Epidemiology of Varicella During the 2-Dose Varicella Vaccination Program — United States, 2005–2014

Lopez, Adriana; Zhang, Junyi; Marin, Mona

doi:10.15585/mmwr.mm6534a4

Cited by 102 publications

(65 citation statements)

References 8 publications

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“…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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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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“…Varicella incidence after implementation of a universal two‐dose vaccination strategy is estimated to be 3.5‐3.9 per 100 000 population, with decreases observed in both varicella‐related hospitalizations and outbreaks . However, countries that do not have mandatory varicella vaccination (which includes most European countries) describe a much higher incidence of 15‐16 per 1000 person/y .…”

Section: Outcomementioning

confidence: 99%

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Suresh

Upton

Green

et al. 2019

Pediatric Transplantation

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Growing evidence suggests receipt of live‐attenuated viral vaccines after solid organ transplant (SOT) has occurred and is safe and needed due to lapses in herd immunity. A 2‐day consortium of experts in infectious diseases, transplantation, vaccinology, and immunology was held with the objective to review evidence and create expert recommendations for clinicians when considering live viral vaccines post‐SOT. For consideration of VV and MMR post‐transplant, evidence exists only for kidney and liver transplant recipients. For MMR vaccine post‐SOT, consider vaccination during outbreak or travel to endemic risk areas. Patients who have received antiproliferative agents (eg. mycophenolate mofetil), T cell–depleting agents, or rituximab; or have persistently elevated EBV viral loads, or are in a state of functional tolerance, should be vaccinated with caution and have a more in‐depth evaluation to define benefit of vaccination and net state of immune suppression prior to considering vaccination. MMR and/or VV (not combined MMRV) is considered to be safe in patients who are clinically well, are greater than 1 year after liver or kidney transplant and 2 months after acute rejection episode, can be closely monitored, and meet specific criteria of “low‐level” immune suppression as defined in the document.

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“…In the absence of vaccination, varicella is a universal infection acquired mainly in childhood. Varicella vaccines based on the live attenuated VZV (Oka strain) are now widely available throughout the world and represent the most effective measure for prevention and control of varicella [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Varicella outbreak in a highly-vaccinated school population in Beijing, China during the voluntary two-dose era

Suo

Lü

Wang

et al. 2017

Vaccine

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Background Two-dose varicella vaccination has been available in Beijing since 2012 in the private sector. We investigated a varicella outbreak in a highly vaccinated elementary school population. Methods A cohort study was carried out and a varicella case was defined as an acute onset of generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 29 through May 17, 2015. Breakthrough varicella was defined as varicella >42 days after the last vaccine dose among both 1- or 2-dose varicella vaccine recipients. Vaccination information was collected from immunization records; information on prior varicella and clinical presentations was collected by surveying students’ parents. Results Of the 1056 students in the school, 1027 (97.3%) reported no history of varicella. Prior to the outbreak, 98.6% of students had received ≥1 dose of varicella vaccine, and most (63.2%) students received two doses. Twenty varicella cases were identified for an overall attack rate of 2.0%. Half of the cases occurred in the classroom of the index case-patient, a two-dose recipient who was not isolated after symptom onset. Breakthrough varicella accounted for 95% of cases (19/20) with attack rates of 14.3% (1/7), 1.6% (6/362) and 2.0% (13/649) among unvaccinated, one-dose, and two-dose students, respectively. Most case-patients (18/20, 90%) had <50 lesions. No difference in clinical presentations was found between one-dose and two-dose recipients with breakthrough varicella. Conclusion Moderate two-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose recipients with breakthrough varicella are contagious. High two-dose varicella vaccine coverage and timely isolation of cases may be needed for varicella outbreak prevention in the two-dose era.

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Epidemiology of Varicella During the 2-Dose Varicella Vaccination Program — United States, 2005–2014

Cited by 102 publications

References 8 publications

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

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

Live vaccines after pediatric solid organ transplant: Proceedings of a consensus meeting, 2018

Varicella outbreak in a highly-vaccinated school population in Beijing, China during the voluntary two-dose era

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