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Guo S, Guo Q, Wan C. An analysis of risk factors for visceral disseminated varicella in children. Front Pediatr 2024; 12:1345272. [PMID: 38873587 PMCID: PMC11172141 DOI: 10.3389/fped.2024.1345272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/09/2024] [Indexed: 06/15/2024] Open
Abstract
Background Visceral disseminated varicella involves the internal organs, and complications such as encephalitis, hepatitis, and coagulation disorders threaten a patient's life. In this study, our aim is to analyze the risk factors for visceral disseminated varicella to enable the early identification of patients at a high risk of visceral disseminated varicella. Methods We reviewed the medical records of children hospitalized with varicella. The data covered demographics, clinical manifestations, auxiliary examinations, treatments, and outcomes. Logistic regression was used to analyze the risk factors. Results A multivariate logistic regression analysis showed that abdominal pain [odds ratio (OR) 20.451, 95% CI 1.637-255.548], increased levels of C-reactive protein (OR 12.794, 95% CI 1.820-89.937), increased levels of alanine aminotransferase (OR 7.453, 95% CI 1.624-34.206), and the time between onset and antiviral therapy of more than 7 days (OR 12.451, 95% CI 1.569-98.810) were independent risk factors for visceral disseminated varicella. Conclusions Patients with varicella who have the abovementioned risk factors need to be monitored for the risk of developing visceral disseminated varicella, for which timely antiviral therapy is necessary.
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Affiliation(s)
- Shuai Guo
- Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
- National Health Commission Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Qin Guo
- Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
- National Health Commission Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China
- National Health Commission Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
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Kujawski SA, Casey CS, Haas H, Patel A, Diomatari C, Holbrook T, Pawaskar M. Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France. Pediatr Infect Dis J 2024; 43:393-399. [PMID: 38456715 PMCID: PMC10919277 DOI: 10.1097/inf.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. METHODS A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. RESULTS Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. CONCLUSION This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.
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Affiliation(s)
- Stephanie A. Kujawski
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Hervé Haas
- Department of Pediatrics and Neonatalogy, Centre Hospitalier Princesse Grace, Monaco
| | | | | | | | - Manjiri Pawaskar
- From the Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, New Jersey
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Fortunato F, Musco A, Iannelli G, Meola M, Luigi Lopalco P, Martinelli D. Effectiveness of the combined MMRV Priorix-Tetra™ vaccine against varicella in a large Italian region: A case-control study. Vaccine 2024; 42:1608-1616. [PMID: 38341290 DOI: 10.1016/j.vaccine.2024.02.002] [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: 12/07/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Priorix-Tetra™ (MMRV GlaxoSmithKline Biologicals' vaccine) was developed based on the existing measles-mumps-rubella and varicella vaccines. In this study, we aimed to estimate the effectiveness of the combined measles-mumps-rubella-varicella Priorix-Tetra™ vaccine against varicella in real-world conditions. We conducted a post-marketing retrospective case-control study in the Apulia region of Italy in children aged 1-9 years born between January 1, 2008 and December 31, 2016. We assessed the effectiveness against varicella of all grades of severity (including hospitalisation) and against hospitalisation for varicella of a single and two doses of Priorix-Tetra™. Moreover, we also assessed effectiveness of monovalent varicella (monovalent-V) vaccine and any varicella vaccines. Vaccine effectiveness was calculated as (1-OR) x 100. We introduced demographic variables in the model to adjust Vaccine effectiveness (aVE) by potential confounders (sex and year of birth). We recorded 625 varicella cases and matched them with 1,875 controls. Among 625 cases, 198 had received a single MMRV dose, 10 two MMRV doses, 46 a single monovalent-V dose, none two monovalent-V doses; four a monovalent-V as first dose and MMRV as second dose, and one a MMRV as first dose and monovalent-V as second dose; 366 cases were not vaccinated. The aVE against varicella of all grades of severity was 77.0% and 93.0% after a single dose and after two doses of MMRV, respectively. The aVE against varicella of all grades was 72.0% after a single dose of monovalent-V vaccine. The aVE against varicella of all grades of severity was 76.0% after a single dose and 94.0% after two doses of any varicella vaccine. The aVE against varicella hospitalisation was 96% after a single dose of any varicella vaccine. Priorix-Tetra™ showed to be an effective vaccine and the two-dose schedule should be recommended to optimise immunisation programmes. A single dose was able to provide protection against varicella hospitalisation.
