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Irham LM, Adikusuma W, Lolita L, Puspitaningrum AN, Afief AR, Sarasmita MA, Dania H, Khairi S, Djalilah GN, Purwanto BD, Chong R. Investigation of susceptibility genes for chickenpox disease across multiple continents. Biochem Biophys Rep 2023; 33:101419. [PMID: 36620086 PMCID: PMC9816662 DOI: 10.1016/j.bbrep.2022.101419] [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: 10/04/2022] [Revised: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
Chickenpox (varicella) is caused by infection with the varicella-zoster virus (VZV), a neurotropic alpha herpes virus with a double-stranded DNA genome. Chickenpox can cause life-threatening complications, including subsequent bacterial infections, central nervous system symptoms, and even death without any risk factors. Few studies have been reported to investigate genetic susceptibility implicated in chickenpox. Herein, our study identified global genetic variants that potentially contributed to chickenpox susceptibility by utilizing the established bioinformatic-based approach. We integrated several databases, such as genome-wide association studies (GWAS) catalog, GTEx portal, HaploReg version 4.1, and Ensembl databases analyses to investigate susceptibility genes associated with chickenpox. Notably, increased expression of HLA-S, HCG4P5, and ABHD16A genes underlie enhanced chickenpox susceptibility in the European, American, and African populations. As compared to the Asian population, Europeans, Americans, and Africans have higher allele frequencies of the extant variants rs9266089, rs10947050, and rs79501286 from the susceptibility genes. Our study suggested that these susceptibility genes and associated genetic variants might play a critical role in chickenpox progression based on host genetics with clinical implications.
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Affiliation(s)
| | - Wirawan Adikusuma
- Department of Pharmacy, University of Muhammadiyah Mataram, Mataram, Indonesia
| | - Lolita Lolita
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | | | | | - Made Ary Sarasmita
- Pharmacy Study Program, Faculty of Science and Mathematics, Udayana University, Bali, Indonesia
| | - Haafizah Dania
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Sabiah Khairi
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, 11031, Taiwan
| | | | - Barkah Djaka Purwanto
- Faculty of Medicine, University of Ahmad Dahlan, Yogyakarta, 55191, Indonesia
- PKU Muhammadiyah Bantul Hospital, Bantul, Yogyakarta, 55711, Indonesia
| | - Rockie Chong
- Department of Chemistry and Biochemistry, University of California, Los Angeles, USA
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Burgess C, Kujawski S, Lapornik A, Bencina G, Pawaskar M. The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:95-102. [PMID: 36196453 PMCID: PMC9489276 DOI: 10.36469/001c.37308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
Background: Despite the substantial burden of varicella infection, Slovenia does not currently have a universal varicella vaccination (UVV) program. We modeled the long-term clinical and economic impact of implementing 2-dose UVV strategies compared with no vaccination in Slovenia. Methods: A previously published dynamic transmission model was adapted to the demographics, varicella seroprevalence, herpes zoster incidence, and contact patterns in Slovenia. Six 2-dose UVV strategies, vs no vaccination, were considered over a 50-year period, including monovalent vaccination (Varivax® [V-MSD] or Varilrix® [V-GSK]) at ages 12 and 24 months, or monovalent vaccination at 15 months followed by monovalent or quadrivalent vaccination (ProQuad® [MMRV-MSD] or Priorix- Tetra® [MMRV-GSK]) at 5.5 years. Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios vs no vaccination were calculated to assess the economic impact of each strategy from payer and societal perspectives. Results: The incidence of varicella infection was estimated as 1228 per 100 000 population in the absence of UVV. Over 50 years, depending on vaccination strategy, UVV reduced varicella cases by 77% to 85% and was associated with substantial reductions in varicella deaths (39%-44%), outpatient cases (74%-82%), and hospitalizations (74%-82%). The greatest reductions were predicted with V-MSD (15 months/5.5 years) and V MSD/MMRV-MSD (15 months/5.5 years). Discussion: All 2-dose UVV strategies were cost-effective compared with no vaccination from payer and societal perspectives, with V-MSD (15 months/5.5 years) being the most favorable from both perspectives. Conclusion: Policymakers should consider implementing UVV to reduce the burden of varicella disease in Slovenia.
