Celebrating 25 Years of Varicella Vaccination Coverage for Children and Adolescents in the United States: A Success Story

Abstract

Tracking vaccination coverage is a critical component of monitoring a vaccine program. Three different surveillance systems were used to examine trends in varicella vaccination coverage during the United States vaccination program: National Immunization Survey–Child, National Immunization Survey–Teen, and immunization information systems (IISs). The relationship of these trends to school requirements and disease decline was also examined. Among children aged 19–35 months, ≥1 dose of varicella vaccine increased from 16.0% in 1996 to 89.2% by the end of the 1-dose program in 2006, stabilizing around at least 90.0% thereafter. The uptake of the second dose was rapid after the 2007 recommendation. Two-dose coverage among children aged 7 years at 6 high-performing IIS sites increased from 2.6%–5.5% in 2006 to 86.0%–100.0% in 2020. Among adolescents aged 13–17 years, ≥2-dose coverage increased from 4.1% in 2006 to 91.9% in 2020. The proportion of adolescents with history of varicella disease declined from 69.9% in 2006 to 8.4% in 2020. In 2006, 92% of states and the District of Columbia (DC) had 1-dose daycare or school entry requirements; 88% of states and DC had 2-dose school entry requirements in the 2020–2021 school year. The successes in attaining and maintaining high vaccine coverage were paramount in the dramatic reduction of the varicella burden in the United States over the 25 years of the vaccination program, but opportunities remain to further increase coverage and decrease varicella morbidity and mortality.

The Clinical and Economic Burden of Antibiotic Use in Pediatric Patients With Varicella Infection: A Retrospective Cohort Analysis of Real-World Data in England

“…A UVV program in the United States resulted in net societal savings of $23.4 billion in its first 25 years [ 47 ]. Furthermore, the introduction of a UVV program in the United States was associated with 97% reduction in varicella cases [ 5 ] with an estimated $259 million reduction in antibiotic and antiviral prescription costs per year [ 48 ].…”

“…The World Health Organization recommends universal vaccination as one of the main preventive interventions where varicella is a public health problem, yet only 39 countries have universal varicella vaccination (UVV) programs [ 2 ]. Varicella vaccination has been part of the recommended pediatric immunization schedule in the United States for >25 years, which has resulted in a substantial decrease in disease burden [ 5 ]. Within Europe, several countries have a lower varicella prevalence as a result of UVV programs [ 1 , 6 ].…”

Impact of implementing a free varicella vaccination policy on incidence in Wuxi City, China: an interrupted time series analysis

“…The literature has shown that a one-dose varicella vaccine is more cost-effective than a two-dose vaccine [ 28 ], but the rate of breakthrough infections with a one-dose vaccine is higher than that with a two-dose vaccine [ 29 , 30 ]. Therefore, considering multiple perspectives of evidence, it is essential to provide children with two doses of the routine varicella vaccine, and high coverage of two-dose varicella vaccination should be achieved to maximise the benefits of the varicella vaccination program [ 31 , 32 ].…”

A Strep A vaccine global demand and return on investment forecast to inform industry research and development prioritization

“…In the Optimistic and Conservative Timeline scenarios, it is assumed that ramp-up to peak coverage takes place over 5 years and 15 years, respectively. This assumption is based on WHO vaccine surveillance reporting for infant and childhood vaccines introduced in public markets across country income levels within the last 20 years, including PCV3, RotaC, MCV2, and second dose of varicella (greater than 10 years to reach peak coverage) 20 , 49 .…”