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Lee YH, Choe YJ. A cost benefit analysis of varicella vaccination in South Korea. Vaccine X 2024; 19:100521. [PMID: 39070929 PMCID: PMC11277761 DOI: 10.1016/j.jvacx.2024.100521] [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: 02/23/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024] Open
Abstract
Background The introduction of varicella vaccination has significantly reduced the burden of chickenpox in many countries, but outbreaks still occur in populations with high vaccination coverage. To address this, some countries, including the United States, Germany, and Japan, have adopted a two-dose varicella vaccination recommendation. Economic evaluations are crucial for assessing vaccine recommendations; however, there are limited studies exist in Asian countries. Thus, our study aimed to evaluate the cost-benefit of one-dose and two-dose varicella vaccination programs compared to no vaccination in South Korea, incorporating updated data on disease burden and costs. Methods We utilized data from South Korea's health databases to estimate varicella burden and vaccination records. Decision tree analysis was employed to compare costs and benefits of vaccination strategies over a ten-year period for the 2012 birth cohort. Sensitivity analyses were conducted to assess the impact of various variables. Results Both one-dose and two-dose vaccination programs showed cost-benefit compared to no vaccination, with substantial societal cost savings. The one-dose program yielded a benefit-cost ratio (BCR) of1.43, while the two-dose program had a direct BCR of1.28. Sensitivity analyses confirmed the robustness of these findings. Conclusion Our study demonstrates the economic benefits of varicella vaccination in South Korea, aligning with findings from other countries. While the second dose did not show additional cost savings compared to the one-dose program, other factors like disease severity and transmission dynamics should be considered. Implementing either a one-dose or two-dose varicella vaccination regimen in South Korea could lead to cost reductions and improved cost-effectiveness compared to no vaccination, emphasizing the importance of vaccination programs in reducing disease burden and enhancing public health outcomes.
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Affiliation(s)
- Young Hwa Lee
- Allergy Immunology Center, Korea University, Seoul, the Republic of Korea
| | - Young June Choe
- Allergy Immunology Center, Korea University, Seoul, the Republic of Korea
- Department of Pediatrics, Korea University College of Medicine and Korea University Anam Hospital, Seoul, the Republic of Korea
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Ishimaru S, Michihata N, Kawamura Y, Uda K, Matsui H, Fushimi K, Yasunaga H, Yoshikawa T. Trend in the Numbers of Hospitalized Patients With Varicella, Herpes Zoster, and Ischemic Stroke in Japanese Individuals <20 Years of Age Before and After Implementation of Universal Varicella Vaccination. Pediatr Infect Dis J 2023:00006454-990000000-00395. [PMID: 36996309 DOI: 10.1097/inf.0000000000003907] [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: 04/01/2023]
Abstract
Several studies have shown an association between varicella-zoster virus infection and ischemic stroke. We analyzed the trends in the numbers of patients with varicella, herpes zoster and ischemic stroke before and after the universal vaccination program using a Japanese database of hospitalized patients. The number of patients with varicella decreased but those of herpes zoster and ischemic stroke did not change.
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Affiliation(s)
- Soichiro Ishimaru
- From the Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiki Kawamura
- From the Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Tetsushi Yoshikawa
- From the Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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Tabet A, Mahé E, Boralevi F, Maruani A, Hesse S, Gentile S, Mallet S. Herpes zoster in children during the COVID-19 pandemic in France: A retrospective multicenter observational study. Ann Dermatol Venereol 2023; 150:46-48. [PMID: 36813638 PMCID: PMC9940797 DOI: 10.1016/j.annder.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/21/2022] [Accepted: 08/30/2022] [Indexed: 02/22/2023]
Affiliation(s)
- A Tabet
- APHM, Aix-Marseille Université, 27, boulevard Jean-Moulin, 13385 Marseille, France.
