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Srikanth P, Arumugam I, Jeganathan SN, Ramesh R, Ranganathan LN, Vijayaraghavan S. Expanded spectrum of varicella disease and the need for vaccination in India. Hum Vaccin Immunother 2024; 20:2328955. [PMID: 38517089 PMCID: PMC10962579 DOI: 10.1080/21645515.2024.2328955] [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: 01/04/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
Varicella vaccine was first licensed in Japan and South Korea in 1989 for use in healthy children and was introduced in US in 1995. So far, 29 countries have adopted varicella vaccine in their universal immunization program (UIP). No Asian country, India included, has adopted the varicella vaccine as part of their UIP. The extra-cutaneous sites for VZV diseases are central nervous system and gastrointestinal tract, the expanded disease spectrum includes vasculopathy, myelitis, inflammatory bowel disease, perforated ulcers, and gastritis. The actual disease burden of varicella is not known as most of the infected individuals may not visit the physician. The amplifiable VZV DNA will not always be detectable in cerebrospinal fluid (CSF) samples in protracted illnesses such as vasculopathies, but demonstrable anti-VZV IgG in CSF has diagnostic value. The World Health Organization (WHO) position paper 2014 recommends two doses of varicella and zoster vaccines in targeted population. In India, varicella vaccine is not included in the UIP due to the cost and the belief that lifelong immunity occurs following primary infection. The expanded spectrum of VZV disease and the mounting body of evidence, however, suggest the need for both varicella and zoster vaccines in routine immunization schedule.
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Affiliation(s)
- Padma Srikanth
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute (SRIHER, DU), Chennai, India
| | - Ilakkiya Arumugam
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute (SRIHER, DU), Chennai, India
| | - Seetha N. Jeganathan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute (SRIHER, DU), Chennai, India
| | - Rithvik Ramesh
- Department of Neurology, Sri Ramachandra Medical College and Research Institute (SRIHER, DU), Chennai, India
| | | | - Shanthi Vijayaraghavan
- Department of Hepatology and Medical Gastroenterology, Sri Ramachandra Medical College and Research Institute (SRIHER, DU), Chennai, India
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Liu F, Li Z, Wang H, Cao Y, Zhang N, Wang F, Wei R, Zhang J, Zhao Y. Effectiveness of the varicella vaccine in the real world, a matched case-control study. Vaccine 2024:S0264-410X(24)00552-8. [PMID: 38734496 DOI: 10.1016/j.vaccine.2024.05.006] [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: 01/25/2024] [Revised: 04/28/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Universal varicella vaccination has been introduced in many countries, but there are a number of important differences in their vaccination strategies. It is essential to establish a vaccination program that can maximize the benefits of varicella vaccine, but there is a lack of comprehensive research on the effectiveness of varicella vaccine in different vaccination status. METHODS Using data from population-based surveillance platforms we conducted a 1:2 matched case-control study. The cases were clinically diagnosed varicella with onset from 2017 to 2021, 1-14 years old in Chaoyang District, Beijing. The controls were matched according to date of birth (±1 month), sex and residence. The vaccination data of the subjects were obtained from the Childhood Immunization Information Management System in Beijing. Using conditional logistic regression models with or without interaction terms, we evaluated the effectiveness of varicella vaccine in different vaccination status. RESULTS A total of 2528 cases and 5056 controls were enrolled. This study found that whether the time since last vaccination was adjusted had a substantial effect on the comparing vaccine effectiveness (VE) between subgroups. After adjustment for the time since last vaccination, 1) the incremental VE of 2-dose was 49.6 % (95 % Confidence Interval [CI], 38.8-58.6) compared with 1-dose (93.9 % vs. 88.0 %); 2) Among children who received one dose, the risk of chickenpox in children vaccinated at 18-23 months was 1.382 (95 %CI, 1.084-1.762) times that in children vaccinated at 12-17 months. 3) the VE with less than one, two, and three year intervals is higher than that with six-year-intervals (P < 0.05), respectively. CONCLUSIONS When comparing VE between subgroups of different vaccination status, the time since last vaccination should be adjusted. The first dose of varicella vaccine should be given as early as the second year of life, and the second dose can improve vaccine effectiveness.
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Affiliation(s)
- Fang Liu
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China.
| | - Zhen Li
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Hongyu Wang
- Haidian District Maternal and Child Health Care Hospital, Beijing, China
| | - Yang Cao
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Nan Zhang
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Fang Wang
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Rui Wei
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Jian Zhang
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Yuqian Zhao
- Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China
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Huang L, Chen Z, Song Y, Tan J, Jia N, You W, Yuan H, Feng G, Li C, Luan C, Quan Y, Wang Y. Immunogenicity and safety of a live-attenuated varicella vaccine in a healthy population aged 13 years and older: A randomized, double-blind, controlled study. Vaccine 2024; 42:396-401. [PMID: 38057208 DOI: 10.1016/j.vaccine.2023.10.031] [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: 05/10/2023] [Revised: 09/27/2023] [Accepted: 10/13/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES Vaccines for prevention against varicella are important for adolescents and adults, who have an increased risk of severe varicella. This study aimed to evaluate the immunogenicity and safety of a two-dose immunization schedule of a live-attenuated varicella vaccine (VarV) manufactured by Sinovac (Dalian) in healthy adolescents and adults. METHODS A randomized, double-blind, controlled clinical trial was conducted in healthy population aged ≥ 13 years old in China. Participants in block 1 were randomly assigned (1:1) to receive two doses of either the test vaccine or an active control vaccine, administered 4, 6 or 8 weeks apart. Participants in block 2 were randomly assigned (2:1) to receive two doses of test vaccine or placebo, administered 10 weeks apart. The primary immunogenicity endpoint was the seroconversion rates and GMTs of varicella zoster virus (VZV) antibodies measured by fluorescent-antibody-to-membrane-antigen (FAMA) 4 weeks post-immunization. The primary safety endpoint was the incidence of adverse reactions within 4 weeks after each dose. RESULTS A total of 2398 participants were enrolled. The seroconversion rates of VZV antibodies were 79.55 % in the test group and 76.41 % in the active control group respectively 4 weeks after two doses of pooled schedule, with the difference of 3.14 % (95 %CI: -0.69 %, 6.97 %). The GMTs were 1:162.07 and 1:160.04 respectively, with the ratio of 1.013 (95 %CI: 0.910, 1.127). Both the seroconversion rates and GMTs reached the prespecified non-inferiority criteria. Two-dose schedule with an interval of 10 weeks could also induce high immune responses, with a seroconversion rate of 83.22 % and a GMT of 1:160.38 in the test group. Safety profiles were similar among the test group, active control group and placebo group. CONCLUSION VarV, manufactured by Sinovac (Dalian), demonstrated higher immune response and better flexibility in the immunization schedule among heathy population aged 13 years and older, without increased safety risk.
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Affiliation(s)
- Lili Huang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Zhen Chen
- National Institutes for Food and Drug Control, Beijing, China
| | - Yufei Song
- Sinovac Biotech Co., Ltd., Beijing, China
| | - Jiebing Tan
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | | | - Wangyang You
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Hongxue Yuan
- Sinovac (Dalian) Vaccine Technology Co., Ltd., Dalian, China
| | - Guangwei Feng
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Changgui Li
- National Institutes for Food and Drug Control, Beijing, China
| | - Chunfang Luan
- Sinovac (Dalian) Vaccine Technology Co., Ltd., Dalian, China.
| | - Yaru Quan
- National Institutes for Food and Drug Control, Beijing, China.
| | - Yanxia Wang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China.
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Sun X, Wang Y, Zhang L, Liu Y, Xu LX, Chen Q, Sun H, Wang F, Wang Z, Wang W. Explore the optimal timing for administering the second dose of the varicella vaccine in China. J Med Virol 2023; 95:e29119. [PMID: 37737678 DOI: 10.1002/jmv.29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
The prevalence of varicella in China has been increasing annually, with a relatively high incidence rate of breakthrough cases. Administering two doses of the varicella vaccine (Varv) proves to be the most effective measure. The objective of this study is to assess the immunogenicity of two doses of the Varv at varying intervals and explore the optimal timing for administering the second dose of the Varv. Utilizing a prospective cohort study design, the quantification of varicella immunoglobulin G (IgG) antibodies' geometric mean concentrations (GMC) is conducted through glycoprotein-based enzyme-linked immunosorbent assay (gpELISA). A total of 903 infants were included in the per-protocol population. After completing the first dose of the Varv, the GMC of antibody after 1 month (Group A) was 463.8 (447.6-480.1) mIU/mL. There was a statistically significant difference in GMC and seroconversion rates among the groups (B/C/D) that received the second dose of the Varv (p < 0.05). Multiple comparisons revealed that the group with a 3-year interval between the two vaccine doses had a higher GMC of 665.2 (622.6-707.8) mIU/mL compared to the group with a 1-year interval of 611.1 (577.1-645.3) mIU/mL and the group with a 5-year interval of 564.7 (540.1-589.4) mIU/mL. To effectively prevent and control the varicella epidemic in Jiangsu Province, two dose Varv vaccination is recommended, the optimal time point for the second dose Varv is 3 years after the first vaccination.
