | - Jiechen Liu
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Zhuoying Huang
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Xiaodong Sun
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Yihan Lu
- Department Of Epidemiology, Ministry Of Education Key Laboratory Of Public Health Safety, School Of Public Health, Fudan University, Shanghai China
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13
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Wang Q, Xiu S, Yang L, Huang J, Cui T, Shi N, Wang X, Shen Y, Chen E, Lu B, Jin H, Lin L. Economic evaluation of varicella vaccination strategies in Jiangsu province, China: a decision-tree Markov model. Hum Vaccin Immunother 2021; 17:4194-4202. [PMID: 34357833 DOI: 10.1080/21645515.2021.1958608] [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: 10/20/2022] Open
Abstract
This study evaluated different varicella vaccination strategies in Jiangsu province, China. A decision-tree Markov model was used to evaluate the cost effectiveness of various varicella vaccination strategies for children, including direct and selective vaccination (serotesting pre-vaccination). A cohort of one-year-old children was followed through 60 one-year Markov cycles. The parameter estimation was based on field work, the literature, and statistical yearbooks. We calculated the incremental cost-utility ratio (ICUR) using the saved quality-adjusted life year (QALY). One-way and probability sensitivity analyses were performed to assess uncertainty. Among 100,000 cohort members, one-dose and two-dose direct vaccination averted 8061 and 10,701 varicella cases, respectively, compared with no vaccination. Furthermore, compared with no vaccination, one-dose and two-dose direct vaccination saved one QALY at the ICUR of USD 21,401.33 and USD 35,420.81, respectively, at less than three times the per capita gross domestic product (USD 47,626.86) of Jiangsu. The ICURs of the one-dose and two-dose selective strategies versus no vaccination were USD 42,623.62 and USD 51,406.35 per QALY gained, respectively. The cost effectiveness results were most sensitive to the QALY loss of outpatients and vaccine prices. Thus, in Jiangsu, one-dose and two-dose direct varicella vaccination in children could be cost effective at the willingness to pay threshold of three times provincial GDP per capita from a societal perspective. The findings were sensitive to the vaccine price and health utility of varicella cases.
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Affiliation(s)
- Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Shixin Xiu
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Jinxin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Xuwen Wang
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Yuan Shen
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Enpin Chen
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Bing Lu
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, PR China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, PR China
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
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14
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Zhang Z, Suo L, Pan J, Zhao D, Lu L. Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment. BMC Infect Dis 2021; 21:543. [PMID: 34107891 PMCID: PMC8188742 DOI: 10.1186/s12879-021-06217-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. METHODS We searched for observational studies on two-dose varicella VE for children in China aged 1-12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. RESULTS A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69-97%). The VE of outbreak studies (87% [95% CI: 76-93%]) was lower than non-outbreak studies (99% [95% CI: 98-99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was "low", which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was "moderate". CONCLUSIONS The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.
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Affiliation(s)
- Zhujiazi Zhang
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Luodan Suo
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Jingbin Pan
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Dan Zhao
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Li Lu
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China.
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15
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Xu Y, Liu Y, Zhang X, Zhang X, Du J, Cai Y, Wang J, Che X, Gu W, Jiang W, Chen J. Epidemiology of varicella and effectiveness of varicella vaccine in Hangzhou, China, 2019. Hum Vaccin Immunother 2021; 17:211-216. [PMID: 32574100 PMCID: PMC7872021 DOI: 10.1080/21645515.2020.1769395] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/10/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The varicella vaccine (VarV) is not included in the national childhood immunization schedules in China, although 2-dose VarV (VarV2) were recommended for children at 1 and 4 years of age in Hangzhou since 2014. However, the reported incremental vaccine effectiveness (VE) of VarV2 varies widely among studies. We described the epidemiological characteristics of varicella in Hangzhou, assessed the VE of VarV, so as to provide scientific evidence on optimization and adjustment of immunization strategies for varicella prevention in China. Methods: All varicella cases diagnosed in a hospital in Hangzhou are reported to China Information System for Disease Control and Prevention (CISDCP). The demographic information of reported varicella cases onset from January 1 to December 31, 2019 was extracted from CISDCP on Jan 31, 2020. The demographic information was obtained from the information system of the National Center for Disease Prevention and Control. We conducted a 1:1 matched case-control study to assess the effectiveness of VarV. Participant data were collected with standardized questionnaires. VarV vaccination status was checked by using Hangzhou Immunization Information System (HZIIS). Results: A total of 11,813 varicella cases were reported in Hangzhou, China, 2019, without any death. Annual estimated incidence of varicella was 120 cases per 100,000 populations in 2019. The overall estimated incidence rate of varicella was high, especially for persons aged 10-19 years old and in suburb areas. The seasonal pattern was apparent, mostly due to the cases among students and children in kindergarten. In total, 218 varicella cases and 218 matched controls were included for evaluating the VE of VarV. VarV vaccination produced a high level of protection against varicella, while VE of VarV2 was even better. VE of VarV1 was 91.0% (95%CI: 81.6%-95.8%), and VE was 98.0% (95.5%-99.2%) for VarV2. Conclusion: Continuous monitoring and management of varicella cases is necessary, especially in those endemic areas, high-risk populations, and peak periods; a 2-dose VarV strategy is highly recommended, and relevant health institutions should consider the inclusion of VarV in the national immunization program to better control varicella epidemic and reduce the burden of varicella.