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Affiliation(s)
- Francesca Fortunato
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Angelo Musco
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppina Iannelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Martina Meola
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Domenico Martinelli
- Hygiene Unit, Policlinico Foggia Hospital, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
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Chokephaibulkit K, Samant S, Chaisavaneeyakorn S, Kamolratanakul S, Limpadanai S, Kebede N, Stephens J, Sukarom I, Pawaskar M. Antimicrobial use for the management of varicella in Thailand: a retrospective observational study. Curr Med Res Opin 2023; 39:873-880. [PMID: 37057414 DOI: 10.1080/03007995.2023.2200123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To describe the clinical characteristics of varicella patients seeking medical consultation and the use of antimicrobials for their management in Thailand in the absence of universal varicella vaccination (UVV). METHODS A multicenter, retrospective chart review of 260 children and adults with a primary diagnosis of varicella was conducted at one private and three public hospitals in Bangkok, Thailand. Charts of varicella patients (inpatient or outpatient) were randomly selected over a 5-year period. Key outcomes included clinical complications and the use of antibiotics, antivirals, and other medications. RESULTS Charts of 200 children (mean age 5.7 years, range 0.3-16 years) and 60 adults (mean age 27.9 years, range 18-50 years) were reviewed. Fourteen patients (including 8 children) were hospitalized. Five percent of the children and none of the adults were immunocompromised. At least 1 varicella-related complication was reported by 7.3% (7% of children, 8.3% of adults, p = .778) of all patients, including 57.1% (62.5% of children, 50% of adults) of inpatients (p < .001, compared with outpatients). Skin/soft tissue infection (47.7%) and dehydration (47.4%) were the most common complications. Antivirals (mainly oral acyclovir) were prescribed to 46.5% of patients (31.5% of children, 96.7% of adults, p < .001). Antibiotics were prescribed to 20.8% of patients (19% of children, 26.7% of adults, p = .199). Topical, oral, and intravenous antibiotics were prescribed to 12.3%, 8.5%, and 1.2% of patients, respectively. Antimicrobial prescriptions were higher among adults (p < .001) and immunocompromised patients (p = .025). Apart from antimicrobials, acetaminophen (62.3%) and oral antihistamines (51.5%) were the most prescribed. CONCLUSION A considerable number of varicella patients, both children and adults, seeking medical consultation in Thai hospitals are prescribed antibiotics and antivirals, with one-fifth of patients being prescribed an antibiotic and almost half prescribed an antiviral. The study may be of interest to policymakers in Thailand and other Asia-Pacific countries considering UVV implementation.
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Bozzola E, Marchesani S, Ficari A, Brusco C, Spina G, Marchili MR, Guolo S. Assessing the use of antibiotics in pediatric patients hospitalized for varicella. Ital J Pediatr 2022; 48:196. [PMID: 36503563 PMCID: PMC9743721 DOI: 10.1186/s13052-022-01393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella. METHODS Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1st of November 2005 to the 1st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered. RESULTS According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures. CONCLUSION Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
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Affiliation(s)
- Elena Bozzola
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Silvio Marchesani
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Ficari
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carla Brusco
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Spina
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Guolo
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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Shu M, Zhang D, Ma R, Yang T, Pan X. Long-term vaccine efficacy of a 2-dose varicella vaccine in China from 2011 to 2021: A retrospective observational study. Front Public Health 2022; 10:1039537. [PMID: 36424959 PMCID: PMC9679788 DOI: 10.3389/fpubh.2022.1039537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
Objective A 2-dose varicella vaccine immunization strategy has been implemented in many cities in China, but there is few evidence on a long-term evaluation of the efficacy of the 2-dose varicella vaccine from China. This study aims to assess the long-term vaccine efficacy of the two doses varicella vaccine and analysis of its influencing factors. Methods A retrospective study was carried out in 837,144 children born between 2011 and 2017 in Ningbo, Easten China. The logistic regression was performed to estimate varicella vaccine effectiveness (VE). Results The overall VE of 2 doses of varicella vaccine compared without the vaccine was 90.31% (89.24-91.26%), and the overall incremental VE of 2 doses of varicella vaccine compared to the 1-dose was 64.71% (59.92-68.93%). Moreover, the varicella vaccination age of the second dose and the interval between 2 doses were both associated with VE. The VE compared to that without the vaccine in children vaccinated at <4 years old was 91.22% (95%CI: 90.16-92.17%) which was higher than in children vaccinated at ≥4 years old (VE: 86.79%; 95%CI: 84.52-88.73). And the effectiveness of the vaccine was 93.60% (95%CI: 92.19-94.75%) in children with the interval of the 2 doses ≤ 24 months significantly higher than in children with the interval of ≥36 months (VE: 85.62%, 95%CI: 82.89-87.91%). Conclusions This study provides evidence for long-term VE of the 2-dose varicella vaccine and the better age for 2-dose vaccination and the interval between 2 doses of the vaccine in China.
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Affiliation(s)
- Mingming Shu
- Ningbo Women and Children's Hospital, Ningbo, China
| | - Dandan Zhang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Rui Ma
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Tianchi Yang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Xingqiang Pan
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China,*Correspondence: Xingqiang Pan
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Liu X, Li Q, Du X, Zhao X, Yin Z. Vaccine Coverage and Effectiveness in a School-Based Varicella Outbreak in Jinan Prefecture, Shandong Province. Vaccines (Basel) 2022; 10:vaccines10081225. [PMID: 36016113 PMCID: PMC9416244 DOI: 10.3390/vaccines10081225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Licheng District of Jinan Prefecture reported a school-based varicella outbreak. We conducted an investigation to analyze the epidemiology and scope of the outbreak, determine varicella vaccine coverage on the school campus, and estimate varicella vaccine effectiveness (VE). Methods: In the epidemiological investigation, we determined the attack rate, the clinical manifestations of varicella cases, and histories of prior varicella disease and varicella vaccination. We tested students for presence of serum IgM antibodies, and we attempted to isolate the varicella virus from vesicular fluid samples. We used chi-square to compare incidences between classes and floors. VE was estimated using a retrospective cohort study. Results: There were 13 varicella cases in the outbreak. All were among fourth grade students - twelve in Class 7 and one in Class 6. The attack rate in the two classrooms was 14.3% (13/91). Clinical symptoms were rash (100%) and fever (46.15%). All cases were reported within one average incubation period, and the epidemic curve suggested common exposure. Six of the 13 cases previously received one dose of varicella vaccine with a median time between vaccination and infection of 9 years; the other seven cases had not been vaccinated. Varicella vaccine coverage with one or more doses was 81.31%; 2-dose coverage was 38.15%. The median age of receipt of dose 1 was 1.18 years, and median age for receiving dose 2 was 5.12 years. One-dose varicella VE was 73.2% (95% confidence interval: 37.0%, 88.6%), and two-dose VE was 100%. Conclusions: Varicella vaccine coverage has been gradually increasing in recent years, as ≥1-dose and 2-dose coverage rates are higher in younger children than older children. High one-dose vaccination coverage limited the outbreak scope and led to the breakthrough cases being mild. Mild cases were difficult to detect in a timely manner. Varicella vaccine was highly effective, with 1-dose VE of 73% nine years after vaccination and 2-dose VE of 100%. We strongly recommended that all school students receive two doses of varicella vaccine.