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Affiliation(s)
- Xiang Sun
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yong Wang
- Scientific Research Department, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Lei Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yuanbao Liu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ling-Xiao Xu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Qiang Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hui Sun
- Medical Department, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Fangfang Wang
- Department of Hematology, Yangzhou University Clinical Medical College, Yangzhou, Jiangsu, China
| | - Zhiguo Wang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Wen Wang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
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Lin M, Wang Q, Deng P, Xiao S, Fei Y, Xue C. Effectiveness of varicella vaccination during an outbreak in a large one-dose-vaccinated population in Shanghai. Hum Vaccin Immunother 2022; 18:2143176. [PMID: 36509511 PMCID: PMC9766464 DOI: 10.1080/21645515.2022.2143176] [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] [Indexed: 12/15/2022] Open
Abstract
Emergency vaccination (EV) is used as effective postexposure prophylaxis (PEP) to control varicella outbreaks within 3-5 days. However, the advantages of a second dose of varicella vaccine (VarV) in students who had received one dose before an outbreak and the potential benefits of EV at more than 5 days after exposure have not been fully evaluated. This study evaluated the vaccine effectiveness (VE) of EV in preventing disease development during a varicella outbreak in Shanghai, China, in 2020. Questionnaires were used to obtain student demographic information, clinical manifestations, varicella history, vaccination status, and willingness to receive EV. The VE of EV was calculated as [1-relative risk (RR)] ×100%. Among the 1455 students included in this study, 31 cases were identified, resulting in an overall attack rate of 2.13%. There were 6 cases in unvaccinated students and 25 cases in one-dose-vaccinated students. A total of 788 students received one EV dose. The attack rates were 6.38% (6/94), 4.26% (19/446), 2.82% (2/71), and 0.56% (4/717) among unvaccinated students, students who received 1 dose of VarV, and students who received EV with the 1st and 2nd dose of VarV, respectively. Compared to that in unvaccinated students, the VE of EV with the 2nd dose of VarV was 88% (95% CI 49% to 97%). EV should be performed as soon as possible after exposure. Nevertheless, vaccination is still recommended at more than 5 days post exposure to control varicella outbreaks.
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Affiliation(s)
- Mingzhu Lin
- Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Qizhang Wang
- Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Pengfei Deng
- Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Shaotan Xiao
- Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Yi Fei
- Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,CONTACT Yi Fei
| | - Caoyi Xue
- Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China,Caoyi Xue Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai200136, China
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Immunogenicity and Safety of a Booster Dose of Live Attenuated Varicella Vaccine, and Immune Persistence of a Primary Dose for Children Aged 2 to 6 Years. Vaccines (Basel) 2022; 10:vaccines10050660. [PMID: 35632416 PMCID: PMC9146173 DOI: 10.3390/vaccines10050660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/27/2022] Open
Abstract
Aim: To evaluate the immunogenicity and safety of a booster dose of live attenuated varicella vaccine (VarV) manufactured by Sinovac (Dalian) Vaccine Technology Co. Ltd., and the immune persistence of a primary dose in 2- to 6-year-old children. Methods: A phase IV, open-label study was conducted in China. Children previously vaccinated with a single dose of VarV at 1~3 years old received one dose of homologous VarV in the first year, the second year, or the third year after the primary immunization as booster immunization. Immune persistence was evaluated in an immune persistence analysis set, while immunogenicity was evaluated in a per-protocol analysis set, and safety was evaluated in a safety analysis set. The primary endpoint was the seropositive rate and the seroconversion rate of VarV antibody. The trial was registered at ClinicalTrials.gov (NCT02981836). Results: From July 2018 to August 2020, a total of 849 vaccinated children received the booster vaccination of VarV, one booster dose for each child (301 vaccinated in the first year after primary immunization (Group 1), 276 vaccinated in the second year after primary immunization (Group 2), 272 vaccinated in the third year after primary immunization (Group 3)). The seropositive rates were 99.34%, 97.83%, and 98.16% in Groups 1–3, with GMTs of 1:22.56, 1:18.49, and 1:18.45, respectively. Thirty days after the vaccine booster dose, the seropositive rates of the three groups were all 100% and the seroconversion rates were 52.54%, 67.46%, and 66.67%, with GMTs of 1:68.49, 1:76.32 and 1:78.34, respectively. The seroconversion rates in Groups 2 and 3 were both higher than that in Group 1 (p = 0.0005 and p = 0.0008). The overall incidence of adverse reactions was 7.77%, with 7.64%, 8.33%, and 7.35% in Groups 1, 2, and 3, respectively. The main symptom among adverse reactions was fever, the incidence of which ranged from 5.07% to 6.64% in each group, and no vaccine-related serious adverse events occurred. Conclusions: VarV had good immune persistence in 1~3 years after primary immunization. A vaccine booster dose for children aged 1~3 years after primary immunization recalled specific immune response to varicella-zoster virus, with no safety concerns increased.
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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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Namazova-Baranova L, Habib MA, Povey M, Efendieva K, Fedorova O, Fedoseenko M, Ivleva T, Kovshirina Y, Levina J, Lyamin A, Ogorodova L, Reshetko O, Romanenko V, Ryzhenkova I, Sidorenko I, Yakovlev Y, Zhestkov A, Tatochenko V, Scherbakov M, Shpeer EL, Casabona G. A randomized trial assessing the efficacy, immunogenicity, and safety of vaccination with live attenuated varicella zoster virus-containing vaccines: ten-year follow-up in Russian children. Hum Vaccin Immunother 2021; 18:1959148. [PMID: 34435933 PMCID: PMC9067519 DOI: 10.1080/21645515.2021.1959148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In Russia, a universal varicella vaccination (UVV) program has not been implemented, and varicella vaccination coverage is low. We assessed the efficacy, antibody persistence, and safety of one- and two-dose varicella vaccination schedules in Russian children with a ten-year follow-up period, as part of an international phase IIIB, observer-blind, randomized, controlled trial (NCT00226499). Children aged 12-22 months were randomized (3:3:1) to receive two doses of tetravalent measles-mumps-rubella-varicella vaccine (V2 group), one dose trivalent measles-mumps-rubella (MMR) vaccine and one dose of varicella vaccine (V1 group), or two doses of MMR vaccine (V0 [control] group), 42 days apart. Main study outcomes were: vaccine efficacy (VE) against confirmed varicella cases, anti-varicella zoster virus (VZV) seropositivity rates and geometric mean concentrations, and reporting of (serious) adverse events ([S]AEs). The total vaccinated cohort in Russia comprised 1000 children; 900 were followed up until study end (year [Y] 10). VE estimates against confirmed varicella (Y10) were 92.4% in the V2 group and 74.7% in the V1 group. Anti-VZV seropositivity rates remained ≥99.4% in the V2 group and ≥89.7% in the V1 group from day 42 post-vaccination 2 until Y10. Occurrence of (un)solicited AEs and SAEs was similar across groups and confirmed the safety profile of the vaccines. No vaccination-related SAEs or deaths were reported. These results are consistent with the global trial results, i.e., the highest VE estimates observed following the two-dose schedule compared to the one-dose schedule. These data may inform decision-making related to potential implementation of a UVV program.
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Affiliation(s)
- Leyla Namazova-Baranova
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.,Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | | | - Kamilla Efendieva
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.,Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Olga Fedorova
- Regional Children Hospital, Tomsk, Russia.,Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - Marina Fedoseenko
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.,Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Tatyana Ivleva
- Medical Clinicodiagnostic Center Reafan, Novosibirsk, Russia
| | - Yulia Kovshirina
- Regional Children Hospital, Tomsk, Russia.,Siberian State Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - Julia Levina
- Scientific Center of Children Health, Moscow, Russia.,Pediatrics and Child Health Research Institute, CCH RAS, Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia
| | | | | | - Olga Reshetko
- City outpatient clinic #11, Saratov, Russia.,Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia
| | - Viktor Romanenko
- Ural State Medical University, Ministry of Health of the Russian Federation, Ekaterinburg, Russia
| | - Inna Ryzhenkova
- City outpatient clinic #11, Saratov, Russia.,Saratov State Medical University, Ministry of Health of the Russian Federation, Saratov, Russia
| | | | - Yakov Yakovlev
- Novokuznetsk Municipal Children Hospital, Novokuznetsk, Russia.,Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia
| | | | - Vladimir Tatochenko
- City Children Hospital Named after T.G.Petrova, Ivanteevka Moscow Region, Russia
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9
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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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10
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Bertamino M, Signa S, Veneruso M, Prato G, Caorsi R, Losurdo G, Teutonico F, Esposito S, Formica F, Tovaglieri N, Nagel MA, Amico G, Zanetti A, Tortora D, Rossi A, Moretti P, Gattorno M, Ravelli A, Severino M. Expanding the clinical and neuroimaging features of post-varicella arteriopathy of childhood. J Neurol 2021; 268:4846-4865. [PMID: 34046727 DOI: 10.1007/s00415-021-10606-6] [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] [Received: 03/06/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Post-varicella arterial ischemic stroke (AIS) is considered an uncommon cause of pediatric stroke that is considered a self-limiting, monophasic disease. However, in a subset of patients, disease recurs; the prevalence of vasculopathy or AIS recurrence, severity of clinical outcomes, and standardized therapies have not been well characterized. Herein, we determined the clinical-neuroradiological features, long-term evolution, and relationship between acute phase treatment and vasculopathy recurrence in a pediatric population with post-varicella AIS. METHODS Clinical, laboratory, and neuroradiological features of 22 children with post-varicella AIS between 2010 and 2019 (16 males, mean age at stroke 4 years, range 1.7-10) were reviewed. Statistical analyses were performed using χ2 and Fisher exact tests. RESULTS Of the 22 cases, mean time from varicella to stroke was 4.5 months with 3 cases presenting more than 12 months after rash; 21 (95%) were not vaccinated for varicella; 3 (13.6%) had posterior circulation involvement; and 5 (22.7%) had AIS or vasculopathy recurrence, of which 4 recurred 6.1 months to 2.8 years after initial clinical onset. Recurrence was associated with lack of antiviral treatment during the first episode (p = 0.02). CONCLUSIONS Post-varicella AIS can occur months after rash making diagnosis challenging. Because recurrent vasculopathy was seen predominantly in cases not treated with antiviral therapy during initial presentation, it is important to rapidly diagnose post-varicella AIS through clinical criteria and/or virological testing then treat with antivirals to prevent recurrence.
