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Lee YH, Choe YJ, Hong K, Yoon Y, Kim YK. The Protective Effectiveness of 2-Dose Varicella Vaccination in Children in Korea: A Case-Control Study. Pediatr Infect Dis J 2023:00006454-990000000-00438. [PMID: 37171976 DOI: 10.1097/inf.0000000000003958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND A 2-dose vaccination against varicella has been adopted in many places; however, it has not been widely introduced in Korea. This study aimed to assess 1-dose and 2-+dose vaccine effectiveness (VE) against laboratory-confirmed varicella in Korea to provide a scientific basis for developing an immunization strategy. METHODS We constructed a national cohort using national surveillance data and the national immunization registry. From the cohort, we conducted a 1:2 matched nested case-control study to estimate and compare the VE of the 1-dose and 2-dose of varicella vaccination using exact conditional logistic regression. VE was calculated as [1 - matched odds ratio (OR) × 100%]. RESULTS From January 1, 2011 to December 31, 2020, a total of 205,173 varicella cases were reported to the notifiable diseases surveillance system. Of these, we included 4,387 laboratory-confirmed varicella cases and 8,774 controls for the analyses. The VE of 1-dose vaccination was 16.8% (95% CI: -9.0% to 36.5%), whereas the VE of 2-doses of the vaccination was 98.6% (95% CI: 96.0%-99.5%). CONCLUSION These findings suggest that the 2-dose vaccination strategy can be an effective strategy to prevent varicella.
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Affiliation(s)
- Young Hwa Lee
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine
| | - Yoonsun Yoon
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea; and
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University Ansan Hospital and Korea University College of Medicine, Seoul, Korea
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Mo ZJ, Huang SJ, Qiu LX, Li CG, Yu XJ, Li MQ, Chen Z, Zhong GH, Pan DQ, Huang LR, Lv BJ, Cui XL, Song QQ, Jia JZ, Han JL, Wang W, Zhu H, Cheng T, Su YY, Li YM, Ye XZ, Wu T, Zhang J, Xia NS. Safety and immunogenicity of a skin- and neuro-attenuated live vaccine for varicella: a randomized, double-blind, controlled, dose-escalation and age de-escalation phase 1 clinical trial. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2023. [DOI: 10.1016/j.lanwpc.2023.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Sun X, Dai C, Wang K, Liu Y, Jin X, Wang C, Yin Y, Ding Z, Lu Z, Wang W, Wang Z, Tang F, Wang K, Peng Z. A Dynamic Compartmental Model to Explore the Optimal Strategy of Varicella Vaccination: An Epidemiological Study in Jiangsu Province, China. Trop Med Infect Dis 2022; 8:tropicalmed8010017. [PMID: 36668924 PMCID: PMC9861499 DOI: 10.3390/tropicalmed8010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/11/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Varicella (chickenpox) is highly contagious among children and frequently breaks out in schools. In this study, we developed a dynamic compartment model to explore the optimal schedule for varicella vaccination in Jiangsu Province, China. A susceptible-infected-recovered (SIR) model was proposed to simulate the transmission of varicella in different age groups. The basic reproduction number was computed by the kinetic model, and the impact of three prevention factors was assessed through the global sensitivity analysis. Finally, the effect of various vaccination scenarios was qualitatively evaluated by numerical simulation. The estimated basic reproduction number was 1.831 ± 0.078, and the greatest contributor was the 5-10 year-old group (0.747 ± 0.042, 40.80%). Sensitivity analysis indicated that there was a strong negative correlation between the second dose vaccination coverage rate and basic reproduction number. In addition, we qualitatively found that the incidence would significantly decrease as the second dose vaccine coverage expands. The results suggest that two-dose varicella vaccination should be mandatory, and the optimal age of second dose vaccination is the 5-10 year-old group. Optimal vaccination time, wide vaccine coverage along with other measures, could enhance the effectiveness of prevention and control of varicella in China.