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Affiliation(s)
- Xiaoxue Liu
- Jinan Municipal Center for Disease Control and Prevention, No.2 Weiliu Road, Huaiyin District, Jinan 250021, China;
| | - Quanxia Li
- Licheng District Center for Disease Control and Prevention, Licheng District, Jinan 250199, China; (Q.L.); (X.D.)
| | - Xu Du
- Licheng District Center for Disease Control and Prevention, Licheng District, Jinan 250199, China; (Q.L.); (X.D.)
| | - Xiaodong Zhao
- Jinan Municipal Center for Disease Control and Prevention, No.2 Weiliu Road, Huaiyin District, Jinan 250021, China;
- Correspondence: (X.Z.); (Z.Y.)
| | - Zundong Yin
- Chinese Center for Disease Control and Prevention, No.27 Nanwei Road, Xicheng District, Beijing 100050, China
- Correspondence: (X.Z.); (Z.Y.)
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Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2021; 11:CD004407. [PMID: 34806766 PMCID: PMC8607336 DOI: 10.1002/14651858.cd004407.pub5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella, using a vaccine with the BRD2 strain which is only used in China, is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS: Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
| | - Alessandro Rivetti
- Dipartimento di Prevenzione - S.Pre.S.A.L, ASL CN2 Alba Bra, Alba, Italy
| | - Pasquale Marchione
- Signal Management Unit, Post-Marketing Surveillance Department, Italian Medicine Agency - AIFA, Rome, Italy
| | | | - Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
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Vandenhaute J, Tsakeu E, Chevalier P, Pawaskar M, Benčina G, Vertriest J. Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis. BMC Infect Dis 2021; 21:1150. [PMID: 34758734 PMCID: PMC8582146 DOI: 10.1186/s12879-021-06848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Varicella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur. Objectives The objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits. Methods The study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period. Results 3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP. Conclusions This study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06848-4.
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Affiliation(s)
| | | | | | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - Jan Vertriest
- MSD, Clos du Lynx 5, Sint-Lambrechts-Woluwe, 1200, Brussels, Belgium
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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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11
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Kauffmann F, Bechini A, Bonanni P, Casabona G, Wutzler P. Varicella vaccination in Italy and Germany – different routes to success: a systematic review. Expert Rev Vaccines 2020; 19:843-869. [DOI: 10.1080/14760584.2020.1825947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Peter Wutzler
- Section of Experimental Virology, Institute of Medical Microbiology, University-Hospital Jena, Germany
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12
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Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2020; 4:CD004407. [PMID: 32309885 PMCID: PMC7169657 DOI: 10.1002/14651858.cd004407.pub4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
| | - Alessandro Rivetti
- ASL CN2 Alba Bra, Dipartimento di Prevenzione - S.Pre.S.A.L, Via Vida 10, Alba, Piemonte, Italy, 12051
| | - Pasquale Marchione
- Italian Medicine Agency - AIFA, Signal Management Unit, Post-Marketing Surveillance Department, Via del Tritone 181, Rome, Italy, 00187
| | | | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
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13
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Lee YH, Choe YJ, Cho SI, Park H, Bang JH, Lee JK. Effects of One-dose Varicella Vaccination on Disease Severity in Children during Outbreaks in Seoul, Korea. J Korean Med Sci 2019; 34:e83. [PMID: 30886550 PMCID: PMC6417997 DOI: 10.3346/jkms.2019.34.e83] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In Korea, the incidence of varicella has increased despite the introduction of a universal one-dose vaccination for children aged 12-15 months in 2005. A previous study demonstrated that the vaccine effectiveness was insufficient to prevent against varicella. We assessed the effect of the varicella vaccination on disease severity. METHODS Epidemiologic investigation of varicella cases in Seoul metropolitan area from 2015 to 2017 were used. Varicella-related symptoms such as rash were determined by the clinical practitioners. Disease severity of patients was assessed by the number of skin lesions and divided into mild (≤ 50) and moderate (51-249) to severe (≥ 250). Unconditional logistic regression analysis was performed and age was controlled. RESULTS Among a total of 1,008 varicella cases reported, 869 cases were breakthrough cases and 139 were unvaccinated cases. The risk for occurrence of moderate-to-severe disease in the breakthrough group was 0.57 times less than that of the unvaccinated group. CONCLUSION These data suggest that national varicella vaccination may have a significant effect on attenuation of disease severity in children.