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Affiliation(s)
- Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Signa
- DINOGMI, University of Genoa, Genoa, Italy. .,Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Giulia Prato
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Rheumatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Losurdo
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Silvia Esposito
- Developmental Neurology Unit, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Formica
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy
| | | | - Maria A Nagel
- Department of Neurology, University of Colorado, Boulder, USA
| | - Giulia Amico
- DINOGMI, University of Genoa, Genoa, Italy.,Laboratory of Genetic and Genomics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,DISSAL, University of Genoa, Genoa, Italy
| | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- Rheumatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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11
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Wolff E, Widgren K, Scalia Tomba G, Roth A, Lep T, Andersson S. Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model. PLoS One 2021; 16:e0251644. [PMID: 33984060 PMCID: PMC8118323 DOI: 10.1371/journal.pone.0251644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/29/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. DESIGN Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. SETTING National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. PARTICIPANTS Hypothetical cohorts of people aged 12 months and 65-years at baseline. INTERVENTIONS Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies. MAIN OUTCOME MEASURES Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). RESULTS It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million. CONCLUSIONS The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective-the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.
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Affiliation(s)
- Ellen Wolff
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Göteborg, Sweden
- * E-mail:
| | - Katarina Widgren
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- Department of Medicine, Huddinge C2:94, Karolinska University Hospital, Stockholm, Sweden
| | | | - Adam Roth
- Institution for Translational Medicine, Lund University, Malmö, Sweden
| | - Tiia Lep
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Sören Andersson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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12
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Prymula R, Povey M, Brzostek J, Cabrnochova H, Chlibek R, Czajka H, Leviniene G, Man S, Neamtu M, Pazdiora P, Plesca D, Ruzkova R, Stefkovicova M, Usonis V, Verdanova D, Wysocki J, Casabona G, Habib MA. Ten-year follow-up on efficacy, immunogenicity and safety of two doses of a combined measles-mumps-rubella-varicella vaccine or one dose of monovalent varicella vaccine: Results from five East European countries. Vaccine 2021; 39:2643-2651. [PMID: 33858718 DOI: 10.1016/j.vaccine.2021.03.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/17/2021] [Accepted: 03/26/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND We assessed the 10-year efficacy, immunogenicity and safety of two doses of a combined measles-mumps-rubella-varicella vaccine (MMRV) or one dose of a monovalent varicella vaccine (V) in children from Czech Republic, Lithuania, Poland, Romania and Slovakia. METHODS This was a phase IIIB follow-up of an observer-blind, randomized, controlled trial (NCT00226499). In phase A, healthy children aged 12-22 months from 10 European countries were randomized in a 3:3:1 ratio to receive two doses of MMRV (MMRV group), one dose of MMR followed by one dose of V (MMR + V group), or two doses of MMR (MMR; control group), 42 days apart. Vaccine efficacy (VE) against varicella (confirmed by viral DNA detection or epidemiological link and clinical assessment) was calculated with 95% confidence intervals using Cox proportional hazards regression model. Immunogenicity was assessed as seropositivity rates and geometric mean concentrations (GMCs). Solicited and unsolicited adverse events (AEs) and serious AEs (SAEs) were recorded. RESULTS A total of 3705 children were vaccinated (1590, MMRV group; 1586, MMR + V group; 529, MMR group). There were 663 confirmed varicella cases (47, MMRV group; 349, MMR + V group; 267, MMR group). VE ranged between 95.4% (Lithuania) and 97.4% (Slovakia) in the MMRV group and between 59.3% (Lithuania) and 74% (Slovakia) in the MMR + V group. At year 10, seropositivity rates were 99.5%-100% in the MMRV group, 98%-100% in the MMR + V group and 50%-100% in the MMR control group, and the anti-VZV antibody GMCs were comparable between MMRV and MMR + V groups. The occurrence of solicited and unsolicited AEs was similar across groups and no SAE was considered as vaccination-related. No new safety concerns were identified. CONCLUSIONS Our results indicated that two doses of varicella zoster virus-containing vaccine provided better protection than one dose against varicella and induced antibody responses that persisted 10 years post-vaccination.
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Affiliation(s)
- Roman Prymula
- Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic.
| | | | | | | | - Roman Chlibek
- University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic.
| | - Hanna Czajka
- Faculty of Medicine, University of Rzeszow, Rzeszow, Poland and Infectious Diseases Outpatient Clinic, The St. Louis Regional Specialised Children's Hospital, Krakow, Poland.
| | - Giedra Leviniene
- Pediatric Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sorin Man
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Mihai Neamtu
- Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania.
| | - Petr Pazdiora
- Department of Epidemiology, Medical Faculty Pilsen of Charles University, Czech Republic.
| | - Doina Plesca
- Pediatrics, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Renata Ruzkova
- Pediatric Office Dr. Renata Ruzkova, Prague, Czech Republic.
| | - Maria Stefkovicova
- Faculty of Health Care, Alexander Dubcek University of Trencín, Trencín, Slovakia
| | - Vytautas Usonis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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13
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Lee T, Suh J, Choi JK, Lee J, Park SH. Estimating the basic reproductive number of varicella in South Korea incorporating social contact patterns and seroprevalence. Hum Vaccin Immunother 2021; 17:2488-2493. [PMID: 33829948 DOI: 10.1080/21645515.2021.1898917] [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: 10/21/2022] Open
Abstract
Varicella, which is caused by the varicella zoster virus (VZV), is a common infectious disease affecting children. Varicella vaccines have been used for decades; however, vaccination policies vary across countries because of differences in VZV epidemiology. The basic reproductive number R0 a transmissibility measure parameter, also differs from country to country. In this study R0 for varicella was estimated in South Korea using the contact rate matrix derived from averaged POLYMOD contact data, the Korean population, and proportionality factor fitted to the Korean VZV seroprevalence R0 for varicella in South Korea was estimated to be 5.67 (95% CI: 5.33, 6.33). Therefore, to reach the herd immunity threshold, the critical vaccine coverage should be greater than 82.4% with a perfect vaccine, or the primary vaccine failure proportion should be less than 17.6% with 100% coverage. Because of the relatively low seroconversion rate and rapidly waning immunity after one-dose vaccination in South Korea, the herd immunity threshold is difficult to attain with only a one-dose vaccine. Two doses of vaccination may be necessary to effectively interrupt varicella transmission and maintain herd immunity in South Korea. The study results can help guide the decision-making on an effective varicella vaccination policy in South Korea.
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Affiliation(s)
- Taeyong Lee
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea
| | - Jiyeon Suh
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, Republic of Korea
| | - Jae-Ki Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeehyun Lee
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea.,School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, Republic of Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Suh J, Lee T, Choi JK, Lee J, Park SH. The impact of two-dose varicella vaccination on varicella and herpes zoster incidence in South Korea using a mathematical model with changing population demographics. Vaccine 2021; 39:2575-2583. [PMID: 33814230 DOI: 10.1016/j.vaccine.2021.03.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND In South Korea, one-dose varicella vaccination was introduced to the National Immunization Program in 2005, but varicella outbreaks have continued to occur. Therefore, a two-dose vaccination strategy is considered. METHODS We developed an age-structured deterministic compartment model using Korean population projection data. The impact of adding a second dose of varicella vaccine on varicella and herpes zoster (HZ) epidemiology was assessed under four different vaccine effectiveness (VE) scenarios (base, moderate, lowest, highest) and the optimal timing of the second vaccine dose (18 months, 4, 5, or 6 years of age) was examined over the period 2020-2065. RESULTS A two-dose vaccination schedule reduced the cumulative varicella incidence by > 90% compared to no vaccination, regardless of the VE. The additional reduction attributable to a second dose compared to a single dose was greatest (82%) with the lowest VE scenario. A second dose at 6 years of age reduced the varicella incidence at a population level, whereas a second dose at 18 months of age reduced the varicella incidence primarily in the target birth cohorts. Routine vaccination at the age of 18 months with a catch-up vaccination of 6-year-olds was the optimal strategy for birth cohort and population-level control. HZ incidence continued to increase under no vaccination scenario, which represents the effect of aging population. Under a two-dose scenario, the additional increase in HZ incidence attributable to the reduced exogenous boosting was small relative to a one-dose scenario and a further reduction in HZ cases was observed. CONCLUSION A two-dose varicella vaccination schedule would significantly reduce varicella and HZ incidence in the long term. A second dose at the age of 18 months with a catch-up vaccination of 6-year-olds would be optimal for controlling varicella in South Korea.