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Affiliation(s)
| | | | - Ajda Lapornik
- MSD Inovativna zdravilla d.o.o., Ljubljana, Slovenia
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Uzoka FME, Akwaowo C, Nwafor-Okoli C, Ekpin V, Nwokoro C, El Hussein M, Osuji J, Aladi F, Akinnuwesi B, Akpelishi TF. Risk factors for some tropical diseases in an African country. BMC Public Health 2021; 21:2261. [PMID: 34895220 PMCID: PMC8666074 DOI: 10.1186/s12889-021-12286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Often, non-clinical risk factors could affect the predisposition of an individual to diseases. Understanding these factors and their impacts helps in disease prevention and control. This study identified risk factors for malaria, yellow fever, typhoid, chickenpox, measles, hepatitis B, and urinary tract infection in a population in an African country. METHODS Our study was an observational, correlational, and quantitative one that explored relationships among risk variables and disease prevalence - without modifying or controlling the variables. Data for this study was obtained through random sampling of a population of patients and physicians in the eastern/southern, western, and northern parts of Nigeria in 2015-2016. A total of 2199 patient consultation forms were returned by 102 (out of 125) physicians, and considered useful for analysis. Demographic data of patients, physicians, and diagnosis outcomes were analysed descriptively through frequency distributions, aggregate analysis, and graphs. The influence of risk factors on the disease manifestations (diagnosis outcomes) was determined using regression analysis. RESULTS Our results show that living in a tropical climate is by far a major risk factor associated with tropical diseases (malaria: t = 19.9, typhoid: t = - 3.2, chickenpox: t = - 6.5 and typhoid: t = 12.7). The risk for contracting infections is relative to specific diseases; for example, contact with chickenpox infected person poses a high risk of contracting the virus (t = 41.8), while poor personal hygiene predisposes people to high risk of urinary tract infection (t = 23.6). On the other hand, urbanization and homelessness pose very low risks of disposing the individual to the diseases under consideration, while low fluid intake, lack of voiding, and wearing non-cotton underwear predispose individuals to few diseases. CONCLUSION The risk factors identified in our study exert differential and discriminating influences in the causation, predisposition, and transmission of these disease studied. It is recommended that significant effort be devoted by governments in the tropics to the mitigation of these modifiable risk factors. The most important strategy to mitigate the occurrence of these risk factors will be improving the living conditions of people and the provision of social protection measures to reduce the occurrence and burden of these diseases.
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Affiliation(s)
- F-M E Uzoka
- Dept. of Math and Computing, Mount Royal University, 4825 Mt Royal Gate SW, Calgary, AB, T3E 6K6, Canada.
| | - C Akwaowo
- Dept. of Public Health, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - C Nwafor-Okoli
- Canadian Institute for Innovation and Development, Calgary, Canada
| | - V Ekpin
- Morat Medical Centre, Benin City, Nigeria
| | - C Nwokoro
- Dept of Computer Science, University of Uyo, Uyo, Nigeria
| | - M El Hussein
- School of Nursing, Mount Royal University, Calgary, Canada
| | - J Osuji
- School of Nursing, Mount Royal University, Calgary, Canada
| | - F Aladi
- Health Watch Medical Clinic, Calgary, Canada
| | - B Akinnuwesi
- Dept of Computer Science, University of Eswatini, Kwaluseni, Eswatini
| | - T F Akpelishi
- Health Centre, Bells University of Technology, Otta, Nigeria
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Goh AEN, Choi EH, Chokephaibulkit K, Choudhury J, Kuter B, Lee PI, Marshall H, Kim JO, Wolfson LJ. Burden of varicella in the Asia-Pacific region: a systematic literature review. Expert Rev Vaccines 2019; 18:475-493. [PMID: 30869552 DOI: 10.1080/14760584.2019.1594781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Varicella is a highly contagious infection that can lead to serious complications, particularly in high-risk groups; however, it is vaccine preventable. Disease awareness and understanding of the disease burden can strongly influence vaccine coverage. This review provides insight into the current epidemiology and the importance of varicella from both public health and economic perspectives across the Asia-Pacific (APAC) region. Areas covered: A systematic literature review was conducted to identify studies on the incidence, seroprevalence, fatality rate and complication rate of varicella. Economic burden studies were also captured. Altogether, 125 studies were identified across the region; these were supplemented by government reports (gray data). Reported vaccine coverage varied from 2.8% to 97%; a key influencing factor was inclusion of the varicella vaccine in national immunization programs. In general, varicella incidence in the unvaccinated population was highest in children ≤5 years old and seroprevalence increased with age. Economic analyses highlighted the cost-saving potential of vaccination programs, especially from a societal perspective. Expert opinion: Varicella-related data varied greatly across the APAC region, highlighting the need to better understand the burden of varicella in this area, and particularly identified the need for better surveillance and reporting.
