The Effectiveness of Varicella Vaccination in Children in Germany

Liese, Johannes G.; Cohen, C.; Rack, Anita; Pirzer, Kerstin; Eber, Stefan; Blum, Maxim; Greenberg, Michael; Streng, Andrea

doi:10.1097/inf.0b013e31829ae263

Cited by 40 publications

(27 citation statements)

References 40 publications

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“…But one study on the outbreak of varicella at a day care center estimated the effectiveness of the vaccine at 44.0% against disease of any severity and 86.0% against moderate or severe disease (35). In other countries, the effectiveness of one dose of Oka strain-based varicella vaccines was good; adjusted effectiveness in a prospective case-control study was 86.4% against any severity and 97.7% against moderate or severe varicella in Germany (36), vaccine effectiveness against varicella based on the data of Taiwan's National Immunization Information System was 82.6% (37), vaccine effectiveness against varicella assessed in a case-control study was 86.4% for Varilrix, 79.6% for Changchun Institutes of Biologic Products, and 92.6% for Shanghai Institutes of Biologic Products in China (38), and in Israel, the effectiveness of varicella vaccine was 71 to 100% in preventing disease of any severity and 95 to 100% in preventing moderate/ severe disease; however, a study of an outbreak of varicella among children attending a day care center demonstrated vaccine efficacy of only 44% (39). Significant decline of varicella cases and VRH seen in the United States has also been reported in Germany (2), Canada (3), Australia (4), and Taiwan (5).…”

Section: Discussionmentioning

confidence: 99%

Varicella and Varicella Vaccination in South Korea

Oh¹,

Choi²,

Shin³

et al. 2014

Clin. Vaccine Immunol.

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r With continuing occurrence of varicella despite increasing vaccine coverage for the past 20 years, a case-based study, a case-control study, and an immunogenicity and safety study were conducted to address the impact of varicella vaccination in South Korea. Varicella patients under the age of 16 years were enrolled for the case-based study. For the case-control study, varicella patients between 12 months and 15 years of age were enrolled with one control matched for each patient. For the immunogenicity and safety study, otherwise healthy children from 12 to 24 months old were immunized with Suduvax (Green Cross, South Korea). Fluorescent antibody to membrane antigen (FAMA) varicella-zoster virus (VZV) antibody was measured before and 6 weeks after immunization. In the casebased study, the median age of the patients was 4 years. Among 152 patients between 1 and 15 years of age, 139 children received varicella vaccine and all had breakthrough infections. Clinical courses were not ameliorated in vaccinated patients, but more vaccinated patients received outpatient rather than inpatient care. In the case-control study, the adjusted overall effectiveness of varicella vaccination was 54%. In the immunogenicity and safety study, the seroconversion rate and geometric mean titer for FAMA antibody were 76.67% and 5.31. Even with increasing varicella vaccine uptake, we illustrate no upward age shift in the peak incidence, a high proportion of breakthrough disease, almost no amelioration in disease presentation by vaccination, and insufficient immunogenicity of domestic varicella vaccine. There is need to improve the varicella vaccine used in South Korea. Varicella caused by varicella-zoster virus (VZV) is a highly infectious disease, and the secondary attack rates may reach up to 90% for susceptible household contacts. In South Korea, a live attenuated Biken Oka strain varicella vaccine was first introduced in 1988, and since then a few more imported and domestic vaccines have been on the market for different lengths of time. Among the few domestic vaccines which were developed in the early 1990s, only Suduvax (Green Cross, South Korea) is currently on the market and is the most popular varicella vaccine in South Korea. With the increase of varicella vaccine coverage in South Korea, varicella became a nationally notifiable disease, and the vaccine was mandated for universal immunization at government expense in 2005; routine varicella immunization for infants at 12 to 15 months of age was recommended. These measures should have reduced the burden of varicella in South Korea. However, the nationwide occurrence of varicella has not decreased substantially, unlike the successful experience in other countries (1-5). We report a short-term case-based study, a case-control study, and an immunogenicity and safety study to evaluate the effectiveness of varicella vaccination in South Korea. MATERIALS AND METHODSA case-based study was conducted prospectively from August 2006 to March 2007, when 176 children with varicella who were...

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Section: Discussionmentioning

confidence: 99%

Varicella and Varicella Vaccination in South Korea

Oh¹,

Choi²,

Shin³

et al. 2014

Clin. Vaccine Immunol.