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Affiliation(s)
- Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xuechao Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Du
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yuxin Cai
- Department of Preventive Medicine, Zhejiang Chinese Medical University School of Public Health, Hangzhou, China
| | - Jun Wang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xinren Che
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wenwen Gu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Jiang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Junfang Chen
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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16
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Mitra M, Chowdhury J, Basu S, Halder PP, Mukherjee M, Karadkhele A, Puppalwar G, Jain R. Evaluation of immunogenicity, safety and breakthrough following administration of live attenuated varicella vaccine in two doses three months apart regimen in Indian children. Ther Adv Vaccines Immunother 2020; 8:2515135520937216. [PMID: 32851202 PMCID: PMC7425319 DOI: 10.1177/2515135520937216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 05/28/2020] [Indexed: 11/15/2022] Open
Abstract
Background: In India, where varicella outbreaks are reported at a younger age, a two-dose vaccine schedule administered at an early age could be highly efficacious in preventing varicella infection. The aim of this study was to evaluate the immunogenicity and safety of live attenuated varicella vaccine (VR 795 Oka strain) in a two-dose, 3 months apart regimen. Methodology: Healthy children (⩾ 12 months and ⩽12 years; mean age: 4.4 years) of either sex were included. Geometric mean titers (GMT) were measured at baseline and 28 days post first- and second-dose, and seroprotection rates were measured 28 days post first and second dose. The incidence of breakthrough (BT) infections post vaccination was determined from 42 days post first and second dose of vaccine up to 12 months. Adverse events (AEs) were monitored and recorded throughout the study period. Results: Of 305 subjects enrolled, 217 were seronegative. The seroconversion rate (a change from a seronegative to a seropositive condition) was 93.3% post first-dose and 100% post two-doses. High levels (9 times) of GMT were reported since post first-dose to post second-dose in children aged 12–18 months, 18–60 months (99.43%); and in and above 60 months (99.02%). The extent of rise of anti-VZV IgG antibody titer post 28 days of first-dose at two-fold, three-fold and four-fold rise was 93.39%, 90.56% and 80.66%, respectively and 100% 4-fold rise post second-dose. A single case, a day after the first-dose of vaccination of mild BT infection, was observed after close contact with a severe case. AEs were mild and none of the serious AEs were related to the study drug. Conclusion: The two-dose schedule of varicella vaccine was safe and immunogenic when given 3 months apart. However, further comparative studies and follow up for both dosing schedules are needed to validate the advantage of early dosing.
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Affiliation(s)
| | | | | | | | | | - Archana Karadkhele
- Medical Affairs Division, Wockhardt Ltd., 1st Floor, West Wing, Wockhardt Global Headquarters, Bandra Kurla Complex, Bandra (East), Mumbai-51, India
| | | | - Rishi Jain
- Medical Affairs Division, Wockhardt Ltd., Mumbai, India
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17
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Zeng WB, Zhang F, Cheng S, Sun JY, Shen H, Luo MH. Concerns on Vaccine against Varicella Caused by Varicella-Zoster Virus Infection. Virol Sin 2020; 36:159-162. [PMID: 32468419 DOI: 10.1007/s12250-020-00231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Wen-Bo Zeng
- State Key Laboratory of Virology, CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Fukun Zhang
- Changchun Keygen Biological Products Co. Ltd, Changchun, 130000, China
| | - Shuang Cheng
- State Key Laboratory of Virology, CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Jin-Yan Sun
- State Key Laboratory of Virology, CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Hongjie Shen
- Changchun Keygen Biological Products Co. Ltd, Changchun, 130000, China.
| | - Min-Hua Luo
- State Key Laboratory of Virology, CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Center for Biosafety Mega-Science, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
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Suo L, Lu L, Zhao D, Pang X. Impact of a 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, 2011–2017. Vaccine 2020; 38:3690-3696. [DOI: 10.1016/j.vaccine.2020.01.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/16/2019] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
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The impact of long-term moderate level of vaccination coverage for epidemiology of varicella in Lu'an, China: should we change immunisation strategy now? Epidemiol Infect 2020; 148:e74. [PMID: 32167037 PMCID: PMC7118725 DOI: 10.1017/s0950268820000667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
As China implements the voluntary vaccination programme of one-dose of varicella vaccine (VarV) for decades, robust estimates of the impact of voluntary vaccination era on epidemiology of varicella are needed. We estimated the vaccination coverage (VC) of VarV by using surveillance data on immunisation. The descriptive epidemiological method was used to describe the changing epidemiology of varicella from 2007 to 2018. The screening method was used to estimate the vaccine effectiveness (VE) of VarV. The overall VC for VarV was 71.7%, ranged from 47.7% to 79.5% among 2008–2017 birth cohorts. In total, 16 660 varicella cases were reported during 2007–2018, the incidence increased from 10.0 cases per 100 000 population in 2007 to 65.2 cases per 100 000 population in 2018. A shift in age group of varicella was observed since 2012, with the age increased from 5–9 years to 10–14 years. The overall VE was 79.9%, and the VE increased from 60.1% in 2008 birth cohort to 96.2% in 2017 birth cohort. We found that the overall VE for VarV is moderate, but appears highly effective within 5 years after vaccination. In addition, a shift varicella infection to older ages has occurred at the long-term moderate level VC of one-dose VarV. Therefore, to contain the incidence of varicella and prevent any potential shift to older ages, the introduction of VarV into routine immunisation programme is likely needed in Lu'an.
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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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