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Affiliation(s)
- Anne Eng Neo Goh
- a Department of Paediatrics , KK Women's and Children's Hospital , Singapore
| | - Eun Hwa Choi
- b Division of Pediatric Infectious Diseases , Seoul National University Hospital , Seoul , South Korea
| | | | - Jaydeep Choudhury
- d Department of Pediatrics , Institute of Child Health , Kolkata , India
| | - Barbara Kuter
- e Global Vaccine Medical Affairs, Merck Research Laboratories, Merck & Co., Inc , Kenilworth , NJ , USA
| | - Ping-Ing Lee
- f Department of Pediatrics , National Taiwan University Children's Hospital , Taipei City , Taiwan
| | - Helen Marshall
- g Women's and Children's Health Network and Robinson Research Institute and Adelaide Medical School , The University of Adelaide , Adelaide , Australia
| | - Jin Oh Kim
- e Global Vaccine Medical Affairs, Merck Research Laboratories, Merck & Co., Inc , Kenilworth , NJ , USA
| | - Lara J Wolfson
- h Center for Observational and Real-World Evidence , Merck & Co., Inc ., Kenilworth , NJ , USA
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Mészner Z, Wysocki J, Richter D, Zavadska D, Ivaskeviciene I, Usonis V, Pokorn M, Mangarov A, Jancoriene L, Man SC, Kristufkova Z, Jesenak M, Tešović G, Pluta J, Wolfson LJ. Burden of varicella in Central and Eastern Europe: findings from a systematic literature review. Expert Rev Vaccines 2019; 18:281-293. [PMID: 30810402 DOI: 10.1080/14760584.2019.1573145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Vaccination against varicella rapidly reduces disease incidence, resulting in reductions in both individual burden and societal costs. Despite these benefits, there is no standardization of varicella immunization policies in Europe, including countries in Central and Eastern Europe (CEE). AREAS COVERED This systematic literature review identified publications on the epidemiology of varicella, its associated health and economic burden, and vaccination strategies within the CEE region, defined as Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, and Slovenia. Twenty-six studies were identified from a search of PubMed, Embase®, and MEDLINE® biomedical literature databases, supplemented by gray literature and country-specific/global websites. EXPERT COMMENTARY Limited information exists in published studies on the burden of varicella in CEE. The wide variability in incidence rates between countries is likely explained by a lack of consistency in reporting systems. Funded universal varicella vaccination (UVV) in CEE is currently available only in Latvia as a one-dose schedule, but Hungary together with Latvia are introducing a two-dose strategy in 2019. For countries that do not provide UVV, introduction of vaccination is predicted to provide substantial reductions in cases and rates of associated complications, with important economic benefits.
