Varicella Disease among Vaccinated Persons: Clinical and Epidemiological Characteristics, 1997–2005

Abstract

Approximately 1 in every 5 children who receives 1 dose of varicella vaccine may develop varicella disease, also known as breakthrough disease, if exposed to varicella-zoster virus. Currently, in communities with high vaccination coverage, varicella cases mostly occur in vaccinated individuals. We report on the first population-based description of the clinical and epidemiological characteristics of varicella in populations with increasing vaccine coverage between 1997 and 2005. In vaccinated children 1-14 years of age, varicella was most often mild and modified; the atypical disease presentation may result in diagnostic challenges to health care providers. However, despite the generally mild nature of these cases, approximately 25% caused >50 lesions, and some resulted in serious complications similar to those occurring in unvaccinated individuals. Continued surveillance of the risk and characteristics of breakthrough disease will be needed, to monitor the effect of the new 2-dose vaccine recommendation for children.

A varicella outbreak in a school with high one-dose vaccination coverage, Beijing, China

“…This study confirms that children vaccinated with a single-dose of varicella vaccine may both contract and transmit varicella, and high singledose varicella vaccination coverage may not provide sufficiently high population immunity to prevent outbreaks [10][11][12][13]. This study also demonstrates, as have others, that single-dose varicella vaccination is highly effective in preventing cases and mitigating the severity of breakthrough cases that occurs [9].…”

A systematic review of tetanus in individuals with previous tetanus toxoid immunization

“…This is in keeping with an attenuation of clinical severity in immunized hosts that is recognized in other vaccine-preventable diseases (24)(25)(26).…”

Trends in varicella mortality in the United States: Data from vital statistics and the national surveillance system

“…20 However, severe breakthrough varicella has been described. 11,14,15,20,21 Since 1996, CDC received reports of 5 varicella-related deaths among children and adolescents who previously received 1 dose of varicella vaccine. Four of these 5 deaths ( Table 4, Patients A-D) have been previously reported in the literature.…”