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Affiliation(s)
- Young Hwa Lee
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
- Institute of Infectious Disease, Seoul National University College of Medicine, Seoul, 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 Graduate School of Public Health, Seoul, Korea
- Institute of Infectious Disease, Seoul National University College of Medicine, Seoul, Korea
| | - HyeKyung Park
- Division of Infectious Disease Surveillance, Center for Control of Infectious Diseases, KCDC, Osong, Korea
| | - Ji Hwan Bang
- Institute of Infectious Disease, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jong-koo Lee
- Institute of Infectious Disease, Seoul National University College of Medicine, Seoul, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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14
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Abstract
Varicella is a common vaccine-preventable disease that usually presents as a mild disorder but can lead to severe complications. Before the implementation of universal varicella vaccination (UVV) in some European countries, the burden of varicella disease was broadly similar across the region. Despite this, countries adopted heterogeneous varicella vaccination strategies. UVV is currently recommended in 12 European countries. Known barriers to UVV implementation in Europe include (1) a perceived low disease burden and low public health priority; (2) cost-effectiveness and funding availability; (3) concerns related to a shift in varicella disease and incidence of herpes zoster and (4) safety concerns related to measles, mumps, rubella and varicella-associated febrile seizures after the first dose. Countries that implemented UVV experienced decreases in varicella incidence, hospitalizations and complications, showing overall beneficial impact. Alternative strategies targeting susceptible individuals at higher risk of complications have been less effective. This article discusses ways to overcome the barriers to move varicella forward as a truly vaccine preventable disease.
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15
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Varela FH, Pinto LA, Scotta MC. Global impact of varicella vaccination programs. Hum Vaccin Immunother 2018; 15:645-657. [PMID: 30427766 PMCID: PMC6605725 DOI: 10.1080/21645515.2018.1546525] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/12/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022] Open
Abstract
Although varicella is usually a mild and self-limited disease, complications can occur. In 1998, the World Health Organization recommended varicella vaccination for countries where the disease has a significant public health burden. Nonetheless, concerns about a shift in the disease to older groups, an increase in herpes zoster in the elderly and cost-effectiveness led many countries to postpone universal varicella vaccine introduction. In this review, we summarize the accumulating evidence, available mostly from high and middle-income countries supporting a high impact of universal vaccination in reductions of the incidence of the disease and hospitalizations and its cost-effectiveness. We have also observed the effect of herd immunity and noted that there is no definitive and consistent association between vaccination and the increase in herpes zoster incidence in the elderly.
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Affiliation(s)
- Fernanda Hammes Varela
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul state, Brazil
| | - Leonardo Araújo Pinto
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul state, Brazil
| | - Marcelo Comerlato Scotta
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul state, Brazil
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Latasa P, Gil de Miguel A, Barranco Ordoñez MD, Rodero Garduño I, Sanz Moreno JC, Ordobás Gavín M, Esteban Vasallo M, Garrido-Estepa M, García-Comas L. Effectiveness and impact of a single-dose vaccine against chickenpox in the community of Madrid between 2001 and 2015. Hum Vaccin Immunother 2018; 14:2274-2280. [PMID: 29771626 DOI: 10.1080/21645515.2018.1475813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Chickenpox is a contagious airborne disease. Immunization by varicella vaccine is an effective preventive measure. The objective of this study is to evaluate the impact and effectiveness of a single-dose vaccination against chickenpox at 15 months of age. METHODS Observational study based on data from the Epidemiological Surveillance System of the Autonomous Community of Madrid from 2001 to 2015. The years were grouped into 4 periods according to epidemic cycles and vaccination schedule: 2001-06, 2007-10, 2011-13 and 2014-15. The impact was calculated as Relative Risk (RR) between the incidence of chickenpox in children between 15 months and 13 years of age between 2011-13 and 2001-06 through Poisson regression using notifications made to the Diseases of Compulsory Declaration (DCD) system, the Sentinel Physicians Network (SPN) and hospital discharge records noted as Minimum Basic Data Set (MBDS). The vaccine effectiveness (VE) was calculated using the screening method and a 1:2 case-control study paired by age and paediatrician in population from 15 months to 13 years and between 2007 and 2015 using SPN source data. RESULTS The RR2011-13/2001-06 using data from the DCD was 0.14 (95% CI: 0.14 to 0.15), 0.07 (95% CI: 0.06 to 0.08) from SPN and 0.17 (95% CI: 0.15 to 0.20) from MBDS. A total of 338 cases were included in the VE screening obtaining an overall of 76.7% (IC 95%: 71.9 to 80.7%). For a case-control study, 120 cases and 247 controls were recruited obtaining a VE of 92.4% (IC 95%: 80.8 to 97.0%). CONCLUSIONS The single-dose vaccination against chickenpox at 15 months of age has high impact and effectiveness.