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Affiliation(s)
- Zsófia Mészner
- a Heim Pal National Paediatric Institute , Budapest , Hungary
| | - Jacek Wysocki
- b Department of Preventive Medicine , Poznan University of Medical Sciences , Poznan , Poland
| | - Darko Richter
- c Department of Paediatrics , University Hospital Centre , Zagreb , Croatia
| | - Dace Zavadska
- d Department of Paediatrics , Riga Stradins University , Riga , Latvia
| | - Inga Ivaskeviciene
- e Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine , Vilnius University , Vilnius , Lithuania.,f Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
| | - Vytautas Usonis
- e Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Marko Pokorn
- g Department of Infectious Diseases , University Medical Centre Ljubljana , Ljubljana , Slovenia
| | - Atanas Mangarov
- h Hospital for Infectious Diseases , Medical University of Sofia , Sofia , Bulgaria
| | - Ligita Jancoriene
- f Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania.,i Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine , Vilnius University , Vilnius , Lithuania
| | - Sorin C Man
- j Mother and Child Care Department , University of Medicine and Pharmacy 'Iuliu Hațieganu' , Cluj-Napoca , Romania
| | - Zuzana Kristufkova
- k Faculty of Public Health , Slovak Medical University , Bratislava , Slovakia
| | - Milos Jesenak
- l Jessenius Faculty of Medicine in Martin , Comenius University , Bratislava , Slovakia
| | - Goran Tešović
- m University Hospital for Infectious Diseases , University of Zagreb, School of Medicine , Zagreb , Croatia
| | - Justyna Pluta
- n Global Medical Affairs , MSD Polska Sp. z. o.o ., Warsaw , Poland
| | - Lara J Wolfson
- o Center for Observational and Real-World Evidence (CORE) , Merck & Co., Inc ., Kenilworth , NJ , USA
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Ibrahim EG, Abdel Wahed WY, Eid HM, Deeb WS. Seroprevalence of varicella-zoster virus among pregnant women in Fayoum Governorate, Egypt. J Egypt Public Health Assoc 2019; 94:2. [PMID: 30686830 PMCID: PMC6325979 DOI: 10.1186/s42506-018-0002-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/13/2018] [Indexed: 01/29/2023]
Abstract
Background Chickenpox infection acquired during pregnancy is a serious condition. There may be congenital malformations and neonatal varicella syndrome with significant morbidity and mortality. Egypt has no routine varicella-zoster vaccination program. Objective To assess the immune status against varicella-zoster virus (VZV) antibodies among a group of pregnant women and to study the relationship between VZV seroprevalence and some sociodemographic characteristics. Subjects and methods A descriptive cross-sectional study was conducted on a group of pregnant women (n = 333) attending antenatal care (ANC) clinic at Fayoum University Hospital. Serologic testing for VZV was performed using ELISA through the years 2016-2017. Results VZV seroprevalence was detected in 294 (88.3%) of the 333 recruited pregnant women. Older age > 25 years old was significantly associated with low percent of VZV-negative antibodies (6.7% in versus 17.4% in younger age, OR (95%CI) 0.34 (0.17-0.70)), also having more than one child was significantly associated with a low percent of VZV-negative antibodies (8.2% versus 16.1% among participants with no children or having one child, OR 0.34 (0.17-0.70)). Conclusions Despite the absence of a routine VZV vaccination program in Egypt, VZV immunity was high among pregnant women, but less than that reported in many developed countries. We recommend targeted vaccination for women in the reproductive age especially young and primipara. Trial registration Ethical Committee Registration number R67 session 42: date 12/11/2017(retrospectively registered).
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Affiliation(s)
- Enas G Ibrahim
- 1Microbiology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Wafaa Y Abdel Wahed
- 2Public Health & Community Medicine Department, Faculty of Medicine, Fayoum University, Faiyum, 63514 Egypt
| | - Hanaa M Eid
- 1Microbiology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Wessam S Deeb
- 3Obstetric and Gynecological Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
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Epidemiology and factors influencing varicella infections in tropical countries including Sri Lanka. Virusdisease 2018; 29:277-284. [PMID: 30159361 DOI: 10.1007/s13337-018-0459-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023] Open
Abstract
Varicella zoster virus (VZV) infections occur worldwide but the epidemiology differs between different geographical regions. Epidemiology of varicella is partly understood in tropical and subtropical regions. Various hypotheses showing differences in exposure rates in different age groups have been proposed. Exposure to VZV during late childhood or adolescent stage causes high morbidity, especially in high school children, university students and young work force in tropical nations. Exposure to VZV infection or sero-prevalence rates through anti-VZV immunoglobulin G appears to be lower in Sri Lanka, similar to other tropical countries prior to the millennium. In contrast, a more recent study in a group of antenatal women showed a relatively higher exposure rate to VZV when compared to the exposure rates prior to 2004 in Sri Lanka. Climatic factors, socioeconomic conditions, mobility and cultural practices appear to play a role in the differences in the exposure rates to VZV infection in the tropics. In most tropical Asian countries including Sri Lanka, routine vaccination against varicella is not carried out. Individuals with negative history for varicella take the vaccine when there is a necessity. Medical and nursing students take the vaccine prior to their clinical training to avoid adulthood varicella.
