Varicella hospitalizations in Los Angeles during the varicella vaccination era, 2003–2011: Are they preventable?

Abstract

Characteristics of varicella-related hospitalizations in the mature varicella vaccination era, including the proportion vaccinated and the severity of disease, are not well described. We present the vaccination status, severity and reasons for hospitalization of the hospitalized varicella cases reported to the Los Angeles County Health Department from 2003 to 2011, the period which includes the last 4 years of the mature one-dose program and the first 5 years after introduction of the routine two-dose program. A total of 158 hospitalized varicella cases were reported overall, of which 52.5% were potentially preventable and eligible for vaccination, 41.8% were not eligible for vaccination, and 5.7% were vaccinated. Most hospitalizations (72.2%) occurred among healthy persons, 54.4% occurred among persons ≥20 years of age, and 3.8% of hospitalizations resulted in death. Our data suggest that as many as half of the hospitalized varicella cases, including half of the deaths, may have been preventable given that they occurred in persons who were eligible for vaccination. More complete implementation of the routine varicella vaccination program could further reduce the disease burden of severe varicella.

Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis

“…Of these, 52 studies were excluded from the meta-analysis, leaving 78 studies eligible for meta-analysis (Fig. 1 ) [ 6 – 9 , 28 , 30 – 32 , 34 , 35 , 37 , 38 , 41 , 43 , 46 , 47 , 51 , 53 , 57 – 68 , 71 – 74 , 76 – 78 , 81 , 85 , 87 , 91 – 94 , 99 – 102 , 104 , 105 , 107 , 109 , 112 – 114 , 116 – 118 , 120 , 121 , 124 , 125 , 128 – 132 , 134 , 136 , 138 – 140 , 142 , 143 , 145 – 147 , 150 ]. From the selected studies, 632 unique complications were extracted, of which 303 were included after clinical review.…”

Severe varicella in persons vaccinated with varicella vaccine (breakthrough varicella): a systematic literature review

“…There were 2 articles that indicated hospitalized breakthrough varicella cases without mention of other organ involvement in addition to skin in 4 patients who received 2 doses of varicella vaccine 21, 22 , although in 1 paper 21 it was unclear whether 2 of these patients were breakthrough cases or the vaccine was received <42 days before rash onset.…”

“…Thirteen articles described a hospitalized breakthrough varicella case without mention of other organ involvement in addition to skin for a total estimated number of 266 cases 18, 21–23, 25, 28, 44–50 . Eleven of these articles described data from various surveillance systems in different countries 18, 21–23, 25, 28, 44, 45, 47, 49, 50 .…”

“…Eleven of these articles described data from various surveillance systems in different countries 18, 21–23, 25, 28, 44, 45, 47, 49, 50 . Among 8 with information on total number of hospitalized varicella cases, in 7 the proportion of breakthrough hospitalizations among all varicella hospitalizations was 0–4%; in 1 the proportion was 12% 45 .…”

Complicações das internações por varicela em um hospital de referência em Fortaleza- Ceará, 2012-2018

“…A maioria da população acredita que a varicela é uma doença benigna, porém nossos dados sugerem que a doença não deve ser subestimada, devido ao número de complicações associadas, ocorrendo em indivíduos imunocompetentes, levando a internação hospitalar e, em alguns quadros, necessidade de terapia intensiva; resultado este semelhante a outros estudos, em que os envolvidos na pesquisa com complicações por varicela não tinham condições crônicas subjacentes 11,19 .…”