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Affiliation(s)
- Pello Latasa
- a Health Department of the Community of Madrid , Subdirectorate of Epidemiology , Madrid , Spain
| | | | - Maria Dolores Barranco Ordoñez
- c Health Department of the Community of Madrid , Subdirectorate of Promotion, Prevention and Health Education , Madrid , Spain
| | | | - Juan Carlos Sanz Moreno
- d Health Department of the Community of Madrid , Regional Public Health Laboratory , Madrid , Spain
| | - María Ordobás Gavín
- a Health Department of the Community of Madrid , Subdirectorate of Epidemiology , Madrid , Spain
| | - María Esteban Vasallo
- a Health Department of the Community of Madrid , Subdirectorate of Epidemiology , Madrid , Spain
| | | | - Luis García-Comas
- a Health Department of the Community of Madrid , Subdirectorate of Epidemiology , Madrid , Spain
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Saitoh A, Okabe N. Progress and challenges for the Japanese immunization program: Beyond the "vaccine gap". Vaccine 2018; 36:4582-4588. [PMID: 29929825 DOI: 10.1016/j.vaccine.2018.01.092] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 02/08/2023]
Abstract
The Japanese immunization program has made considerable recent progress. The introduction of several new vaccines, especially foreign-produced vaccines, and the inclusion of important new vaccines in the National Immunization Program (NIP) are closing the "vaccine gap", i.e., the delay in the Japanese immunization program relative to programs in other developed countries. Major progress in the Japanese immunization program since 2014 includes (1) elimination of measles in March 2015, (2) introduction of a varicella vaccine as a routine immunization in the NIP in October 2015, and (3) introduction of hepatitis B virus vaccines as routine immunizations in the NIP in October 2016. Despite these promising developments, important issues remain. First, the government withdrew the active recommendation for human papilloma virus vaccines temporarily in 2013. The withdrawal has continued and unresolved despite new scientific evidence confirming the safety of these vaccines. Second, a few important voluntary vaccines, including vaccines for mumps and rotavirus, have not been included in the NIP since their introduction to Japan. Finally, there are concerns related to a shortage of mandatory domestic vaccines, which was caused by a natural disaster in the area where a vaccine-producing factory was located. Additionally, the manufacturer included unauthorized additives in some vaccine products with falsifying the production-process records. To avoid problems related to vaccine shortages, essential vaccines need to be stockpiled, and the future vaccine needs for children should to be discussed. New initiatives must continue to close the vaccine gap, as this will protect children living in Japan from vaccine-preventable diseases.
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Affiliation(s)
- Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510 Japan.
| | - Nobuhiko Okabe
- Kawasaki City Institute for Public Health, Kanagawa, Japan, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki, Kanagawa 210-0821 Japan
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Yin M, Xu X, Liang Y, Ni J. Effectiveness, immunogenicity and safety of one vs. two-dose varicella vaccination:a meta-analysis. Expert Rev Vaccines 2018; 17:351-362. [DOI: 10.1080/14760584.2018.1433999] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mingjuan Yin
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Xiaojia Xu
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Yaping Liang
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
| | - Jindong Ni
- Department of Epidemiology and Biostatistics, Guangdong Medical University, Dongguan, China
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Zhu S, Zeng F, Xia L, He H, Zhang J. Incidence rate of breakthrough varicella observed in healthy children after 1 or 2 doses of varicella vaccine: Results from a meta-analysis. Am J Infect Control 2018; 46:e1-e7. [PMID: 28935482 DOI: 10.1016/j.ajic.2017.07.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although extensive varicella vaccination coverage has been reported in many countries, breakthrough varicella (BV) still occurs in healthy children. We performed a meta-analysis to understand whether 2 varicella vaccine doses are needed in children and, if so, to determine the best time to vaccinate. METHODS The BV incidence rates after 1 or 2 doses of varicella vaccine were pooled using random effects, and 95% confidence intervals (CI) were used to estimate the risk factors after vaccination. RESULTS A total of 27 original articles were included in this meta-analysis. The pooled average BV incidence rate in children vaccinated with 1 dose was 8.5 cases per 1,000 person years (PY) (95% confidence interval [CI], 5.3-13.7; random effects model) and 2.2 cases per 1,000 PY (95% CI, 0.5-9.3; random effects model) in children vaccinated with 2 doses. The pooled trend of the annual BV incidence rate from the first to eighth year fluctuated, with a peak annual incidence rate of 35.3 cases per 1,000 population in the fourth year. The meta-regression showed that design type, type of vaccine, and their interaction accounted for approximately 71.74% of the heterogeneity in the average BV incidence rate after 1 vaccine dose. CONCLUSIONS Two doses of varicella vaccine are more effective than a single dose, and 3-4 years between the first and second vaccinations may achieve higher efficacy.
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Affiliation(s)
- Sui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Fangfang Zeng
- Department of Epidemiology, School of Basic Medical Sciences, Jinan University, Guangzhou, Guangdong, China; Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lan Xia
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Hong He
- Health Care and Physical Examination Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Juying Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China.
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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: 22] [Impact Index Per Article: 3.1] [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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Scotta MC, Paternina-de la Ossa R, Lumertz MS, Jones MH, Mattiello R, Pinto LA. Early impact of universal varicella vaccination on childhood varicella and herpes zoster hospitalizations in Brazil. Vaccine 2017; 36:280-284. [PMID: 29198917 DOI: 10.1016/j.vaccine.2017.11.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/04/2017] [Accepted: 11/12/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Brazilian childhood National Immunization Program (NIP) introduced live and attenuated varicella vaccination in a single dose, combined as tetraviral vaccine, at 15 months of age in the whole country, during September to December of 2013. The aim of this study was to report trends in incidence of childhood hospital admissions related to varicella and zoster in Brazil from 2003 to 2016, including the first three years after vaccine introduction. METHODS The number and incidence of hospital admission in patients aged less than 20 years in Brazilian public health system with an admission diagnosis of varicella and zoster from 2003 to 2016 were analyzed and pre (2003-2013) and post-vaccination periods (2014-2016) were compared. The data were obtained from DATASUS, a Brazilian government's open-access public health database system, and analyzed adjusting for secular trend and seasonality if a statistically significant change was found. RESULTS During the study period, 69,791 admissions due to varicella and herpes zoster occurred in the children younger than 20 years. After adjusting for seasonality, the incidence of hospitalizations decreased from 27.33 to 14.33 per 100000 per year, which corresponds to a reduction of 47.6% (95% confidence interval 18.19-77.04%, p < 0.001) in the vaccinated age group (1-4 years) in 2014-2016 compared to pre-vaccination period. The changes were not significant in the unvaccinated age groups. CONCLUSION The hospitalizations due to varicella and herpes zoster were decreased by half early after the introduction of a single dose of tetraviral vaccine in NIP in the vaccinated children. Further studies may assess duration and intensity of this effect, as well as the indirect effect in the unvaccinated age groups.