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“…VE for one dose of varicella vaccine against any disease ranged from 55% to 87%, while after two doses, the VE ranged between 84% and 98% [23,44–46]. VE was higher against moderate or severe disease, ranging from 70% to 98% after one dose and 94% to 98% after two doses [23,47]. Two studies from Israel [48] and Korea [49] recorded much lower VE – in case of Israel, this was most probably due to the very low coverage (37%) [48] and in the case of Korea was due to the ineffectiveness of one of the administered vaccines [49].…”

Section: Evidence For Varicella Vaccinationmentioning

confidence: 99%

Varicella vaccination - the global experience

Wutzler

Bonanni

Burgess

et al. 2017

Expert Review of Vaccines

136

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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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“…Four studies reported decline in VE with time since vaccination; however, the differences did not reach statistical significance. [42][43][44][45] Vazquez et al used laboratory confirmed cases and described a decline in VE for Varivax between years 1 and 2 (from 97% to 86%) after vaccination but not subsequently (up to 7 years of follow-up, 84%) 46 ; another study in the United States reported a significant decline in 1-dose VE from 94% within 5 years after vaccination to 88% for 5 to 9 years and 82% for ≥10 years after vaccination. 47 Additionally, Bayer et al in their meta-analysis of outbreak data, concluded waning immunity based on data from four studies which all showed a decrease in VE by time since vaccination (data available for an average of 4 to 6 years since…”

Section: Figurementioning

confidence: 99%

Global Varicella Vaccine Effectiveness: A Meta-analysis

et al. 2016

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CONTEXT: Several varicella vaccines are available worldwide. Countries with a varicella vaccination program use 1-or 2-dose schedules. OBJECTIVE:We examined postlicensure estimates of varicella vaccine effectiveness (VE) among healthy children.DATA SOURCES: Systematic review and descriptive and meta-analysis of Medline, Embase, Cochrane libraries, and CINAHL databases for reports published during 1995-2014. STUDY SELECTION:Publications that reported original data on dose-specific varicella VE among immunocompetent children. DATA EXTRACTION:We used random effects meta-analysis models to obtain pooled one dose VE estimates by disease severity (all varicella and moderate/severe varicella). Within each severity category, we assessed pooled VE by vaccine and by study design. We used descriptive statistics to summarize 1-dose VE against severe disease. For 2-dose VE, we calculated pooled estimates against all varicella and by study design. RESULTS:The pooled 1-dose VE was 81% (95% confidence interval [CI]: 78%-84%) against all varicella and 98% (95% CI: 97%-99%) against moderate/severe varicella with no significant association between VE and vaccine type or study design (P > .1). For 1 dose, median VE for prevention of severe disease was 100% (mean = 99.4%). The pooled 2-dose VE against all varicella was 92% (95% CI: 88%-95%), with similar estimates by study design.LIMITATIONS: VE was assessed primarily during outbreak investigations and using clinically diagnosed varicella. CONCLUSIONS:One dose of varicella vaccine was moderately effective in preventing all varicella and highly effective in preventing moderate/severe varicella, with no differences by vaccine. The second dose adds improved protection against all varicella.a National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and b Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland Dr Marin conceptualized and designed the study, reviewed the articles and collected the data, supervised the analysis, interpreted the data, drafted the initial manuscript, and revised the manuscript; Dr Marti conceptualized the study, reviewed part of the articles, interpreted the data, and reviewed and revised the manuscript; Ms Kambhampati carried out the meta-analyses, interpreted the data, and reviewed the manuscript; Dr Jeram conducted an initial literature review, reviewed part of the articles and collected the data, and reviewed the manuscript; Dr Seward conceptualized and designed the study, reviewed part of the articles, critically reviewed the manuscript, and interpreted the data; and all authors approved the fi nal manuscript as submitted.The fi ndings and conclusions in this report are those of the authors and do not necessarily represent the offi cial position of the Centers for Disease Control and Prevention. For authors affi liated with the World Health Organization, the authors alone are responsible for the views expressed in this publication ...

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The Effectiveness of Varicella Vaccination in Children in Germany

Abstract: One dose of varicella vaccine provided high protection against moderate and severe varicella disease for a period of up to 5 years after vaccination. However, further effectiveness data are needed to assess long-term protection.

Cited by 40 publications

References 40 publications

Varicella and Varicella Vaccination in South Korea

Varicella and Varicella Vaccination in South Korea

Varicella vaccination - the global experience

Global Varicella Vaccine Effectiveness: A Meta-analysis

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