Outbreak of varicella in preschool children despite one-dose vaccination

Kurugöl, Zafer; Gökçe, Şule

doi:10.24953/turkjped.2018.01.008

Cited by 12 publications

(11 citation statements)

References 30 publications

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“…In Turkey, varicella vaccines have been available in the private sector since 2000, and one-dose UVV at 12 months of age was implemented in 2013, with current coverage reported to be >95%for children 12–36 months of age [13]. An ongoing prospective multicenter study, VARICOMP, has provided important epidemiologic and economic surveillance data on varicella-related hospitalizations among children in Turkey for the 5 years between 2008 and 2013 (pre-vaccine era) and 2013 and 2018, during which time breakthrough varicella requiring hospitalization was observed most commonly in previously healthy children at 5 years after a single vaccine dose [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…In one report from 2008–2009, among vaccinated children, 28% experienced breakthrough varicella, mostly mild disease but moderate to severe for one-quarter of these children; the risk of breakthrough varicella was determined to be 3.7-fold higher among children vaccinated ≥5 years vs. < 5years earlier [16]. More recently, in April 2016, a varicella outbreak occurred at three preschools despite 62% of children having received one-dose vaccination [13].…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

et al. 2019

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Background In 2013, Turkey introduced one-dose universal varicella vaccination (UVV) at 12 months of age. Inclusion of a second dose is being considered. Methods We developed a dynamic transmission model to evaluate three vaccination strategies: single dose at 12 months (1D) or second dose at either 18 months (2D-short) or 6 years of age (2D-long). Costs and utilization were age-stratified and separated into inpatient and outpatient costs for varicella and herpes zoster (HZ). We ran the model including and excluding HZ-related costs and impact of exogenous boosting. Results Five years post-introduction of UVV (1D), the projected varicella incidence rate decreases from 1,674 cases pre-vaccine to 80 cases/100,000 person-years. By 25 years, varicella incidence equilibrates at 39, 12, and 16 cases/100,000 person-years for 1D, 2D-short, and 2D-long strategies, respectively, using a highly effective vaccine. With or without including exogenous boosting impact and/or HZ-related costs and health benefits, the 1D strategy is least costly, but 2-dose strategies are cost-effective considering a willingness-to-pay threshold equivalent to the gross domestic product. The model predicted a modest increase in HZ burden during the first 20–30 years, after which time HZ incidence equilibrates at a lower rate than pre-vaccine. Conclusions Our findings support adding a second varicella vaccine dose in Turkey, as doing so is highly cost-effective across a wide range of assumptions regarding the burden associated with varicella and HZ disease.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

et al. 2019

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“…26 It was also noted that the risk of disease increased with time since vaccination; the risk was 3.5 times higher in children vaccinated ≥5 y versus those vaccinated more recently. 26…”

Section: Surveillance and Incidence Reportingmentioning

confidence: 98%

“…14 Similar findings were reported in a study of a varicella outbreak in preschool children (n = 124) in Turkey that was identified as part of the gray data. 26 Among vaccinated children (who had received one dose of vaccine before the outbreak), 23.4% had varicella compared with 34% among unvaccinated children. 26 It was also noted that the risk of disease increased with time since vaccination; the risk was 3.5 times higher in children vaccinated ≥5 y versus those vaccinated more recently.…”

Section: Surveillance and Incidence Reportingmentioning

confidence: 99%

The clinical and economic burden of varicella in the Middle East: a systematic literature review

Kaabi

Olama

Qaseer

et al. 2019

Human Vaccines & Immunotherapeutics

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This systematic literature review was conducted to better understand the epidemiology and burden of varicella across the Middle East, gain insight into the evidence to support using universal varicella vaccination (UVV), and identify potential data gaps. Both epidemiology and economic data on the burden of varicella were limited and varied significantly. Most of the data focussed on varicella burden in the absence of a UVV program. In the absence of UVV, varicella incidence is increasing across this region with varicella infection associated with substantial morbidity. Although limited, data on the impact of vaccination at a population level indicated UVV programs reduce varicella incidence and hospitalizations, in line with global experience. Further research and action are needed to better understand varicella epidemiology in the Middle East, increase awareness and understanding in the region, and provide local data to support national public-health decisions regarding the implementation of UVV programs. ARTICLE HISTORY

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“…Although great achievement had been made in reducing varicella incidence, outbreaks continued to be reported, especially in preschools, schools, etc. [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

A Centralized Outbreak of Varicella among Children Attending Preschool in Suzhou, China

Zhang¹,

Gui²,

Guo³

et al. 2020

BioMed Research International

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Background. Varicella vaccine is available for voluntary purchase with a single dose currently recommended for children aged ≥12 months. An epidemiological study was undertaken in order to determine the characteristics of the outbreak, assess vaccine effectiveness, and examine risk factors for vaccine failure. Methods. A varicella case was defined as a generalized papulovesicular rash (without other apparent causes) in a child without prior varicella attending the kindergarten during February 22 to April 7 of 2016. Varicella among vaccinated children (breakthrough varicella) was defined as varicella occurring >42 days after vaccination. Children’s vaccination status was verified with immunization records through local vaccination information platform. Results. Of the 738 children, 664 (90.0%) had no prior varicella history. Of these, 364 (54.8%) had received a single-dose varicella vaccine before outbreak. A total of 30 cases occurred in the outbreak, and 9 of them (30%) had breakthrough varicella. Age at vaccination (<15 months vs. ≥15 months) and time since vaccination before the outbreak (<3 years vs. ≥3 years) were not related to the occurrence of breakthrough varicella (P>0.05). Single-dose varicella vaccination was 64.7% effective in preventing any varicella. Conclusions. Single-dose varicella vaccine is effective in reducing the varicella attack rate, but not high enough to prevent outbreak. Timely detection and effective isolation are key factors in controlling varicella. Improving single-dose vaccination coverage and implementing two-dose vaccination strategy should be recommended to provide excellent protection to prevent varicella in the future in Suzhou.

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Outbreak of varicella in preschool children despite one-dose vaccination

Cited by 12 publications

References 30 publications

Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

The clinical and economic burden of varicella in the Middle East: a systematic literature review

A Centralized Outbreak of Varicella among Children Attending Preschool in Suzhou, China

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