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Affiliation(s)
- Jiyeon Suh
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, Republic of Korea
| | - Taeyong Lee
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea
| | - Jae-Ki Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeehyun Lee
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, Republic of Korea; School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea.
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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15
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Rafferty ERS, McDonald W, Osgood ND, Doroshenko A, Farag M. What We Know Now: An Economic Evaluation of Chickenpox Vaccination and Dose Timing Using an Agent-Based Model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:50-60. [PMID: 33431153 DOI: 10.1016/j.jval.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 09/03/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The value of chickenpox vaccination is still debated in the literature and by jurisdictions worldwide. This uncertainty is reflected in the inconsistent uptake of the vaccine, where some countries offer routine childhood immunization programs, others have targeted programs, and in many the vaccine is only privately available. Even across the countries that have universal funding for the vaccine, there is a diversity of schedules and dosing intervals. Using an agent-based model of chickenpox and shingles, we conducted an economic evaluation of chickenpox vaccination in Alberta, Canada. METHODS We compared the cost-effectiveness of 2 common chickenpox vaccination schedules, specifically a long dosing interval (first dose: 12 months; second dose: 4-6 years) and a short dosing interval (first dose: 12 months; second dose: 18 months). RESULTS The economic evaluation demonstrated a shorter dosing interval may be marginally preferred, although it consistently led to higher costs from both the societal and healthcare perspectives. We found that chickenpox vaccination would be cost-saving and highly cost-effective from the societal and healthcare perspective, assuming there was no impact on shingles. CONCLUSION Chickenpox vaccine was cost-effective when not considering shingles and remained so even if there was a minor increase in shingles following vaccination. However, if chickenpox vaccination did lead to a substantial increase in shingles, then chickenpox vaccination was not cost-effective from the healthcare perspective.
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Affiliation(s)
- Ellen R S Rafferty
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada.
| | - Wade McDonald
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander Doroshenko
- Faculty of Medicine and Dentistry, Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Doha, Qatar
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16
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Trevisan A, Nicolli A, De Nuzzo D, Lago L, Artuso E, Maso S. Varicella seroepidemiology and immunization in a cohort of future healthcare workers in the pre-vaccination era. Int J Infect Dis 2020; 96:228-232. [PMID: 32387376 DOI: 10.1016/j.ijid.2020.04.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The goal of this study was to establish the seroprevalence of positive antibodies against varicella and compliance with varicella vaccination in the pre-vaccination era. METHODS A cohort of 10 683 Italian students from Padua University Medical School (from 2004 to 2019) were enrolled and classified as unvaccinated, vaccinated once, or vaccinated twice against varicella, according to their vaccination certificate. The antibody titre was measured and the seroprevalence of positive subjects was determined. Subjects with negative or equivocal antibodies were invited for vaccination, and then the antibody titre was retested. RESULTS Unvaccinated students were mostly seropositive (95.6%), compared with vaccinated students who were less seropositive (68.0% after one dose and 78.6% after two doses) and had significantly lower antibody titres (p < 0.0001). The post-test vaccination had a positive response rate of 85.4%: 67.4% after one dose and 91.4% after two doses. CONCLUSIONS In the pre-vaccination era, only 3.3% of future healthcare workers were vaccinated against varicella (1.1% once and 2.2% twice). Vaccination or revaccination of negative and equivocal individuals could reduce the number of susceptible people. Implementation of varicella vaccine (two doses) in healthcare workers is of primary importance to reduce the risk of transmission.
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Affiliation(s)
- Andrea Trevisan
- Department of Cardiac Thoracic Vascilar Sciences and Public Health, Unit of Occupational Medicine, University of Padova, Padova, Italy.
| | - Annamaria Nicolli
- Department of Cardiac Thoracic Vascilar Sciences and Public Health, Unit of Occupational Medicine, University of Padova, Padova, Italy
| | - Davide De Nuzzo
- Department of Cardiac Thoracic Vascilar Sciences and Public Health, Unit of Occupational Medicine, University of Padova, Padova, Italy
| | - Laura Lago
- Department of Cardiac Thoracic Vascilar Sciences and Public Health, Unit of Occupational Medicine, University of Padova, Padova, Italy
| | - Elisa Artuso
- Department of Cardiac Thoracic Vascilar Sciences and Public Health, Unit of Occupational Medicine, University of Padova, Padova, Italy
| | - Stefano Maso
- Department of Cardiac Thoracic Vascilar Sciences and Public Health, Unit of Occupational Medicine, University of Padova, Padova, Italy
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17
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Chan YWD, Edmunds WJ, Chan HL, Wong ML, Au KWA, Chuang SK, van Hoek AJ, Flasche S. Varicella vaccine dose depended effectiveness and waning among preschool children in Hong Kong. Hum Vaccin Immunother 2020; 16:499-505. [PMID: 31642729 PMCID: PMC7227687 DOI: 10.1080/21645515.2019.1663121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/09/2019] [Accepted: 08/25/2019] [Indexed: 10/31/2022] Open
Abstract
In Hong Kong, universal varicella vaccination was introduced in July 2014 with a two-dose schedule but the vaccines had been available in the private market since 1996. With data from varicella notification and surveys on immunization coverage, we used the screening method to estimate dose-specific varicella vaccine effectiveness (VE) among preschool children in Hong Kong before universal vaccination. We estimated the VE of one- and two-dose varicella vaccination against all notified varicella as 69.4% (95% confidence interval (95% CI) 69.5-71.2) and 93.4% (95% CI 91.7-94.7), respectively. We found that VE did not decrease with time since receipt. Varicella vaccine was more effective against complications (85.4% [95% CI 48.8-95.8] for one dose and 100% [95% CI -Inf to 100] for two doses) and against hospital admission (75.2% [95% CI 53.4-86.8] for one dose and 93.1% [95% CI 47.1-99.1] for two doses). Lower protection of one-dose varicella vaccine resulted in breakthrough varicella. Under universal vaccination, second-dose varicella vaccine (given as combined measles, mumps, rubella and varicella vaccine) was first scheduled for children when they reach primary one (about 6 years of age) and was recently advanced to 18 months of age. Shortening the interval between the first dose and second dose of varicella vaccination should reduce breakthrough varicella and outbreaks in preschool.
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Affiliation(s)
- Yung-Wai Desmond Chan
- Communicable Disease Division, Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health Hong Kong SAR Government, Kowloon, Hong Kong SAR
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hong-Lam Chan
- Communicable Disease Division, Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health Hong Kong SAR Government, Kowloon, Hong Kong SAR
| | - Miu-Ling Wong
- Communicable Disease Division, Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health Hong Kong SAR Government, Kowloon, Hong Kong SAR
| | - Ka-Wing Albert Au
- Communicable Disease Division, Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health Hong Kong SAR Government, Kowloon, Hong Kong SAR
| | - Shuk-Kwan Chuang
- Communicable Disease Division, Surveillance and Epidemiology Branch, Centre for Health Protection, Department of Health Hong Kong SAR Government, Kowloon, Hong Kong SAR
| | - Albert Jan van Hoek
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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18
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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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19
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Seeking the optimal schedule for chickenpox vaccination in Canada: Using an agent-based model to explore the impact of dose timing, coverage and waning of immunity on disease outcomes. Vaccine 2020; 38:521-529. [DOI: 10.1016/j.vaccine.2019.10.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022]
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20
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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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21
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Gabutti G, Bolognesi N, Sandri F, Florescu C, Stefanati A. Varicella zoster virus vaccines: an update. Immunotargets Ther 2019; 8:15-28. [PMID: 31497569 PMCID: PMC6689529 DOI: 10.2147/itt.s176383] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/06/2019] [Indexed: 12/18/2022] Open
Abstract
Varicella zoster virus (VZV) is the etiological agent of varicella, a highly infectious, self-limiting disease with serious complications. The decline in cell-mediated immunity (CMI) that occurs with aging or immunodepression causes a reactivation of the latent VZV as herpes zoster (HZ). Prevention of VZV through varicella vaccination strategies allows to avoid the primary infection in newborns and susceptible subjects. Available monovalent and combined VZV vaccines are effective, safe and generally well tolerated. Universal varicella vaccination has significantly impacted on incidence, complications and deaths related to this disease. Prevention of HZ through vaccination is a priority to avoid the significant burden of its incidence and complications. Currently two HZ vaccines are available. The recombinant zoster vaccine (RZV), approved by the FDA in 2017 and Zoster Vaccine Live (ZVL) licensed in the United States by the FDA in 2006. The advisory committee on immunization practices (ACIP) preferentially recommends RZV. ZVL remains an option for prevention of HZ in immunocompetent adults aged ≥60 years, although the CMI tends to wane a few years after vaccination.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Niccolò Bolognesi
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Caterina Florescu
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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22
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Choi JK, Park SH, Park S, Choi SM, Kim SH, Lee DG, Yoo JH, Choi JH, Kang JH. Trends in varicella and herpes zoster epidemiology before and after the implementation of universal one-dose varicella vaccination over one decade in South Korea, 2003-2015. Hum Vaccin Immunother 2019; 15:2554-2560. [PMID: 31008679 DOI: 10.1080/21645515.2019.1603985] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: In South Korea, the one-dose varicella vaccine was included in the National Immunization Program for children aged 12-15 months in 2005, and the vaccine coverage reached >95%. The impact of varicella vaccination on varicella and herpes zoster (HZ) was investigated, accounting for demographic changes over time.Methods: We calculated the crude and age-sex standardized incidence rates (IRs) and age-specific IRs of varicella and HZ from 2003 to 2015, using the National Health Information Database including approximately 50 million Koreans. The annual incidence rate ratios (IRRs) were calculated using a negative binomial regression analysis, adjusting for age and sex.Results: The crude varicella IR steadily declined by 67%, from 5.70/1000 to 1.87/1000 person years (IRR per year: 0.91; 95% CI 0.89-0.93), but the adjusted IRs showed a significant decline only during 2010-2015 (adjusted IRR per year: 0.90; 95% CI 0.88-0.93). The greatest decline was found in children ≤4 years of age, whereas the IR increased until 2011 and then declined afterward in children aged 5-9 years, who represented the highest incidence age group in 2013-2015. The crude HZ IR increased from 2.67/1000 to 9.80/1000 person years (IRR per year: 1.12; 95% CI 1.10-1.15), and the adjusted IR also followed the same trend. A similar increasing trend was observed before and after universal vaccination.Conclusions: One-dose varicella vaccination was moderately effective in preventing varicella, but this strategy was insufficient to interrupt varicella transmission in children. Furthermore, the HZ incidence dramatically increased over this decade. The current vaccination strategy against varicella-zoster disease should be reconsidered.