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Affiliation(s)
- Marcelo Comerlato Scotta
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, ZIP-Code: 90610-000, Porto Alegre, Rio Grande do Sul State, Brazil.
| | - Rolando Paternina-de la Ossa
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, ZIP-Code: 90610-000, Porto Alegre, Rio Grande do Sul State, Brazil.
| | - Magali Santos Lumertz
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, ZIP-Code: 90610-000, Porto Alegre, Rio Grande do Sul State, Brazil.
| | - Marcus Herbert Jones
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, ZIP-Code: 90610-000, Porto Alegre, Rio Grande do Sul State, Brazil.
| | - Rita Mattiello
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, ZIP-Code: 90610-000, Porto Alegre, Rio Grande do Sul State, Brazil.
| | - Leonardo Araújo Pinto
- Centro Infant, Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, ZIP-Code: 90610-000, Porto Alegre, Rio Grande do Sul State, Brazil.
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Evaluating the effectiveness of the universal immunization program against varicella in Japanese children. Vaccine 2017; 35:4936-4941. [PMID: 28784281 DOI: 10.1016/j.vaccine.2017.07.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Matched case control study was conducted to elucidate the effectiveness of the Oka/Biken vaccine immediately after implementation of the universal immunization program in Japan. METHODS Cases were laboratory confirmed varicella patient under 15years of age diagnosed at 14 designated pediatric clinics between September 2015 and September 2016. Controls were selected from patients who visited the same practice for different reasons as the varicella case within 2weeks. Swab samples were collected from varicella suspected patients and molecular diagnostic assays were used to confirm varicella cases. Matched odds ratio were used to calculate vaccine effectiveness (VE). RESULTS Varicella zoster virus DNA was detected in 183 (81.3%) of 225 suspected cases. One sample was excluded because it was positive for the Oka vaccine strain (182/225, 80.9%). Three hundred twenty-three control subjects were enrolled. The effectiveness of 1 dose of the Oka/Biken vaccine compared with no vaccine was 76.7% (95% confidence interval [CI]: 58.6-86.9%; P<0.001). The effectiveness of 2 doses of the Oka/Biken vaccine was 94.2% (95% CI: 85.7-97.6%; P<0.001). After adjusting for potential confounding effects, the adjusted VE of 1 and 2 doses of varicella vaccine were 76.9% (95% CI: 58.1-87.3%; P<0.001) and 94.7% (95% CI: 86.0-98.0%; P<0.001), respectively. CONCLUSIONS VE of one dose of Oka/Biken varicella vaccine was insufficient to control varicella. Therefore, two doses of Oka/Biken varicella vaccine is significant for controlling varicella in Japan.
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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: 115] [Impact Index Per Article: 16.4] [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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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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Lee YH, Choe YJ, Cho SI, Kang CR, Bang JH, Oh MD, Lee JK. Effectiveness of Varicella Vaccination Program in Preventing Laboratory-Confirmed Cases in Children in Seoul, Korea. J Korean Med Sci 2016; 31:1897-1901. [PMID: 27822926 PMCID: PMC5102851 DOI: 10.3346/jkms.2016.31.12.1897] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022] Open
Abstract
A universal one-dose varicella vaccination program was introduced in 2005 in Republic of Korea. However, the incidence of varicella in Korea has tripled over the last decade. We conducted a community based 1:1 matched case-control study to assess the effectiveness of one MAV strain-based vaccine and three Oka strain-based vaccines licensed for use in Korea. All cases were children in Seoul, Korea with varicella who were reported to the National Notifiable Disease Surveillance System in Seoul during 2013. The controls were age-matched children with mumps or scarlet fever but no history of varicella. We included 537 cases and 537 controls. The overall effectiveness of one dose of varicella vaccination was 13% (95% confidence interval [CI], -17.3-35.6). Of the four licensed varicella vaccines, only one was highly effective (88.9%; 95% CI, 52.1-97.4). The vaccine effectiveness for the other vaccines were 71.4% (95% CI, -37.5-94.1), -5% (95% CI, -61.9-31.9), and -100% (95% CI, -700-50.0). The overall effectiveness of vaccination was 75.8% (95% CI, 22.8-92.4) in the first year after vaccination and decreased thereafter; the effectiveness became -7.2% (95% CI, -130.9-59.2) in the fourth year after vaccination. Further studies are warranted to investigate reduced effectiveness of varicella vaccines in Korea.