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Abstract
The present cross-sectional serosurvey constitutes the first effort to describe the varicella zoster virus (VZV) seroepidemiology in Serbia. An age-stratified serum bank of 3570 residual samples collected between 2015 and 2016 in each of the seven districts of the Vojvodina Province was tested for IgG anti-VZV antibodies with an enzyme immunoassay. Results were standardised into common units according to the European Sero-Epidemiology Network (ESEN2) methodology. Univariable and multivariable analyses were used to examine the relationships between standardised anti-VZV positivity or logarithmically transformed antibody titres and demographic features of study subjects. Seropositivity (85% overall) increased with age, in parallel with geometric mean titres. By the time of school entry, 68% of children were immune. The slower subsequent acquisition of immunity leaves epidemiologically relevant proportions of adolescents (7%), young adults (6%) and especially females of reproductive age (6%) prone to more severe forms of varicella. In the ongoing pre-vaccine era, natural infection provides a high level of collective immunity, with the highest VZV transmission in children of preschool age. The detected gaps in VZV immunity of the Serbian population support the adoption of the official recommendations for varicella immunisation of non-immune adolescents and young adults, including non-pregnant women of childbearing age.
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Medić S, Katsilieris M, Lozanov-Crvenković Z, Siettos CI, Petrović V, Milošević V, Brkić S, Andrews N, Ubavić M, Anastassopoulou C. Varicella zoster virus transmission dynamics in Vojvodina, Serbia. PLoS One 2018; 13:e0193838. [PMID: 29505590 PMCID: PMC5837184 DOI: 10.1371/journal.pone.0193838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/19/2018] [Indexed: 01/29/2023] Open
Abstract
This study aimed at establishing baseline key epidemiological parameters for varicella zoster virus (VZV) infection in Vojvodina, Serbia, with the ultimate goal to quantify the VZV transmission potential in the population. Seroprevalence data generated during the first large cross-sectional VZV serosurvey were modelled, using a two-tiered modelling approach to calculate age-specific forces of infection (FOI), the basic reproduction number (R0) and herd immunity threshold (H). Seroprevalence and modelling data were compared with corresponding pre-vaccination epidemiological parameters from 11 countries participating in the European Sero-Epidemiology Network 2 (ESEN2) project. Serbia fits into the general dynamic VZV transmission patterns in Europe in the pre-vaccine era, with estimated R0 = 4.12, (95% CI: 2.69–7.07) and H = 0.76 (95% CI: 0.63–0.86). The highest VZV transmission occurs among preschool children, as evidenced by the estimation of the highest FOI (0.22, 95% CI: 0.11–0.34) in the 0.5–4 age group, with a peak FOI of 0.25 at 2.23 years. Seroprevalence was consistently lower in 5–14 year-olds, resulting in considerable shares of VZV-susceptible adolescents (7.3%), and young adults (6%), resembling the situation in a minority of European countries. The obtained key epidemiological parameters showed most intense VZV transmission in preschool children aged <4 years, justifying the consideration of universal childhood immunization in the future. National immunization strategy should consider programs for VZV serologic screening and immunization of susceptible groups, including adolescents and women of reproductive age. This work is an important milestone towards the evaluation of varicella immunization policy options in Serbia.