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Affiliation(s)
- Jae-Ki Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sanghyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Si-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hong Yoo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Lee YH, Choe YJ, Cho SI, Bang JH, Oh MD, Lee JK. Increasing varicella incidence rates among children in the Republic of Korea: an age-period-cohort analysis. Epidemiol Infect 2019; 147:e245. [PMID: 31364576 PMCID: PMC6805734 DOI: 10.1017/s0950268819001389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 05/18/2019] [Accepted: 05/31/2019] [Indexed: 11/06/2022] Open
Abstract
In the Republic of Korea, despite the introduction of one-dose universal varicella vaccination in 2005 and achieving a high coverage rate of 98.9% in 2012, the incidence rate has been increased sevenfold. This study aimed to investigate time trends of varicella incidence rate, assessing the age, period and birth cohort effects. We used national data on the annual number of reported cases from 2006 to 2017. A log-linear Poisson regression model was used to estimate age-period-cohort effects on varicella incidence rate. From 2006 to 2017, the incidence of varicella increased from 22.5 cases to more than 154.8 cases per 100 000. Peak incidence has shifted from 4 to 6 years old. The estimated period and cohort effects showed significant upward patterns, with a linear increasing trend by net drift. There has been an increase in the incidence among the Korean population regarding period and cohort despite the universal vaccination of varicella vaccine. Our data suggest the need for additional studies to address the current gap in herd immunity.
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Affiliation(s)
- Young Hwa Lee
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Republic of Korea
| | - Young June Choe
- Division of Pediatric Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University School of Public Health, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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24
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Varicella breakthrough infection and effectiveness of 2-dose varicella vaccine in China. Vaccine 2018; 36:5665-5670. [DOI: 10.1016/j.vaccine.2018.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/18/2018] [Accepted: 05/04/2018] [Indexed: 11/20/2022]
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25
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Rafferty E, McDonald W, Qian W, Osgood ND, Doroshenko A. Evaluation of the effect of chickenpox vaccination on shingles epidemiology using agent-based modeling. PeerJ 2018; 6:e5012. [PMID: 29942688 PMCID: PMC6015493 DOI: 10.7717/peerj.5012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/30/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Biological interactions between varicella (chickenpox) and herpes zoster (shingles), two diseases caused by the varicella zoster virus (VZV), continue to be debated including the potential effect on shingles cases following the introduction of universal childhood chickenpox vaccination programs. We investigated how chickenpox vaccination in Alberta impacts the incidence and age-distribution of shingles over 75 years post-vaccination, taking into consideration a variety of plausible theories of waning and boosting of immunity. METHODS We developed an agent-based model representing VZV disease, transmission, vaccination states and coverage, waning and boosting of immunity in a stylized geographic area, utilizing a distance-based network. We derived parameters from literature, including modeling, epidemiological, and immunology studies. We calibrated our model to the age-specific incidence of shingles and chickenpox prior to vaccination to derive optimal combinations of duration of boosting (DoB) and waning of immunity. We conducted paired simulations with and without implementing chickenpox vaccination. We computed the count and cumulative incidence rate of shingles cases at 10, 25, 50, and 75 years intervals, following introduction of vaccination, and compared the difference between runs with vaccination and without vaccination using the Mann-Whitney U-test to determine statistical significance. We carried out sensitivity analyses by increasing and lowering vaccination coverage and removing biological effect of boosting. RESULTS Chickenpox vaccination led to a decrease in chickenpox cases. The cumulative incidence of chickenpox had dropped from 1,254 cases per 100,000 person-years pre chickenpox vaccination to 193 cases per 100,000 person-years 10 years after the vaccine implementation. We observed an increase in the all-ages shingles cumulative incidence at 10 and 25 years post chickenpox vaccination and mixed cumulative incidence change at 50 and 75 years post-vaccination. The magnitude of change was sensitive to DoB and ranged from an increase of 22-100 per 100,000 person-years at 10 years post-vaccination for two and seven years of boosting respectively (p < 0.001). At 75 years post-vaccination, cumulative incidence ranged from a decline of 70 to an increase of 71 per 100,000 person-years for two and seven years of boosting respectively (p < 0.001). Sensitivity analyses had a minimal impact on our inferences except for removing the effect of boosting. DISCUSSION Our model demonstrates that over the longer time period, there will be a reduction in shingles incidence driven by the depletion of the source of shingles reactivation; however in the short to medium term some age cohorts may experience an increase in shingles incidence. Our model offers a platform to further explore the relationship between chickenpox and shingles, including analyzing the impact of different chickenpox vaccination schedules and cost-effectiveness studies.
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Affiliation(s)
- Ellen Rafferty
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Wade McDonald
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Weicheng Qian
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alexander Doroshenko
- Faculty of Medicine and Dentistry, Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
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26
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Medić S, Katsilieris M, Lozanov-Crvenković Z, Siettos CI, Petrović V, Milošević V, Brkić S, Andrews N, Ubavić M, Anastassopoulou C. Varicella zoster virus transmission dynamics in Vojvodina, Serbia. PLoS One 2018; 13:e0193838. [PMID: 29505590 PMCID: PMC5837184 DOI: 10.1371/journal.pone.0193838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/19/2018] [Indexed: 01/29/2023] Open
Abstract
This study aimed at establishing baseline key epidemiological parameters for varicella zoster virus (VZV) infection in Vojvodina, Serbia, with the ultimate goal to quantify the VZV transmission potential in the population. Seroprevalence data generated during the first large cross-sectional VZV serosurvey were modelled, using a two-tiered modelling approach to calculate age-specific forces of infection (FOI), the basic reproduction number (R0) and herd immunity threshold (H). Seroprevalence and modelling data were compared with corresponding pre-vaccination epidemiological parameters from 11 countries participating in the European Sero-Epidemiology Network 2 (ESEN2) project. Serbia fits into the general dynamic VZV transmission patterns in Europe in the pre-vaccine era, with estimated R0 = 4.12, (95% CI: 2.69–7.07) and H = 0.76 (95% CI: 0.63–0.86). The highest VZV transmission occurs among preschool children, as evidenced by the estimation of the highest FOI (0.22, 95% CI: 0.11–0.34) in the 0.5–4 age group, with a peak FOI of 0.25 at 2.23 years. Seroprevalence was consistently lower in 5–14 year-olds, resulting in considerable shares of VZV-susceptible adolescents (7.3%), and young adults (6%), resembling the situation in a minority of European countries. The obtained key epidemiological parameters showed most intense VZV transmission in preschool children aged <4 years, justifying the consideration of universal childhood immunization in the future. National immunization strategy should consider programs for VZV serologic screening and immunization of susceptible groups, including adolescents and women of reproductive age. This work is an important milestone towards the evaluation of varicella immunization policy options in Serbia.