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Affiliation(s)
- Young Hwa Lee
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Young June Choe
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Sung Il Cho
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Cho Ryok Kang
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Institute of Endemic Disease, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Division of Infectious Diseases, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Myoung Don Oh
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Jong Koo Lee
- Seoul Center for Infectious Disease Control, Seoul, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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Heikkinen T, Silvennoinen H, Heinonen S, Vuorinen T. Clinical and socioeconomic impact of moderate-to-severe versus mild influenza in children. Eur J Clin Microbiol Infect Dis 2016; 35:1107-13. [PMID: 27086364 DOI: 10.1007/s10096-016-2641-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/28/2016] [Indexed: 01/05/2023]
Abstract
Some studies have assessed the efficacy of influenza vaccination in children separately for moderate-to-severe and any influenza, but the definition used for identifying children with moderate-to-severe illness has not been validated. We analyzed clinical and socioeconomic data from two prospective cohort studies of respiratory infections among children aged ≤13 years (four influenza seasons, 3,416 child-seasons of follow-up). We categorized children with laboratory-confirmed influenza into two mutually exclusive groups of moderate-to-severe and mild influenza using the previously proposed criteria. We obtained the data for the analyses from structured medical records filled out by the study physicians and from daily symptom cards filled out by the parents. Of 434 cases of influenza, 217 (50 %) were classified as moderate-to-severe and 217 (50 %) as mild. The mean duration of fever was 4.0 days in children with moderate-to-severe influenza and 3.1 days in those with milder illness (P < 0.0001). Antibiotics were prescribed to 111 (51 %) children with moderate-to-severe and to ten (5 %) children with mild influenza (P < 0.0001). The rates of parental work absenteeism were 184 days per 100 children with moderate-to-severe influenza and 135 days per 100 children with mild influenza (P = 0.02). The corresponding rates of children's own absenteeism from day care or school were 297 and 233 days respectively per 100 children (P = 0.006). Categorization of children into groups with moderate-to-severe and mild influenza is meaningful, and it identifies children in whom the clinical and socioeconomic impact of influenza is highest. Illness severity should be considered when assessing influenza vaccine effectiveness in children.
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Affiliation(s)
- T Heikkinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.
| | - H Silvennoinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - S Heinonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Pediatrics, Helsinki University Hospital, Helsinki, Finland
| | - T Vuorinen
- Department of Clinical Virology, Division of Microbiology and Genetics, Turku University Hospital, Turku, Finland
- Department of Virology, University of Turku, Turku, Finland
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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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Marin M, Marti M, Kambhampati A, Jeram SM, Seward JF. Global Varicella Vaccine Effectiveness: A Meta-analysis. Pediatrics 2016; 137:e20153741. [PMID: 26908671 DOI: 10.1542/peds.2015-3741] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Several varicella vaccines are available worldwide. Countries with a varicella vaccination program use 1- or 2-dose schedules. OBJECTIVE We examined postlicensure estimates of varicella vaccine effectiveness (VE) among healthy children. DATA SOURCES Systematic review and descriptive and meta-analysis of Medline, Embase, Cochrane libraries, and CINAHL databases for reports published during 1995-2014. STUDY SELECTION Publications that reported original data on dose-specific varicella VE among immunocompetent children. DATA EXTRACTION We used random effects meta-analysis models to obtain pooled one dose VE estimates by disease severity (all varicella and moderate/severe varicella). Within each severity category, we assessed pooled VE by vaccine and by study design. We used descriptive statistics to summarize 1-dose VE against severe disease. For 2-dose VE, we calculated pooled estimates against all varicella and by study design. RESULTS The pooled 1-dose VE was 81% (95% confidence interval [CI]: 78%-84%) against all varicella and 98% (95% CI: 97%-99%) against moderate/severe varicella with no significant association between VE and vaccine type or study design (P > .1). For 1 dose, median VE for prevention of severe disease was 100% (mean = 99.4%). The pooled 2-dose VE against all varicella was 92% (95% CI: 88%-95%), with similar estimates by study design. LIMITATIONS VE was assessed primarily during outbreak investigations and using clinically diagnosed varicella. CONCLUSIONS One dose of varicella vaccine was moderately effective in preventing all varicella and highly effective in preventing moderate/severe varicella, with no differences by vaccine. The second dose adds improved protection against all varicella.
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Affiliation(s)
- Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Melanie Marti
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Anita Kambhampati
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Stanley M Jeram
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Jane F Seward
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
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Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis 2016; 35:723-34. [PMID: 26873382 DOI: 10.1007/s10096-016-2605-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/05/2016] [Indexed: 12/26/2022]
Abstract
Varicella-zoster virus (VZV), an important member of the Herpesviridae family, is the etiological agent of varicella as primary infection and zoster as recurrence. An outstanding feature is the lifelong viral latency in dorsal root and cranial nerve ganglia. Both varicella and zoster are worldwide widespread diseases that may be associated with significant complications. However, there is a broad spectrum of laboratory methods to diagnose VZV infections. In contrast to many other viral infections, antiviral treatment of VZV infections and their prevention by vaccination or passive immunoprophylaxis are well established in medical practice. The present manuscript provides an overview about the basic knowledge of VZV infections, their laboratory diagnosis, antiviral therapy, and the prevention procedures, especially in Germany.
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Affiliation(s)
- A Sauerbrei
- Institute of Virology and Antiviral Therapy, German Consulting Laboratory for HSV and VZV, Jena University Hospital, Friedrich-Schiller University, Hans-Knoell-Strasse 2, Jena, Germany.