| | - E Mahé
- Service de Dermatologie, CH Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95107 Argenteuil, France
| | - F Boralevi
- Université de Bordeaux, Unité de Dermatologie Pédiatrique, CHU Pellegrin Enfants, place Amélie Raba Léon, 33000 Bordeaux, France
| | - A Maruani
- Universités de Tours et Nantes, SPHERE-INSERM 1246, Service de Dermatologie et Unité de Dermatologie Pédiatrique, CHRU de Tours, 37044 Tours Cedex 9, France
| | - S Hesse
- Aix-Marseille Université, Service de Dermatologie, CHU Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - S Gentile
- Aix-Marseille Université, School of Medicine, La Timone, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Service d'Evaluation Médicale, CHU Conception, 147 boulevard Baille, 13005 Marseille, France
| | - S Mallet
- Aix-Marseille Université, Service de Dermatologie, CHU Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
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Ozaki T, Nishimura N, Gotoh K, Takemoto K. Anti-varicella-zoster virus antibody titers and seroprotection status from before the first dose of varicella vaccination to before entering elementary school in one region in Japan. Vaccine 2023; 41:1274-1279. [PMID: 36631357 DOI: 10.1016/j.vaccine.2023.01.010] [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: 08/23/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to examine changes in anti-varicella-zoster virus (VZV) antibody titers and seroprotection status from before the first dose of vaccination to before 7 years old entering elementary school in children who received the routine two-dose varicella vaccination. METHODS Participants were 37 healthy children who received the routine two-dose varicella vaccination at our hospital. A total of five serum samples per child were collected immediately before and 4-6 weeks after each dose of the vaccination and in the year before entry to elementary school. We measured anti-VZV antibody titers by immune adherence hemagglutination (IAHA) method and glycoprotein-based enzyme-linked immunosorbent assay (gpELISA). A positive antibody titer and the seroprotection level were set as ≥2-fold and ≥16-fold, respectively, for IAHA antibody and as ≥50 units and ≥105 units, respectively, for gpELISA-IgG antibody. RESULTS The rates of IAHA antibody positivity in the five samples (in order of collection) were 0%, 65%, 38%, 100%, and 59%, and the rates of seroprotection were 0%, 43%, 8%, 100%, and 43%. The rates of gpELISA-IgG antibody positivity were 8%, 81%, 89%, 100%, and 100%, and the rates of seroprotection were 5%, 54%, 70%, 100%, and 89%. The mean IAHA antibody titer and mean gpELISA-IgG antibody titer before entering elementary school were both lower than the respective titers obtained after the second vaccination (both p < 0.01). CONCLUSIONS Routine two-dose varicella vaccination leads to good antibody production, but titers of acquired antibodies decrease before children enter elementary school.
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Affiliation(s)
- Takao Ozaki
- Department of Pediatrics, Konan Kosei Hospital, Konan, Aichi 483-8704, Japan.
| | - Naoko Nishimura
- Department of Pediatrics, Konan Kosei Hospital, Konan, Aichi 483-8704, Japan
| | - Kensei Gotoh
- Department of Pediatrics, Konan Kosei Hospital, Konan, Aichi 483-8704, Japan
| | - Koji Takemoto
- Department of Pediatrics, Konan Kosei Hospital, Konan, Aichi 483-8704, Japan
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Higashimoto Y, Hattori F, Kawamura Y, Kozawa K, Hamano A, Kato M, Kato S, Hosokawa A, Enya Y, Ihira M, Yoshikawa T. Analysis of the reliability of rapid diagnostic tests for varicella, including breakthrough cases. J Med Virol 2023; 95:e28569. [PMID: 36762573 DOI: 10.1002/jmv.28569] [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: 11/24/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
In the era of universal varicella vaccination, diagnosis of varicella is challenging, especially for breakthrough cases. We sought to clarify the reliability of direct varicella-zoster virus (VZV) loop-mediated isothermal amplification (LAMP) and DermaQuick® VZV using the immunochromatography technique as rapid diagnostic tests for varicella. In addition, the usefulness of saliva as a sample type for direct LAMP was investigated. Among the 46 enrolled patients with suspected VZV infection, 31 patients (67.3%) were positive for the nucleic acid test based on real-time PCR from skin swab samples. Direct LAMP of skin swabs was positive in 29 (63.0%) of 46 patients. DermaQuick® VZV was positive in 25 (54.3%) of 46 patients. VZV DNA was detected in only 48.4% of oral swabs with the direct LAMP method. With real-time polymerase chain reaction (PCR) as the standard for diagnosing varicella, the sensitivity and specificity of DermaQuick® VZV were 80.7% and 100%, respectively. The sensitivity and specificity of direct LAMP from skin swabs were 93.6% and 100%, respectively. The sensitivity and specificity of real-time PCR for DNA extracted from oral swabs were 74.2% and 93.3%, respectively. Thus, oral swab samples are not suitable for breakthrough varicella diagnosis. Although DermaQuick® VZV is considered the most convenient point-of-care test for varicella, its sensitivity and specificity were lower than those of direct VZV LAMP.