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Affiliation(s)
- Xiang Sun
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Chenxi Dai
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, China
| | - Kai Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yuanbao Liu
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Xinye Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Congyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yi Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhongxing Ding
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhenzhen Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Weiming Wang
- Department of Mathematics and Statistics, Huaiyin Normal University, Huaian 223300, China
| | - Zhiguo Wang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Fenyang Tang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
- Correspondence: (F.T.); (K.W.); (Z.P.); Tel.: +86-25-83759423 (F.T.); +86-23-68771726 (K.W.); +86-25-86868244 (Z.P.)
| | - Kaifa Wang
- Department of Mathematics and Statistics, Southwest University, Chongqing 400715, China
- Correspondence: (F.T.); (K.W.); (Z.P.); Tel.: +86-25-83759423 (F.T.); +86-23-68771726 (K.W.); +86-25-86868244 (Z.P.)
| | - Zhihang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Correspondence: (F.T.); (K.W.); (Z.P.); Tel.: +86-25-83759423 (F.T.); +86-23-68771726 (K.W.); +86-25-86868244 (Z.P.)
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Shapiro ED, Marin M. The Effectiveness of Varicella Vaccine: 25 Years of Postlicensure Experience in the United States. J Infect Dis 2022; 226:S425-S430. [PMID: 36265844 DOI: 10.1093/infdis/jiac299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We summarize studies of varicella vaccine's effectiveness for prevention of varicella and lessons learned during the first 25 years of the varicella vaccination program in the United States. One dose of varicella vaccine provided moderate protection (82%-85%) against varicella of any severity and high protection (100%) against severe varicella, with some waning of protection over time. The 1-dose program (1995-2006) had a substantial impact on the incidence both of varicella and of severe outcomes (71%-90% decrease) although it did not prevent low-level community transmission and some outbreaks continued to occur in highly vaccinated populations. Two doses of varicella vaccine improved the vaccine's effectiveness by at least 10% against varicella of any severity, with further declines in the incidence both of varicella and of severe outcomes as well as in both number and size of outbreaks. There is no evidence for waning of the effectiveness of 2 doses of the vaccine.
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Affiliation(s)
- Eugene D Shapiro
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wang W, Pan D, Cheng T, Zhu H. Rational Design of a Skin- and Neuro-Attenuated Live Varicella Vaccine: A Review and Future Perspectives. Viruses 2022; 14:848. [PMID: 35632591 PMCID: PMC9144592 DOI: 10.3390/v14050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Primary varicella-zoster virus (VZV) infection causes varicella, which remains a prominent public health concern in children. Current varicella vaccines adopt the live-attenuated Oka strain, vOka, which retains the ability to infect neurons, establish latency and reactivate, leading to vaccine-associated zoster in some vaccinees. Therefore, it is necessary to develop a safer next-generation varicella vaccine to help reduce vaccine hesitancy. This paper reviews the discovery and identification of the skin- and neuro-tropic factor, the open reading frame 7 (ORF7) of VZV, as well as the development of a skin- and neuro-attenuated live varicella vaccine comprising an ORF7-deficient mutant, v7D. This work could provide insights into the research of novel virus vaccines based on functional genomics and reverse genetics.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361102, China; (W.W.); (D.P.)
| | - Dequan Pan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361102, China; (W.W.); (D.P.)
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361102, China; (W.W.); (D.P.)
| | - Hua Zhu
- Department of Microbiology and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 070101, USA
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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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Meng QH, Cheng XP, Liu DD, Chen CH, Yao KH. One single-center cross-sectional investigation on varicella antibody level of all age groups in Chinese people. Hum Vaccin Immunother 2021; 17:358-362. [PMID: 32966147 PMCID: PMC7899669 DOI: 10.1080/21645515.2020.1784653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
Abstract
Varicella outbreaks were mainly reported in developed regions with high vaccine coverage, but not in undeveloped areas. It is still not clear that whether the published data of varicella epidemiology could reflect the reality in China or not. In 2019, 657 subjects from People's Hospital of Chongqing Youyang County were included. Anti-varicella-zoster virus (VZV) IgG antibodies were determined by ELISA. The anti-VZV IgG levels were categorized as positive when values were ≥100 mIU/mL. Our results showed that the rates of anti-VZV IgG seropositivity (χ2 = 328.957, P < .0001) and geometric mean titers (P < .0001) were significantly influenced by age. The seropositivity declined dramatically from 84.5% in subjects ≤3 m of age, to 7.9% in subjects of >3 m-1 y (P < .0001). Then, the positivity rate increased slowly as age to 26.7% in >1-<3 y (P = .0006), and 34.5% in 3-<7 y (P = .4294). A steady rise (45.6%) in positivity was observed in subjects aged 7-<18 y. After then, the positivity began to increase robustly. A total of 87.8% of adults aged 18-<40 y had acquired VZV-specific immunity (P < .0001). The highest positivity rate was found in 40-<60 y (98.3%) and ≥60 y (98.2%) group. In conclusion, most subjects of >3 m-<7 y age were susceptible to VZV. The proportion of subjects with natural infection-induced immunity increased with age. Nearly all subjects over 40 ages had positive anti-VZV IgG antibodies, which proved that they were infected by this virus in the past. These results suggested that VarV should be included in the national immunization program in China.