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Affiliation(s)
- Snežana Medić
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- * E-mail:
| | - Michalis Katsilieris
- School of Applied Mathematics and Physical Sciences, National Tehnical University of Athens, Athens, Greece
| | - Zagorka Lozanov-Crvenković
- Department of Mathematics and Computer Science, Faculty of Science, University of Novi Sad, Novi Sad, Serbia
| | - Constantinos I. Siettos
- School of Applied Mathematics and Physical Sciences, National Tehnical University of Athens, Athens, Greece
| | - Vladimir Petrović
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vesna Milošević
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Snežana Brkić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, National Infections Services, Public Health England, London, United Kingdom
| | | | - Cleo Anastassopoulou
- Division of Genetics, Cell and Developmental Biology, Department of Biology, University of Patras, Patras, Greece
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27
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Rieck T, Feig M, An der Heiden M, Siedler A, Wichmann O. Assessing varicella vaccine effectiveness and its influencing factors using health insurance claims data, Germany, 2006 to 2015. ACTA ACUST UNITED AC 2017; 22:30521. [PMID: 28488996 PMCID: PMC5434885 DOI: 10.2807/1560-7917.es.2017.22.17.30521] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
Abstract
In Germany, routine childhood varicella vaccination was implemented in 2004 with two doses recommended since 2009. We used an immunisation information system based on countrywide health insurance claims data to analyse vaccine effectiveness (VE) and factors influencing VE. We applied proportional hazard models to estimate VE under various conditions and compared the risk of acquiring varicella among unvaccinated children in regions with high vs low vaccination coverage (VC). Among 1.4 million children we identified 29,404 varicella cases over a maximum follow-up of 8 years post-vaccination. One-dose VE was 81.9% (95% confidence interval (CI): 81.4–82.5), two-dose VE 94.4% (95% CI: 94.2–94.6). With dose one given 1–27 days after measles-containing vaccine (MCV), one-dose VE was 32.2% (95% CI: 10.4–48.6), two-dose VE 92.8% (95% CI: 84.8–96.6). VE was not associated with age at vaccination (11–14 vs ≥ 15 months), time since vaccination, or vaccine type. Unvaccinated children had a twofold higher risk of acquiring varicella in low VC regions. Our system generated valuable data, showing that two-dose varicella vaccination provides good protection for at least 8 years. Unvaccinated children benefit from herd effects. When the first varicella vaccine dose is given shortly after MCV, a second dose is essential.
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Affiliation(s)
- Thorsten Rieck
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany.,Charité - University Medicine Berlin, Berlin, Germany
| | - Marcel Feig
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | | | - Anette Siedler
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Ole Wichmann
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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28
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Caution When Assessing Immunity to Varicella Through Antibody Testing in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis 2017; 23:E50-E51. [PMID: 28906295 DOI: 10.1097/mib.0000000000001239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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29
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Wutzler P, Bonanni P, Burgess M, Gershon A, Sáfadi MA, Casabona G. Varicella vaccination - the global experience. Expert Rev Vaccines 2017. [PMID: 28644696 DOI: 10.1080/14760584.2017.1343669] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Varicella, although a frequently benign childhood disease, nevertheless represents a considerable health burden. WHO recommends including varicella vaccines in universal routine vaccination programs, and maintaining coverage >80%. Many countries have successfully introduced varicella vaccination and have benefited from lower disease burden, but many others have not adopted the vaccine. Reasons include cost commitment for a 'mild childhood disease' or concerns that vaccination will shift varicella to older age groups or increase herpes zoster incidence. Areas covered: This literature review summarizes the effectiveness and epidemiological impact of varicella immunization programs. Expert commentary: Varicella vaccines are immunogenic with acceptable safety profiles. One and two dose schedules are highly effective against varicella and large reductions in disease incidence, particularly moderate-severe disease, have been widely reported. There is currently no evidence to suggest that the introduction of varicella vaccination results in a shift of varicella disease burden to older age groups. Although epidemiological studies have shown an increased incidence of herpes zoster since the vaccines were launched, there are many other contributing factors, and indeed, this secular trend was evident before their introduction. In conclusion, varicella vaccination easily fits into existing immunization programs and significantly reduces the often underestimated burden of varicella.
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Affiliation(s)
- Peter Wutzler
- a Institute of Virology and Antiviral Therapy , Friedrich Schiller University , Jena , Germany
| | - Paolo Bonanni
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Margaret Burgess
- c The Discipline of Paediatrics and Adolescent Health , University of Sydney , Sydney , Australia
| | - Anne Gershon
- d Division of Infectious Disease , Columbia University , New York , NY , USA
| | - Marco Aurélio Sáfadi
- e Department of Pediatrics , Santa Casa de Sao Paulo School of Medical Sciences , Sao Paulo , Brazil
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30
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Bonanni P, Grazzini M, Niccolai G, Paolini D, Varone O, Bartoloni A, Bartalesi F, Santini MG, Baretti S, Bonito C, Zini P, Mechi MT, Niccolini F, Magistri L, Pulci MB, Boccalini S, Bechini A. Recommended vaccinations for asplenic and hyposplenic adult patients. Hum Vaccin Immunother 2017; 13:359-368. [PMID: 27929751 PMCID: PMC5328222 DOI: 10.1080/21645515.2017.1264797] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Asplenic or hyposplenic (AH) individuals are particularly vulnerable to invasive infections caused by encapsulated bacteria. Such infections have often a sudden onset and a fulminant course. Infectious diseases (IDs) incidence in AH subjects can be reduced by preventive measures such as vaccination. The aim of our work is to provide updated recommendations on prevention of infectious diseases in AH adult patients, and to supply a useful and practical tool to healthcare workers for the management of these subjects, in hospital setting and in outpatients consultation. A systematic literature review on evidence based measures for the prevention of IDs in adult AH patients was performed in 2015. Updated recommendations on available vaccines were consequently provided. Vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b and influenza virus are strongly recommended and should be administered at least 2 weeks before surgery in elective cases or at least 2 weeks after the surgical intervention in emergency cases. In subjects without evidence of immunity, 2 doses of live attenuated vaccines against measles-mumps-rubella and varicella should be administered 4-8 weeks apart from each other; a booster dose of tetanus, diphtheria and pertussis vaccine should be administered also to subjects fully vaccinated, and a 3-dose primary vaccination series is recommended in AH subjects with unknown or incomplete vaccination series (as in healthy people). Evidence based prevention data support the above recommendations to reduce the risk of infection in AH individuals.
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Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Maddalena Grazzini
- Specialization Medical School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giuditta Niccolai
- Specialization Medical School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Diana Paolini
- Specialization Medical School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Ornella Varone
- Specialization Medical School of Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Italy and Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Bartalesi
- Department of Experimental and Clinical Medicine, University of Florence, Italy and Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Maria Grazia Santini
- Operative Unit of Hygiene and Public Health, Local Health Unit of Florence, Regional Health Service, Florence, Italy
| | - Simonetta Baretti
- Operative Unit of Hygiene and Public Health, Local Health Unit of Florence, Regional Health Service, Florence, Italy
| | - Carlo Bonito
- Operative Unit of Hygiene and Public Health, Local Health Unit of Florence, Regional Health Service, Florence, Italy
| | - Paola Zini
- Operative Unit of Hygiene and Public Health, Local Health Unit of Florence, Regional Health Service, Florence, Italy
| | - Maria Teresa Mechi
- Tuscany Region, Rights of Citizenship and Social Cohesion, Florence, Italy
| | | | - Lea Magistri
- Health Direction, Careggi University Hospital, Florence, Italy
| | | | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
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31
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García-Comas L, Ordobás Gavín M, Sanz Moreno JC, Ramos Blázquez B, Gutiérrez Rodríguez MA, Barranco Ordóñez D. Seroprevalencia de anticuerpos frente al virus de la varicela zóster tras la introducción reciente de la vacunación infantil universal en la Comunidad de Madrid. Enferm Infecc Microbiol Clin 2016; 34:633-638. [DOI: 10.1016/j.eimc.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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32
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Holl K, Sauboin C, Amodio E, Bonanni P, Gabutti G. Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy. BMC Public Health 2016; 16:1103. [PMID: 27769206 PMCID: PMC5073465 DOI: 10.1186/s12889-016-3738-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/30/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Varicella is a highly infectious disease with a significant public health and economic burden, which can be prevented with childhood routine varicella vaccination. Vaccination strategies differ by country. Some factors are known to play an important role (number of doses, coverage, dosing interval, efficacy and catch-up programmes), however, their relative impact on the reduction of varicella in the population remains unclear. This paper aims to help policy makers prioritise the critical factors to achieve the most successful vaccination programme with the available budget. METHODS Scenarios assessed the impact of different vaccination strategies on reduction of varicella disease in the population. A dynamic transmission model was used and adapted to fit Italian demographics and population mixing patterns. Inputs included coverage, number of doses, dosing intervals, first-dose efficacy and availability of catch-up programmes, based on strategies currently used or likely to be used in different countries. The time horizon was 30 years. RESULTS Both one- and two-dose routine varicella vaccination strategies prevented a comparable number of varicella cases with complications, but two-doses provided broader protection due to prevention of a higher number of milder varicella cases. A catch-up programme in susceptible adolescents aged 10-14 years old reduced varicella cases by 27-43 % in older children, which are often more severe than in younger children. Coverage, for all strategies, sustained at high levels achieved the largest reduction in varicella. In general, a 20 % increase in coverage resulted in a further 27-31 % reduction in varicella cases. When high coverage is reached, the impact of dosing interval and first-dose vaccine efficacy had a relatively lower impact on disease prevention in the population. Compared to the long (11 years) dosing interval, the short (5 months) and medium (5 years) interval schedules reduced varicella cases by a further 5-13 % and 2-5 %, respectively. Similarly, a 10 % increase in first-dose efficacy (from 65 to 75 % efficacy) prevented 2-5 % more varicella cases, suggesting it is the least influential factor when considering routine varicella vaccination. CONCLUSIONS Vaccination strategies can be implemented differently in each country depending on their needs, infrastructure and healthcare budget. However, ensuring high coverage remains the critical success factor for significant prevention of varicella when introducing varicella vaccination in the national immunisation programme.
