Burden of varicella in Italy, 2001–2010: analysis of data from multiple sources and assessment of universal vaccination impact in three pilot regions

Trucchi, Cecilia; Gabutti, Giovanni; Rota, Maria Cristina; Bella, Antonino

doi:10.1099/jmm.0.000061

Cited by 22 publications

(20 citation statements)

References 43 publications

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“…The results presented demonstrate a high degree healthcare resource use, with 92.0% of outpatients and 57.3% of inpatients visiting a doctor’s office at least once when they had varicella; among these patients, the average number of visits reported per outpatients and inpatients was 1.3 and 1.2 respectively. For inpatients, a mean hospital stay of 4.7 days was observed, which is supported by previous European data that reports three to 8 days [ 30 , 39 , 50 – 53 ]. These results also align with a recent systematic review which found that for Europe, in the absence of universal varicella vaccination, healthcare-related burden of varicella is substantial, reaching approximately 3 million pediatric cases per year, with overall annual number of varicella-related primary care physician consults and hospitalizations estimated at 3–3.9 million and 18,200–23,500 [33].…”

Section: Discussionsupporting

confidence: 87%

“…For example, the US, Canada, Uruguay, Spain, Germany, Italy, and Australia have observed declines of > 99.2%, 93.0%, 94.0%, 95.2%, 77.6%, 84.0%, and 76.8%, respectively, in hospitalizations associated with varicella after introducing the vaccine in their national vaccination program [ 29 ]. A study conducted in Italy between 2001 and 2010 also demonstrated decreasing varicella incidence and associated hospitalizations with increasing vaccine coverage rates in the first 3 Italian regions to implement universal varicella vaccination [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Varicella in Poland: economic burden in children 1–12 years of age in Poland, 2010–2015

et al. 2018

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BackgroundThe safety and efficacy of live-attenuated varicella zoster virus (VZV) vaccines in preventing varicella and reducing associated morbidity and mortality in real-world have been previously shown. In Poland, VZV vaccination is only mandatory for certain high-risk individuals. Here, we have conducted an evaluation of the clinical and economic burden of varicella in Poland.MethodsMulticenter, retrospective chart review of varicella inpatients and outpatients aged 1–12 years with a primary diagnosis between 2010 and 2015. Varicella-related outcomes included the incidence of complications, the proportion of patients reporting healthcare resource utilization (HCRU), and frequency of HCRU. Direct costs were derived from per patient resource use multiplied by unit costs, and indirect costs were calculated as loss of revenue of caregivers reporting work days missed. The overall annual cost of varicella in Poland was estimated based on the calculated direct and indirect costs per case and the estimated number of varicella cases. All costs are presented in 2015 Polish złoty (PLN) / Euros (€).ResultsA total of 150 children with varicella were included, of which 75 were outpatients and 75 were inpatients with a mean (± SD) age of 3.9 (±2.6) and 4.2 (±2.3) years, respectively. Complications were experienced by 14.7% of outpatients and 82.7% of inpatients, of which the most common were skin and soft tissue infections and dehydration. The rate of HCRU was as follows: over-the-counter medications (80.0% outpatients, 81.3% inpatients), prescription medications (80.0% outpatients, 93.3% inpatients), tests/procedures (0.0% outpatients, 69.3% inpatients), and allied health professional consults (0.0% outpatients, 24.0% inpatients). Total (direct and indirect) cost per varicella case was 5013.3 PLN (€ 1198.1) for inpatients and 1027.2 PLN (€ 245.5) for outpatients, resulting in an estimated overall annual (2015) cost of varicella in Poland of 178,198,320 PLN (€ 42,588,385) among children aged 1–15 years.ConclusionsSignificant clinical and economic burden is associated with varicella in Poland. These results may be used to foster discussion related to the implications of implementing routine VZV vaccination in Poland.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Varicella in Poland: economic burden in children 1–12 years of age in Poland, 2010–2015

et al. 2018

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“…Many patients with varicella will visit a general practitioner (GP) and 2–6 % of those cases will have complications, while the annual incidence of varicella hospitalisations in Europe is 1.9 to 5.8 per 100,000 population [ 3 ]. The high infection rates and associated economic burden of varicella result in a significant public health burden [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy