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Affiliation(s)
- Qing-Hong Meng
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline, Laboratory of Dermatology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiao-Ping Cheng
- Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University; People’s Hospital of Chongqing Youyang County, Chongqing, China
| | - Dan-Dan Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline, Laboratory of Dermatology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Chang-Hui Chen
- Youyang Hospital, The First Affiliated Hospital of Chongqing Medical University; People’s Hospital of Chongqing Youyang County, Chongqing, China
| | - Kai-Hu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline, Laboratory of Dermatology, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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Xu Y, Liu Y, Zhang X, Zhang X, Du J, Cai Y, Wang J, Che X, Gu W, Jiang W, Chen J. Epidemiology of varicella and effectiveness of varicella vaccine in Hangzhou, China, 2019. Hum Vaccin Immunother 2021; 17:211-216. [PMID: 32574100 PMCID: PMC7872021 DOI: 10.1080/21645515.2020.1769395] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/10/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The varicella vaccine (VarV) is not included in the national childhood immunization schedules in China, although 2-dose VarV (VarV2) were recommended for children at 1 and 4 years of age in Hangzhou since 2014. However, the reported incremental vaccine effectiveness (VE) of VarV2 varies widely among studies. We described the epidemiological characteristics of varicella in Hangzhou, assessed the VE of VarV, so as to provide scientific evidence on optimization and adjustment of immunization strategies for varicella prevention in China. Methods: All varicella cases diagnosed in a hospital in Hangzhou are reported to China Information System for Disease Control and Prevention (CISDCP). The demographic information of reported varicella cases onset from January 1 to December 31, 2019 was extracted from CISDCP on Jan 31, 2020. The demographic information was obtained from the information system of the National Center for Disease Prevention and Control. We conducted a 1:1 matched case-control study to assess the effectiveness of VarV. Participant data were collected with standardized questionnaires. VarV vaccination status was checked by using Hangzhou Immunization Information System (HZIIS). Results: A total of 11,813 varicella cases were reported in Hangzhou, China, 2019, without any death. Annual estimated incidence of varicella was 120 cases per 100,000 populations in 2019. The overall estimated incidence rate of varicella was high, especially for persons aged 10-19 years old and in suburb areas. The seasonal pattern was apparent, mostly due to the cases among students and children in kindergarten. In total, 218 varicella cases and 218 matched controls were included for evaluating the VE of VarV. VarV vaccination produced a high level of protection against varicella, while VE of VarV2 was even better. VE of VarV1 was 91.0% (95%CI: 81.6%-95.8%), and VE was 98.0% (95.5%-99.2%) for VarV2. Conclusion: Continuous monitoring and management of varicella cases is necessary, especially in those endemic areas, high-risk populations, and peak periods; a 2-dose VarV strategy is highly recommended, and relevant health institutions should consider the inclusion of VarV in the national immunization program to better control varicella epidemic and reduce the burden of varicella.