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Affiliation(s)
| | | | - Emanuele Amodio
- University of Palermo, Via Del Vespro 133, 90127, Palermo, Italy.,Present Address: Unit of Epidemiology, ATS Brianza, Viale Elvezia 2, 20900, Monza, Italy
| | - Paolo Bonanni
- University of Florence, Viale GB Morgagni, 48, 50134, Florence, Italy
| | - Giovanni Gabutti
- University of Ferrara, Via Fossato di Mortara 64b, 44121, Ferrara, Italy
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De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World J Virol 2016; 5:97-124. [PMID: 27563537 PMCID: PMC4981827 DOI: 10.5501/wjv.v5.i3.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/08/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.
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Choi UY, Huh DH, Kim JH, Kang JH. Seropositivity of Varicella zoster virus in vaccinated Korean children and MAV vaccine group. Hum Vaccin Immunother 2016; 12:2560-2564. [PMID: 27484734 DOI: 10.1080/21645515.2016.1190056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In 2005, a single-dose varicella vaccination was incorporated into the national immunization program in Korea. Although the Oka strain is the most commonly circulating Varicella zoster virus (VZV) genotype in Korea, a domestically manufactured vaccine based on the MAV strain is widely distributed in Korea. High vaccination coverage was achieved, but breakthrough infections were frequently reported. Therefore, in this study, we aimed to analyze the maintenance of immunity after single-dose vaccination and to compare the immunity provided by the MAV and Oka vaccines. Enzyme-linked immunosorbent assays of samples from 715 vaccinated Korean children were used to assess seropositivity rates against VZV. Additionally, fluorescent-antibody-to-membrane-antigen (FAMA) tests were performed in 35 individuals in the MAV vaccine group, and seropositivity rates against the Oka strain were determined. The progressive decrease of the seropositivity rate was demonstrated from ages 1 to 4 as follows: 65% in age 1, 59% in age 2, 53% in age 3, 49% in age 4. It then increased to 62% in age 5 and 70% in age 6. Both the MAV and Oka vaccine groups showed a progressive decrease of the seropositivity rate from the age of 1 to 4 years, but the MAV vaccine group had higher seropositivity rates. In FAMA test, the MAV group demonstrated 71% seropositivity against the Oka strain. This study indicates that immunity wanes after single-dose varicella vaccination and that the MAV vaccine is not inferior to the Oka vaccine in providing immunity against VZV. The MAV vaccine also induced cross-immunity against circulating Oka strain.
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Affiliation(s)
- Ui Yoon Choi
- a Pediatrics, College of Medicine, The Catholic University of Korea , Dongdaemungu, Seoul , Republic of Korea
| | - Dong Ho Huh
- b The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Jong Hyun Kim
- c The Catholic University of Korea, St. Vincent's Hospital , Gyeonggi-do, Gyeonggi-do , Republic of Korea
| | - Jin Han Kang
- d Department of Pediatrics , College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea , Seoul , Republic of Korea
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Deng X, Xu W, Yan R, Chen H, Shen W, Zhang M, Wu T, Xu B, He H, Ma Y. Immunogenicity and safety of different schedules of 2-dose varicella vaccination in China. Hum Vaccin Immunother 2016; 12:3113-3117. [PMID: 27455445 DOI: 10.1080/21645515.2016.1212795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We evaluated the safety and immunogenicity of different time intervals for a second dose of varicella vaccine in children in Zhejiang Province, China. Participants had all received a first dose of varicella vaccine and were assigned to 4 groups according to age (2-7 years). A second dose of live attenuated varicella vaccine was administered 1 month, 1 year, 3 years, or 5 years after the first. A serology assay was conducted and fluorescent-antibody-to-membrane-antigen test performed to measure the antibody titers against varicella before and approximately 30 days after the second dose. Of 1,078 participants, most tolerated the second dose well. Age at first dose did not affect the response to vaccination. Geometric mean titers (GMTs) significantly differed between group 1 and all other groups, both before and after the second vaccination. The GMT for group 1 was higher than those for the other 3 groups prior to the second vaccination (GMT = 20.52, 14.68, 12.49, 12.29, respectively, p < 0.001 for all), while the opposite was true after the second vaccination (GMT = 51.14, 83.37, 85.01, 81.83, respectively, p < 0.001 for all). There was no significant difference in seropositive rate among the 4 groups prior to the second vaccination (p = 0.093), and these rates were all 100% after the second vaccination. The vaccine was well tolerated in healthy children, regardless of the timing of the second dose. GMTs showed a particularly high boost after the second dose when the interval between doses was more than 1 year.
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Affiliation(s)
- Xuan Deng
- a Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , PR China
| | - Wenqing Xu
- b Shanghai Institute of Biological Products Company , Shanghai , PR China
| | - Rui Yan
- a Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , PR China
| | - Haiping Chen
- c China National Pharmaceutical Group Corporation , Beijing , PR China
| | - Wei Shen
- b Shanghai Institute of Biological Products Company , Shanghai , PR China
| | - Min Zhang
- c China National Pharmaceutical Group Corporation , Beijing , PR China
| | - Tengjie Wu
- b Shanghai Institute of Biological Products Company , Shanghai , PR China
| | - Bin Xu
- c China National Pharmaceutical Group Corporation , Beijing , PR China
| | - Hanqing He
- a Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , PR China
| | - Yanli Ma
- c China National Pharmaceutical Group Corporation , Beijing , PR China
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Siedler A, Rieck T, Tolksdorf K. Strong Additional Effect of a Second Varicella Vaccine Dose in Children in Germany, 2009-2014. J Pediatr 2016; 173:202-206.e2. [PMID: 26995703 DOI: 10.1016/j.jpeds.2016.02.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Vaccine effectiveness (VE) of 1 and 2 varicella vaccine doses in children aged 1-4 years in Germany was evaluated to determine the additional effect of a second dose recommended at least 4 weeks after the first dose and before the second birthday. STUDY DESIGN To estimate the VE, the proportion of cases vaccinated was compared with the proportion of the population vaccinated using nationwide sentinel surveillance data from 2009-2014 and health insurance claims data covering the period January 2009-March 2014, respectively. A general linear model was used to estimate the OR of vaccination in the cases and the population and the corresponding CIs to observe the stability of the VE estimates over time, and to assess the incremental effectiveness of a second dose. RESULTS The overall VE after 1 dose was 86.6% (95% CI: 85.2-87.9), ranging between 94.6% (95% CI: 87.9-97.6) in the first quarter of 2011 and 50.3% (95% CI: 7.3-73.4) in the third quarter of 2013. The overall VE after 2 doses was 97.3% (95% CI: 97.0-97.6), ranging between 99.5% (95% CI: 97.8-99.9) in the second quarter of 2009 and 91.3% (95% CI: 85.7-94.8) in the third quarter of 2013. The incremental VE of 2 doses was 84.6% (95% CI: 81.7-86.9). CONCLUSIONS The substantially higher VE of 2 varicella vaccine doses compared with 1 dose in young children and the strong additional effect of the second dose support the public health relevance of a 2-dose schedule and the success of the early second vaccine dose.
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Affiliation(s)
| | - Thorsten Rieck
- Robert Koch Institute, Berlin, Germany; Charité-University Medicine Berlin, Berlin, Germany
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37
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Immunization practices in solid organ transplant recipients. Vaccine 2016; 34:1958-64. [DOI: 10.1016/j.vaccine.2016.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/25/2015] [Accepted: 01/14/2016] [Indexed: 01/26/2023]
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Yoshikawa T, Kawamura Y, Ohashi M. Universal varicella vaccine immunization in Japan. Vaccine 2016; 34:1965-70. [DOI: 10.1016/j.vaccine.2016.02.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/10/2015] [Accepted: 12/10/2015] [Indexed: 01/31/2023]
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Nicolai R, Cortis E, Ravà L, Bracaglia C, Pardeo M, Insalaco A, Buonuomo PS, Tozzi AE, De Benedetti F. Herpes Virus Infections During Treatment With Etanercept in Juvenile Idiopathic Arthritis. J Pediatric Infect Dis Soc 2016; 5:76-9. [PMID: 26908493 DOI: 10.1093/jpids/piu078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/18/2014] [Indexed: 11/14/2022]
Abstract
Incidence rates for varicella and herpes zoster were similar in patients with juvenile idiopathic arthritis receiving etanercept/methotrexate (n = 85, 184.9 patient-years [PY]) or methotrexate alone (n = 71, 199.4 PY); no complicated varicella or herpes zoster cases were reported; herpes labialis incidence was higher in patients receiving etanercept/methotrexate versus methotrexate alone (0.38 vs. 0.24 PY).
