Safety and Cellular and Humoral Immune Responses of a Booster Dose of Varicella Vaccine 6 Years after Primary Immunization

Watson, Barbara; Rothstein, Edward; Bernstein, Henry H.; Arbeter, Allan M.; Arvin, Ann M.; Chartrand, Stephen A.; Clements, Dennis A.; Kumar, Mary L.; Reisinger, Keith S.; Blatter, Mark M.; Starr, Stuart E.; Staehle, Brenda; Ngai, Angela; White, C. J.

doi:10.1093/infdis/172.1.217

Cited by 63 publications

(41 citation statements)

References 12 publications

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“…53 When a second dose of varicella vaccine is administered 4 to 6 years after the first dose, a rise in VZV-specific antibody concentrations occurs rapidly and overall VZV antibody concentrations achieved are comparable with antibody concentrations achieved when 2 vaccine doses are administered 3 months apart. 58 Varicella, measles, mumps, and rubella antibody concentrations after administration of a single dose of MMRV vaccine are comparable with concentrations after administration of MMR vaccine and monovalent varicella vaccine concomitantly at separate injection sites. 43 Among 5446 healthy children 12 to 23 months of age enrolled in 4 clinical trials, 91.2% achieved varicella antibody titers of Ն5 gpELISA units per mL (95% confidence interval: 90.3%-92%).…”

Section: Immunogenicitymentioning

confidence: 89%

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Bocchini¹,

Baltimore²,

Bernstein³

et al. 2007

Pediatrics

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National varicella immunization coverage using the current 1-dose immunization strategy has increased among vaccine-eligible children 19 through 35 months of age from 27% in 1997 to 88% by 2005. These high immunization rates have resulted in a 71% to 84% decrease in the reported number of varicella cases, an 88% decrease in varicella-related hospitalizations, a 59% decrease in varicellarelated ambulatory care visits, and a 92% decrease in varicella-related deaths in 1-to 4-year-old children when compared with data from the prevaccine era. Despite this significant decrease, the number of reported cases of varicella has remained relatively constant during the past 5 to 6 years. Since vaccine effectiveness for prevention of disease of any severity has been 80% to 85%, a large number of cases of varicella continue to occur among people who already have received the vaccine (breakthrough varicella), and outbreaks of varicella have been reported among highly immunized populations of schoolchildren. The peak age-specific incidence has shifted from 3-to 6-year-old children in the prevaccine era to 9-to 11-year-old children in the postvaccine era for cases in both immunized and unimmunized children during these outbreaks. Outbreaks of varicella are likely to continue with the current 1-dose immunization strategy.After administration of 2 doses of varicella vaccine in children, the immune response is markedly enhanced, with Ͼ99% of children achieving an antibody concentration (determined by glycoprotein enzyme-linked immunosorbent assay) of Ն5 U/mL (an approximate correlate of protection) and a marked increase in geometric mean antibody titers after the second vaccine dose. The estimated vaccine efficacy over a 10-year observation period of 2 doses for prevention of any varicella disease is 98% (compared with 94% for 1 dose), with 100% efficacy for prevention of severe disease. Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella, compared with those who are given 1 dose, during the first 10 years after immunization.To achieve greater levels of immunity with fewer serosusceptible people, greater protection against breakthrough varicella disease, and reduction in the number of outbreaks that occur nationwide among school-aged populations, a 2-dose varicella immunization strategy is now recommended for children Ն12 months of age. All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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Section: Immunogenicitymentioning

confidence: 89%

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Bocchini¹,

Baltimore²,

Bernstein³

et al. 2007

Pediatrics

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“…16 To address this issue, a second dose of varicella vaccine was routinely recommended in the United States beginning in 2006. 1 Studies have indicated that a second dose among children produces an improved humoral and cellular immune response [24][25][26] that correlates with improved protection against disease. 24,27 Therefore, the second dose has the potential to further increase the population immunity, also providing indirect vaccine protection for people with contraindications to vaccination.…”

Section: Figurementioning

confidence: 99%

Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program

2011

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WHAT'S KNOWN ON THIS SUBJECT:The impact of the 1-dose varicella vaccination program on varicella deaths has been documented for the early stages of program implementation. During the first 6 years of the program, deaths for which varicella was listed as the underlying cause declined 66% overall and Ն74% for people younger than 50 years. WHAT THIS STUDY ADDS:Our study documents the impressive impact on varicella mortality of the 1-dose US vaccination program: a decline of 88% overall and 96% among subjects younger than 50 years. With the current 2-dose program, there is potential that these most severe outcomes could be eliminated. abstract OBJECTIVE: Varicella has been preventable by vaccination in the United States since 1995. Previous studies reported a 66% decline in mortality rate during the first 6 years of the program. Since then, vaccination coverage has increased substantially. We updated the analysis of US varicella mortality for [2002][2003][2004][2005][2006][2007] and assessed the impact of the first 12 years of the US varicella vaccination program on varicella deaths. METHODS: National data on deaths for which varicella was listed as an underlying or contributing cause were obtained from the Mortality Multiple Cause-of-Death records from the US National Center for Health Statistics. We calculated the age-adjusted and age-specific mortality rates for 2002-2007 and trends since the prevaccine years. RESULTS: During the 12 years of the mostly 1-dose US varicella vaccination program, the annual average mortality rate for varicella listed as the underlying cause declined 88%, from 0.41 per million population in

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“…A one-dose schedule has been shown to be highly effective in reducing severe disease, but breakthrough cases of mild varicella occur. Studies comparing immune responses following a one- or two-dose regime have shown that higher seroconversion rates and a higher antibody titer are achieved among subjects who receive two vaccine doses, regardless of the time interval between doses [59–62]. Nevertheless, cost-effectiveness modeling of two- versus one-dose schedules, suggesting that addition of a second dose demonstrates unfavorable incremental cost-effectiveness, has been instrumental in informing Australia’s decision to implement a one-dose schedule [55,63].…”

Section: Story Of Varicella Vaccine Developmentmentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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Introduction: Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines’ efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.

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Safety and Cellular and Humoral Immune Responses of a Booster Dose of Varicella Vaccine 6 Years after Primary Immunization

Cited by 63 publications

References 12 publications

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program

Varicella and herpes zoster vaccine development: lessons learned

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