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Affiliation(s)
- Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoping Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xuechao Zhang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jian Du
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yuxin Cai
- Department of Preventive Medicine, Zhejiang Chinese Medical University School of Public Health, Hangzhou, China
| | - Jun Wang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xinren Che
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wenwen Gu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Jiang
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Junfang Chen
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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Barrenechea GG, Bastos LS. Evaluation of impact of one dose varicella vaccine on the incidence of chickenpox in Argentina. Vaccine 2019; 38:330-335. [PMID: 31630938 DOI: 10.1016/j.vaccine.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Varicella, also known as chickenpox is one of the most common immunizable diseases. In 1998, the World Health Organization (WHO) recommended to incorporate this vaccine in the national immunization programs, which Argentina did in 2015. OBJECTIVES To describe the behavior of the varicella time series for the 2005-2017 period, and to evaluate the impact of the vaccine in Argentina. METHODOLOGY An ecological observational study was performed, using the varicella cases reported in the National Health Monitoring System, and the data of the National census as secondary data sources. A model based time series analysis of the notified varicella cases in Argentina was performed, using a Negative Binomial Mixed Model. For the verification of the vaccine impact, the 2005-2014 period was selected, and a prognosis for the following years was performed. Impact was evaluated by comparing the rates and confidence intervals between the predicted and observed values. RESULTS Argentina reported 1,775,587 varicella cases for the 2005-2017 period. The series exhibited seasonality, and, a decreasing trend in the number of cases was observed in 2016 and 2017. A reduction of the incidence rate after the implementation of the vaccine was observed. The transmission risk decreased in the country after vaccine implementation. CONCLUSIONS This study is the first concrete evidence of the varicella incidence decline after the implementation of a single dose application program in Argentina.
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Affiliation(s)
- Guillermo G Barrenechea
- Departamento Bioquímico-Laboratorio de Salud Pública, Mendoza 128 4° Piso, San Miguel de Tucumán, Tucumán CP: 4107, Argentina; Dirección de Investigación en Salud, Virgen de la Merced 189 1° Piso, San Miguel de Tucumán, Tucumán CP: 4107, Argentina.
| | - Leonardo S Bastos
- Scientific Computing Program, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro CEP: 21040-900, Brazil; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Sullivan NL, Eberhardt CS, Wieland A, Akondy RS, Yi J, McElroy AK, Ahmed R. Characterization of Virus-specific Immune Response During Varicella Zoster Virus Encephalitis in a Young Adult. Clin Infect Dis 2019; 69:348-351. [PMID: 30668661 PMCID: PMC7322817 DOI: 10.1093/cid/ciy984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
An immunocompetent adult received corticosteroids for chest pain, which later was clinically found to be herpes zoster (HZ). She developed severe disease and rapid viral dissemination that elicited an exceptionally strong varicella zoster virus-specific B-cell and CD8 T-cell response. Clinicians should consider atypical HZ presentation prior to corticosteroid administration.
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Affiliation(s)
- Nicole L Sullivan
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Christiane S Eberhardt
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics and Pathology-Immunology, Center for Vaccinology and Neonatal Immunology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Switzerland
| | - Andreas Wieland
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Rama S Akondy
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Jumi Yi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Georgia
| | - Anita K McElroy
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Georgia
| | - Rafi Ahmed
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
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Bastos MDS, Folster J, Alvarenga OPD, Sampaio DDA, Rabelo RMP, João GAP, Lacerda MVGD, Schmid DS. Genotypes of clinical varicella-zoster virus isolates from Manaus, Brazil. Rev Soc Bras Med Trop 2019; 52:e20180166. [PMID: 31141042 DOI: 10.1590/0037-8682-0166-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/29/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Vaccination against varicella-zoster virus (VZV) has been effective and safe in countries that routinely administer the vaccine. Brazil began universal VZV vaccination in 2013. This study aimed to identify VZV genotypes present in Manaus, Brazil prior to widespread immunization. METHODS Vesicular lesions or cerebral-spinal-fluid samples were collected from patients diagnosed with VZV, herpes zoster, or meningitis/encephalitis. DNA was extracted, amplified, and sequenced. RESULTS Half the isolates were clade-5 viruses and the remaining were divided between the European clades 1 and 3. CONCLUSIONS This study provides insights into the circulating VZV genotypes in Manaus prior to widespread vaccination.