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Zhang X, Yu Y, Zhang J, Kwan EP, Huang S, Wang Z, Zhang J, Peng X, Yan Y, Zhang L, Luo Y, Han S, Han X, Liu G, Liu F, Zhao J, He Y. One-dose vaccination associated with attenuated disease severity of adolescent and adult varicella cases in Beijing's Fengtai District. Hum Vaccin Immunother 2015; 10:2417-20. [PMID: 25424949 DOI: 10.4161/hv.29140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In recent years, the number of varicella cases in adults has significantly increased in Beijing. However, the effect of the vaccination on varicella-related characteristics among adults has not been studied. METHODS AND RESULTS Using data from the Infectious Disease Reporting System and the Immunization Information System, we compared the epidemiology and disease severity in breakthrough and unvaccinated varicella cases in adolescents and adults (≥ 15 year-old) from 2008 to 2011 in Beijing's Fengtai district, China. The results showed that the age (P = 0.003),contact history (90% vs. 73%, P = 0.019) and outbreak cases (10% vs. 1%, P < 0.0001) were significantly differently distributed between the two groups and that both the incidence of moderate-to-severe cases (26% vs. 45%, P = 0.035, OR = 0.446) and varicella-associated fever (49% vs. 66%, P = 0.068, OR = 0.534) were either significantly lower or trended to be lower in the breakthrough group than in the unvaccinated group. Additionally,vaccine effectiveness against moderate-to-severe cases of varicella was 55.4%. CONCLUSION Altogether, these results indicate that vaccination against varicella among adolescents and adults affected the epidemiology and attenuated the disease severity of the cases. The Results from this study will provide useful information for the prevention of varicella in adolescents and adults.
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Affiliation(s)
- Xue Zhang
- Department of Epidemiology and Biostatistics; School of Public Health; Capital Medical University; 2. Fengtai Center for Disease Control and Prevention; Beijing, China
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Helmuth IG, Poulsen A, Suppli CH, Mølbak K. Varicella in Europe-A review of the epidemiology and experience with vaccination. Vaccine 2015; 33:2406-13. [PMID: 25839105 DOI: 10.1016/j.vaccine.2015.03.055] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
There is no consensus as regards the European varicella immunisation policy; some countries have introduced varicella vaccination in their routine childhood immunisation programs whereas others have decided against or are debating. With the aim of providing an overview of the epidemiology of varicella in Europe and addressing the different strategies and the experiences so far, we performed a review of epidemiological studies done in Europe from 2004 to 2014. Varicella is mainly a disease of childhood, but sero-epidemiological studies show regional differences in the proportion of susceptible adults. Hospitalisation due to varicella is not common, but complications and hospitalisation mainly affect previously healthy children, which underlines the importance of not dismissing varicella as a disease of little importance. The experience with universal vaccination in Europe shows that vaccination leads to a rapid reduction of disease incidence. Vaccine effectiveness is high and a protective herd effect is obtained. Experience with vaccination in Europe has not been long enough, though, to draw conclusions on benefits and drawbacks with vaccination as well as the capacity for national programs in Europe to maintain a sufficiently high coverage to prevent a change in age group distribution to older children and young adults or on the impact that varicella immunisation may have on the epidemiology of shingles.
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Affiliation(s)
- Ida Glode Helmuth
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Camilla Hiul Suppli
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Kåre Mølbak
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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Waldram A, McKerr C, Gobin M, Adak G, Stuart JM, Cleary P. Control selection methods in recent case-control studies conducted as part of infectious disease outbreaks. Eur J Epidemiol 2015; 30:465-71. [PMID: 25762171 DOI: 10.1007/s10654-015-0005-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/20/2015] [Indexed: 02/01/2023]
Abstract
Successful investigation of national outbreaks of communicable disease relies on rapid identification of the source. Case-control methodologies are commonly used to achieve this. We assessed control selection methods used in recently published case-control studies for methodological and resource issues to determine if a standard approach could be identified. Neighbourhood controls were the most frequently used method in 53 studies of a range of different sizes, infections and settings. The most commonly used method of data collection was face to face interview. Control selection issues were identified in four areas: method of identification of controls, appropriateness of controls, ease of recruitment of controls, and resource requirements. Potential biases arising from the method of control selection were identified in half of the studies assessed. There is a need to develop new ways of selecting controls in a rapid, random and representative manner to improve the accuracy and timeliness of epidemiological investigations and maximise the effectiveness of public health interventions. Innovative methods such as prior recruitment of controls could improve timeliness and representativeness of control selection.
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Affiliation(s)
- Alison Waldram
- Field Epidemiology Service Liverpool, Public Health England, Liverpool, UK,
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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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Varicella and varicella vaccination in South Korea. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:762-8. [PMID: 24671555 DOI: 10.1128/cvi.00645-13] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
With continuing occurrence of varicella despite increasing vaccine coverage for the past 20 years, a case-based study, a case-control study, and an immunogenicity and safety study were conducted to address the impact of varicella vaccination in South Korea. Varicella patients under the age of 16 years were enrolled for the case-based study. For the case-control study, varicella patients between 12 months and 15 years of age were enrolled with one control matched for each patient. For the immunogenicity and safety study, otherwise healthy children from 12 to 24 months old were immunized with Suduvax (Green Cross, South Korea). Fluorescent antibody to membrane antigen (FAMA) varicella-zoster virus (VZV) antibody was measured before and 6 weeks after immunization. In the case-based study, the median age of the patients was 4 years. Among 152 patients between 1 and 15 years of age, 139 children received varicella vaccine and all had breakthrough infections. Clinical courses were not ameliorated in vaccinated patients, but more vaccinated patients received outpatient rather than inpatient care. In the case-control study, the adjusted overall effectiveness of varicella vaccination was 54%. In the immunogenicity and safety study, the seroconversion rate and geometric mean titer for FAMA antibody were 76.67% and 5.31. Even with increasing varicella vaccine uptake, we illustrate no upward age shift in the peak incidence, a high proportion of breakthrough disease, almost no amelioration in disease presentation by vaccination, and insufficient immunogenicity of domestic varicella vaccine. There is need to improve the varicella vaccine used in South Korea.
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