Effectiveness of varicella vaccine as post-exposure prophylaxis during a varicella outbreak in Shanghai, China

Wu, Qiangsong; Liu, Jingyi; Xian, Wang; Chen, Yuanfang; Zhou, Qi; Wu, Anqi; Wang, Lan

doi:10.1016/j.ijid.2017.10.016

Cited by 13 publications

(14 citation statements)

References 17 publications

(20 reference statements)

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“…This study found that the vaccination coverage rate of healthy children in Jiangsu Province was low (43.1%), and it was lower than the estimated coverage rate of varicella in Jiangsu Province’s vaccine management system (approximately 55–65%). The overall antibody positive rate (43.5%) and antibody GMC (225.4 mU/ ml) were lower than those reported in relevant studies in Beijing city and Shanghai city [ 14 – 16 ]. According to several clinical trial and observational studies in the domestic and foreign literature, relatively low vaccination rates and sero-conversion rates will lead to an increase in varicella outbreaks [ 17 – 19 ].…”

Section: Discussioncontrasting

confidence: 67%

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

Zhang

Liu

et al. 2018

BMC Infect Dis

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BackgroundIn recent years, outbreaks of varicella have continued to occur, and the coverage rate of varicella vaccine in Jiangsu Province, China, remains unclear. This study aims to analyse the levels of immune antibody against varicella and obtain a comprehensive understanding of the varicella attenuated live vaccine (VarV) coverage rate in children aged 1–9 years in Jiangsu Province.MethodsFrom June to October 2016, a cross-sectional survey was conducted to collect 3631 serum samples from healthy children aged 1–9 years in Jiangsu Province. The immunoglobulin G (IgG) antibody levels of varicella were detected by enzyme-linked immunosorbent assay (ELISA).ResultsThe VarV coverage rate of healthy children was only 43.1% (95% CI: 41.1–44.7%). The seroprevalence after vaccination with a single dose of VarV was only 57.1%, and the overall seropositivity and geometric antibody titre (GMC) were 43.5% and 225.4 mU/ml, respectively. The seropositivity was significantly higher in girls than in boys (χ2 = 18.82, P < 0.001). The difference in seropositivity between the 5–9 age group and 1–4 age group was statistically significant (χ2 = 84.31, P < 0.001). The difference in seropositivity between different regions was statistically significant, with the highest seropositivity in the northern area, 53.7% (χ2 = 35.64, P < 0.001). The seropositivity in the group receiving one dose of VarV was significantly higher than that of the unvaccinated group (χ2 = 205.16, P < 0.001). Linear regression analysis suggested that the GMC of varicella antibodies wanes with the time since vaccination (F = 65.01, P = 0.002).ConclusionThe VarV coverage rate of healthy children in Jiangsu Province was low. Sero-conversion rates were also low after one dose of VarV, and the immune effectiveness of a single dose of VarV was limited. To control the spread of varicella, VarV should be included in the routine immunization program, and strengthened immunization measures for the varicella-susceptible population warrant additional consideration.

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Section: Discussioncontrasting

confidence: 67%

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

Zhang

Liu

et al. 2018

BMC Infect Dis

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“…434 studies were reviewed by abstract after preliminary exclusion by title, the majority of which were excluded for measuring a preventative vaccine effect (330 of 360 clinical trials; 51 of 73 observational studies). After discarding post-exposure studies focused on immunoglobulin or surrogate models and adding 15 studies found through bibliographies, a total of 14 clinical trials and 31 observational studies reported data for chickenpox/varicella (38)(39)(40)(41)(42)(43)(44)(45)(46), hepatitis A (47-51), hepatitis B (52-56), measles (57)(58)(59)(60)(61)(62), mumps (63)(64), rabies (65)(66)(67)(68)(69)(70), and smallpox (71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). No clinical or observational studies that fit our criteria were located for 21 of the 28 eligible vaccines, although tetanus and diphtheria toxoids have proven to be effective forms of PEP (1).…”