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Affiliation(s)
| | - Jennifer Folster
- Centers for Disease Control and Prevention, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, GA, USA
| | | | | | | | - Guilherme Augusto Pivoto João
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Hospital Universitário Getúlio Vargas, Manaus, AM, Brasil
| | - Marcus Vinícius Guimarães de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Instituto de Pesquisa Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil
| | - D Scott Schmid
- Centers for Disease Control and Prevention, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, GA, USA
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12
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Cheng HY, Chang LY, Lu CY, Huang LM. Epidemiology of Breakthrough Varicella after the Implementation of a Universal Varicella Vaccination Program in Taiwan, 2004-2014. Sci Rep 2018; 8:17192. [PMID: 30464186 PMCID: PMC6249209 DOI: 10.1038/s41598-018-35451-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022] Open
Abstract
National one-dose varicella vaccination at 12 months of age was implemented in Taiwan since 2004.Our study aimed to evaluate breakthrough varicella (BV) in post-vaccine era and its associated risk factors. We retrospectively identified children vaccinated against varicella between 12-23 months of age during 2004-2008. Their vaccination information was extracted from the national vaccination registry system and linked to the 2004-2014 National Health Insurance database. BV was defined as a diagnosis of varicella (ICD-9-CM codes 052 and 052.0-052.9) beyond 42 days post-vaccination. Multiple Cox regression model was used to identify risk factors for BV. Among 932,874 enrolled vaccinees, 26,446 (2.8%) had BV and 219 (0.024%) required hospitalization over the study period. Varicella incidence declined from 4.71 per 1000 person-year (PY) in 2004 to 0.81/1000 PY in 2014. BV incidence decreased from 3.90/1000 PY at first year to 1.94/1000 PY at 11th year after vaccination. Females had a lower risk for BV than males (hazard ratio [HR] 0.85, 95% CI, 0.83-0.87); Varivax® recipients had a lower risk for BV than Varilrix® recipients (HR 0.75, 95% CI, 0.72-0.78). Our study showed the incidence of varicella, BV and varicella-related hospitalizations in Taiwan were kept low in post-vaccine era.
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Affiliation(s)
- Hao-Yuan Cheng
- Taiwan Centers for Disease Control, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Kim SH, Park SH, Choi SM, Lee DG. Implementation of Hospital Policy for Healthcare Workers and Patients Exposed to Varicella-Zoster Virus. J Korean Med Sci 2018; 33:e252. [PMID: 30181734 PMCID: PMC6115693 DOI: 10.3346/jkms.2018.33.e252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/12/2018] [Indexed: 01/04/2023] Open
Abstract
Varicella-zoster virus (VZV) causes a highly contagious and generally benign, self-limited disease. However, in high-risk populations including immunocompromised patients, pregnant women, and neonates, VZV infection can be associated with significant morbidity and mortality. Healthcare-associated transmission of VZV occurs among healthcare workers (HCWs) and patients by airborne transmission or by direct contact with the index case. To minimize the risk of transmission in healthcare settings, all VZV-susceptible HCWs should be encouraged strongly to be immunized with the varicella vaccine. For post-exposure management, active immunization (varicella vaccine), passive immunization (varicella-zoster immune globulin) and/or antiviral agents, and isolation could be used in specific situations. To prevent the transmission of VZV infection in the hospital settings, the development and implementation of hospital policies for appropriate infection control is also warranted. This article reviews the general information and healthcare-associated transmission of VZV and summarizes the recommendations for the pre- and post-exposure management of HCWs and patients, in hospital settings.
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Affiliation(s)
- Si-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Varicella breakthrough infection and effectiveness of 2-dose varicella vaccine in China. Vaccine 2018; 36:5665-5670. [DOI: 10.1016/j.vaccine.2018.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/18/2018] [Accepted: 05/04/2018] [Indexed: 11/20/2022]
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15
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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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Oh HS, Bae JM. Vaccination history in elementary school children enrolled in the varicella epidemic investigations held in Jeju-si, Korea in the first half of 2017. Epidemiol Health 2017; 39:e2017053. [PMID: 29278902 PMCID: PMC5790978 DOI: 10.4178/epih.e2017053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/13/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The reported incidence rate of varicella infection in Jeju-do is higher compared with the national average. This study aimed to examine varicella vaccination history and evaluate clinical manifestation of varicella cases in Jeju-do. METHODS Based on the guideline suggested by the Korea Centers for Disease Control and Prevention (KCDC), two epidemic investigations for varicella infection were conducted in the first half of 2017. The history of varicella vaccination was confirmed using the Integrated Control System for Diseases and Health operated by the KCDC. RESULTS Out of a total of 60 elementary school children as the study subjects, all had been previously vaccinated against varicella. Twenty cases (33%) showed mild clinical manifestations and no complications. CONCLUSIONS As the government of Jeju-do has supplied a single-labeled vaccine since 2011, there is a need to evaluate the type of vaccination failure such as primary or secondary.