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Affiliation(s)
- Yuki Higashimoto
- Department of Cellular and Molecular Biology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Fumihiko Hattori
- Department of Pediatrics, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kei Kozawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Aoi Hamano
- Department of Cellular and Molecular Biology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Mizuki Kato
- Department of Cellular and Molecular Biology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Sayaka Kato
- Department of Cellular and Molecular Biology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Asuka Hosokawa
- Department of Cellular and Molecular Biology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Yasuko Enya
- Department of Clinical Science for Biological Monitoring, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Masaru Ihira
- Department of Clinical Science for Biological Monitoring, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Abstract
Here, we present a previously healthy adolescent with aseptic meningitis without skin rash caused by varicella vaccine derived from the Oka/Biken strain; the patient received a single dose of varicella vaccine at 1 year of age. Pediatricians should be aware of the potential for reactivation of varicella vaccine derived from the Oka/Biken strain, which can cause aseptic meningitis in vaccinated children even in the absence of a skin rash.
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Yoshikawa T. Implementing vaccination policies based upon scientific evidence in Japan. Vaccine 2021; 39:5447-5450. [PMID: 34373119 PMCID: PMC8346366 DOI: 10.1016/j.vaccine.2021.07.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 01/29/2023]
Abstract
The theme of the 24th Annual Meeting of the Japanese Society for Vaccinology was “Sustainable Future Medical Care Created by Vaccines.” This theme includes topics such as the proposal to reduce the medical costs incurred by societies with aging populations through prophylactic vaccination. The coronavirus disease 2019 (COVID-19) pandemic alerted us to the important roles that preventive measures, such as vaccines, play in fighting infectious diseases. In order to inform the public of the benefits of vaccines, it is important to provide society with information regarding new vaccine developments, adjuvants, the cost–benefit ratio of vaccine introduction, and vaccine effectiveness and safety. Clinical research is essential for obtaining evidence of vaccine effectiveness and safety. The United States Centers for Disease Control and Prevention (CDC) conducts active surveillance in defined areas before and after the introduction of vaccines and documents the reduction in infection rates as a measure of vaccine effectiveness. However, vaccine efficacy and side effects may vary by country and ethnicity. Therefore, it is necessary for individual countries to develop their own evidence-based surveillance programs. We have studied vaccine efficacy and documented side-effects observed in patients for the varicella and rotavirus vaccines in Japan. This review outlines the importance of providing scientific evidence for vaccine effectiveness and safety.
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Affiliation(s)
- Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Kawamura Y, Hattori F, Higashimoto Y, Kozawa K, Yoshikawa T. Evaluation of varicella vaccine effectiveness during outbreaks in schools or nurseries by cross-sectional study. Vaccine 2021; 39:2901-2905. [PMID: 33895017 DOI: 10.1016/j.vaccine.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate vaccine effectiveness (VE) during varicella outbreaks in schools and nurseries in Japan. METHODS An outbreak was defined as emergence of three or more cases of varicella within 21 days at the same institute. Clinical information such as varicella vaccination status, and history of varicella was collected. If a child had varicella during the outbreak, information about absences, fever, and disease severity was collected. RESULTS From September 2018 to January 2020, four outbreaks were reported around our institute from three elementary schools and one nursery. A total of 676 children were analyzed in this study. Seventy-six children (11.2%) were unvaccinated, 309 (45.7%) had received one dose of vaccine, and 291 (43.0%) had received two doses. Most children in Pre-K2 (1-2 years old) to Pre-K6 (5-6 years old), who were the targets of the national immunization schedule, received two doses. Meanwhile, most children older than third grade received single dose. Seventy-five children (11.1%) had varicella. Varicella prevalence from Pre-K5 to the third grade was greater than 10%. The adjusted VEs of single- and two-dose of varicella vaccine were 57.8% and 89.0%. The number of days absent was significantly longer in unvaccinated children than single-dose recipients (P = 0.0145). Unvaccinated children had significantly more severe skin eruptions than single-dose recipients (P = 0.0046) and two-dose recipients (P = 0.0258). CONCLUSIONS Although VEs of single-dose varicella vaccination during outbreaks was not high, the VE of two-dose vaccination was similar to that in a previously reported case-control study.
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Affiliation(s)
- Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan.
| | - Fumihiko Hattori
- Department of Pediatrics, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Yuki Higashimoto
- Faculty of Medical Technology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Kei Kozawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
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