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Affiliation(s)
- Snežana Medić
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- * E-mail:
| | - Michalis Katsilieris
- School of Applied Mathematics and Physical Sciences, National Tehnical University of Athens, Athens, Greece
| | - Zagorka Lozanov-Crvenković
- Department of Mathematics and Computer Science, Faculty of Science, University of Novi Sad, Novi Sad, Serbia
| | - Constantinos I. Siettos
- School of Applied Mathematics and Physical Sciences, National Tehnical University of Athens, Athens, Greece
| | - Vladimir Petrović
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vesna Milošević
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Snežana Brkić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, National Infections Services, Public Health England, London, United Kingdom
| | | | - Cleo Anastassopoulou
- Division of Genetics, Cell and Developmental Biology, Department of Biology, University of Patras, Patras, Greece
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The Seroprevalence of Varicella Zoster Virus in a Healthy Population from Tehran, Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.59883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Riera-Montes M, Bollaerts K, Heininger U, Hens N, Gabutti G, Gil A, Nozad B, Mirinaviciute G, Flem E, Souverain A, Verstraeten T, Hartwig S. Estimation of the burden of varicella in Europe before the introduction of universal childhood immunization. BMC Infect Dis 2017; 17:353. [PMID: 28521810 PMCID: PMC5437534 DOI: 10.1186/s12879-017-2445-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Varicella is generally considered a mild disease. Disease burden is not well known and country-level estimation is challenging. As varicella disease is not notifiable, notification criteria and rates vary between countries. In general, existing surveillance systems do not capture cases that do not seek medical care, and most are affected by underreporting and underascertainment. We aimed to estimate the overall varicella disease burden in Europe to provide critical information to support decision-making regarding varicella vaccination. METHODS We conducted a systematic literature review to identify all available epidemiological data on varicella IgG antibody seroprevalence, primary care and hospitalisation incidence, and mortality. We then developed methods to estimate age-specific varicella incidence and annual number of cases by different levels of severity (cases in the community, health care seekers in primary care and hospitals, and deaths) for all countries belonging to the European Medicines Agency (EMA) region and Switzerland. RESULTS In the absence of universal varicella immunization, the burden of varicella would be substantial with a total of 5.5 million (95% CI: 4.7-6.4) varicella cases occurring annually across Europe. Variation exists between countries but overall the majority of cases (3 million; 95% CI: 2.7-3.3) would occur in children <5 years. Annually, 3-3.9 million patients would consult a primary care physician, 18,200-23,500 patients would be hospitalised, and 80 varicella-related deaths would occur (95% CI: 19-822). CONCLUSIONS Varicella disease burden is substantial. Most cases occur in children <5 years old but adults require hospitalisation more often and are at higher risk of death. This information should be considered when planning and evaluating varicella control strategies. A better understanding of the driving factors of country-specific differences in varicella transmission and health care utilization is needed. Improving and standardizing varicella surveillance in Europe, as initiated by the European Centre for Disease Prevention and Control (ECDC), is important to improve data quality to facilitate inter-country comparison.
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Affiliation(s)
- Margarita Riera-Montes
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium.
| | - Kaatje Bollaerts
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium
| | - Ulrich Heininger
- Division of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, CH-4056, Basel, Switzerland
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Antwerp, Belgium.,Centre for Health Economics Research and Modelling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Angel Gil
- Universidad Rey Juan Carlos, Madrid, Spain
| | - Bayad Nozad
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Grazina Mirinaviciute
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Elmira Flem
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Thomas Verstraeten
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001, Leuven, Belgium
| | - Susanne Hartwig
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, 69007, Lyon, France
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Del Fava E, Rimseliene G, Flem E, Freiesleben de Blasio B, Scalia Tomba G, Manfredi P. Estimating Age-Specific Immunity and Force of Infection of Varicella Zoster Virus in Norway Using Mixture Models. PLoS One 2016; 11:e0163636. [PMID: 27689800 PMCID: PMC5045180 DOI: 10.1371/journal.pone.0163636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/12/2016] [Indexed: 01/28/2023] Open
Abstract
This study applies mixture modelling to examine age-specific immunity to varicella zoster virus (VZV) infection in Norway based on the first large-scale serological study in the general population. We estimated the seropositive proportions at different ages and calculated the underlying force of infection by using a sample of 2103 residual sera obtained from patients seeking primary and hospital care. A rapid increase in the VZV-associated immunity is observed in the first years of life with 63% of children being immune by age 5. The increase in the immunity levels slows down thereafter, with a large proportion of adults still susceptible by age 20 (around 14.5%), thus at risk of serious sequelae of varicella infection. The corresponding force of infection peaks during the preschool period, subsequently declines to a minimum between ages 10 and 20 years, and afterwards moderately increases to reach a plateau lasting throughout the childbearing period. In comparison with the traditional cut-off approach, mixture modelling used the whole data without producing any inconclusive cases, led to an unbiased classification of individuals between susceptible and immune, and provided a smoother immune profile by age. These findings represent an important step towards any decision about the introduction of varicella vaccination in Norway, as they are a primary input for mathematical transmission models aimed at evaluating potential vaccination scenarios.