Section: Resultsmentioning

confidence: 99%

Post-Exposure Effects of Vaccines on Infectious Diseases

Lipsitch

2019

Preprint

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Many available vaccines have demonstrated post-exposure effectiveness, but no published systematic reviews have synthesized these findings. We searched the PubMed database for clinical trials and observational human studies concerning the post-exposure vaccination effects, targeting infections with an FDA-licensed vaccine plus dengue, hepatitis E, malaria, and tick borne encephalitis, which have licensed vaccines outside of the U.S. Studies concerning animal models, serologic testing, and pipeline vaccines were excluded. Eligible studies were evaluated by definition of exposure, and their attempt at distinguishing pre- and post-exposure effects was rated on a scale of 1-4. We screened 4518 articles and ultimately identified 14 clinical trials and 31 observational studies for this review, amounting to 45 eligible articles spanning 7 of the 28 vaccine-preventable diseases. For secondary attack rate, this body of evidence found the following medians for post-exposure vaccination effectiveness: hepatitis A: 85% (IQR: 28; 5 sources), hepatitis B: 85% (IQR: 22; 5 sources), measles: 83% (IQR: 21; 8 sources), varicella: 67% (IQR: 48; 9 sources), smallpox: 45% (IQR: 39; 4 sources), and mumps: 38% (IQR: 7; 2 sources). For case fatality proportions resulting from rabies and smallpox, the vaccine efficacies had medians of 100% (IQR: 0; 6 sources) and 63% (IQR: 50; 8 sources) post-exposure. Although mainly used for preventive measures, many available vaccines can modify or preclude disease if administered after exposure. This post-exposure effectiveness could be important to consider during vaccine trials and while developing new vaccines.

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“…The varicella vaccine was approved and marketed in the USA in 1995, but the vaccination coefficient in China was not high because the varicella vaccine was voluntary. It took 15 days to produce antibodies after vaccination [2021]; therefore, it is necessary to improve the vaccination coefficient of varicella for students, a high-risk group, and they should be vaccinated early at least 15 days before the period of high incidence of varicella, which usually is in the 16 th and 45 th weeks per year [22]. In the actual prevention and control work, ventilation and disinfection are also one of the important prevention and control measures.…”

Section: Discussionmentioning

confidence: 99%

Research about the optimal strategies for prevention and control of varicella outbreak in a school in a central city of China: based on an SEIR dynamic model

et al. 2020

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Varicella is an acute respiratory infectious diseases, with high transmissibility and quick dissemination. In this study, an SEIR (susceptible-exposed-infected-recovered) dynamic model was established to explore the optimal prevention and control measures according to the epidemiological characteristics about varicella outbreak in a school in a central city of China. Berkeley Madonna 8.3.18 and Microsoft Office Excel 2010 software were employed for the model simulation and data management, respectively. The result showed that the simulated result of SEIR model agreed well with the reported data when β (infected rate) equal to 0.067. Models showed that the cumulative number of cases was only 13 when isolation adopted when the infected individuals were identified (assuming isolation rate was up to 100%); the cumulative number of cases was only two and the TAR (total attack rate) was 0.56% when the vaccination coefficient reached 50%. The cumulative number of cases did not change significantly with the change of efficiency of ventilation and disinfection, but the peak time was delayed; when δ (vaccination coefficient) = 0.1, m (ventilation efficiency) = 0.7 or δ = 0.2, m = 0.5 or δ = 0.3, m = 0.1 or δ = 0.4 and above, the cumulative number of cases would reduce to one case and TAR would reduce to 0.28% with combined interventions. Varicella outbreak in school could be controlled through strict isolation or vaccination singly; combined interventions have been adopted when the vaccination coefficient was low.

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Effectiveness of varicella vaccine as post-exposure prophylaxis during a varicella outbreak in Shanghai, China

Abstract: Post-exposure vaccination should be given as soon as possible after exposure. Nevertheless, vaccination is still recommended even at more than 5days post-exposure to control varicella outbreaks.

Cited by 13 publications

References 17 publications

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China

Post-Exposure Effects of Vaccines on Infectious Diseases

Research about the optimal strategies for prevention and control of varicella outbreak in a school in a central city of China: based on an SEIR dynamic model

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