Effectiveness of 2 Doses of Varicella Vaccine in Children

Shapiro, Eugene D.; Vázquez, Marietta; Esposito, D. H.; Holabird, Nancy; Steinberg, Sharon; Dziura, James; LaRussa, Philip; Gershon, Anne A.

doi:10.1093/infdis/jiq052

Cited by 158 publications

(113 citation statements)

References 15 publications

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“…The reduction was particularly great in the vaccinated cohorts of children aged one to eight years, with a 98.5% decline in incidence within a period of only five years, higher than that reported in other places where universal vaccination has been introduced, such as the US and the Veneto region in Italy [6,12,[23][24][25]. An important reduction in varicella incidence was also noted in persons aged 10 to 21 years, in cohorts included in the strategy of vaccination of susceptibles.…”

Section: Discussionmentioning

confidence: 72%

Impact of universal two-dose vaccination on varicella epidemiology in Navarre, Spain, 2006 to 2012

et al. 2013

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In 2007 in Navarre, Spain, universal varicella vaccination with two doses of Varivax was introduced in the childhood immunisation schedule for children aged 15 months and three years. This study describes changes in the epidemiology of varicella in the period 2006 to 2012 and evaluates vaccination effectiveness using epidemiological surveillance data. The incidence of varicella in children aged 0 to 14 years decreased by 98.1%, from 50.1 cases per 1,000 inhabitants in 2006, to 1.0 per 1,000 in 2012. Children aged one to eight years were the vaccinated cohorts, and their incidence of varicella decreased by 98.5% (p<0.0001). In unvaccinated age groups, important reductions were also achieved between 2006 and 2012: 90.5% (p<0.0001) in infants under one year of age, and 89.4% (p<0.0001) in children aged nine years. In the period 2006 to 2012, the hospital admissions rate for varicella or its complications decreased by 89.0%, and in 2012, there was only one admission of a newborn with neonatal varicella. Vaccine effectiveness for at least one dose was 96.8% (95% confidence interval: 96.3-97.2%). Universal vaccination with two doses has reduced varicella circulation to minimum levels within five years and has proved highly effective.

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Section: Discussionmentioning

confidence: 72%

Impact of universal two-dose vaccination on varicella epidemiology in Navarre, Spain, 2006 to 2012

et al. 2013

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“…6 Varivax [8][9][10] leading to a recommendation for a second dose of the vaccine at 4 to 6 years of age by the ACIP in 2006. 11 Recent studies have revealed that varicella incidence has declined further since implementation of the second dose 12,13 and effectiveness of the 2-dose series has been estimated to be as high as 98%, 14 confirming findings from clinical trials. 15 In a previous cohort study conducted from 1995 to 2009, we reported an effectiveness of ∼90% over 14 years postvaccination for the first dose, with no cases noted after the second dose.…”

Section: Discussionmentioning

confidence: 80%

Impact of Vaccination on the Epidemiology of Varicella: 1995–2009

et al. 2014

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BACKGROUND: When varicella vaccine was licensed in the United States in 1995, there were concerns that childhood vaccination might increase the number of adolescents susceptible to varicella and shift disease toward older age groups where it can be more severe. METHODS: We conducted a series of 5 cross-sectional studies in 1994 to 1995 (prevaccine), 2000, 2003, 2006, and 2009 in Kaiser Permanente of Northern California to assess changes in varicella epidemiology in children and adolescents, as well as changes in varicella hospitalization in people of all ages. For each study, information on varicella history and varicella occurrence during the past year was obtained by telephone survey from a sample of ∼8000 members 5 to 19 years old; varicella hospitalization rates were calculated for the entire membership. RESULTS: Between 1995 and 2009, the overall incidence of varicella in 5- to 19-year-olds decreased from 25.8 to 1.3 per 1000 person-years, a ∼90% to 95% decline in the various age categories (5–9, 10–14, and 15–19 years of age). The proportion of varicella-susceptible children and adolescents also decreased in all age groups, including in 15- to 19-year-olds (from 15.6% in 1995 to 7.6% in 2009). From 1994 to 2009, age-adjusted varicella hospitalization rates in the general member population decreased from 2.13 to 0.25 per 100 000, a ∼90% decline. CONCLUSIONS: In the 15 years after the introduction of varicella vaccine, a major reduction in varicella incidence and hospitalization was observed with no evidence of a shift in the burden of varicella to older age groups.

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“…The current 2-dose varicella vaccine schedule is expected to further reduce the number of varicella cases and exposures in vaccinated persons. 28,29 To further mitigate VZV exposure, persons with herpes zoster who have direct contact with infants should be advised to cover their rash until lesions are completely healed. For persons aged 60 years and older, herpes zoster vaccine is recommended to reduce the likelihood of VZV reactivation.…”

Section: Discussionmentioning

confidence: 99%

Varicella in Infants After Implementation of the US Varicella Vaccination Program

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Risk of severe varicella disease in infants might not be uniform throughout the first year of life, because maternal antibodies decline over time. The risk of infant exposure to varicella can be decreased by indirect vaccination (or herd immunity) effects. WHAT THIS STUDY ADDS:Tremendous indirect benefits of the US varicella vaccination program were demonstrated by a 90% decrease in varicella incidence among infants. Clinical disease was milder in younger (0 -5 months) versus older (6 -11 months) infants, possibly because of the presence of maternal antibodies to varicella-zoster virus.abstract OBJECTIVE: To describe varicella disease in infants since implementation of the varicella vaccination program in the United States. PATIENTS AND METHODS:From 1995 to 2008, demographic, clinical, and epidemiologic data on cases of varicella in infants were collected prospectively through a community-based active surveillance project. We examined disease patterns for infants in 2 age groups: 0 to 5 and 6 to 11 months. RESULTS:Infant varicella disease incidence declined 89.7% from 1995 to 2008. Infants aged 0 to 5 months had milder clinical disease than those aged 6 to 11 months: Ն50 lesions, 49% vs 58% (P ϭ .038); fever (body temperature Ͼ 38°C), 12% vs 21% (P ϭ .014); and varicellarelated complications, 6% vs 14% (P ϭ .009), respectively. Age was an independent predictor of the occurrence of complications. CONCLUSIONS:The varicella vaccination program has resulted in substantial indirect benefits for infants, who are not eligible for vaccination. Presence of maternal varicella-zoster virus antibodies might explain attenuated disease in very young infants likely born to mothers with history of varicella. Although varicella disease incidence has declined, exposure to varicella-zoster virus continues to occur. Improving varicella vaccination coverage in all age groups will further reduce the risk of varicella exposure and protect those not eligible for varicella vaccination.

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Effectiveness of 2 Doses of Varicella Vaccine in Children

Abstract: The effectiveness of 2 doses of varicella vaccine in the first 2.5 years after recommendation of a routine second dose of the vaccine for children is excellent. Odds of developing varicella were 95% lower for children who received 2 doses compared with 1 dose of varicella vaccine.

Cited by 158 publications

References 15 publications

Impact of universal two-dose vaccination on varicella epidemiology in Navarre, Spain, 2006 to 2012

Impact of universal two-dose vaccination on varicella epidemiology in Navarre, Spain, 2006 to 2012

Impact of Vaccination on the Epidemiology of Varicella: 1995–2009

Varicella in Infants After Implementation of the US Varicella Vaccination Program

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