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Affiliation(s)
| | - E Cortis
- Division of Pediatrics, Ospedale Santa Maria della Stella, Orvieto, Italy
| | - L Ravà
- Division of Epidemiology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | | | | | - P S Buonuomo
- Division of Rare Diseases, Department of Pediatric Medicine
| | - A E Tozzi
- Division of Epidemiology, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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40
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Children with breakthrough varicella infection requiring hospitalization in Turkey (VARICOMP Study 2008–2013). Vaccine 2015; 33:3983-7. [DOI: 10.1016/j.vaccine.2015.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 11/24/2022]
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41
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Baxter R. Impact of vaccination on the epidemiology of varicella. Transl Pediatr 2015; 4:63-4. [PMID: 26835362 PMCID: PMC4729062 DOI: 10.3978/j.issn.2224-4336.2014.12.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, California, USA
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42
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Thomas CA, Shwe T, Bixler D, del Rosario M, Grytdal S, Wang C, Haddy LE, Bialek SR. Two-dose varicella vaccine effectiveness and rash severity in outbreaks of varicella among public school students. Pediatr Infect Dis J 2014; 33:1164-8. [PMID: 24911894 PMCID: PMC4673889 DOI: 10.1097/inf.0000000000000444] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Universal 2-dose varicella vaccination was recommended in 2006 to further reduce varicella disease burden. This study examined 2-dose varicella vaccine effectiveness (VE) and rash severity in the setting of school-associated varicella outbreaks. METHODS A case control study was conducted from January 2010 to May 2011 in all West Virginia public schools. Clinically diagnosed cases from varicella outbreaks were matched with classmate controls. Vaccination information was collected from school, health department and healthcare provider immunization information systems. RESULTS Among the 133 cases and 365 controls enrolled, VE against all varicella was 83.2% [95% confidence interval (CI): 69.2%-90.8%] for 1-dose of varicella vaccine and 93.9% (95% CI: 86.9%-97.1%) for 2-dose; the incremental VE (2-dose vs. 1-dose) was 63.6% (95% CI: 32.6%-80.3%). In preventing moderate/severe varicella, 1-dose varicella vaccine was 88.2% (95% CI: 72.7%- 94.9%) effective, and 2-dose vaccination was 97.5% (95% CI: 91.6%-99.2%) effective, with the incremental VE of 78.6% (95% CI: 40.9%-92.3%). One-dose VE declined along with time since vaccination (VE = 93.0%, 88.0% and 81.8% in <5, 5-9 and ≥ 10 years after vaccination, P = 0.001 for trend). Both 1- and 2-dose breakthrough cases had milder rash than unvaccinated cases (<50 lesion: 24.6%, 49.1% and 70.0% in unvaccinated, 1-dose and 2-dose cases, P < 0.001), and no severe disease was found in 2-dose cases. CONCLUSIONS Two-dose varicella vaccination is highly effective and confers higher protection than a 1-dose regimen. High 2-dose varicella vaccination coverage should maximize the benefits of the varicella vaccination program and further reduce varicella disease burden in the United States.
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Affiliation(s)
- Carrie A. Thomas
- West Virginia Department of Health and Human Resources, Charleston, WV
| | - Thein Shwe
- West Virginia Department of Health and Human Resources, Charleston, WV
| | - Dee Bixler
- West Virginia Department of Health and Human Resources, Charleston, WV
| | - Maria del Rosario
- West Virginia Department of Health and Human Resources, Charleston, WV
| | - Scott Grytdal
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Chengbin Wang
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Loretta E. Haddy
- West Virginia Department of Health and Human Resources, Charleston, WV
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Bechini A, Boccalini S, Baldo V, Cocchio S, Castiglia P, Gallo T, Giuffrida S, Locuratolo F, Tafuri S, Martinelli D, Prato R, Amodio E, Vitale F, Bonanni P. Impact of universal vaccination against varicella in Italy. Hum Vaccin Immunother 2014; 11:63-71. [PMID: 25483517 PMCID: PMC4514224 DOI: 10.4161/hv.34311] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Italy, the introduction of Universal Varicella Vaccination (UVV) has been decided but postponed, as a national programme, until 2015, when data from Regions which have already implemented it will be available. Starting from 2003, eight Italian Regions (Basilicata, Calabria, Friuli Venezia Giulia, Apulia, Sardinia, Sicily, Tuscany and Veneto) have progressively introduced UVV, in their immunization programme, with different schedules in children aged 13-15 months and 5-6 years, currently a two-dose schedule is adopted by all Regions. In June 2013, an Interregional Group on Varicella Vaccination (IGVV) has been established in order to assess the effectiveness of varicella vaccination with standardized and shared tools. The aim of this study was to evaluate the impact of varicella vaccination on the incidence and hospitalizations due to varicella and its complications in the period 2003-2012 in order to support the Italian decision makers on the future national adoption. Preliminary data showed that a general reduction of incidence and hospitalization rates was observed in the study period, resulting in relevant savings for the National Health Service. Immunization coverage with first dose at 24 months of age was high in all Regions (84%-95%) in 2012. Adverse events due to varicella vaccines were rare and without permanent sequelae. Underreporting of varicella cases and delays in the administration of the first dose of varicella vaccines were the main critical issues. In conclusion, solid evidences in support of universal UVV arise from the experiences available today in Italy.
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Affiliation(s)
- Angela Bechini
- a Department of Health Sciences; University of Florence; Florence, Italy
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Papaloukas O, Giannouli G, Papaevangelou V. Successes and challenges in varicella vaccine. THERAPEUTIC ADVANCES IN VACCINES 2014; 2:39-55. [PMID: 24757524 DOI: 10.1177/2051013613515621] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Varicella is a highly contagious disease caused by primary infection with varicella zoster virus (VZV). VZV infection, as well as varicella vaccination, induces VZV-specific antibody and T-cell-mediated immunity, essential for recovery. The immune responses developed contribute to protection following re-exposure to VZV. When cell-mediated immunity declines, as occurs with aging or immunosuppression, reactivation of VZV leads to herpes zoster (HZ). It has been almost 20 years since universal varicella vaccination has been implemented in many areas around the globe and this has resulted in a significant reduction of varicella-associated disease burden. Successes are reviewed here, whilst emphasis is put on the challenges ahead. Most countries that have not implemented routine childhood varicella vaccination have chosen to vaccinate high-risk groups alone. The main reasons for not introducing universal vaccination are discussed, including fear of age shift of peak incidence age and of HZ incidence increase. Possible reasons for not observing the predicted increase in HZ incidence are explored. The advantages and disadvantages of universal vs targeted vaccination as well as different vaccination schedules are discussed.
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Affiliation(s)
- Orestis Papaloukas
- Second Department of Pediatrics, University of Athens Medical School, P&A Kyriakou Childrens' Hospital, Greece
| | - Georgia Giannouli
- Second Department of Pediatrics, University of Athens Medical School, P&A Kyriakou Childrens' Hospital, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, University of Athens Medical School, General University Hospital 'ATTIKON', Rimini 1, Chaidari 124 62, Greece
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Tafuri S, Guerra R, Cappelli MG, Martinelli D, Prato R, Germinario C. Determinants of varicella breakthrough: results of a 2012 case control study. Hum Vaccin Immunother 2014; 10:667-70. [PMID: 24398423 DOI: 10.4161/hv.27382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study aims to evaluate the determinants of breakthrough infection after one dose of varicella vaccine. We designed a retrospective case-control study. Breakthrough cases were children, aged 1-15, who presented varicella symptoms ≥ 42 days after the first dose of varicella vaccine (breakthrough). Controls were children, aged 1-15 years, who attended the same class (in a school or in a kindergarten) than the cases in the year of the breakthrough onset; they received a dose of varicella vaccine ≥ 42 days before the case rash onset and they did not develop varicella symptoms. We enrolled 45 cases and 135 controls. 40% of cases (n = 18; 95% CI = 25.4-54.6) presented at least one risk factor; this proportion was 39.2% (95% CI = 30.9-47.6) among the controls (chi-square = 0.0078; P = 0.93). Time between vaccination and virus exposure was longer among cases. Logistic regression showed that breakthrough disease was associated with duration of time from vaccination.
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Affiliation(s)
- Silvio Tafuri
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
| | - Rocco Guerra
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
| | - Maria Giovanna Cappelli
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
| | - Domenico Martinelli
- Department of Medical and Surgical Science; University of Foggia; Foggia, Italy
| | - Rosa Prato
- Department of Medical and Surgical Science; University of Foggia; Foggia, Italy
| | - Cinzia Germinario
- Department of Biomedical Science and Human Oncology; Aldo Moro University of Bari; Bari, Italy
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Moreno-Pérez D, Álvarez García F, Arístegui Fernández J, Cilleruelo Ortega M, Corretger Rauet J, García Sánchez N, Hernández Merino A, Hernández-Sampelayo Matos T, Merino Moína M, Ortigosa del Castillo L, Ruiz-Contreras J. Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2014. An Pediatr (Barc) 2014; 80:55.e1-55.e37. [DOI: 10.1016/j.anpedi.2013.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 01/29/2023] Open
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