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Affiliation(s)
- Emanuele Del Fava
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- * E-mail:
| | - Grazina Rimseliene
- Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Elmira Flem
- Department of Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Birgitte Freiesleben de Blasio
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Piero Manfredi
- Department of Economics and Management, University of Pisa, Pisa, Italy
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De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World J Virol 2016; 5:97-124. [PMID: 27563537 PMCID: PMC4981827 DOI: 10.5501/wjv.v5.i3.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/08/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.
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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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Tafuri S, Gallone MS, Cappelli MG, Gallone MF, Larocca AMV, Germinario C. A seroprevalence survey on varicella among adults in the vaccination era in Apulia (Italy). Vaccine 2014; 32:6544-7. [PMID: 25236583 DOI: 10.1016/j.vaccine.2014.08.088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 01/11/2023]
Abstract
In 2006, the Apulia Region (Italy) introduced universal routine vaccination (URV) against varicella disease. The coverage for one dose of varicella vaccine at 24 month of age reached 91.1% in 2010 birth-cohort. Vaccination coverage for the second dose at 5-6 years was 64.8% for the cohort 2005, and 28.8% for adolescents born in 1997. The aim of the present study is to evaluate the pattern of immunity/susceptibility to varicella in Apulian adults by a seroprevalence survey carried out 6 years after the introduction of URV. The study was carried out from May 2011 to June 2012 among blood donors of the Department of Transfusion Medicine of Policlinico General Hospital in Bari. Subjects were enrolled by a convenience sample. For each enrolled patient we collected a sample of serum of 5 ml. Anti-VZV IgG in collected sera were analyzed by chemiluminescence (CLIA). We enrolled 1769 subject; 1365 (77.2%) were male with a mean age of 38.4 ± 11.7 years. 93% (95% CI=91.7-94.1) of enrolled subject presented a titre of anti-VZV IgG >164 mIU/mL. GMT of anti-VZV IgG titre was 1063.4 mIU/ml and no difference was observed between different age group. According to our data, URV did not seem to have any impact on susceptibility among adults and in particular we did not note any cluster of susceptible subjects among young adults. Also in the vaccination era, we did not note that the average age of infection shifts among adults and then we could exclude an increase of case of complicated varicella related to the URV.
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Affiliation(s)
- S Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
| | - M S Gallone
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - M G Cappelli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - M F Gallone
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - A M V Larocca
- Hygiene Department, Policlinico General Hospital, Bari, Italy
| | - C Germinario
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
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Pourakbari B, Shahbaznezhad L, Parvaneh N, Nikkhah S, Mahmoudi S, Teymuri M, Alyari AE, Mamishi S. Seroepidemiology of Varicella Zoster Virus among children, adolescents and medical students in a referral children medical center, Tehran, Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2012; 4:136-8. [PMID: 23066488 PMCID: PMC3465539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Varicella is a benign childhood infection with considerable complication in none immune adults. The aim of this study was to survey Varicella Zoster Virus (VZV) seroepidemiology in children, adolescents and medical students in Children Medical Center, Tehran, Iran. MATERIAL AND METHODS In this cross sectional study, serum sample of children, adolescents 10 to 18 years old and medical students 18 to 25 years old were tested for VZV IgG with a commercial ELISA kit. RESULTS A total of 412 individuals who were 10 to 25 years of age participated in this study. Overall 269 individuals (65.3%) were seropositive for VZV IgG. Seroprevalence of VZV antibody increased with age of participants, from 59% in 10-11years children to 80% in 20-21 years old young adult students, except in 22-23 and 24-25 years old, whom the frequency of positive results decreased interestingly to 41.7 and 52.8%, respectively. Prevalence of positive VZV antibody between two genders was not statistically different. CONCLUSION On-going monitoring of the seroepidemilogy of VZV is necessary to assess trends of infection in the community. A considerable proportion of young medical students in this study were still susceptible to VZV and consequent complications.