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Affiliation(s)
- Hyun-Suk Oh
- Jeju Heathcare Center of Jeju-si, Jeju, Korea
| | - Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University Scool of Medicine, Jeju, Korea
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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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Suo L, Lu L, Wang Q, Yang F, Wang X, Pang X, Marin M, Wang C. Varicella outbreak in a highly-vaccinated school population in Beijing, China during the voluntary two-dose era. Vaccine 2017; 35:4368-4373. [PMID: 28684165 DOI: 10.1016/j.vaccine.2017.06.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Two-dose varicella vaccination has been available in Beijing since 2012 in the private sector. We investigated a varicella outbreak in a highly vaccinated elementary school population. METHODS A cohort study was carried out and a varicella case was defined as an acute onset of generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 29 through May 17, 2015. Breakthrough varicella was defined as varicella >42days after the last vaccine dose among both 1- or 2-dose varicella vaccine recipients. Vaccination information was collected from immunization records; information on prior varicella and clinical presentations was collected by surveying students' parents. RESULTS Of the 1056 students in the school, 1027 (97.3%) reported no history of varicella. Prior to the outbreak, 98.6% of students had received ≥1 dose of varicella vaccine, and most (63.2%) students received two doses. Twenty varicella cases were identified for an overall attack rate of 2.0%. Half of the cases occurred in the classroom of the index case-patient, a two-dose recipient who was not isolated after symptom onset. Breakthrough varicella accounted for 95% of cases (19/20) with attack rates of 14.3% (1/7), 1.6% (6/362) and 2.0% (13/649) among unvaccinated, one-dose, and two-dose students, respectively. Most case-patients (18/20, 90%) had <50 lesions. No difference in clinical presentations was found between one-dose and two-dose recipients with breakthrough varicella. CONCLUSION Moderate two-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose recipients with breakthrough varicella are contagious. High two-dose varicella vaccine coverage and timely isolation of cases may be needed for varicella outbreak prevention in the two-dose era.
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Affiliation(s)
- Luodan Suo
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Li Lu
- Beijing Center for Disease Control and Prevention, Beijing, China.
| | - Qinghai Wang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Fan Yang
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Xu Wang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Xinghuo Pang
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chengbin Wang
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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A Highly Efficacious Herpes Simplex Virus 1 Vaccine Blocks Viral Pathogenesis and Prevents Corneal Immunopathology via Humoral Immunity. J Virol 2016; 90:5514-5529. [PMID: 27030264 DOI: 10.1128/jvi.00517-16] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Correlates of immunologic protection requisite for an efficacious herpes simplex virus 1 (HSV-1) vaccine remain unclear with respect to viral pathogenesis and clinical disease. In the present study, mice were vaccinated with a novel avirulent, live attenuated virus (0ΔNLS) or an adjuvanted glycoprotein D subunit (gD-2) similar to that used in several human clinical trials. Mice vaccinated with 0ΔNLS showed superior protection against early viral replication, neuroinvasion, latency, and mortality compared to that of gD-2-vaccinated or naive mice following ocular challenge with a neurovirulent clinical isolate of HSV-1. Moreover, 0ΔNLS-vaccinated mice exhibited protection against ocular immunopathology and maintained corneal mechanosensory function. Vaccinated mice also showed suppressed T cell activation in the draining lymph nodes following challenge. Vaccine efficacy correlated with serum neutralizing antibody titers. Humoral immunity was identified as the correlate of protection against corneal neovascularization, HSV-1 shedding, and latency through passive immunization. Overall, 0ΔNLS affords remarkable protection against HSV-1-associated ocular sequelae by impeding viral replication, dissemination, and establishment of latency. IMPORTANCE HSV-1 manifests in a variety of clinical presentations ranging from a rather benign "cold sore" to more severe forms of infection, including necrotizing stromal keratitis and herpes simplex encephalitis. The present study was undertaken to evaluate a novel vaccine to ocular HSV-1 infection not only for resistance to viral replication and spread but also for maintenance of the visual axis. The results underscore the necessity to reconsider strategies that utilize attenuated live virus as opposed to subunit vaccines against ocular HSV-1 infection.
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