Varicella breakthrough infection and vaccine effectiveness in Taiwan

Huang, Wen-Chan; Huang, Li‐Min; Chang, I‐Shou; Tsai, Fang‐Yu; Chang, Luan‐Yin

doi:10.1016/j.vaccine.2011.01.092

Cited by 38 publications

(37 citation statements)

References 32 publications

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“…[19][20][21][22] For 1 study that reported VE and CIs for 4 birth cohorts and an overall VE without CI, we pooled estimates from the 4 birth cohorts to calculate CI for the overall VE. 23 When publications reported crude and adjusted VE, we included the adjusted estimates. VE was calculated as 1 -relative risk (RR) or 1 -odds ratio (OR), depending on the study design.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Additionally, publications that reported no cases of severe disease were assigned a VE of 100% against severe disease for our analysis. One study reported VE against varicella-related hospitalizations 23 ; this estimate was included in the summary of findings for severe disease.…”

Section: Discussionmentioning

confidence: 99%

Global Varicella Vaccine Effectiveness: A Meta-analysis

et al. 2016

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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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“…Despite a randomized controlled trial demonstrating one-dose vaccine efficacy of 94% and two-dose efficacy of 98% after 10 years [11], varicella outbreaks in immunized children with attack rates of 10-13% suggest varicella vaccine effectiveness of 82-85% among one-dose recipients and 86-88% among two-dose recipients [12][13][14]. In a nationwide retrospective study in Taiwan, annual breakthrough infections of chickenpox of up to 2% were seen among persons vaccinated against varicella [15]. Recent varicella outbreaks in the United States highlight the need for complete immunization against varicella [16], and more robust reporting data are needed to better monitor the outcomes of varicella vaccination programs [17].…”

Section: Introductionmentioning

confidence: 99%

Varicella seroepidemiology in United States air force recruits: A retrospective cohort study comparing immunogenicity of varicella vaccination and natural infection

Duncan

Witkop

Webber

et al. 2017

Vaccine

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seroepidemiology in United States air force recruits: A retrospective cohort study comparing immunogenicity of varicella vaccination and natural infection" (2017 a b s t r a c tBackground/Objectives: Infection with varicella zoster virus (VZV) produces lifelong immunity, but duration of post-vaccination immunity has not been established. The purpose of this study is to determine if a difference exists in the long-term seropositivity of anti-VZV antibodies in a cohort of young adults who were vaccinated against varicella as compared to a similar cohort with a history of chickenpox disease, and to determine which variables best predict waning seropositivity following varicella vaccination. Methods: This retrospective cohort study captures immunization and serology data from approximately 10,000 recruits who entered basic military training between January 1, 2008, and December 31, 2015, and who have childhood immunization records in the Air Force Aeromedical Services Information Management System. Varicella vaccine immunogenicity was determined relative to the immunogenicity of chickenpox disease, as measured by multiplex flow immunoassay. Among vaccine recipients, waning seroimmunity was modeled and adjusted for several important covariates. Results: Basic military trainees who received varicella vaccine in childhood were 24% less likely to be seropositive to VZV than trainees who were exempt from vaccine due to a history of chickenpox disease. There was no significant difference in seropositivity between male and female trainees. The odds of a vaccinated trainee being seropositive to VZV decreased by 8% with each year elapsed since vaccination. Seroprevalence declined below estimated herd immunity thresholds in vaccinated trainees born after 1994, and in the cohort as a whole for trainees born after 1995. Conclusion: Despite prior vaccination, seroimmunity in a large cohort of young adults unexposed to wildtype VZV failed to meet the estimated threshold for herd immunity. If vaccination in accordance with the current US VZV vaccination schedule is inadequate to maintain herd immunity, young adults not previously exposed to wild-type VZV may be at increased risk for varicella outbreaks.Published by Elsevier Ltd.

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Varicella breakthrough infection and vaccine effectiveness in Taiwan

Cited by 38 publications

References 32 publications

Global Varicella Vaccine Effectiveness: A Meta-analysis

Global Varicella Vaccine Effectiveness: A Meta-analysis

Varicella and Varicella Vaccination in South Korea

Varicella seroepidemiology in United States air force recruits: A retrospective cohort study comparing immunogenicity of varicella vaccination and natural infection

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