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Affiliation(s)
- B Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - L Shahbaznezhad
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - N Parvaneh
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Nikkhah
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Teymuri
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - AE Alyari
- Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran,Departments of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran,
Corresponding author: Dr. Setare Mamishi, Address: No. 62, Dr. Gharib St., Department of Infectious Disease, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-21-66428996. Fax: +98-21-66428996. E-mail:
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17
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Immunity to varicella-zoster virus in Croatian women of reproductive age targeted for serology testing. Arch Gynecol Obstet 2012; 286:901-4. [PMID: 22678561 DOI: 10.1007/s00404-012-2398-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 05/24/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the immunity to varicella-zoster virus (VZV) in Croatian pregnant and non-pregnant women of reproductive age. METHODS During 2007-2011, a total of 638 women aged 16-45 years were tested for the presence of VZV IgM and IgG antibodies using commercial enzyme-linked immunosorbent assay. Samples positive for IgG antibodies with positive or equivocal IgM antibodies were tested for IgG avidity. RESULTS The overall IgG seroprevalence was 84.3 %. There was a significant increase in IgG seropositivity with age (OR = 1.04 for 1-year increase in age; 95 % CI 1.01-1.08). The lowest seroprevalence rate was reported in the 16-20 age groups (78.6 %), and the highest was in the 41-45 age groups (94.3 %). There was no significant difference in seroprevalence among women residing in urban and rural areas (83.6 vs. 87.0 %, OR 0.76, 95 % CI 0.43-1.34). CONCLUSIONS The results of this study have shown that a high proportion of Croatian childbearing-aged women (15.7 %) who were referred to the laboratory for VZV serology testing are susceptible to VZV and, thus, at risk for contracting varicella during pregnancy. Serology testing of adolescent girls and adult women who do not have a documented history of varicella is encouraged with the aim of vaccinating seronegative girls and women against VZV before pregnancy. In addition, testing of pregnant women is advised to identify susceptible women and vaccinate them after delivery.
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Guido M, Tinelli A, De Donno A, Quattrocchi M, Malvasi A, Campilongo F, Zizza A. Susceptibility to varicella-zoster among pregnant women in the province of Lecce, Italy. J Clin Virol 2011; 53:72-6. [PMID: 22074933 DOI: 10.1016/j.jcv.2011.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/21/2011] [Accepted: 10/14/2011] [Indexed: 01/30/2023]
Abstract
BACKGROUND Varicella is predominantly a childhood disease, considered a mild self-limiting disease that can have serious complications for a pregnant woman and her developing fetus. OBJECTIVES We investigated the susceptibility to varicella-zoster Virus (VZV) among pregnant women in the province of Lecce. STUDY DESIGN A cross-sectional study was carried out in Departments of Gynecology and Obstetrics of the Province of Lecce, where 539 pregnant women were recruited, and face-to-face interviews were conducted. Varicella IgG tests were performed. RESULTS The prevalence of varicella susceptibility among pregnant mothers was 10.6%. The prevalence of IgG antibodies increases significantly with increasing age, from 62.5% in the age group 15-19 years to 94.4% in the age group 40-49 years. DISCUSSION In the Italian National Vaccination Plan 2005-2007, varicella vaccine is only recommended for childbearing women. A safe and effective vaccine is available and no abnormalities have been observed among infants born to susceptible women who received varicella vaccines during pregnancy. Such a high number of susceptible women indicates that preventive and informative programs should be introduced, even among those who do not plan to become pregnant. Routine counselling, varicella IgG antibody screening and varicella vaccination should be considered if they have no history of the infection, to reduce the risk of fetal complications and the cost of healthcare associated with the infection.
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Affiliation(s)
- M Guido
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy
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