et al. 2016

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BackgroundVaricella is a highly infectious disease with a significant public health and economic burden, which can be prevented with childhood routine varicella vaccination. Vaccination strategies differ by country. Some factors are known to play an important role (number of doses, coverage, dosing interval, efficacy and catch-up programmes), however, their relative impact on the reduction of varicella in the population remains unclear. This paper aims to help policy makers prioritise the critical factors to achieve the most successful vaccination programme with the available budget.MethodsScenarios assessed the impact of different vaccination strategies on reduction of varicella disease in the population. A dynamic transmission model was used and adapted to fit Italian demographics and population mixing patterns. Inputs included coverage, number of doses, dosing intervals, first-dose efficacy and availability of catch-up programmes, based on strategies currently used or likely to be used in different countries. The time horizon was 30 years.ResultsBoth one- and two-dose routine varicella vaccination strategies prevented a comparable number of varicella cases with complications, but two-doses provided broader protection due to prevention of a higher number of milder varicella cases. A catch-up programme in susceptible adolescents aged 10–14 years old reduced varicella cases by 27–43 % in older children, which are often more severe than in younger children. Coverage, for all strategies, sustained at high levels achieved the largest reduction in varicella. In general, a 20 % increase in coverage resulted in a further 27–31 % reduction in varicella cases. When high coverage is reached, the impact of dosing interval and first-dose vaccine efficacy had a relatively lower impact on disease prevention in the population. Compared to the long (11 years) dosing interval, the short (5 months) and medium (5 years) interval schedules reduced varicella cases by a further 5-13 % and 2-5 %, respectively. Similarly, a 10 % increase in first-dose efficacy (from 65 to 75 % efficacy) prevented 2–5 % more varicella cases, suggesting it is the least influential factor when considering routine varicella vaccination.ConclusionsVaccination strategies can be implemented differently in each country depending on their needs, infrastructure and healthcare budget. However, ensuring high coverage remains the critical success factor for significant prevention of varicella when introducing varicella vaccination in the national immunisation programme.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3738-x) contains supplementary material, which is available to authorized users.

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“…14 systems, the nationwide trend of notifications and hospitalizations from 2005 showed a progressive decrease that could be at least partly related to the impact of vaccine interventions implemented in the above mentioned regions. 20,21 The effectiveness of immunization has also been demonstrated in a previous research where the changes in the seroepidemiological pattern were assessed in the same 8 "pilot" regions. The increase in seroprevalence was most evident in the age groups target of immunization.…”

Section: Discussionmentioning

confidence: 96%

Has VZV epidemiology changed in Italy? Results of a seroprevalence study

Donno

Kuhdari

Guido

et al. 2016

Human Vaccines & Immunotherapeutics

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The aim of the study was to evaluate if and how varicella prevalence has changed in Italy. In particular a seroprevalence study was performed, comparing it to similar surveys conducted in pre-immunization era. During 2013-2014, sera obtained from blood samples taken for diagnostic purposes or routine investigations were collected in collaboration with at least one laboratory/center for each region, following the approval of the Ethics Committee. Data were stratified by sex and age. All samples were processed in a national reference laboratory by an immunoassay with high sensitivity and specificity. Statutory notifications, national hospital discharge database and mortality data related to VZV infection were analyzed as well. A total of 3707 sera were collected and tested. In the studied period both incidence and hospitalization rates decreased and about 5 deaths per year have been registered. The seroprevalence decreased in the first year of life in subjects passively protected by their mother, followed by an increase in the following age classes. The overall antibody prevalence was 84%. The comparison with surveys conducted with the same methodology in 1996-1997 and 2003-2004 showed significant differences in age groups 1-19 y. The study confirms that in Italy VZV infection typically occurs in children. The impact of varicella on Italian population is changing. The comparison between studies performed in different periods shows a significant increase of seropositivity in age class 1 -4 years, expression of vaccine interventions already adopted in some regions.

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Burden of varicella in Italy, 2001–2010: analysis of data from multiple sources and assessment of universal vaccination impact in three pilot regions

Cited by 22 publications

References 43 publications

Varicella in Poland: economic burden in children 1–12 years of age in Poland, 2010–2015

Varicella in Poland: economic burden in children 1–12 years of age in Poland, 2010–2015

Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy

Has VZV epidemiology changed in Italy? Results of a seroprevalence study

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